· SAVI Advances Partial Breast Radiation Treatmenty
· Industry Initiative: Professional Societies Focus on Patient Education
· Technologies and Therapies: Promising Advances in Prostate Cancer
· Study Discovers New Way to Evaluate Tumor Activity

SAVI Advances Partial Breast Radiation Treatment

Electron-beam linear accelerator facilitates new treatment

Within the last decade, the practice of breast-conservation therapy has gained much ground, due in large part to the emergence of advanced innovations.

Interstitial therapy—radioactive materials placed within the breast through multiple catheters—was the first innovation to allow “partial breast radiation,” where only the portion of the breast where the tumor resided received radiation. This not only decreased the normal tissue exposed to radiation, it also allowed treatment to be completed in 5 days rather than the traditional 6 weeks. Later, Cytyc developed MammoSite, a 5-day targeted radiation therapy that involves a balloon placed inside a lumpectomy cavity and inflated with saline solution. One of the most recent developments in the field represents a marriage of the two treatments, called the SAVI applicator.

SAVI applicator is a single-entry, multicatheter device that delivers treatment in 5 days.

Manufactured by Cianna Medical Inc, the SAVI applicator is a single-entry, multicatheter device that delivers treatment in 5 days. Furthermore, it has been shown to have multiple benefits, as indicated by Catheryn Yashar, MD, assistant professor and chief of Breast and Gynecological Services in the University of California, San Diego, Department of Radiation Oncology.

“Our early experience with SAVI has been excellent,” Yashar said. “We were able to reproducibly treat the lumpectomy site and avoid healthy tissue, such as the skin, chest wall, and lungs, because the radiation dose is precisely targeted.”

Containing what Yashar describes as “spokes,” the SAVI applicator offers a couple of key improvements on previous methods of treatment. Although the MammoSite is a great breakthrough technology, Yashar said, it provides only one location in which to place radiation. Consequently, depending on where it is placed within the body, the MammoSite can possibly burn the patient’s skin or subject other healthy tissue to unnecessary dose. On the other hand, the SAVI applicator’s spokes allow physicians to tailor radiation to where it is needed.

“Each individual spoke can be loaded with radiation, and that allows us to shape the radiation to the patient’s anatomy,” Yashar said. “It gives you a lot more flexibility where you want it.”

Also, a major advantage it has over interstitial treatment is that SAVI only requires one incision in the skin, compared to the 15-20 needles that interstitial mandates. Patients report minimal pain and are prescribed a painkiller only on the night of the procedure. No one has needed any more after the first evening, Yashar said.

Among its other reported benefits, the SAVI is easy to insert on an outpatient basis, using local anesthesia and ultrasound guidance. The applicator stays in place after insertion and does not move between treatments. Because SAVI is well tolerated by patients, no anesthesia is needed a week later during its removal. Yashar also noted the shortened amount of time needed for radiation therapy, which will have favorable repercussions for women who live far away from their treatment facilities.

As breast brachytherapy’s popularity continues to grow, so does interest from prominent national organizations. In fact, the National Surgical Breast and Bowel Project is currently in the process of clinical trials to determine the effectiveness of partial breast irradiation for women with cancer, versus the traditional whole breast approach. Yashar believes that cutting-edge technologies like the SAVI applicator are a driving force behind embarking on the study.

—Elaine Sanchez

Industry Initiative: Professional Societies Focus on Patient Education

The American Society for Therapeutic Radiology and Oncology (ASTRO) has always had a strong focus on patient education, and that priority has been brought to the forefront in recent months as the society has continued to expand its Education Department and has received acclaim for its patient-oriented pamphlets. Meanwhile, the American College of Radiology (ACR), Reston, Va, is gearing up to launch its new “Face of Radiology” campaign, an initiative designed to educate payors, patients, government officials, and other providers on the role of radiology in health care.

“As medical imaging procedures increasingly replace more invasive and more costly techniques, radiology is now, more than ever, at the vanguard of medicine,” noted Arl Van Moore, Jr, MD, chair of the ACR Board of Chancellors. “We need to help all health care stakeholders, from patients, to Congress, better understand what radiologists are and what they do, so that patients can make more informed health care choices and payors can better understand how their coverage decisions affect patients’ ability to receive the highest-quality care.”

The most recent addition to ASTRO’s Education Department is Jill Randolph, who joined as assistant director of education in late September. Randolph previously held the position of project manager at PerformTech, an e-learning firm based out of Alexandria, Va. At ASTRO, Randolph will be responsible for developing and managing the society’s eLearning Component and technologies, and will oversee the day-to-day operations of the Education Department.

Earlier this year, ASTRO’s Education Department was honored with an Hermes Creative Award issued by the Association of Marketing and Communications Professionals; the society’s patient brochure, Radiation Therapy for Cancer, won an honorable mention in the educational brochure category. “ASTRO’s members and staff work hard to ensure that our members and the patients they serve have the information they need,” said Laura I. Thevenot, CEO of ASTRO. “We have dedicated physician volunteers and a wonderful creative team in our communications department, and it’s a privilege to see them honored.”

ASTRO also recently called attention to the results of a study presented at its annual meeting, held in late October in Los Angeles. The study found that there are very few Spanish-language educational resources available in the United States, and showed that Spanish-speaking cancer patients have limited access to the Internet compared with English-speaking patients. “There is an urgent need for more Web-based information to be available to Spanish-speaking patients with cancer, and Internet access needs to be more widely available,” said Charles Simone II, MD, lead author of the study and a radiation oncologist at the Hospital of the University of Pennsylvania, Philadelphia. “The increased knowledge gained among these patients will help to eliminate health care disparities and lead to improved medical outcomes.”

Meanwhile, the ACR’s new Face of Radiology campaign is set to launch next month. The goal of the new initiative is to educate patients, payors, government officials, and other health care providers on what radiologists do and how they contribute to high-quality patient care.

The campaign will involve targeted advertising and media relations efforts, along with a multitude of new patient education materials. The ACR will also be providing a series of videos for use in radiologists’ offices and waiting rooms; the message of the films will be, as the ACR said on its Web site, that “your radiologist is the physician expert in diagnosis, patient care, and treatment through medical imaging.”

“To transform the current public misperception about our profession, the distance between patient and radiologist must be bridged,” Van Moore said. “Patients acquire their value judgments largely through personal interactions with individual medical professionals. It is important that radiologists make their role in patient care known so that patients are aware of radiology’s tremendous contribution to their well-being, and can choose to receive care from the physicians most qualified to provide it.”

—Cat Vasko

Technologies and Therapies: Promising Advances in Prostate Cancer

Nearly 220,000 new cases of prostate cancer will be diagnosed in the United States by the end of this year, according to the American Cancer Society.

While one in six men will get the disease in his lifetime, studies show that one in 35 will eventually die from it.

But there is much good news about waging the war on prostate cancer. Today, there are new diagnostic technologies that allow for early detection as well as increasingly effective treatment options in development.

One offering in the works is a noninvasive imaging solution by Confirma Inc, Bellevue, Wash, whose CADstream system for breast MRI is in use at hundreds of breast imaging sites around the world. CADstream automates the analysis and interventional guidance of MRI studies by providing higher-quality imaging studies and improved communication features for physicians and patients.

Recently, the company has installed its new CADstream system for prostate MRI at various research sites, including Belfair, Beth Israel, Simonmed, and Lahey Clinic. With the modality, Confirma is seeking to offer a less invasive procedure as an alternative to immediate biopsy, thus allowing the physician to target areas of the body more precisely for biopsy planning.

According to researchers, the new technology is showing great promise as a way to map disease within the prostate for minimally invasive treatment planning. The application will be developed to offer physicians comprehensive and clinically valuable tools for improved quality, standardization and efficiency of study analysis, interpretation, and reporting, relating to the prostate.

Another advancement in the field involves an up-and-coming therapy technique for early-stage prostate cancer patients.

Intensity modulated radiation therapy (IMRT) spares the bladder significantly more from direct radiation when compared with 3D conformal proton therapy (3D-CPT), according to the October issue of ASTRO’s International Journal for Radiation Oncology*Biology*Physics.

“This study was important because it reassures a patient with prostate cancer that the methods that are available at his local hospital may, in many cases, be as good as those that are currently only available in a limited number of centers,” said Anthony L. Zietman, MD, professor of radiation oncology at Harvard Medical School.

In a study jointly conducted by the Massachusetts General Hospital Department of Radiation Oncology and Harvard Medical School, 10 patients with clinically localized early-stage prostate cancer were randomly selected and treated with IMRT and 3D-CPT. The percentage of bladder volumes receiving more than 70 Gy/CGE was reduced by an average of 34% when using IMRT. Moreover, results showed that rectal volumes were equivalent.

—E. Sanchez

Study Discovers New Way to Evaluate Tumor Activity

A fresh look at blood vessels could finally lead to clinical acceptance of MR’s viability as a monitor of tumor activity.

According to a recent report in the December issue of Radiology, MR angiography can be employed to measure changes in blood-vessel morphology during treatment of brain metastases from breast cancer. Moreover, it can supply an early indication of treatment response, the report contends.

While noninvasive methods of assessing a malignant brain tumor’s response to therapy have already been explored, or are currently in the process of development, none of the approaches have proven to be “sufficiently reliable to meet full clinical acceptance,” Elizabeth Bullitt, MD, told Reuters Health.

“Our approach involves assessing vessel shape on noninvasively acquired MR scans and offers a new means of evaluating tumor activity,” continued Bullitt, a professor in the Division of Neurosurgery at the University of North Carolina-Chapel Hill.

Bullitt and a team of researchers examined MR angiography’s capacity to account for intracranial vascular morphologic changes during treatment of brain metastases from breast cancer. The group also embarked on an investigation to determine whether serial quantitative vessel tortuosity measurements could predict tumor treatment response sooner than traditional methods.

Based on a study of multiple vessel shape parameters in patients with varying types of tumors, a computer program was used to calculate MR angiography-based malignancy probability (MP).

Researchers found that with vessel shape analysis, the mean time to recognize patient unresponsiveness to treatment was shortest, at 2 months, whereas it took 3.9 months using clinical criteria and 3.1 months with volumetric measurement. Bullitt and her colleagues reported that two patients shown to possess normalization of vessel tortuosity abnormalities, or reduced MP, had a higher mean progression-free survival than the 19 patients without normalization of vessel shape. At the 2-month follow-up marker, the two patients’ mean progression-free survival was 8.5 months, compared with the others’ 3.9 months.

“The approach may be useful not only in monitoring tumor treatment response, but in assessing the likelihood that a de novo tumor is malignant,” Bullitt said, adding MRA “may provide new insights into how tumor vasculature develops and reacts to various forms of therapy” when it is combined with traditional perfusion and permeability imaging of the vasculature.

Looking further ahead to the future, Bullitt said her group’s findings may be applicable to a wide range of disease states—not just for cancer.

“Almost every disease that one can think of affects vessel number or vessel shape,” Bullitt said.

—E. Sanchez