· ProCure and U Penn Team Up On Proton Therapy Research
· Medical Imaging Advance Spots Small Breast Tumors
· Novalis Tx Wins Orders and Accolades

ProCure and U Penn Team Up On Proton Therapy Research

ProCure Treatment Centers Inc, Bloomington, Ind, and the University of Pennsylvania’s Roberts Proton Therapy Center, Philadelphia, have announced an agreement intended to provide advanced training programs and accredit medical professionals in proton therapy. The expansion of this technology, which provides an alternative to conventional radiation therapy, is the central focus of the agreement, which looks at expanding research on proton therapy delivery and developing new protocols using protons to treat a wider range of cancer tumors.

“The partnership allows us to integrate our research with a national network of proton therapy centers all working to learn more about the optimal utilization of proton therapy,” said Stephen M. Hahn, MD, Chairman of the Department of Radiation Oncology at Penn. “With an estimated 250,000 patients who could benefit from proton therapy each year, the more research and data we can collect, the better we will be able to treat patients.”

Proton therapy is currently used for select clinical indications including base-of-skull tumors, ocular melanoma, sinus tumors, pediatric cancers, and prostate cancer; this course of treatment is sometimes preferred over conventional radiation therapy because of radiation therapy’s potential side effects.

The agreement between ProCure and U Penn includes the establishment of new clinical studies to evaluate the use of protons in areas including proton therapy in combination with chemotherapy; ProCure’s network of proton therapy centers will increase the number of patients eligible for enrollment, while the Roberts Center will offer oversight, establish data-collection procedures, analyze data, and handle regulatory issues.

The accreditation and training portion of the agreement addresses the growing need for clinicians specializing in proton therapy. Within the next 5 years, 10 new proton therapy facilities are expected to open their doors in the United States, creating a demand for qualified and trained staff at every level, including radiation oncologists, medical physicists, dosimetrists, radiation therapists, and more. ProCure’s new Training and Development Center, the world’s first training facility dedicated solely to proton therapy, will play host to educational programs. The 20,000-square-foot facility, also located in Bloomington, simulates a working proton therapy center; it will provide training for clinical staff at every level.

“By partnering with a world-renowned academic institution that has a strong interest in furthering the use of proton therapy, we can significantly enhance the caliber of training programs at the Training and Development Center,” said Nick Schreuder, senior vice president of technology at ProCure. “This will be the first facility to offer accreditation in proton therapy, which is an important advance in the field.”

ProCure currently has proton centers under construction in Oklahoma and Illinois; the company is working with community hospitals and local radiation oncology practices to open proton centers across the country. When it opens in 2009, the Roberts Proton Therapy Center in Philadelphia will be the largest and most comprehensive proton therapy facility in the world; additionally, it will be the only cancer treatment center to combine conventional radiation therapy with proton therapy. Pediatric cancers will be treated at Roberts, and Penn has established a relationship with Walter Reed Medical Center intended to make proton therapy available to US military personnel and veterans.

—Cat Vasko

Medical Imaging Advance Spots Small Breast Tumors

A new medical imaging approach that detects and guides the biopsy of suspicious breast cancer lesions has the ability to locate tumors half the size of the smallest ones found by standard imaging systems, according to a recent study.

Called the PEM/PET system, the novel method incorporates positron emission mammography to achieve high-resolution, 3D PET images of the breast, using a moveable array of two pairs of two flat detection heads. Results of the initial testing, which were published in the journal Physics in Medicine and Biology on February 7, revealed that the technique can complete an image and biopsy in roughly the same amount of time as a traditional biopsy.

“This is the most important and most difficult imager we’ve developed so far,” said Stan Majewski, Jefferson Lab Radiation Detector and Medical Imaging Group leader. “It is another example of nuclear physics detector technology that we have put a lot of time and effort into adapting for the common good.”

Scientists at the Department of Energy’s Thomas Jefferson National Accelerator Facility, West Virginia University School of Medicine, and the University of Maryland School of Medicine designed and built the system. The study’s lead author, Ray Raylman, also a radiology professor and vice chair of Radiology Research at WVU, led a team of researchers who imaged various radioactive sources to test the system’s resolution.

“We had good performance characteristics, with image resolution below two millimeters,” said Raylman, who authored the system’s concept and holds a patent on his idea. “The ability of the device to do biopsy is probably one of its most unique characteristics. There are other breast imagers, but none that are built specifically to do biopsy as well as imaging.”

Once a suspected lesion is discovered, a single pair of flat detection heads guides a needle biopsy of the lesion, a procedure performed with a person-controlled robot arm. This approach is particularly useful in imaging tumors in women who have indeterminate mammograms because of dense or fibroglandular breasts, according to the study.

The Jefferson Lab Radiation Detector and Medical Imaging Group, which has a group member now affiliated with the University of Maryland School of Medicine, developed the detector heads with the onboard electronics, the data acquisition, and the image-reconstruction software. A team of researchers from West Virginia University created the imaging device’s gantry and motion-control software.

Up next for the team of scientists are plans to include minor improvements in the detector systems and image-reconstruction software, as well as adding components for taking x-ray computed tomography scans.

Initial clinical trials are planned after system testing is completed.

—Elaine Sanchez

Novalis Tx Wins Orders and Accolades

Varian Medical Systems Inc, Palo Alto, Calif, recently announced that its new Novalis Tx radiosurgical platform with BrainLAB software has garnered 14 orders since its launch just a few months ago. Ten institutions in the United States and four in Europe have placed orders for the system, which combines cone-beam CT imaging with stereotactic radiation.

The Novalis Tx radiosurgical system

“Novalis Tx orders have come in at twice the rate normally seen for any type of radiosurgical device, and we are delighted with the early response from the surgical community,” said Dow Wilson, president of Varian’s Oncology Systems business. “We have received orders from some of the world’s leading surgical and radiotherapy centers as well as from community hospitals that are intent on enhancing their radiosurgical capabilities.”

One such leader in the field is the Henry Ford Health System, Detroit, where more than 1,500 patients have been treated with the previous iteration of the Novalis system for a wide range of clinical indications. Benjamin Movsas, MD, Herndon Chair in Oncology Research and chairman of the department of radiation oncology at Henry Ford, explained, “In the past there’s been a lot of emphasis placed on having a dedicated stereotactic unit, but in reality, having the flexibility to use a single unit to treat both patients who may benefit from IMRT and then being able to convert the same unit to a stereotactic unit is a very efficient way to handle patient load. It’s very cost-efficient and flexible.”

Movsas says his team is looking forward to the installation of their new Novalis Tx system because it will heighten the radiosurgical capabilities they’ve been developing with the older Novalis platform. “One of the things we’ve helped to pioneer is the use of the Novalis unit for stereotactic spine radiosurgery,” he said. “It allows you to give a single dose of intense radiation to areas adjacent to the spine, and it’s a very efficient way to treat patients for pain. The Novalis Tx will only make that type of treatment easier because of the extra imaging capability we’ll have.”

The Novalis Tx radiosurgical system features a new high-definition multileaf collimator.

Another exciting application of the device is treatment of central lung lesions. “There have been reports of toxicity in treating more central lesions in a paper out of Indiana University,” Movsas said. “What we found is that they used 20 Gy fractions, a very intense dose. We used 12 Gy fractions to treat over a dozen patients who’ve been followed for over a year, and that treatment has been very well tolerated. Having a Novalis Tx will only improve on this type of treatment, and allow us to treat more complex tumors in more difficult locations.”

The system’s software capabilities are another factor that give it an edge over similar devices from other manufacturers, according to Movsas. “The unit has a remote viewing system, Internet-based,” he said. “Let’s say you’re at Site A and have a plan for a patient at Site B. Using iPlan Net, you can view the plan from Site A and modify it, and other doctors can look at it at the same time from different locations and work on it together.”

Finally, Movsas cites the system’s efficiency as a major advantage. “We have patients who are seen in the morning for stereotactic radiosurgery and get treated a few hours later, which is really quite remarkable,” he said. “It’s a flexible, efficient, and user-friendly system.”

—C. Vasko