Providing top-rated cancer care takes the expertise of a host of cancer specialists and caregivers using the latest advances in medicine. While the experienced, knowledgeable people are vital to this care, so is the equipment they rely on to help them diagnose and treat patients. That's why the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine backs its experts with the most innovative equipment available.

The Siteman Cancer Center recently added two significant pieces of equipment that provide image-guided radiation therapy. The major feature is their ability to perform a CT-like image on a radiation therapy machine. Patients are scanned and treated on the same machine for the most precise treatment.

Two-for-One, Targeted Treatment
Traditionally, patients have X-rays or CT scans before treatment and then radiation oncologists plan a series of treatments using reference points based on where the tumor should be. But tumors have a tendency to shift or shrink. In image-guided radiotherapy, physicians have the ability to image the tumor daily to adjust the reference points. It offers day-to-day set up accuracy and the ability to monitor tumor response and adapt accordingly.

"Image-guided radiotherapy is like a 'two-for-one' treatment," explains Simon Powell, MD, PhD, chief of radiation oncology at the Siteman Cancer Center. "Each day of radiation treatment, a CT scan is taken that gives a precise image of a tumor or area at that time. Then the treatment beams can be focused right on the money on the same machine. Every radiation treatment is custom-fitted. For example, a tumor can shrink with treatment. As the tumor shrinks, the treatment shrinks with it, so only the target area gets radiation."

Dr. Powell says in addition to reducing complications by decreasing radiation to surrounding tissue, the major advantage of this adaptive radiotherapy is that patients can receive higher doses of radiation to a more precise area, which improves the effects of radiation on the tumor

Pioneering New Treatments
The two new image-guided radiotherapy systems installed at Siteman are the Trilogy and TomoTherapy treatment units. The Trilogy system is used for the treatment of tumors that move during breathing, such as those in the lungs or abdomen. The TomoTherapy unit rotates around the patient to acquire the CT scan and deliver therapy.

"We're exploring new ways to use the TomoTherapy device for wider treatment areas," Dr. Powell says. "For diseases like leukemia or lymphoma, wider areas need to be treated. Because this device rotates around the patient, radiation can be delivered from any angle. Siteman does a number of stem cell transplants for leukemia and currently we do a total body irradiation to prepare patients for this. But the TomoTherapy device could change how we do that in the future. In addition, it also will be useful for patients with brain tumors that affect the entire central nervous system because the unit can provide radiation to a selected region of the body."

The addition of the Trilogy and TomoTherapy units to the already available Gamma Knife radiation tool makes Siteman one of only a few facilities in the nation to offer all three of these state-of-the-art treatment methods. "With the combination of these systems, there's nothing we can't treat," Dr. Powell says. "We now have a choice as to what equipment is best for each patient."

Dr. Powell adds, "This new equipment is where the field of radiation oncology is going. And Barnes-Jewish Hospital is in a good position to make a major contribution to the field."