A cancer diagnosis is hard enough; the challenges of treatment can be equally devastating. TomoTherapy, based in Madison Wisconsin, was founded with the goal of providing highly accurate radiation treatments in order to minimize the discomforts of the treatments and maximize their effectiveness. By combining radiation therapy with integrated imaging technology, the TomoTherapy platform leverages CT scanning capabilities to deliver highly precise treatments for cancer patients. We asked TomoTherapy President and CEO Frederick A. Robertson, MD, about the technology and, in general, innovation in his field.
Can you explain how the TomoTherapy system is different from other imaging companies and products? What makes them leading edge?
For decades, radiation therapy has been delivered by systems that have a linear accelerator (linac) mounted on a c-arm gantry. The design has inherent limitations that, to this day, impact the types of cases that can be treated on these devices. In 2002, we introduced the TomoTherapy platform, which, by its unique design, changed the way that radiation therapy could be delivered. The TomoTherapy radiation therapy system includes a linac mounted on a ring gantry, which is very similar to the CT imaging devices with which we are all familiar. By enabling daily CT imaging of tumor location and a continuous, 360 degree IMRT delivery from around the patient, the TomoTherapy system has fundamentally changed the way cancer is treated. Because clinicians are able to see an image of the treatment area every day before delivering radiation, they can easily adapt treatments to address changing patient anatomy or general movement of the tumor. And, the ability of the TomoTherapy system to conform radiation delivery to the shape of the tumor means that the healthy tissue and surrounding critical structures can be better spared from irradiation, which can result in fewer side effects for patients.
In what other ways is TomoTherapy advancing cancer care?
Our innovative compact design has enabled us to put our standard radiation therapy platform in a mobile environment, with the goal of bringing our advanced technology to patients in underserved and rural markets. The TomoMobile solution allows cancer centers to begin treating patients in a matter of weeks – not months or years that it takes to construct permanent facilities. Cancer centers can use the solution to treat patients while a new facility is being built, to alleviate backlogs when patient demand increases or even as a permanent site where space and other constraints prevent a brick-and-mortar facility from going up.
How is the platform better for patients?
The TomoTherapy platform offers a number of features that enhance patient safety and treatment delivery. First, is the integrated nature of the TomoTherapy platform. Imaging, treatment planning and delivery are all done from a single system, using a single database. This helps enable clinicians to avoid the possibility of data entry error that could impact dose delivered or area treated. Secondly, the ability to do daily 3D imaging aids in the set-up of the patient before treatment, and enables clinicians to help ensure precision delivery of the beam. The daily imaging also allows clinicians to adjust treatment plans quickly and safely, if there are variances in the patient’s anatomical structure from day to day or if they see that the tumor being treated has shrunk and therefore the amount of radiation delivered needs to be reassessed.
Most healthcare providers are saying that patients are much more educated about both their diagnosis and treatment plans than ever before. Is that your experience and how has that changed your marketing and patient education?
Yes, I believe that patients are becoming much better informed about the treatment options available to them. We frequently hear from our customers that patients will come in and ask for TomoTherapy by name, which is evidence that they have explored various options and they have a good understanding of the benefits of our technology. We also see that patients are willing to travel to receive TomoTherapy treatments, even when other radiation therapy alternatives are available in their hometowns.
In addition, we often hear directly from patients who have successfully battled cancer with TomoTherapy treatments. We welcome and cherish the stories that they share because they are powerful reminders why we do what we do. It is great to see that patients are taking more control over their care and becoming more educated on their options, because they ultimately emerge as passionate advocates who can help others navigate through difficult times.
As an industry leader, what are the two or three broad trends you see that have the capability of changing how healthcare is delivered?
One of the clear trends that we’re seeing in radiation therapy is the power of daily imaging. By being able to better “see” the patient’s anatomy, we can fundamentally change the way cancer is treated – from being able to more accurately deliver radiation so that we’re treating cancer as a chronic disease to personalizing cancer care. Some trends we’re seeing in advanced cancer care, made possible only through 3D volumetric imaging, include:
- Adaptive radiation therapy - Conventional radiation therapy often lacks an imaging component that enables clinicians to compare current scans with the original image to adjust for changes in the tumor or patient. Daily 3D volumetric imaging capabilities available in the TomoTherapy platform enable clinicians to offer not just daily image guidance, but adaptive radiation therapy. The images first allow for adjustments to be made in delivery, based on any day-to-day changes to a patient’s anatomy. And, secondly they offer a more comprehensive picture of the dose the tumor has already received to ensure the treatment is on track to meet the prescription.
- Hypofractionation – Clinicians are now moving to treatment regimens that use short courses of high-dose radiation, also known as hypofractionation. Daily 3D image guidance is critically important with hypofractionated dosing because when larger fractions are being delivered, they need to be delivered correctly and with extreme precision. In fact, many doctors agree that hypofractionated radiation therapy treatment is only possible with exemplary 3D volumetric image guidance capabilities because they are comfortable delivering such high doses only when they are confident of the location of the target and surrounding normal tissue. Hypofractionation has become an effective way to treat localized cases, such as head, neck, lung and prostate cancers. Tumors in the head, neck and lung are often fast-growing and can repopulate within a few weeks. So a higher dose and faster treatment cycle often results in a more effective treatment. For the prostate, there is a growing belief and clinical evidence that shows patients fare better with fewer, higher doses, as well.
- Personalized Cancer Care – Historically, with conventional radiation therapy, almost all patients with a given stage of tumor received a similar dose prescription. However, this can result in tumors – which have varying levels of radiosensitivity – to be either under-dosed or receive doses that are higher than necessary. The advent of advanced imaging, IMRT and image-guided radiotherapy (IGRT), has opened up the possibility of being able to personalize radiation therapy prescriptions to most effectively treat each patient’s unique case.