University of Florida radiation oncologists are using a sophisticated medical device to treat patients who have recent diagnoses of metastatic cancer, where the disease has started to spread from one part of the body to another.
The device, called Vero, delivers stereotactic body radiotherapy (SBRT) in a way that allows the physician to track and view the tumor in real time during treatment. This permits a high degree of precision in delivering targeted doses of radiation therapy, especially in areas of the body that experience motion during treatment.
"With Vero we can track tumors in real time, allowing precise doses of SBRT to be delivered to tumors that are moving as the patient breathes or with the patient's heart beat," said Paul Okunieff , M.D., a professor and chair of the UF department of radiation oncology and director of the UF Shands Cancer Center. "This enables us to deliver the optimum dose of radiation to the tumor, destroying it from the inside out while sparing healthy tissues surrounding it."
Okunieff pioneered the use of SBRT to treat metastatic disease in its early stages, before it has spread more widely through the body. His research, published with colleagues from the University of Rochester, concludes that the chances for long-term survival improve significantly when metastatic disease in a very early state – that is, with five or fewer lesions – is treated with high dose, targeted SBRT. This aggressive approach has a track record of success, with long-term overall survival of as much as 46 percent for certain types of metastatic cancers.
"The ability to track tumors with Vero allows us to treat smaller target volumes, while giving us the confidence that we are not missing the tumor. We believe that patients will tolerate well the short treatment which is usually given during a five- to 10-day period," said Roi Dagan, M.D., assistant professor in the UF department of radiation oncology and radiation oncologist at the University of Florida Proton Therapy Institute. "There is great potential for Vero-delivered radiation in combination with other common metastatic treatments like chemotherapy and surgery to improve patient outcomes."
The Vero technology is part of the UF Metastatic Cancer Program recently established to treat patients on the UF&Shands Jacksonville and Gainesville campuses. Rather than accepting the dogma that cancer that has spread should only be treated to alleviate symptoms, the UF Metastatic Cancer Program is taking a radically different approach – working with the patient's existing physician to catch the cancer's spread early and treating with intent to cure. The program's goal is to enroll each patient accepted into the program into clinical research studies in an effort to generate the scientific evidence of the treatment's success in changing metastatic cancer from a terminal condition to one that is manageable, if not completely curable.
"We know we can save peoples' lives using SBRT to destroy cancer that has limited spread, and we know advanced, modern medical imaging can help us by finding metastatic tumors very early while they're still limited in size and spread," Okunieff said. "Now, we must generate the compelling and reproducible scientific evidence necessary to convince the medical community that this is so and to change how people think about metastatic disease. It isn't always a terminal diagnosis."
The program began accepting patients for treatment in October, and as many as five of those have been treated on the Vero system since the beginning of November. The device is located on the campus of Shands Jacksonville at the University of Florida Proton Therapy Institute. This is the first Vero machine in the Southeast United States and the second in North America.
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