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Does TomoTherapy Actually Work?

August 12, 2020

The World Health Organization (WHO) reports that cancer was responsible for approximately 9.6 million deaths around the world in 2018. Most cancer deaths come from individuals with lung cancer, and this was followed by colorectal cancer and then breast cancer. (https://www.who.int/news-room/fact-sheets/detail/cancer) The statistics show a great deal about cancer, it is a major cause of death around the world and requires a speedy diagnosis and treatment to improve the survival rates. Cancer treatments can include chemotherapy, surgery, and radiation therapy.

In the 1990s, Professors Paul Reckwerdt and Thomas Mackie from the University of Wisconsin–Madison began pioneering TomoTherapy. TomoTherapy is a medical system that administers radiation therapy to cancer patients to get rid of the cancer cells and to prevent the spread of cancer to the rest of the body. TomoTherapy Inc was formed in 1997, and in 2002, the first-ever patient was treated with the TomoTherapy prototype, the patient was a lady with bone metastases. TomoTherapy has been in the works for quite a while but has come a long way since the early-stage prototypes.

The TomoTherapy machine has been used over the years to treat various cancers such as head and neck tumors, breast cancer, lung cancer, and much more. This cancer treatment provides very precise doses of radiation to the patient because the TomoTherapy machine is image-guided, the radiation beam can be rotated in a 360-degree fashion around the patient, and the radiation intensity can be changed depending on personal needs.

What Steps Are Involved in the TomoTherapy Treatment?

  1. The first step is the planning stage. Before the treatment, the clinician will take 3D images to find out where the tumor is and to determine the size and shape of the tumor. This will help the clinician decide how much radiation will be needed for the treatment later on.
  2. The next step is positioning. Just before each TomoTherapy treatment session, a CT scan will be done. This is done to ensure that the right area is being targeted with the radiation, as sometimes the tumor can move and the shape of the tumor may change somewhat throughout the treatment sessions.
  3. The final step is radiation therapy.  This is when the radiation is administered; the TomoTherapy machine uses a spiral delivery mechanism meaning that the radiation can be delivered at various angles to target the tumor. 

The Benefits of TomoTherapy

The image-guided system allows clinicians to precisely locate the tumor and a patient-specific treatment plan is made, so the treatment is completely personalized for the patient’s specific requirements.

The advanced precision of the system allows the radiation dose to be targeted towards the tumor specifically and so the healthy tissues surrounding the tumor are less prone to damage by the radiation. This should reduce the side effects the patient experiences.

The TomoTherapy radiation therapy offers a low treatment time, reports have shown that it took on average 15 minutes per patient and the lowest treatment time recorded was for prostate cancer patients at nearly 7 minutes.  (https://journals.sagepub.com/doi/10.7785/tcrt.2012.500374)

The Side Effects of TomoTherapy

As with all radiation therapy, TomoTherapy may also come with side-effects. These side-effects may begin to show two weeks after the first session but the side-effects may vary depending on the individual treatment plan and will most likely be specific to the body part targeted with the radiation. The side effects may include:

  • Fatigue and tiredness
  • Nausea, vomiting and maybe headaches
  • Skin complications such as redness and itchy skin
  • Soreness or pain in the treated area

The Possible Complications

Some individuals that use TomoTherapy may experience complications as a result of the treatment. In a study, a small percentage of prostate cancer patients treated with TomoTherapy experienced gastrointestinal or genitourinary toxicity within five years of being treated. (http://ar.iiarjournals.org/content/37/10/5829.full) However, the researchers suggest that TomoTherapy is completely safe and the rates of toxicity are pretty low.

Recent Clinical Studies

Two studies were conducted this year that reported the benefits of using TomoTherapy in advanced stage rectal cancer.

The first study was conducted in Switzerland and was led by Dr. Berardino De Bari. It was found that TomoHelical had low toxicity and was very safe. The patients were called back four years after their treatment with TomoHelical and 74.6% of them were cancer-free.

"The results of our analysis are encouraging because they indicate that patients with advanced rectal cancer may have a better option for effectively treating their disease. Further studies are needed, however, we believe that highly conformal radiation doses delivered with TomoHelical in combination with daily image guidance may become the new standard of care for pre-surgical treatment in patients with advanced rectal cancer,” said Dr. Berardino De Bari, assistant professor and radiation oncologist in the radiation oncology department, CHUV.

In a second study, the clinicians found that the TomoHelical system was able to substantially decrease the tumor size and even more importantly, 70.9% of the patients were cancer-free even five years after the TomoTherapy. Therefore, the TomoHelical system seems as though it is an efficient and safe cancer treatment.

If that wasn’t enough evidence supporting the benefits of TomoTherapy, listen to this. TomoTherapy is a revolutionary innovation for cancer treatment; the initial concept has evolved over the years and now the Radixact® System (a next-gen TomoTherapy system) has been generated. Recently, Accuray Incorporated, the company that develops and manufactures TomoTherapy machines, won the 2020 MedTech Breakthrough award “best overall medical device solution” for the Radixact® System. (https://investors.accuray.com/news-releases/news-release-details/accuray-synchronyr-real-time-adaptive-technology-radixactr) The TomoTherapy systems have been recognized for their success as a cancer treatment which further proves their benefits.

References

https://www.prnewswire.com/news-releases/studies-support-use-of-the-accuray-tomotherapy-system-for-advanced-rectal-cancer-to-improve-treatment-efficacy-and-reduce-side-effects-300999198.html

http://www.jlgh.org/Past-Issues/Volume-4---Issue-3/A-New-Tool-to-Help-Fight-Cancer.aspx#4

https://www.sprmn.pt/pdf/pmb6_13_r24_History_of_Thomotherapy_(TRMackie).pdf

Image: Rhoda Baer - National Cancer Institute (https://visualsonline.cancer.gov/details.cfm?imageid=4478)