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Intensity Modulated Radiation Therapy (IMRT) for Head and Neck cancer at Perth Radiation Oncology:

16th Sep 2009

The Head and Neck Cancer radiation therapy programme at Perth Radiation Oncology (PRO) now offers Intensity Modulated Radiation Therapy (IMRT) for selected cases where salivary gland sparing is deemed to be feasible.

Our experience in advanced Image-Guided Radiation Therapy (IGRT) has enabled us to deliver an optimally safe and efficacious programme of IMRT for head and neck cancer.

The PRO head and neck cancer IMRT programme is actively led by radiation oncologists Dr Janelle Heywood MBBS FRANZCR and Dr Jerome Freund MBBS FRANZCR, having over 45 years combined specialist experience in radiation treatment for head and neck cancers.

Dr Heywood and Dr Freund jointly trained at an IMRT specialist’s practicum run by the American Society for Therapeutic Radiation Oncology in Orlando, Florida (USA) in February 2008.

PRO has implemented an IGRT-based head and neck cancer IMRT programme offering treatments for appropriately selected cases with the aim of significantly improving quality of life outcomes.

Conventional conformal radiation therapy techniques are generally unable to reduce the radiation dose received by the parotid glands to a point where adequate salivary function is preserved.

This means that the majority of head and neck cancer cases treated with conventional conformal techniques are left with long term consequences on their quality of life including a permanently dry mouth, loss of taste and potential dental problems.

The use of the IMRT technique at PRO now offers appropriately selected patients a chance to limit dose to the parotid glands and hence significantly preserve salivary function.

This can lead to improved quality of life outcomes (less dry mouth, better taste function and fewer dental problems) for selected head and neck cancer patients treated with the IMRT technique.

PRO uses cone-beam computed tomography (CT) with the patient lying in his/her treatment position to ensure the accurate delivery of our IMRT treatment.

Unlike conventional (two-dimensional) patient localisation devices, our on-board cone-beam CT uses a very low dose of diagnostic-quality x-rays to produce fully three-dimensional images of a patient\'s internal anatomy.

Our Elekta Synergy® treatment machine has the ability to perform real-time automated digital image registration and also uses a computer-controlled treatment table to position a patient within one millimetre of their planned position.

The PRO image-guided radiation therapy (IGRT) leadership team - comprising radiation oncologists, radiation therapists, radiation oncology medical physics specialists and biomedical engineers - have been developing our expertise in cone-beam CT image guidance techniques since January 2008.

The use of frequent cone-beam CT in image-guided delivery of IMRT allows our clinical team to monitor the progress of a patient throughout treatment.

We will soon be adding a new level of sophistication to our cone-beam technology by enabling quantitative dosimetry calculations on the cone-beam CT studies to assess changes in anatomy that might occur over a course of treatment.

Our IMRT and IGRT techniques are rigorously tested within a comprehensive Quality Assurance programme, which includes precise calibration of multi-leaf collimators, dosimetric accuracy checks for each IMRT patient prior to commencing treatment and routine calibration of our cone-beam CT-guided system for optimal performance.

In keeping with our patient-focussed evidence-based approach, treatment accuracy and position reproducibility data are recorded securely and confidentially for on-going analysis by our leadership team.

Our clinical results are currently being used to direct further improvements and refinements to our IMRT and IGRT programmes.

Glossary of technical terms

Image-Guided Radiation Therapy
... is a radiation treatment process that captures images (or other data) which represent the spatial extent and geometry of relevant anatomy with the patient in the treatment position, to enable radiation treatment to be delivered with enhanced accuracy and precision to mobile targets.

Intensity-Modulated Radiation Therapy
... is a radiation treatment technique that utilises independently moving \"leaves\" of highly attenuating material, known as multi-leaf collimators, which customise the intensity of a radiation beam across the treatment field, so as to create dose distributions that closely conform to the shape of targets deep within the body.

Computed Tomography
… is a process of capturing two-dimensional projection images through an object or a person from many different directions in order to mathematically and computationally \"reconstruct\" a full three-dimensional image of the same object or person.

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