How the Synergy S System will Positively Impact Cancer Care and Radiation Oncology Treatment in the Salem, Roanoke and New River Valley Regions

By Dr. John Rogers, a board-certified Radiation Oncologist at Lewis-Gale Regional Cancer Center and medical director of the Radiation Oncology Department.

The last decade has seen tremendous advances in technology and its application. Cell phones now have more computing power than a laptop did just a few years ago. This expansion in capability has affected many aspects of our lives and medicine is no exception. We have seen increased use of electronic medical records, digital x-ray imaging, and minimally-invasive surgery. Cancer therapy has also benefited from the use of genetic testing to a new generation of more targeted chemotherapy. Computing and imaging have had a particularly expansive role in the evolving field of Radiation Oncology.

Radiation Oncology is a medical specialty that uses x-rays to target and treat cancer. It is a standard treatment for patients with cancers of the breast, prostate, lung and many others. Historically, delivery of radiation treatment to a tumor would also affect the adjacent organs causing potentially serious complications. In order to minimize these effects, a typical course of radiation therapy involves daily delivery of small doses given over multiple weeks of treatments. Much like hammering a nail, a series of small taps drives the nail without damage where a sledgehammer could do the job in one hit, but might also damage the wood. However, if we can hit the nail very precisely we can reduce the chance of damaging the wood. Similarly, the advent of new technologies is allowing radiation oncology physicians to target treatments in ways that reduce the dose received to surrounding organs while increasing the effect of treatment to the cancer. One such delivery system is now in place at Lewis-Gale Cancer Center.

The Synergy-S is an integrated radiation treatment delivery system built to deliver highly targeted radiation therapy. The key components to the increased capabilities of the Synergy-S are its ability to change the shape of the beam of radiation and to acquire accurate images of the cancer at the time of treatment.

Since every cancer is unique in its size and shape, the ability to conform the radiation beam to the contours of a tumor allows for greater sparing of the surrounding organs. To do this, the Synergy-S uses sliding blocks inside the machine that shape the radiation beam to match the tumor. The technology is similar to touching the fingertips of your hands together in front of a flashlight beam then moving your fingers individually to let more or less light through. Now imagine several hundred fingers and the almost limitless shapes that different combinations of their positions can produce. In addition to beam shaping, the machine can rotate 360° around the patient and deliver different radiation amounts from different positions. This allows more or less treatment to be given from different positions depending on how surrounding organs are affected.

In order for the shape of the beam to effectively treat the tumor, it is critical to know where the tumor is located inside the patient at the time of treatment. To do this the Synergy-S has an integrated CT scan capability. Once a patient is positioned for treatment, the Synergy-S obtains a full 360° scan of the tumor site. The images are then used to create a three dimensional picture of the patient’s cancer and the surrounding anatomy. Corrections in the patient’s position can then be made to ensure that the radiation is delivered exactly where it is intended.

Both of these capabilities have significantly improved the precision of radiation treatment delivery. This not only improves the likelihood of cancer control, but it has significantly reduced the severity of treatment related complications. Another benefit to such precision is in reducing the number of treatments. As in the previous description of driving a nail, if we have a precise enough sledgehammer, perhaps a single, large dose can be done safely. Using the technologies described here, the capability exists to treat tumors with very large doses in a few or even a single treatment.  In radiation treatment this is a growing practice called stereotactic radiotherapy.
 
There are two situations where stereotactic radiotherapy has created treatment options for cancer patients where historically there have been very limited options. The first are patients whom prior radiation treatments have already delivered the safe limits to surrounding organs. Second are those situations where a cancer is immediately adjacent to, or even within, a critical organ that cannot tolerate significant treatment.
Imagine a patient with lung cancer that was successfully treated with radiation and chemotherapy. As recently as a few years ago, if that patient had a recurrence of their lung cancer, no matter how small, the only options for treatment were to resume chemotherapy or remove the lung. Likewise, a patient with a tumor in the bones of the spine has limited options because of the risk of injury to the spinal cord. Using radiation systems like Synergy-S, patients like this can have the single site of cancer treated very precisely, often with one or just a few high dose treatments. Further, the treatments are completely non-invasive and have only limited risk of immediate side effects. While still a relatively new field, published studies have demonstrated excellent cancer regression rates at treated sites.

With the continued development of technology we discover applications that seemed unfathomable even a few years ago. Along with this comes the hope that each step is leading toward the ultimate achievement of complete cancer control. We are very fortunate to live and work in a place with tremendous access to state-of-the-art medical care and while a cure is still many years away, tools like the Synergy-S at Lewis-Gale Cancer Center make that reality seem all the more attainable.

Dr. John Rogers is a board-certified Radiation Oncologist at Lewis-Gale Regional Cancer Center and medical director of the Radiation Oncology Department. He has practiced at Lewis-Gale Cancer Center for five years. Dr. Rogers is a partner with Blue Ridge Cancer Care, an independent, multi-specialty oncology practice serving the Roanoke and New River Valley regions.