Henry Ford offers cutting-edge MRI-guided radiation cancer therapy

  • Henry Ford spends $10 million on advanced MRI-guided radiation therapy program in Grosse Pointe Farms
  • Treats adult cancers of the prostate, liver, pancreas and abdomen with precision doses
  • Will add second system in 2020 when downtown outpatient cancer center opens

 

Henry Ford Health System took a big step in precision medicine this year when they introduced an advanced cancer therapy system that uses magnetic resonance imaging to guide radiation treatment in real time.

“This is the first one in the world to use linear acceleration with an MRI,” said Benjamin Movsas, chair of the department of radiation oncology at the Henry Ford Cancer Institute in Detroit.

“This completely transforms what we do for patients,” he said.

Benjamin Movsas

In July, Henry Ford installed the $10 million cutting-edge advanced radiation therapy system, called MRIdian Linac, at its Henry Ford Medical Center-Cottage in Grosse Pointe Farms. The radiation therapy system was designed and manufactured by ViewRay Inc. (Nasdaq: VRAY) of Oakwood Village, Ohio.

The first patient in Michigan and one of the first in the world was treated there on July 19 for prostate cancer. Using MRI and linear accelerator delivery, the dosages are more precise and therefore the radiation treatments are more accurate. They are also more efficient. For example, treatment of a cancerous prostate or liver can be done in 45 minutes to one hour, compared to a more typical two to three hour treatment. That increases patient convenience, Movsas said.

“In radiation oncology our field has done good job with precision of radiation. We have gotten margins (where tumor and healthy tissue intersect) down from half an inch to millimeters,” he said. “The gap has been on the accuracy side. Accuracy is to hit the true target (tumor) every time.”

Movsas said current radiation technologies, including proton beam therapy or intensity-modulated radiation therapy, can hit the margins but miss the target because the tumor can move from the time it was scanned for position.

“We can see the target in real time. We have beautiful imaging and have never been able to do this before,” he said. “This is the future of radiation oncology. You will see more and more of these MRI-based units because we can give patients effective doses, more confidently.”

When Movsas’ fellow radiation oncologists saw what MRIdian could do “my colleagues jaws dropped open. This is easily the most exciting thing of my entire career. It’s exciting. But the reason we are doing it is because of patients,” he said.

Under most current systems, patients are given computed tomography (CT) scans before treatment. Because patients are on CT and treatment tables for 20 to 30 minutes, they often move, or the tumor moves.

“We get feedback in real time. It can make a difference,” he said.

Henry Ford Health System
Benjamin Movsas, M.D. (center) with Indrin Chetty (left), head of medical physics division in radiation oncology, and Paul Jackson (right), radiation oncology therapist, in control room using the MRIdian Linac radiation cancer system.

For example, using real time MR imaging on a prostate patient, Movsas said one recent case he saw gas come down the rectum, pushing the cancer in the prostate away.

“We paused the radiation and waited for the gas to pass, then switched the beam back on. We can say the radiation was treating the cancer 100 percent of the time,” Movsas said. “It is extremely helpful for the prostate and the pancreas, which are moving all the time.”

Movsas said another recent patient had a lymph node in the abdomen that was causing a lot of pain.

“It was so close to the small bowel that we could not offer radiation or low dose because the bowel obstructed the view,” he said. “We asked him to hold his breath to move the bowel away so we could treat it. Two months later that cancer is gone, and the pain is gone.”

These type of examples are why Movsas says the MRIdian offers patients personalized treatment. Doctors are able to assess tumors and internal organs and deliver the dose to match each patient individually.

So far, Henry Ford has treated more than 50 patients, including those with cancers of the prostate, pancreas, liver, abdominal nodes and partial breast.

“It is very exciting for partial breast treatments,” he said. “For lumpectomy cavity, you take out the lump and you are treating the residual cells. You had to visual it on CT, but using the MRI it shows you like a light bulb.”

Movsas said the typical treatment regimen takes three to four weeks. Using MRIdian, he said patients can have 10 treatments in five days, one in the morning and one in the afternoon, and the partial breast treatment is done in a week.

“We can have better targeting and outcomes because you can get the full dose to tumor. That is the main benefit,” he said. “It is my belief this will lead to better outcomes.”

Movsas said the MRIdian linear accelerator is very cost effective and offers a variety of treatments. He said it is covered by health insurance and not more expensive than traditional radiation oncology treatments.

“When you think about other options, proton beam, at $40 million for a single room (for proton beam therapy), this offers something very cost effective and extremely good,” he said.

Beaumont, McLaren invest in proton beam therapy

This past July, Beaumont Hospital in Royal Oak opened Michigan’s first proton therapy cancer center. The Beaumont Proton Therapy Center is one of only 25 active proton beam centers in the U.S.

Competition for proton beam therapy to precisely target cancer cells and avoid healthy organs and tissues goes back to 2008 in Michigan.

Multiple hospitals competed for the title of first to build. They included Beaumont, McLaren Health Care Corp., Henry Ford Health System, St. John Providence Health System and the University of Michigan.

Movsas said each type of radiation therapy has its differences and advantages. He said proton therapy has been shown to work effectively with pediatric patients.

“Henry Ford does not focus on pediatric oncology and we won’t unless something changes,” he said. “We treat adult patients.”

Henry Ford doctors send most of their pediatric patients to DMC Children’s Hospital of Michigan, where Wayne State University and private oncologists treat children.

Now that Henry Ford has decided to move ahead with Michigan’s second linear accelerator, MRIdian, what has McLaren done with the proton beam center it built in 2015 for $50 million?

After two years, McLaren’s three-room “synchrotron” proton beam therapy center in Flint is still in the testing phase, said Greg Lane, its executive vice president. He said a start date still hasn’t been determined.

“We continue to work through a couple of technical issues in our goal to begin treating certain types of cancer at our proton center in Flint,” Lane said in an email to Crain’s.

“While these issues are relatively small in terms of scale of the project itself, they nonetheless must be addressed to the satisfaction of our physicists and physicians prior to treating any patients. Providing safe, clinically-effective care is our number one priority. We will be treating patients in the near term.”

Similar to the MRIdian, McLaren’s Radiance 330 synchrotron, which was made in Russia, uses an imaging system to provide real-time treatment planning. Using a CT instead of an MRI, however, physicians can visualize and control the location of the proton beam during active treatment sessions.

Next steps

Movsas said Henry Ford will need a second MRIdian in a few years because demand will increase. Plans call for Henry Ford to install a second MRIdian in 2020 at its Brigitte Harris Cancer Pavilion, which is under construction, at the Henry Ford Cancer Institute in downtown Detroit in Midtown.

“Our program is growing. We got a call from a patient in Atlanta and expect to treat patients from all over the country,” he said. “We will need a second one in a few years because the more we use it the more we realize the potential.”

Original Source: http://www.crainsdetroit.com/article/20171220/news/648236/henry-ford-offers-cutting-edge-mri-guided-radiation-cancer-therapy

Original Author: Jay Greene

Original Date: Dec 20 2017

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