Breast IMRT Cancer Treatment with TomoHelical^™

Targeting complex tumors with unmatched precision and homogeneity

TomoHelical^™ IMRT cancer treatment is Accuray’s flagship helical delivery mode available for the Radixact^® and TomoTherapy^®Systems that sets the gold standard for the treatment of complex breast tumors.

TomoHelical^™ IMRT cancer treatment delivery mode expands Radixact’s treatment like no other system in the world

Image guided, intensity modulated radiation therapy (IG-IMRT), featuring best-in-class clinical workflows and highly conformal and homogenous treatments enabled by a unique ultra-fast multi-leaf collimator (MLC).

Highly conformal dose sculpting over long treatment fields

TomoHelical combines continuous gantry rotation, continuous couch motion, and ultra-fast multi-leaf collimator (MLC). This technology delivers intensity-modulated radiotherapy (IMRT) over extended treatment fields. The unique binary MLC—with the fastest leaf speed in the industry—produces more modulation compare to other IMRT delivery techniques. Bortfeld and Webb have demonstrated that TomoHelical delivery offers superior dose sculpting capability compared to other IMRT delivery techniques (static and rotational), enabling highly conformal and homogeneous dose distribution.¹ The advantages of TomoHelical delivery have also been shown in plan comparisons for many clinical indications.^2-12

Simplicity & speed

Longest treatment fields in the industry: Eliminates multiple isocenters and field junctions that are time-consuming to plan and deliver and can lead to hot and cold spots.
Simultaneous irradiation of multiple target volumes.
3DCRT and IMRT modes: Same straightforward treatment planning process for routine and complex cases.

Outstanding precision & dose fall-off

360-degree treatment delivery provides highly conformal, uniform dose distribution while minimizing dose to surrounding normal structures.
TomoEDGE^™ Dynamic Jaws dynamically conform to the target in the craniocaudal direction, producing sharp dose fall-off for precise sparing of normal tissue and increased throughput.
Fastest leaf speed in the industry produces more modulation compared to other IMRT delivery techniques.

An ideal clinical solution for routine and complex breast cancer treatments

The Radixact and TomoTherapy Systems offer TomoHelical^™ delivery, providing the flexibility to treat a spectrum of cancer cases from a single platform.

Tailoring Radiotherapy to Breast Cancer:

The Role of the TomoTherapy^® System

Professor Roberto Orecchia
Scientific Director of the European, Institute of Oncology, Milan, Italy

TomoEDGE^™ Dynamic Jaws

Total scheduled procedure time averages 10-15 minutes^* with TomoEDGE dynamic jaws

*Includes set-up, full 3D imaging and average beam-on time of 4.5 minutes. Total procedure times are approximate and based on internal Accuray test data. Times may vary with various clinical situations.

“Advantages include better conformity of treatment with lowering of dosages to underlying organs at risk, for example ipsilateral lung and heart. There is improved coverage of the planning target volume, including regional nodes, without field junction problems.”

Early experience of tomotherapy-based intensity-modulated radiotherapy for breast cancer treatment.
Clin Oncol (R Coll Radiol). 2009 May; 21(4):294-301.
O’Donnell H, Cooke K, Walsh N, Plowman PN.

Clinical Examples

Chest Wall Sarcoma

Treatment mode: TomoHelical IMRT
Rx: 54Gy/27Fx
Delivery time: 3:37 min:sec

Breast with concurrent boost

Treatment mode: TomoHelical IMRT
Rx: 50.40 Gy / 28 Fx + 60 Gy concurrent boost to the lumpectomy cavity
Delivery time: 4:28 min:sec

Radixact & TomoTherapy for Breast

Explore the Radixact and TomoTherapy systems.

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References:

1. Bortfeld T and Webb S. “Single-Arc IMRT?” Phys. Med. Biol. 2009; 54: N9-N20 – https://doi.org/10.1088/0031-9155/54/1/N02

H&N:

2. Van Gestel D. et al. “Fast Helical Tomotherapy in a head and neck cancer planning study: is time priceless?” Radiation Oncology. 2015; 10: 261 – https://doi.org/10.1186/s13014-015-0556-8

3. Van Gestel D. et al. “RapidArc, SmartArc, and TomoDH compared with classical step and shoot and sliding window intensity modulated radiotherapy in oropharyngeal cancer treatment plan comparison.” Radiation Oncology. 2013; 8:37 – https://doi.org/10.1186/1748-717X-8-37

4. Vernat S.S. et al. “Intensity Modulated Arc Therapy in Bilaterally Irradiated Head and Neck Cancer: A Comparative and Prospective Multicenter Planning Study.” Cancer Invest. 2014; 32(5): 159-167

5. Chen A.M. et al. “Intensity-modulated radiotherapy for nasopharyngeal carcinoma: improvement of the therapeutic ratio with helical tomotherapy vs segmental multileaf collimator-based techniques.” The British Journal of Radiology. 2012; 85: e537-543 – https://doi.org/10.1259/bjr/23807619

6. Broggi S. et al. “Static and rotational intensity modulated techniques for head-neck cancer radiotherapy: a planning comparison.” Phys Med. 2014; 30(8): 973-979

Breast:

7. Nagai A. et al. “Intensity-modulated radiotherapy using two static ports of TomoTherapy for breast cancer after conservative surgery: dosimetric comparison with other treatment methods and 3-year clinical results.” Journal of Radiation Research. 2017; Feb 23: 1-8 – https://doi.org/10.1093/jrr/rrw132

8. Han E.Y. et al. “Estimation of the risk of secondary malignancy arising from whole-breast irradiation: comparison of five radiotherapy modalities, including TomoHDA” Oncotarget. 2016; 7(16): 22960-9 – https://doi.org/10.18632/oncotarget.8392

9. Michalski A. et al. “A dosimetric comparison of 3D-CRT, IMRT, and static TomoTherapy with an SIB for large and small breast volumes.” Medical Dosimetry. 2014; 39: 163-168

CSI:

10. Sugie C. et al. “Craniospinal irradiation using helical TomoTherapy: evaluation of acute toxicity and dose distribution.” Technol Cancer Res Treat. 2011; 10: 187-195 – https://doi.org/10.7785/tcrt.2012.500194

Brain:

11. Levegrun S. et al. “Helical TomoTherapy for whole-brain irradiation with integrated boost to multiple brain metastases: evaluation of dose distribution characteristics and comparison with alternative techniques.” International Journal of Radiation Oncology Biology Physics. 2013; 86: 734-742

Lung:

12. Chi A. et al. “Critical structure sparing in stereotactic ablative radiotherapy for central lung lesions: helical tomotherapy vs. volumetric modulated arc therapy.” PloS one. 2013; 8(4): e59729 – https://doi.org/10.1371/journal.pone.0059729