Redefining Adaptive Radiotherapy And The Future of Cancer Treatment?

Redefining Adaptive Radiotherapy And The Future of Cancer Treatment?

By Yves Archambault, strategic initiative director, Varian.

It’s hard to imagine what it can be like to go through cancer treatment, even when being treated with the latest adaptive therapy technology. You walk into the clinic, lay perfectly still inside a long, narrow tunnel-like machine…for about 45 minutes or so, as your clinician uses an MR-linac system to visualize and treat the target area. Uncomfortable? Yes. Slow and resource-intensive? Definitely. Expensive? Certainly. This is adaptive therapy today.

Despite its barriers to entry,
adaptive therapy is often dubbed as the “holy
grail” of radiation therapy as long-term
clinical adaptive therapy follow-up has shown significant improvement in terms
of tumor control and low toxicity profile cancers below the respiratory system
including prostate cancer. Additionally adaptive therapy has
proven to offer dosimetric benefits, especially with head and neck cancers and cancers below the
respiratory system.

Not all
Cancer Cells Are Created Equal

Adaptive
therapy is
a type of radiation cancer treatment that evolves over
time in response to the temporal and spatial variability of tumor
microenvironment and cellular phenotype. It accounts for
macro fluctuations in the tumor’s shape and position due to changes
in nearby organs. Adaptive therapy also considers physiological changes, like
bladder fluctuations. With adaptive therapy,
a clinician regularly adapts his or her treatment approach based
on how the patient responds or changes throughout
the treatment process, adjusting it to better target the cancer. It
takes daily variabilities into account. Unlike adaptive therapy, standard treatment follows
a strictly detailed, rigid plan that is set in place at the beginning and tracks
a pre-defined schedule, not accounting for unpredictable anatomy changes.
                           

Adaptive therapy creates a personalized
treatment strategy guided by the individual patient’s experience. Updated
details about the patient’s internal anatomy and treatment response are constantly
being evaluated and are used to adjust the course of treatment. In adaptive
therapy’s current state, the slow process, significant capital equipment, hours
of training, and need for extensive involvement from a highly skilled clinician
makes it unattainable for many.

Limitations
Should Not be Ever-Limiting

The reality is, as healthcare advances,
we must adapt. Whether it’s the way clinicians interact with
patients, how we’re tracking prescriptions, or new
innovations that incorporate automation, industry is challenged to
evolve and grow alongside such advances.

This begs
the questions, “What does the future of adaptive therapy look like? Is there
reason to hope it will evolve and dismiss its current
patient and doctor limitations?” 

In cancer care, the future is now. It is time to
remove these barriers and redefine adaptive therapy, so the experience becomes more accessible, comfortable, and executed
with more efficacy for both patients and clinicians. An
intelligent, accessible adaptive therapy approach has
the potential to improve patient outcomes that can result in a longer
disease-free life expectancy for patients. Additionally, it may
help open the door for more opportunities, research and advancements in
cancer treatment.

We
would be remiss not to acknowledge the fact that it will take time to overcome
these limitations, drive clinical adoption and see results. This present
reality, however, should not keep us from building its future today. 

Nobody Said Change Was
Easy
 

As with any change or clinical evolution, there
are roadblocks to adoption. Clinics may choose to
remain conservative when it comes to new treatment methods
and hold out until additional statistically-significant data surface.
Additionally, the time, resources and training needed to implement new, or
unknown, technologies can hinder initial adoption. 

Policies
around payment and reimbursement will also likely be an obstacle for
the clinical community. There are protocols, processes, and standards
that clinics must follow when implementing treatment adjustments and
changes. The frequent changes made during
adaptive therapy require authorization from a radiation oncologist,
which can be time-consuming, tedious, and costly. But every
patient is unique, and it has been proven that one size does not fit all when
it comes to cancer treatments.

The Adaptive Complexity of Cancer Requires
Intelligent Advancement

We expect the
challenges to be worthwhile, as the future of adaptive therapy has the
potential to offer patients a better experience overall—faster, more
comfortable, and more accessible treatment. Additionally, faster
treatment will open the door to hopefully allow clinicians to treat more
patients each day. The AI and automation that the future of adaptive therapy
will incorporate may also empower clinicians to do more in less
time. Finally, as the future of adaptive therapy may be
more affordable, clinicians across the globe would be able to leverage the
technology in order to deliver better patient experiences. 

It’s a continuous
process and we’re hopeful of advancements as we continue to build and improve
on what was done before. It is amazing to see how far adaptive therapy has come
in even the last two years. The future of adaptive therapy will offer a
personalized, long-term treatment strategy that can offer better experiences to
clinics large and small, and most importantly, to patients of every kind.


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