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Pioneering Innovative Radiation Oncology Technology in Clinics

Teh, B.S., and Ortiz, P., and Paulino, A.C., and Bloch, C., and Grant, W.H., and Butler, E.B., (2007) Pioneering Innovative Radiation Oncology Technology in Clinics. Biomedical Imaging and Intervention Journal, 3 (3).

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Official URL: http://www.biij.org/2007/3/e57/e57.pdf

Affiliations

Baylor College of Medicine, Tezas, USA, Dept. of Radiology/Radiation Oncology
Methodist Hospital, Houston, Texas, USA, Dept. of Radiation Oncology
Methodist Hospital Research Institute, Houston, Texas, USA

Abstract

Pioneering and implementing new technology successfully in a radiation oncology clinic requires hard work, team effort and management support. Over the last 15 years, we have pioneered the clinical implementation of intensitymodulated radiation therapy (IMRT) as well as combined radio-gene-therapy in the treatment of cancer. The entire department including physicists, dosimetrists, therapists, nurses, managers, data managers, radiation oncologists and residents in training, other medical specialists e.g. neurosurgeons, urologists, pathologists, radiologists, molecular biologists and many others have joined forces and contributed to the success. IMRT has transitioned from an initial experimental approach to a standard of care approach now in various disease sites. We are entering a new era of imageguided radiation therapy (IGRT) and molecular-targeted therapy and we continue to strive to implement these new technologies in the clinics. Frameless stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) have now become a clinical reality. Again, all these require a tremendous amount of efficient management and cooperation among all departmental staff. Five fundamental principles which can help the successful pioneering and implementation of innovative radiation oncology approaches will be discussed. These include identifying a project champion(s), pursuing a multi-disciplinary approach, showing clinical efficacy and return on investment (ROI), ability to articulate the project and celebrating the successful implementation.

Item Type:Journal
Keywords:Pioneering, innovative, technology, radiation oncology, intensity modulated radiation therapy (IMRT)
Subjects:R Medicine, Dentistry, Pharmacy, Nursing
ID Code:4901

1. Teh BS, Woo SY, Butler EB. Intensity modulated radiation therapy (IMRT): a new promising technology in radiation oncology. Oncologist 1999; 4(6):433-42.

2. Teh BS, Paulino AC, Lu HH et al. Versatility of the Novalis system to deliver image-guided stereotactic body radiation therapy (SBRT) for various anatomical sites. Technol Cancer Res Treat 2007; 6(4):347-54.

3. Teh BS. Image-guided stereotactic body radiation therapy (SBRT): an emerging treatment paradigm with a new promise in radiation oncology. Biomed Imaging Interv J 2007; 3(1):e5.

4. Teh, B.S., Bloch, C., Galli-Guevara, M. et al. The treatment of primary and metastatic renal cell carcinoma (RCC) with image-guided stereotactic body radiation therapy (SBRT). Biomedical Imaging and Intervention Journal 2007; 3(1):e6.

5. Bonner JA, Harari PM, Giralt J et al. Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. N Engl J Med 2006; 354(6):567-78.

6. Woo SY, Grant W 3rd, McGary JE et al. The evolution of quality assurance for intensity- modulated radiation therapy (IMRT): sequential tomotherapy. Int J Radiat Oncol Biol Phys 2003; 56(1):274-86.

7. Amosson CM, Teh BS, Mai WY et al. Using technology to decrease xerostomia for head and neck cancer patients treated with radiation therapy. Semin Oncol 2002; 29(6 Suppl 19):71-9.

8. Amosson CM, Teh BS, Van TJ et al. Dosimetric predictors of xerostomia for head-and-neck cancer patients treated with the smart (simultaneous modulated accelerated radiation therapy) boost technique. Int J Radiat Oncol Biol Phys 2003; 56(1):136-44.

9. Teh BS, Amosson CM, Mai WY et al. Intensity modulated radiation therapy (IMRT) in the management of prostate cancer. Cancer Invest 2004; 22(6):913-24.

10. Teh BS, Mai WY, Uhl BM et al. Intensity-modulated radiation therapy (IMRT) for prostate cancer with the use of a rectal balloon for prostate immobilization: acute toxicity and dose-volume analysis. Int J Radiat Oncol Biol Phys 2001; 49(3):705-12.

11. Teh BS, Dong L, McGary JE et al. Rectal wall sparing by dosimetric effect of rectal balloon used during intensity-modulated radiation therapy (IMRT) for prostate cancer. Med Dosim 2005; 30(1):25-30.

12. Teh BS, Woo SY, Mai WY et al. Clinical experience with intensity-modulated radiation therapy (IMRT) for prostate cancer with the use of rectal balloon for prostate immobilization. Med Dosim 2002; 27(2):105-13.

13. Bastasch MD, Teh BS, Mai WY et al. Tolerance of endorectal balloon in 396 patients treated with intensity modulated radiation therapy (IMRT) for prostate cancer. Am J Clin Oncol 2006; 29(1):8-11.

14. Huang E, Teh BS, Strother DR et al. Intensity-modulated radiation therapy for pediatric medulloblastoma: early report on the reduction of ototoxicity. Int J Radiat Oncol Biol Phys 2002; 52(3):599-605.

15. Paulino AC, Skwarchuk M. Intensity-modulated radiation therapy in the treatment of children. Med Dosim 2002; 27(2):115-20.

16. Teh BS, Mai WY, Grant WH 3rd et al. Intensity modulated radiotherapy (IMRT) decreases treatment-related morbidity and potentially enhances tumor control. Cancer Invest 2002; 20(4):437-51.

17. Butler EB, Teh BS, Grant WH 3rd et al. Smart (simultaneous modulated accelerated radiation therapy) boost: a new accelerated fractionation schedule for the treatment of head and neck cancer with intensity modulated radiotherapy. Int J Radiat Oncol Biol Phys 1999; 45(1):21-32.

18. Lu TX, Mai WY, Teh BS et al. Initial experience using intensitymodulated radiotherapy for recurrent nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 2004; 58(3):682-7.

19. Teh BS, Paulino AC, Butler EB. Reirradiation in the era of IMRT: a dream or reality? Am J Clin Oncol 2005; 28(5):472-3.

20. Teh BS, Aguilar-Cordova E, Vlachaki MT et al. Combining radiotherapy with gene therapy (from the bench to the bedside): a novel treatment strategy for prostate cancer. Oncologist 2002; 7(5):458-66.

21. Teh BS, Ayala G, Aguilar L et al. Phase I-II trial evaluating combined intensity-modulated radiotherapy and in situ gene therapy with or without hormonal therapy in treatment of prostate cancer-interim report on PSA response and biopsy data. Int J Radiat Oncol Biol Phys 2004; 58(5):1520-9.

22. Tetzlaff MT, Teh BS, Timme TL et al. Expanding the therapeutic index of radiation therapy by combining in situ gene therapy in the treatment of prostate cancer. Technol Cancer Res Treat 2006; 5(1):23-36.

23. Teh BS, Aguilar-Cordova E, Kernen K et al. Phase I/II trial evaluating combined radiotherapy and in situ gene therapy with or without hormonal therapy in the treatment of prostate cancer—a preliminary report. Int J Radiat Oncol Biol Phys 2001; 51(3):605-13.

24. Chhikara M, Huang H, Vlachaki MT et al. Enhanced therapeutic effect of HSV-tk+GCV gene therapy and ionizing radiation for prostate cancer. Mol Ther 2001; 3(4):536-42.

25. Fujita T, Timme TL, Tabata K et al. Cooperative effects of adenoviral vector-mediated interleukin 12 gene therapy with radiotherapy in a preclinical model of metastatic prostate cancer. Gene Ther 2007; 14(3):227-36.

26. Satoh T, Teh BS, Timme TL et al. Enhanced systemic T-cell activation after in situ gene therapy with radiotherapy in prostate cancer patients. Int J Radiat Oncol Biol Phys 2004; 59(2):562-71.

27. Fujita T, Teh BS, Timme TL et al. Sustained long-term immune responses after in situ gene therapy combined with radiotherapy and hormonal therapy in prostate cancer patients. Int J Radiat Oncol Biol Phys 2006; 65(1):84-90.

28. Teh BS, Bloch C, Paulino AC et al. Pathologic complete response in renal cell carcinoma brain metastases treated with stereotactic radiosurgery. Clin Genitourin Cancer 2007; 5(5):334-7.

29. Potters L, Steinberg M, Rose C et al. American Society for Therapeutic Radiology and Oncology and American College of Radiology practice guideline for the performance of stereotactic body radiation therapy. Int J Radiat Oncol Biol Phys 2004; 60(4):1026-32.

30. Koshy M, Paulino AC, Howell R et al. F-18 FDG PET-CT fusion in radiotherapy treatment planning for head and neck cancer. Head Neck 2005; 27(6):494-502.

31. Paulino AC, Thorstad WL, Fox T. Role of fusion in radiotherapy treatment planning. Semin Nucl Med 2003; 33(3):238-43.

32. Gregoire V, Daisne JF, Geets X. Comparison of CT- and FDGPET- defined GT: in regard to Paulino et al. (Int J Radiat Oncol Biol Phys 2005;61:1385-1392). Int J Radiat Oncol Biol Phys 2005; 63:308-9; author reply 309.

33. Rusthoven KE, Koshy M, Paulino AC. The role of PET-CT fusion in head and neck cancer. Oncology (Williston Park) 2005; 19(2):241-6; dicussion 246, 249-50, 253.

34. Paulino AC, Johnstone PA. FDG-PET in radiotherapy treatment planning: Pandora's box? Int J Radiat Oncol Biol Phys 2004; 59(1):4-5.

35. Paulino AC, Teh BS. PET CT in radiotherapy treatment planning. Elsevier, 2008.

36. Butler EB, Shukla V, Paulino AC et al. Computer visualization techniques (CVTs) foster evidence-based target delineation. Cancer Invest 2007; 25(1):1-5.

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