The newly renovated Department of Radiation Oncology at the White Plains Hospital Center for Cancer Care couples exceptionally precise treatments with an intensely patient-centric model of care.
In recent years, as software, image guidance and radiation delivery technology have grown more sophisticated, radiation oncology has entered a golden age in which the arc of progress bends toward enhanced outcomes and significantly reduced side effects. For many of the approximately 50 percent of oncology patients who require radiation therapy as part of their treatment, radiation oncologists can treat areas as minute as a millimeter with less damage to healthy tissue in much shorter amounts of time. Sometimes as little as one treatment session is needed, according to Randy Stevens, MD, Director of the Department of Radiation Oncology at the White Plains Hospital Center for Cancer Care.
“The advances that have transformed radiation oncology allow us to treat cancer with greater precision, fewer side effects, and higher control and cure rates,” Dr. Stevens says. “Because we can be more precise, we’re able to administer higher doses with each treatment, which allows us to prescribe fewer total treatments. That wouldn’t be possible without the precision we can now offer in radiation oncology, especially using radiosurgery.”
Radiosurgery — bladeless, incisionless irradiation of tumors with pinpoint accuracy — was a key driver behind the Department of Radiation Oncology’s recent yearlong renovation, which was completed in June. The department now features a refurbished reception and waiting area, five consultation rooms, a beautiful gowned waiting area, a state-of-the-art 4-D, wide-bore CT simulator, and two state-of-the-art linear accelerators — one of which, the Edge Radiosurgery System by Varian, is used to perform stereotactic radiosurgery (SRS) and stereotactic body radiotherapy (SBRT). It is the first of its kind in Westchester and the surrounding counties. Shalom Kalnicki, MD, Chair of the Department of Radiation Oncology at Montefiore Medical Center and a member of the White Plains Hospital Cancer Program Executive Council, collaborated with the team to select the technology as the perfect fit for the program.
Jeffrey Vainshtein, MD, Medical Director of the Center for Radiosurgery, and Randy Stevens, MD, Director of the Department of Radiation Oncology at the White Plains Hospital Center for Cancer Care, discuss a patient’s course of treatment in the newly renovated Department of Radiation Oncology.
Advanced, Comprehensive Capabilities
The Edge is the centerpiece of the cancer center’s new Center for Radiosurgery, a multidisciplinary collaboration between radiation oncologists and subspecialty experts.
“The Center for Radiosurgery allows us to unify the processes involved in the delivery of radiosurgery by bringing surgical specialists in a variety of cancer disease sites, including the brain, spine, lungs, liver, pancreas and prostate, under the same roof as our radiation oncologists to develop individualized treatment plans for our patients,” says Jeffrey Vainshtein, MD, Medical Director of the Center for Radiosurgery. “Compared with patients who undergo more conventional radiotherapy techniques or invasive surgery, patients who have radiosurgery do not require hospitalization and experience minimal effects to surrounding tissues and organs.”
A hallmark of the Edge is its versatility. It can target lesions ranging from 1-millimeter brain tumors using SRS, a type of radiosurgery often reserved for small, localized cancers, especially in the brain, to large tumors affecting a variety of organs using SBRT, which is typically used to treat extracranial tumors.
The Varian Edge Radiosurgery System targets cancer with pinpoint accuracy, in as little as one treatment, with less harm to surrounding tissue.
Treatment with the Edge begins with an outpatient consultation between the patient and radiation oncologist, followed by a CT simulation to plan the treatment.
“After the simulation, the radiation oncologist works with a team of dosimetrists and physicists to design a treatment plan that offers the best chance of tumor eradication,” Dr. Vainshtein says. “The patient returns to the Center for Radiosurgery for a ‘dry run’ and has the actual treatment the following day. Each treatment takes 15 to 20 minutes. The Edge rotates around the patient, delivering high-energy X-rays directly to the site of the tumor from a variety of angles. From the patient’s perspective, the experience is basically no different from a typical CT scan.”
Radiosurgery with the Edge also offers a level of convenience unknown to prior generations of radiation oncology patients. Previously, elderly individuals with early-stage lung cancer and comorbid conditions who were not candidates for surgery faced up to nine weeks of five-times-per-week external beam radiation therapy, according to Dr. Vainshtein.
“With radiosurgery, we’re able to treat these patients — for example, those with early-stage lung cancer who aren’t able to undergo surgery, are borderline surgical candidates or decline surgery — in three to five treatments with minimal side effects and tumor ablation rates exceeding 90 percent,” Dr. Vainshtein says. “For this population, the advent of SBRT has markedly transformed the way we manage early-stage lung cancer.”
A Treatment for Every Tumor
The Edge was the second of two new linear accelerators to arrive at the Center for Cancer Care in the past year — the first was the TrueBeam Radiotherapy System by Varian. Like the Edge, the TrueBeam is multifunctional — it can perform image-guided radiotherapy and intensity-modulated radiotherapy as well as SBRT. At the Center for Cancer Care, radiation oncologists typically use the Edge to deliver stereotactic treatments and utilize the TrueBeam for non-stereotactic radiotherapy.
Dr. Stevens is Chair of the White Plains Hospital Institutional Review Board for clinical research and a surveyor for the National Accreditation Program for Breast Centers.
“Examples of tumors we treat using the TrueBeam include lung, head and neck, and breast tumors that require larger areas of radiation therapy, as well as colorectal, bladder and advanced prostate tumors,” Dr. Stevens says. “Uterine and cervical cancers are best treated using the TrueBeam, as well.”
The brevity of treatment courses that radiosurgery and other advanced radiotherapy techniques have made possible is striking.
“Radiotherapy courses are shorter now — many are five sessions or fewer, with some as few as one — and that has really changed the face of our department,” Dr. Stevens says. “We used to have patients come for radiotherapy for six weeks, on average. Individuals with prostate cancer typically needed nine weeks of treatment, for example, and women with breast cancer needed six. Now, these patients can finish their treatments in a week, and with the same or sometimes better cure rates than six- or nine-week courses.”
Dr. Vainshtein collaborates with subspecialty experts to develop individualized treatment plans for patients.
The Department of Radiation Oncology also provides brachytherapy — the placement of small radiation sources in or near a tumor to treat gynecologic, breast and some prostate cancers — and electron therapy. These capabilities, in addition to the Edge and the TrueBeam, make the department a comprehensive destination for radiotherapy. It is also part of a one-stop center for oncology services.
“In terms of radiotherapy, we can treat every type of tumor in the most sophisticated fashion and with the multidisciplinary approach that cancer demands,” Dr. Stevens says. “Our infusion center, medical oncologists, surgical oncologists and radiation oncologists are located in the same building. Patients park once, and then they can go from one appointment to another with ease.”
Integration and Personalization
The future of the Department of Radiation Oncology will mirror ongoing progress in this dynamic field, according to Drs. Vainshtein and Stevens.
The Hospital’s Center for Cancer Care employs advanced technology, including the Varian Edge and the Varian TrueBeam Radiotherapy System, to treat larger tumors (left) with general radiation therapy and the smallest of cancers (right) requiring stereotactic radiosurgery.
“As we improve the delivery of radiotherapy, the quality and sophistication of our diagnostic imaging, and our systemic treatments for cancer, we will see a continually increasing role for radiosurgery,” Dr. Vainshtein says. “For cancer recurrence or new lesions, radiosurgery technology allows us the ability to pick off small tumors that may not be sensitive to systemic therapy, rather than being limited to treating them with surgical interventions.”
“We’re treating patients with as sophisticated techniques as they could find at tertiary-care academic medical centers and major-city centers. It’s wonderful for patients to get that level of care in their backyard.”
— Randy Stevens, MD, Director of the Department of Radiation Oncology at the White Plains Hospital Center for Cancer Care
Dr. Stevens sees an important role for radiation oncology in the burgeoning field of personalized medicine.
“As we develop more and more personalized medicine techniques and begin to explore the specific genomics of patients’ tumors, we will be personalizing not just their medical oncology, but also their radiation oncology,” she says. “Who needs treatment? Who needs more versus less treatment? Who can forgo radiotherapy without compromising cure rate? Those are questions we will be able to answer. That’s going to be extremely exciting.”
For more information about the Department of Radiation Oncology at the White Plains Hospital Center for Cancer Care, visit wphospital.org/edge.