The National Cancer Institute has awarded a five-year, $10.7 million grant to Virginia Commonwealth University Massey Cancer Center researchers to develop a new form of radiation therapy that will enable the safe administration of more aggressive cancer treatments.
The NCI’s Project Program Grant, titled “Image Guided Adaptive Radiation Therapy,” or IGART, was awarded to Jeffrey F. Williamson, Ph.D., professor of radiation oncology and chair of that department’s division of medical physics. The methods in development are based on sophisticated mathematical models that allow higher doses of radiation to kill cancer cells while sparing the surrounding normal cells from damage.
“This project grant is a testament to the high impact of the ideas generated by researchers at VCU, and to the national leadership of the VCU Massey Cancer Center and its radiation biology and oncology program,” said VCU President Eugene P. Trani, Ph.D.
“In an era of decreased federal cancer research grants, securing such large-scale funding is an extraordinary achievement by Dr. Williamson and his colleagues,” added Jerome Strauss, M.D., dean of the VCU School of Medicine.Williamson and colleagues also will collaborate with investigators from Stanford University, the M.D. Anderson Cancer Center at the University of Texas, the University of Iowa and the Netherlands Cancer Institute.
The Project
The project will enhance the safety and effectiveness of current treatments by incorporating quantitative and predictive image analysis into treatment planning.
“Anyone can acquire treatment technology, but knowing how to maximize its potential by layering on advances in imaging science, biostatistics and biology is what will really improve cancer outcomes in patients,” said Williamson. As radiation treatments are administered, a tumor’s shape and size changes. Lung tumors, in particular, change shape and position during treatment due to the patient’s breathing. Radiation is often given daily over a period of days or weeks, and the ability to adapt the treatment to a tumor’s movement during the course of treatment can have a significant effect on the patient’s outcome.
“Human anatomy is dynamic and constantly changing, and organs shift and deform differently during each daily treatment,” explained Williamson. “We know that tumors have day-to-day motions, daily motions, and second-by-second motions. By acquiring data on these motions and developing 4-D models and predictions, we will be better-able to predict where a tumor will be a second from now rather than where it was a second ago as we deliver radiation.”
One of the technologies being adopted for the project functions much like a Global Positioning System and will be implanted in tumors to provide real-time feedback to scientists. The information on tumor movement will be updated 10 times per second.
Clinical Studies
In about six months, researchers will begin accruing patients with lung, cervical or prostate cancer to participate in the IGART project. They expect to enroll about 25 patients from each cancer type for the first two years of study.Using state-of-the-art technologies that provide images to guide the delivery of radiation doses, researchers first will carefully examine the movement of tumors and then employ adaptation techniques based on the unique characteristics of those tumors.
“By updating the 4-D anatomy as patients are treated, we can adapt or modify the treatment daily, or, if necessary, on a second-to-second basis to accommodate anatomical and biological changes,” Williamson said.
Patients involved in clinical studies receive a high level of care and communication from their treatment team, and are assured of receiving the current standard plus the new, potentially better, components being applied to their treatment.
Massey’s radiation oncology program is the largest in Virginia, with 106 faculty and staff. Its chairman, Mitchell Anscher, M.D., is a nationally recognized expert in radiation treatment for prostate cancer.
Massey’s treatment facilities and capabilities include:
Trilogy combined with ExacTrac, a first-in-the-world combination of the most advanced image guidance and X-ray positioning that accounts for patients’ breathing movements on the treatment couch.
Brachytherapy Suites with advanced imaging-science computational techniques. Brachytherapy involves seed implants to deliver radiation over time.
Cone-beam x-ray computed tomography imaging (CBCT)
Deformable image registration (DIR)
Biological imaging for target delineation
4-D intensity modulated radiotherapy (IMRT) treatment delivery
Probablistic IMRT optimization
NCI Project Program Grants: Few and Far Between
About a dozen leading institutions in the United States hold NCI Project Program Grants for radiation oncology. Of these, only VCU’s Massey Cancer Center and Massachusetts General Hospital have grants in both biology and physics within their radiation oncology programs. These grants tend to lead to proof-of-concepts and new standards of treatment for cancer treatment nationwide.
The other radiation oncology NCI Project Program Grant at Massey is titled “Genetic Modulation of Cellular Radiation Response,” which is now in its eighth year under the leadership of Kristoffer Valerie, Ph.D. The IGART project will involve the contributions of dozens of researchers at VCU. In addition to Williamson, principal investigators include radiation oncology faculty members Jeffrey Siebers, Ph.D.; Martin Murphy, Ph.D.; Nesrin Dogan, Ph.D.; and Paul Keall, Ph.D., an adjunct professor at VCU who is also director of radiation oncology physics at Stanford University.