For decades, cervical cancer—a cancer that women ages 35 to 44 get much more frequently than other cancers—has been treated with Intensity Modulated Radiation Therapy (IMRT). While IMRT has a long history as a safe and effective therapy specifically designed to minimize radiation to healthy tissues, there are practical limits to its ability because of the potential to lead to debilitating and long-lasting side effects during and after treatment, including toxicity to the bowels and gastrointestinal system
Jeremy Price, MD, a radiation oncologist in the Fox Chase Cancer Center Department of Radiation Oncology, wants to change this scenario, and is leading the ARTIA-Cervix trial at Fox Chase using adaptive radiation therapy (ART)—an advanced form of radiation that more accurately focuses radiation on the tumor and can limit symptoms because it avoids irradiating normal tissue.
Unlike IMRT therapy, where a one-time-only planning session occurs at beginning of therapy to guide the entire course of treatment. “ART technology allows us to disrupt this one-and-done method by allowing physicians to adapt and re-plan a patient’s treatment every single day of therapy using the FDA-approved technology of the ETHOS linear accelerator, and a CT-based adaptive or MRI-based adaptive software,” says Dr. Price.
At the start of every therapy day, in real-time, the radiation oncologist takes new scans of the treatment area, and compares these newest images to the pre-treatment plan. “Very often there is a significant difference because the tumor, as well as normal tissues and organs, have shifted due to the treatment. This everyday re-revaluation gives us flexibility to recalibrate the treatment plan ‘on the fly’ for that treatment day – and ensures that the patient is getting the most accurate and precise treatment possible. In a 25-day course of treatment that can make a big difference,” says Price.
“With the ARTIA trial, we hope to forge a real breakthrough into relieving the symptoms associated with radiation therapy for patients with cervical cancer,” explains Dr. Price. The study is the first prospective trial in this country designed to demonstrate that adaptive radiotherapy for locally advanced cervical cancer will translate into a decreased rate of acute gastrointestinal toxicity compared with the historically reported rate for non-adaptive intensity modulated radiation therapy (IMRT). The goal: to help patients avoid the occurrence of severe diarrhea, or bladder problems such as polyuria or dysuria which prescription medicines are unable to control.
Well before its inception as an FDA-approved technology, the Fox Chase Radiation Oncology team led by Eric Horwitz, MD, FABS, FASTRO, Chair of the Department of Radiation Oncology at Fox Chase and the Lewis Katz School of Medicine at Temple University, took years to develop the resources, clinical knowledge, and infrastructure to bring adaptive radiation therapy to patients. It was a huge learning curve, but the Department of Radiation Oncology was dedicated to it, boldly moving it into the mainstream.
Fox Chase was first in the US to offer a prostate cancer clinical trial using adaptive technology. demonstrating its clinical advantages for treating prostate, bladder, liver, pancreas, breast, lung, and head and neck cancers. Perseverance and a deep understanding of this sophisticated technology has built Fox Chase into a national and regional ART leader offering a robust clinical care program and innovative clinical trials.
Fox Chase and only five other institutions across the country are participating in the ARTIA-Cervix Trial, demonstrating dedication to participate in clinical trials that can directly benefit patients, both younger and older. And in this case, provide a pathway to avoid another clinical dilemma after a woman’s cervical cancer has been treated.
A hallmark of Fox Chase’s elite standing as an NCI-designated Cancer Center is that research is led by extraordinarily talented scientists who work in an ideal environment for fundamentally important discoveries: a place for clinical discovery and delivery, and for taking newly established technologies such as ART and exploring how far they can be advanced.
With additional support from our partnership with Temple University Health System’s oncology research, treatment and prevention programs, Fox Chase research makes a world of difference in Northeast Philadelphia and all other communities that we serve.
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As one of the four original cancer centers to receive comprehensive designation from the National Cancer Institute, Fox Chase Cancer Center has been at the forefront of cancer research for more than 100 years. With a singular focus on cancer, we combine discovery science with state-of-the-art clinical care and population health.
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