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Image-guided radiation therapy that saves more lives

Sunnybrook doctors will become the first in the world to guide internal radiation treatment, called brachytherapy, with real-time magnetic resonance imaging (MRI). As a result, they will be able to target tumours with unprecedented precision.

Brachytherapy involves the placement of radioactive seeds directly into cancerous tissue. Typically used to treat tumours that can be reached with surgical instruments, such as prostate, breast and gynecological cancers, brachytherapy enables doctors to strike tumours with high doses of radiation.

By making it possible to image tumours with MRI and then instantly place the brachytherapy seeds, Sunnybrook will be able to zero in on tumours like never before. Our doctors will also use MRI to quickly observe the treatment's effect on tumours, allowing them to adjust treatment if needed. For patients, MRI-guided brachytherapy will be more effective than brachytherapy guided by ultrasound imaging, while also having less of an impact on their daily lives.

A new high-tech arsenal to beat brain cancer

The standard treatment for people with metastatic brain tumours – cancer that has spread to the brain from elsewhere in the body – has been radiation of the entire brain (whole-brain radiation). While this tactic helps control tumours, it also harms quality of life by damaging memory and other cognitive functioning.

A precise radiation therapy increasingly used at Sunnybrook, called stereotactic radiosurgery (SRS), may make whole-brain radiation – and its side-effects – a thing of the past. To make that happen, Sunnybrook will install the Gamma Knife Icon, the newest and most advanced SRS system, in the Odette Cancer Centre.

With the Icon, our cancer experts will offer precision radiation to a broader group of patients – for instance, to people with as many as 30 brain tumours. And thanks to the Icon's design, patients can look forward to a considerably more comfortable experience.

The Gamma Knife Icon works by focusing hundreds of radiation beams on a single target. Individually each beam is too weak to damage the healthy tissue it crosses on the way to its target, but at the site where they converge, cancerous tissue is destroyed.

The Icon's pinpoint precision allows for the safe delivery of potent and effective doses of radiation. The Icon will allow the Odette Cancer Centre to continue replacing whole-brain radiation with targeted radiation procedures for as many as 500 patients annually, a 30-per-cent increase.

It's a game-changer for people with cancers such as metastatic melanoma, which tends to produce a large number of metastatic brain tumours.

The Icon promises to be effective in treating more than brain cancer, however. With its ability to target select areas of the brain, it may eventually be able to address depression, epilepsy, obsessive compulsiveness and essential tremor.

A new radiation technology that will target even the most elusive forms of cancer

Soon doctors at Sunnybrook's Odette Cancer Centre will be able to watch a beam of radiation move through a patient's body in real time and direct that beam precisely at a tumour. In the past, they could only estimate where a tumour might be based on images taken before the radiation treatment begins.

The technology is called MR-Linac. It is the world's first machine to combine radiation and high-resolution magnetic resonance imaging (MRI). This hybrid technology will let doctors at the Odette Cancer Centre target tumours and monitor their response to radiation with unprecedented precision – even as a tumour moves – thanks to the machine's real-time MRI guidance.

"It has not yet been possible to see the tumour right before and, more importantly, during treatment. The inability to correct for that limitation has always held us back. So now with the MR-Linac we will be able to hit the target exactly. We're not going to let these tumours hide anymore," explains Dr. Calvin Law, chief of the Odette Cancer Program, one of Canada's largest and most advanced cancer programs.

Thanks to the machine's MRI-guided precision, physicians will be better able to avoid radiating and harming healthy tissue that surrounds tumours.

"We will use the MR-Linac to treat a wide range of cancers, from pancreatic to prostate to breast to incurable brain cancers. It will help for almost all of our patients," says Dr. Greg Czarnota, head of the Odette Cancer Research Program.

As the first and only Canadian centre to be able to offer radiation that is guided by real-time MRI, Sunnybrook's team will remain at the forefront of cancer care, and an invaluable source of expertise and teaching for cancer ablation specialists across the country. "This technology is going to allow people to have their treatments faster, and will result in improved quality of life," says Dr. Law. "More importantly, for those who can't be treated today, this will define how we're going to treat them tomorrow."

Relative strength

Duane Smith and his parents Ed and Barbara are either lucky or unlucky, depending on one's perspective. They believe the former.

All three have been successfully treated for cancer at Sunnybrook – Duane and Ed for prostate cancer, and Barbara for breast cancer.

"The care has been brilliant," says Duane, 46, who received radiation and hormone therapy in 2011 under the direction of radiation oncologist Dr. Andrew Loblaw. It was Duane's second bout with prostate cancer. His prostate gland was surgically removed at another hospital in 2009.

Barbara, 73, and Ed, 77, are also impressed by the treatment they received through the Odette Cancer Program. "I knew I was going to get excellent care. I felt safe, in lots of ways," says Barbara, who also had to contend with a recurrent cancer.

Fortunately for Duane, a husband and father of two, his cancer remained confined to his prostate region. Dr. Loblaw treated it with 37 radiation sessions over eight weeks, followed by six months of hormone therapy to temporarily eliminate Duane's production of testosterone, a hormone essential to the growth of prostate cancer cells.

Treatment was difficult, but Duane was ultimately able to return to his active lifestyle, including competitive hockey, triathlon training, golfing and coaching his kids' hockey teams.

The Smiths, however, weren't out of the woods. Ed was diagnosed with prostate cancer in 2014, prompting Duane to contact Dr. Loblaw to see if he would review his dad's file.

Rather than receive standard radiation therapy in Kingston (closer to their Trenton home), Ed chose to come to Sunnybrook to be treated by Dr. Loblaw with a novel radiation therapy called stereotactic body radiotherapy. Thanks to the therapy's power and precision, Ed required only five sessions. "I would recommend it to anybody. I had no side-effects," Ed says.

Just when the family thought it was done with cancer, Barbara learned in the fall of 2014 that her breast cancer had returned, 11 years after under-going a lumpectomy and radiation for a small tumour in her left breast.

Dr. Loblaw again played an important role in the family's care, connecting Barbara to experts within Sunnybrook's Louise Temerty Breast Cancer Centre. They were able to conserve her breast by performing a lumpectomy and using radiation therapy. Barbara is also undergoing genetic testing at Sunnybrook that may provide some clues as to the prevalence of cancer in her family.

Through the delivery of advanced, personalized care, Sunnybrook saved a family and made their journey a little easier. For their part, the Smiths are enjoying life and feeling that, just maybe, luck is on their side.