Sheba Medical Center advances the use of CPAP in SBRT treatment with astounding results. Stereotactic body radiation therapy (SBRT) is used in the treatment of metastatic cancer, most commonly to the lymph nodes, liver, and abdomen.
The goal of radiation therapy is accuracy – exposing cancer cells to radiation while minimizing the exposure of healthy tissues. This can be a difficult undertaking, as even the normal movement associated with breathing can move target tissues out of alignment. This means that radiation oncologists often must increase the treatment area beyond the tumor in order to ensure that the entire tumor is treated, therefore exposing healthy tissue to the radiation treatment.
Dr. Yaacov Lawrence, the director of the Center for Translational Radiation Oncology at Sheba Medical Center, puts it succinctly,
“The tumor moves as the patient breathes, and this can mean that in order to hit the tumor, there is a need to treat a larger area than the size of the tumor itself. For example, if the tumor is 2 cm in diameter but the chest moves with respiration, we need to treat at least 6 cm, expanding the margins in order to treat the entire tumor.”
CPAP for SBRT – A New Application
In order to avoid irradiating healthy tissue, physicians at Sheba Medical Center in Israel have adapted an existing therapy. Continuous positive airway pressure (CPAP) therapy has been used for many years to treat obstructive sleep apnea. CPAP patients wear a mask during sleep that is attached to a small machine. This machine gently forces air into the nose, keeping the airway open when the patient is relaxed and asleep.
Now, staff at Radiation Oncology Department at Sheba, led by Prof. Zvi Symon, are using CPAP to reduce patient movement during SBRT sessions. Dr. Lawrence explains it,
“From our perspective, two things happen when we connect patients to a CPAP machine- the tumor moves less while the lungs still expand. This means that we are able to better avoid treating healthy lung tissue. In cancer treatment, we always calculate the benefits of treating the tumor versus the harm of damaging healthy tissue. Using this technique, we are able to improve this ratio and give patients more benefit.”
This new advance in maximizing the effectiveness of radiation therapy while reducing side effects is another way in which Sheba Medical Center offers world-class medicine with a personal touch.
Outstanding Results and Only Available at Sheba
While the use of CPAP for SBRT is an ongoing study, the results so far are extremely positive. Sheba physicians have presented the results at numerous international meetings and published a paper in the International Journal of Radiation Oncology– the leading medical journal in the radiation oncology field. CPAP in conjunction with SBRT is only available at Sheba Medical Center.
Results have demonstrated that CPAP significantly reduces lung tumor motion compared with free, normal breathing. By augmenting lung volume with CPAP to a relative increase of 32%, Sheba doctors have been able to achieve a 22% relative reduction in average lung radiation dose. Additionally, there was also a relative reduction of 29% in average radiation dose to the heart. What this all means is that more healthy tissue is being spared during radiation treatment.
Yaacov Lawrence, MD
Dr. Lawrence sums it up, “We’ve treated about 60 patients using this technique and discovered no side effects. CPAP is well tolerated by patients, it’s reproducible, and simple to implement in the treatment room.”
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