Minimally invasive delivery of radiation therapy to pancreatic tumors

Pancreatic cancer is one of the most lethal types of cancer, expected to cause more than 44,000 deaths in the U.S. this year. It’s a deadly trend that continues to rise. Radiation therapy can be an important component of a pancreatic cancer patient’s treatment plan, but it doesn’t offer a chance at a cure.

This prompted MD Anderson experts to initiate the first clinical trial in the U.S. examining the safety and effectiveness of OncoSil™, an implantable radiological device developed by a Sydney-based medical device company.

“We know that we need higher doses of radiation for this therapy to more effective,” says Manoop S. Bhutani, M.D., professor of Gastroenterology, Hepatology and Nutrition, and renowned endoscopy expert. “But the amount we can give is limited because current techniques are toxic to the organs surrounding the pancreas.”

In this Phase I trial, endoscopic ultrasound is used to deposit OncoSil directly into the pancreatic tumor, allowing much higher doses of radiation to be given.

Normally, we give around 50 gray of radiation. With this new technique, we’re able to deliver about 100 gray.

Pioneering minimally invasive delivery of radiation therapy

Endoscopic ultrasound plays several important roles in pancreatic cancer care. MD Anderson is the first institution in the nation to extend its uses to include delivery of radiation therapy using the OncoSil platform.

By using endoscopic ultrasound to deposit radiation internally, the healthy tissue and organs surrounding the tumor are spared. Additionally, this technique is minimally invasive and performed as an outpatient procedure.

Drastically reducing the length of radiation therapy

Standard radiation therapy usually is administered daily for at least five weeks. Although newer techniques have reduced the duration of treatment to less than a week, the OncoSil trial reduces radiation delivery to a single outpatient procedure.

Because this is a one-day treatment, patients can go home sooner. That improves quality of life and patient satisfaction.

A better partner for chemotherapy

The short delivery window of radiation therapy in the OncoSil trial also benefits a patient’s systemic treatment plan. Usually, chemotherapy has to be suspended for several weeks while standard radiation therapy is administered. But because OncoSil can be delivered during a patient’s scheduled break in chemotherapy, there’s no delay in systemic therapy during this new treatment.

As with all treatment plans, eligible patients must be carefully selected. If a patient’s tumor is growing into surrounding organs or is small and tightly wound around blood vessels, the risks of this therapy may outweigh the benefits.

A multidisciplinary approach to radiation therapy

Delivering radiation internally is complex. Expertise from many disciplines is required to ensure the treatment is delivered safely and is truly benefitting patients. The OncoSil trial relies on cooperative teamwork from MD Anderson experts that spans several disciplines, including:

• Franklin Wong, M.D. (Nuclear Medicine)
• William Erwin, M.S. (Imaging Physics)
• Eric Tamm, M.D. (Diagnostic Radiology)
• Eugene Koay, M.D., Ph.D. (Radiation Oncology)
• David Fogelman, M.D. (Gastrointestinal Medical Oncology)

“It’s a prime example of teamwork and interdisciplinary collaboration,” Bhutani says.

If proven effective, this innovative way of delivering radiation could have a lasting impact on pancreatic cancer treatment.