News and Events
World first trial to improve prostate cancer care
28 November 2013
Researchers and clinicians from the University of Sydney and the Northern Sydney Cancer Centre are leading a world first clinical trial using a tracking system to improve prostate cancer radiotherapy treatment.
The multileaf collimator (MLC) tracking system uses the Calypso system, a GPS-like device to track the position of the prostate to continuously target the tumour with sub-millimetre accuracy as it moves during therapy.
A prostate can move up to 1.5 centimetres during a radiation treatment session and in current practice the tumour is positioned before treatment, but this motion is not monitored or corrected for during treatment.
MLC is a computer-controlled device with numerous narrow slats or leaves that can be moved in and out to create apertures of different sizes. This tool is used to shape and reshape the radiotherapy treatment beam during treatment to match the three-dimensional shape of the area being targeted.
In addition to shaping the treatment beam, the MLC responds to signals from a tiny set of transponders implanted into the prostate to follow the tumour as it moves.
The trial's lead clinician Dr Tom Eade said the use of MLC tracking will potentially improve the accuracy of radiation delivery and reduce the impact on surrounding healthy tissue and sensitive structures such as the rectum and bladder.
"Royal North Shore Hospital has a history of implementing some of the most advanced radiotherapy in Australia and this is reflected in our excellent patient outcomes at the Northern Sydney Cancer Centre," he said.
"But today is the first time we will follow the tumour continuously during treatment. This breakthrough may potentially change the paradigm of prostate cancer treatments, opening the opportunity for patients to have their cancer cured with radiation in just 1-2 weeks of treatment with very low side effects," said Dr Eade.
University of Sydney Medical School's Professor Paul Keall said having a radiation beam continuously target the prostate means that the prostate will receive more than 98 per cent of the radiation dose planned.
"We are recording the estimated treatment improvements with MLC tracking, as well as recording the actual patient outcomes.
"Based on prior data we estimate that tumour dose misses, which can be up to 30 per cent in current practice, can be reduced to below two per cent," Professor Keall said.
The revolutionary use of MLC tracking also has the potential to reduce prostate cancer radiation therapy from an eight week program to just five days, as the greater level of accuracy could make it possible to safely deliver higher doses across fewer treatment sessions.
"This shorter treatment course is better for patients and more cost-efficient," Dr Eade said.
About: Prostate cancer is the most common cancer diagnosed in Australia and the third most common cause of cancer death. It is more common in older men, with 85 per cent of cases diagnosed in men over 65 years of age.
The trial is the culmination of a 14-year research project initially started by Professor Keall. It is being supported by Varian Medical Systems to undertake the study at the Northern Sydney Cancer Centre at Royal North Shore Hospital.
Professor Keall said the team hoped the MLC tracking technology could extend to other cancers such as lung, pancreas and liver tumours in the future.
Thirty prostate cancer patients will be the first to benefit from MLC tracking technology during this current clinical trial.
Those interested in participating in the trial can call the Northern Sydney Cancer Centre on 02 9463 1199.
Congratulations to Fiona, Danny, Jin and Emma!
January 4, 2012
The end of 2012 brought with it some great success for the Radiation Physics Lab! Fiona Hegi was one of the successful recipients of the NHMRC Postgraduate Scholarship ($94k), Danny Lee received an APA scholarship offer, Jin-Aun Ng Received a $10k grant for research support for the study “Radiation Beam Gating with Kilovoltage Intrafraction Monitoring for Prostate Radiotherapy: First Clinical Implementation” through the Northern Translational Cancer Research Unit (NTCRU), and Emma Colvill was the recipient of one of the best presenter awards at ‘MedPhys12’, the Student Research Symposium of the ACT/NSW Branch of the ACPSEM. Congratulations to all!
Radiation Physics Laboratory move to the Medical Foundation Building
September 1, 2012
In early August 2012, members of the Radiation Physics Laboratory moved into new offices in the Medical Foundation Building. The building, situated on Parramatta Rd, provides a pleasant view of the city skyline.
Radiation Physics Laboratory acquire new Redmine server
August 10, 2012
In mid 2012, the Radiation Physics Group acquired a HP ProLiant DL585 G7 server. Powered by 16 AMD Opteron® 16 core processors, leading to a total count of 64 individual cores, and equipped with 384 GB of RAM, this 4P multi-core rack mount server is ideal for computation intensive research tasks, such as finite element modelling and global optimization problems.
World’s most accurate prostate cancer motion monitoring system implemented
August 3, 2012
Prostate cancer patients being treated with radiotherapy can now have their prostate position known to within 0.5mm during radiation treatment. The prostate cancer position is critical to accurate targeting of the radiation beam to avoid missing the tumour and irradiating healthy tissue. The results of a pilot study led by Professor Paul Keall, NHMRC Australia Fellow at the University of Sydney were presented at the 2012 American Association of Physicists in Medicine (AAPM) conference in Charlotte, North Carolina on August 2.
In a world first, a new prostate cancer tracking system has been implemented in a 10-patient pilot study at the Royal North Shore Hospital. The technique termed ‘KIM’ for Kilovoltage Intrafraction Monitoring uses x-rays during the radiation treatment to measure the position of markers implanted into the prostate though a novel 2D-to-3D calculation method. The system was originally conceived at Stanford University in 2008 by two of the investigators of this research, Drs Keall and Poulsen, and is a collaboration between the University of Sydney, Royal North Shore Hospital and Aarhus University in Denmark. In the current study, prostate cancer motion of over 10mm was seen during treatment.
The overall accuracy of the system was higher than 0.5mm, better than other dedicated commercial prostate monitoring systems that can be purchased but have not been widely implemented in clinical practice. As well as being more accurate, an additional advantage of the KIM system over the dedicated systems is that is uses readily available radiation therapy equipment. So there is enormous potential for low cost routine use of the system worldwide.
“KIM is exciting for patients because it’s going to open up a new area of radiation oncology, real time tumour tracking,” said Dr Thomas Eade, a radiation oncologist at the Royal North Shore Hospital. “But, it could potentially be available to all cancer radiotherapy patients that are treated using standard machines.”
Using the KIM system X-rays to measure the prostate motion adds a small amount of additional imaging dose delivered to the patient- approximately 1% of the treatment dose in the current studies, though there is potential for improvement. “KIM was implemented within the constraints of an existing clinical cancer radiotherapy system,” said Professor Keall. “We have several ideas to explore to make the system even more accurate with lower imaging dose.”
In the future, the research team plan to use the KIM information to pause the treatment when the prostate moves beyond a motion threshold, and ultimately to continuously align the radiation beam with the cancer throughout the treatment.
The research was supported primarily through an NHMRC Australia Fellowship grant. A paper based on this work has been accepted for publication in the International Journal of Radiation Oncology Biology, Physics.
Dr Yuanyuan Ge honoured by Cure Cancer as one of 30 young grant recipients
March 20, 2012
Dr Yuanyuan Ge, Postdoctoral Fellow in the Radiation Physics Laboratory is one of the 30 young researchers to receive a Cure Cancer grant to pursue their dream of finding a cure for cancer. The recipients were formally announced at an event held last night at History House, Sydney.
“Young researchers find it difficult to get funding to kick-start their careers into cancer research. First-time funding received from Cure Cancer provides a much needed start for researchers who go on to achieve wonderful outcomes” said Leanne Warner, CEO Cure Cancer Australia.
Dr Ge will use the grant to help improve the accuracy of radiotherapy. Her current research is the first of its kind, involving the investigation of real-time image-guided radiotherapy, and intensity-modulated radiotherapy.
“My research aims to develop an internationally unique radiotherapy system that can adjust the radiation beam in real time to follow the changing tumour shape,” she says. “Tumours in
lung and prostate cancer change shape during radiotherapy treatment. This is not accounted for in current care, compromising the therapeutic efficacy.”
This groundbreaking research therefore has the potential to improve the health of patients receiving radiotherapy, and also
allow specialists to more closely monitor the tumour.
“This technology is a world-first study to investigate the strategy of accounting for real-time tumour shape-change during radiotherapy. For this research, I hope to deliver an experimental radiotherapy system with quantified clinical benefit for lung and prostate cancer patients with changing tumours,” says Yuanyuan.
“In the long term, I hope to incorporate this technology into the Australian-first MRI-Linac radiotherapy machine that is under construction at Liverpool Hospital. The MRI-Linac can provide superb anatomy images during radiotherapy which are critical for this technology.”
Yuanyuan is originally from a Particle Physics background, receiving her Bachelor of Science in Applied Physics from the University of Science and Technology of China and her Doctor of Science in Particle Physics from the Swiss Federal Institute of
Despite her fascination with this area of science, however, it was the allure of using her knowledge to help people dealing with cancer which attracted her to medical research. She is thrilled to be able to combine these two passions.
“The direction of the cancer research I am working on is called Medical Physics, which focuses on the physics aspects when using radiation to treat cancer,” Yuanyuan explains. “Exploring
the mystery of the universe was very amazing, but I found it is more exciting to realise that I can apply my knowledge on saving cancer patients.”
Past recipients have included Professor Robyn Ward who is now internationally recognised for her breakthrough work in identifying factors determining people at risk of developing bowel
cancer, Professor Andrew Biankin who is currently the head of Pancreatic Cancer Research at the Garvan Institute of Medical Research, and Dr Catherine Suter currently Head of Epigenetics at the Victor Chang Cardiac Research Institute.
Project to target lung cancer tumours takes top ranking
December 1, 2011
Professor Paul Keall was recognised with a major award last night at the National Health and Medical Research Council's 75th Anniversary Gala Dinner and Awards.
Professor Keall is developing techniques to provide real-time information about the exact location and shape of tumours receiving radiation therapy. He took out the award for the top ranked project in the NHMRC's latest round of grants.
Professor Keall said his aim is to treat patients with the "lowest radiation dose in the shortest time by using the patient's breathing signal to guide how the tumours are imaged."
The technology he is developing, called 'respiratory motion guided 4D cone beam CT imaging', will lead to higher quality images of tumours - which typically move from 0.5 to 1cm and up to 5cm with breathing - in real time.
"The better images of the tumour we have, the better we can target the tumour and reduce toxic side effects such as pneumonitis," Professor Keall explained.
Lung cancer is the leading cause of cancer death worldwide, with 1.2 million new cases per year. Approximately 44 percent of lung cancer patients in Australia receive radiotherapy.
Currently the five-year survival rate for lung cancer patients is just 16 percent. Increasing radiation doses increases a patient's survival chances, but it also increases toxic side effects such as pneumonitis.
Professor Keall's project was the top ranked project of 3495 applications in the latest NHMRC funding round, and one of only three projects receiving the highest possible scores in the three key ranking categories: the project's scientific quality, its real world impact and significance, and the researcher's track record.
"I am delighted with the recognition of our project and I look forward to implementing our methods for patient treatment in the project's later stages," Professor Keall said.
Professor Keall's project collaborators at the University of Sydney include PhD student Ben Cooper, software developer Ricky O'Brien and computer engineer Associate Professor Alistair McEwan.
He will also work with David Ball, radiation oncologist at the Peter MacCallum Cancer Centre, and Geoffrey Hugo and Jeffrey Williamson, professors at Virginia Commonwealth University (US) who have provided key insights and data.
The NHMRC 75th Anniversary Gala Dinner and Awards was held at Parliament House last night.
Work on real-time tumour deformation tracking was presented at 2011 EPSM-ABEC conference
August 24, 2011
Dr. Yuanyuan Ge recently presented her work on real-time adaptation to tumour deformation using the dynamic multileaf collimator (DMLC) at the 2011 Engineering and Physical Sciences in Medicine and the Australian Biomedical Engineering Conference in Darwin. The talk, "Towards Development of an Image-guided Radiotherapy System to Treat Deforming Tumours in Real-Time", reported the latest progress on adding the ability of adapting to tumour deformation in real-time to the current DMLC tracking system. Find out more about tumour deformation tracking...
Radiation Physics Laboratory launch at RPAH
June 10, 2011
The launch of the Radiation Physics Laboratory, located in the Radiation Oncology building at Royal Prince Alfred was well attended yesterday afternoon. Staff, researchers and students from both RPAH and the University of Sydney were treated to a series of demonstrations on the group’s current projects.