Dynamic Adaptive Radiotherapy (DART) For Prostate, Breast, and Other Cancers

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Dynamic Adaptive Radiotherapy (DART) as a Curative or Salvage Treatment Option For Prostate, Breast, and Other Cancers

By Michael J. Dattoli, M.D. and Arvind B. Soni, M.D

At the Dattoli Cancer Center, patients with localized prostate cancer are most often treated with a combination of Dynamic Adaptive Radiotherapy (DART) and brachytherapy (radioactive seed implants). DART utilizes multiple 4D image-guided technologies simultaneously to achieve maximal precision. The course of treatment may also include hormonal therapy, which has been shown to have a synergistic effect when combined with radiation. DART can be utilized not only for treating prostate cancer, but also breast, lung, and other cancers. Our extensive array of radiation technology is state-of-the-art and unique to our center.

Regardless of which type of cancer is being treated, DART relies on the ability to monitor physical changes in real time during treatment and to make dynamic adjustments in the delivery of the radiation beamlets (or micro-beams) in order to account for the slightest motion of the target organ and proximal critical structures. When treating the prostate, we avoid exposing nearby organs such as the bladder and rectum. Essentially, with DART, we are able to hit a moving target the size of a grain of sand, an extraordinary feat that was out of reach until recent years.

Some of our prostate cancer patients are not eligible for brachytherapy, but many of those cases can be successfully treated with DART technologies, taking advantage of the most sophisticated form of external radiation therapy imaginable. With those patients who qualify for DART as a sole therapy without seeds implants, we emphasize that they are not being shortchanged. They will receive the most advanced and effective treatment available, suited to the unique characteristics of each man’s individual case. When DART is used to treat breast cancer at our center, the same is true for women, often post-surgical patients, 2

with each treatment suited to the unique characteristics of each woman’s case. So, in essence, the same overall treatment strategy is utilized for prostate, breast, lung and other cancers, maximizing the radiation dose to the malignancy while avoiding nearby healthy organs.

This most advanced radiotherapy protocol utilizes an ensemble of technologies to focus, aim and deliver a microbeam of photon radiation to a target the size of a voxel (a dot, or cubic mm), accurately every time. Included in the suite are strict immobilization techniques using Vac-Lock assistance, motion sensing tracking cameras, “exact couch” and “exact arm” positioning, electronic online portal imaging “portal vision” and portal dosimetry, electronic on-board portal imaging, 4th generation Cone Beam Tomography, real-time 4D soft tissue and bone to bone matching capability, 2nd generation Respiratory Gating tracking, along with VisionRT and AlignRT surface guidance.

DART is the culmination of decades of research in the field of medical radiation delivery. DART ensures that the cancer – each type of malignancy – is targeted with pinpoint accuracy to receive the highest dose of radiation that can be safely delivered, at the same time avoiding healthy tissue and nearby organs. With this single treatment modality, we believe our patients will have the best chance for cure, while minimizing the risk of unwanted side effects. In addition, DART is also effective as a salvage therapy for many patients who experience recurrence (or persistence) of disease after some other form of primary treatment. We welcome all patient referrals from medical oncologists, urologists and surgical treatment centers.

The purpose of this website is to provide those patients who are considering DART and/or brachytherapy with the most up-to-date and accurate information on these advanced treatment regimens. Before making any decisions about treatment, you should carefully evaluate the likelihood of cure for each treatment option and the risk of side effects that may alter your quality of life.

Taking into account your age, overall health, and the extent and aggressiveness of the cancer, you will want to find a balance between treatment effectiveness and potential side effects – a balance with which you are comfortable and can live with before, during 3

and after treatment. Regardless of the type of therapy you decide is right for you, having a positive mental outlook and knowing what to expect each step of the way are keys to prevailing over all forms of cancer.

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