The IMOR Foundation, Medical Institute for Radiotherapy and Oncology, from Barcelona, has began the Image Guided Radiotherapy (IGRT), for the first time in Spain.

The IMOR Foundation, Medical Institute for Radiotherapy and Oncology, from Barcelona, has began the Image Guided Radiotherapy (IGRT) technique for the first time in Spain. With the Image Guided Radiotherapy (IGRT) the position of the target organs are checked on a daily basis in real time just before each treatment fraction. With an ultrasonography the target organ is visualized and treatment couch is displaced as needed to reposition target in the isocenter of the linac. With IGRT the irradiation of normal surrounding tissues is avoided.

“The great advantage of IGRT is that allows us to perform a real time quality control of the precision with which radiotherapy is being administered. This means a quality assurance to the patient that normal organs side-effects can be avoided, told professor Benjamín Guix, MD, PhD, director of IMOR Foundation, Medocal Institute for Radiotherapy and Oncology, when presenting the new equipment.

The new IGRT equipment at IMOR foundation, is the 9^th that is running in Europe and the first one corresponding to the 2^nd generation, that is even more precise with a maximum tolerance of less than 1 mm. At USA there are more than 400 first-generation units working, being considered IGRT as the gold standard for prostate cancer radiotherapy. Nevertheless, its applications are extensive to other abdominal and pelvic tumors, like bladder cancer, pancreas tumors, and liver primary as well as metastatic lesions.

In preliminary studies, prostate displacement has been shown to be in the range of 2-2.5 cm between fractions. With traditional 3D conformal radiotherapy or IMRT, to be sure that every day the whole prostate is irradiated, a safety margin of 2.5 cm has to be taken around the prostate, what means that such a large amount of normal tissue is unnecessarily irradiated. With IGRT, target position is verified just before treatment is delivered, repositioning the patient if needed. In this way, not only the tumor control probability increases dramatically, if not the risk of long-term side-effects (rectitis, urinary incontinence or impotence) is nearly zero.

“It’s absolutely impressive to see in real time how much the prostate moves” explained Dr. Guix. “Now that we know and can measure the prostate movement, it’s completely unthinkable to treat prostate cancer without IGRT”, he concluded.

At IMOR Foundation, IGRT treatments started at June 2005. Since then, more than 25 patients have been successfully treated. Treatment results have permitted to reduce rectitis (rectal inflammation quite frequent with external beam radiotherapy) to less than 0.5%. Other types of tumors that has been successfully treated are pancreas and liver (primary as well as metastatic lesions) tumors. Results are extremely good, with a numbers of local control and survival absolutely unknown up to now for this kind of tumors.

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