Selected Podcast
MRI Guided Radiation Therapy
Robert Zlotecki MD, PhD discusses MRI guided radiation therapy. He helps us to understand the role and effectiveness of radiation therapy in cure and palliation of GI tract cancers. He speaks about the technologic advances that have increased the safety of radiation therapy treatment and he explores how this has the potential to preserve and improve patient quality of life factors in the treatment of cancer.
Featuring:
Robert Zlotecki, MD, PhD
During my 15 years at the University of Florida, one of my areas if focus has been the multidisciplinary management of patients with pediatric sarcomas of soft tissue and bone. Currently, I serve as the Medical Director for the UF Department of Radiation Oncology and participate in several national professional societies and committees, including the American Board of Radiology and the Radiologic Society of North America. Clinical research productivity includes 55 peer-reviewed publications and several supporting grants. My clinical practice integrates translational research collaborations with our UF Prostate Disease Center, and also with our medical physics and informatics programs. Direct collaboration with colleagues in the UF Cancer and Genetics Institute connects my PhD training in Pharmacology with the applied radiation biology, to facilitate the translation of laboratory research to clinical application in the delivery of multi-modality integrated cancer therapies. My specific technical interests include the management of metastatic cancers utilizing the technologies of Stereotactic Body Radiotherapy (SBRT) with Image Guidance (IGRT), which employ accelerated hypo-fractionation dose delivery protocols; and the development of emerging mobile and interactive technologies to enable an eMedical infrastructure to facilitate the collection of physician and patient reported quality and satisfaction data related to cancer diagnosis, treatment, and Quality of Life (QoL) outcomes.
Transcription:
Melanie Cole (Host): Welcome to UF Health Med Ed Cast with UF Health Shands Hospital. I'm Melanie Cole. And today we're exploring MRI guided radiation therapy. Joining me is Dr. Robert Zlotecki. He's the Medical Director and a Professor in the Department of Radiation Oncology at the University of Florida College of Medicine. And he practices at UF Health Shand Hospital. Dr. Zlotecki, thank you so much for being with us today. As we start, can you set the table for us a little bit with the evolution of radiotherapy for cancer and help us to understand the role and effectiveness specifically of radiation therapy in the cure and palliation of GI tract cancers?
Robert Zlotecki, MD, PhD (Guest): Very simply, image is everything. And this has been one of the resoundingly advances in not just the delivery of radiotherapy, but the precision delivery of radiotherapy treatment for the cure and sometimes palliation, affective palliation of any malignancy, especially in the GI and genitourinary tracts.
So, the imaging and the corporation of the imaging into the advanced radiotherapy feedback loop, has been one of the biggest things that we have seen and have adopted, and will be bringing forward.
Host: Well, then tell us how this has the potential to preserve and improve patient quality of life factors as these cancers are getting treated.
Dr. Zlotecki: Well, because we can more effectively see our target, we can keep our target radius, our basically low value points to a minimum and keep the high value of bulls eyes on target exactly. And that means a much, much more effective delivery of the cancer therapy, in an efficient manner that reduces the overall number of days sessions, or as we call fractions of therapy for the patient to have to commit to for their course of effective therapy.
So, it's a huge time improvement for the patient. And thus, it's also becoming a huge quality of life improvement, not just from the commitment and the experience, the side measures of investment in the cure of cancer, but also in sparing the risks of side effects, that is without a doubt, a huge focus of the whole treatment. But in this case, we achieve that while also increasing the efficiency of the care overall and the targeting of the effective treatment to the tumor.
Host: Dr. Zlotecki, this is really fascinating technology. So how have you been integrating this into clinical radiotherapy planning and monitoring. Tell us a little bit about what you're doing at UF Health Shands Hospital.
Dr. Zlotecki: At UF Health Shands, we've always had a very close working relationship between the diagnostic radiology and the therapeutic radiology departments, and we've incorporated many of the diagnostic findings and that technique honing in on targets that are identified, directly brought into our treatment planning process.
We have not just adopted the imaging and the imaging technology, but we've also adopted greatly the knowledge base from diagnostics to better identify both the presence of a tumor and the boundaries of a tumor. So bringing that translational knowledge base from the diagnostic and the biometrics fields into the radiotherapy treatment has been a constant process. The latest generation of imaging for cancers of the GI tract that we're focused on today has been the use of MRI guidance and especially the use of advanced sequences that are biomarkers for disease presence and in disease status.
Those include the fusion weighted imaging, an effective, just basically the, the water motion around and about a tumor and surrounding tissues and other factors that will become much more applicable in the future, such as blood oxygen and tissue oxygenation effects. So, we are first adopting the diagnostic imaging technology and incorporating the treatment response markers into our treatment planning process.
Host: So Doctor now, as we look towards what's happening with this technology, how has the added value of real-time physiologic MRI for treatment planning and response, addressing a longstanding challenge for radiation oncologists for mobile tumors, which can often change positions in unpredictable ways? Tell us what you're doing at UF Health Shands Hospital in that regard.
Dr. Zlotecki: So one of the biggest advances in MRI guided radiotherapy is the concept of adaptive therapy, adapting to position, which is really, not that different than what's been enabled in CAT scan based technologies, but adapting to shape and into motion. So we'll be adopting those aspects of technological advantages afforded by MRI, but also by taking advantage of the energy and spectrum of the MRI device and the fact that it is always on and always collecting data, we will be taking the data stream, measuring the fusion weighted image sequences, which is the first foremost biomarker and using that as part of our adaptive response modification on the daily treatments of rectal cancers and other disease sites.
Host: Can you speak about some of the technologic advances that have increased the safety of radiation therapy treatment for other providers that are counseling their patients? This is always a big question.
Dr. Zlotecki: The technology safety is absolutely inherent in everything that we do. The technology is so advanced, just think of it as even the realms of rocket science safety and airline safety. Those are the kinds of things that we strive for and hope to exceed. The practicality of it for patient care delivery in the treatment of GI cancers, centers on concentrating the focus of the radiation on the tumor site, while very importantly, excluding or achieving avoidance of what we call organs at risk. First step is identifying the position of those normal, healthy tissues and organs, and basically accounting for the fact that in the gastrointestinal tract, they're in a constant state of motion. So that is, the short-term and the long-term advances that are being achieved with the real-time active imaging. And not just in any single fraction of radiotherapy, but from fraction to fraction as, the patient's anatomy and physiology adjusts on a daily basis.
And now as the tumor parameters adjust in response to treatment effect of the day before and the day before, we can better optimize the avoidance of normal health of tissues and the treatment volume that is really needed and really required to cure that tumor and do it safely.
Host: As we wrap up Dr. Zlotecki, and again, this is really interesting technology, what would you like other providers to take away from this podcast? What do you feel are the meaningful end points of what you're doing at UF Health Shands Hospital?
Dr. Zlotecki: First and foremost is we're providing an effective deliverable comprehensive path of treatment for patients within a system that will be efficient and effective. We will be able to safely very, very safely reduce a course of radiotherapy treatment from 25 fractions over five weeks to five fractions in one week and do it with safety and efficacy. Not only will it be taking advantage of the most sophisticated, real time imaging surveillance of the patient and patient anatomy during the course of treatment, but will on a day by day basis, will be taking into account in the treatment planning process, the biometric physiologic responses of the tumor as it is day by day, treated and destroyed by the delivery of radiotherapy.
Host: Thank you so much, Doctor for joining us today and sharing your expertise. To refer your patient, or to listen to more podcasts from our experts, you can always visit UFhealth.org/medmatters. That concludes today's episode of UF Health Med Ed Cast with UF Health Shands Hospital. For updates on the latest medical advancements, breakthroughs and research, follow us on your social channels. I'm Melanie Cole. Thanks so much for joining us today.
Melanie Cole (Host): Welcome to UF Health Med Ed Cast with UF Health Shands Hospital. I'm Melanie Cole. And today we're exploring MRI guided radiation therapy. Joining me is Dr. Robert Zlotecki. He's the Medical Director and a Professor in the Department of Radiation Oncology at the University of Florida College of Medicine. And he practices at UF Health Shand Hospital. Dr. Zlotecki, thank you so much for being with us today. As we start, can you set the table for us a little bit with the evolution of radiotherapy for cancer and help us to understand the role and effectiveness specifically of radiation therapy in the cure and palliation of GI tract cancers?
Robert Zlotecki, MD, PhD (Guest): Very simply, image is everything. And this has been one of the resoundingly advances in not just the delivery of radiotherapy, but the precision delivery of radiotherapy treatment for the cure and sometimes palliation, affective palliation of any malignancy, especially in the GI and genitourinary tracts.
So, the imaging and the corporation of the imaging into the advanced radiotherapy feedback loop, has been one of the biggest things that we have seen and have adopted, and will be bringing forward.
Host: Well, then tell us how this has the potential to preserve and improve patient quality of life factors as these cancers are getting treated.
Dr. Zlotecki: Well, because we can more effectively see our target, we can keep our target radius, our basically low value points to a minimum and keep the high value of bulls eyes on target exactly. And that means a much, much more effective delivery of the cancer therapy, in an efficient manner that reduces the overall number of days sessions, or as we call fractions of therapy for the patient to have to commit to for their course of effective therapy.
So, it's a huge time improvement for the patient. And thus, it's also becoming a huge quality of life improvement, not just from the commitment and the experience, the side measures of investment in the cure of cancer, but also in sparing the risks of side effects, that is without a doubt, a huge focus of the whole treatment. But in this case, we achieve that while also increasing the efficiency of the care overall and the targeting of the effective treatment to the tumor.
Host: Dr. Zlotecki, this is really fascinating technology. So how have you been integrating this into clinical radiotherapy planning and monitoring. Tell us a little bit about what you're doing at UF Health Shands Hospital.
Dr. Zlotecki: At UF Health Shands, we've always had a very close working relationship between the diagnostic radiology and the therapeutic radiology departments, and we've incorporated many of the diagnostic findings and that technique honing in on targets that are identified, directly brought into our treatment planning process.
We have not just adopted the imaging and the imaging technology, but we've also adopted greatly the knowledge base from diagnostics to better identify both the presence of a tumor and the boundaries of a tumor. So bringing that translational knowledge base from the diagnostic and the biometrics fields into the radiotherapy treatment has been a constant process. The latest generation of imaging for cancers of the GI tract that we're focused on today has been the use of MRI guidance and especially the use of advanced sequences that are biomarkers for disease presence and in disease status.
Those include the fusion weighted imaging, an effective, just basically the, the water motion around and about a tumor and surrounding tissues and other factors that will become much more applicable in the future, such as blood oxygen and tissue oxygenation effects. So, we are first adopting the diagnostic imaging technology and incorporating the treatment response markers into our treatment planning process.
Host: So Doctor now, as we look towards what's happening with this technology, how has the added value of real-time physiologic MRI for treatment planning and response, addressing a longstanding challenge for radiation oncologists for mobile tumors, which can often change positions in unpredictable ways? Tell us what you're doing at UF Health Shands Hospital in that regard.
Dr. Zlotecki: So one of the biggest advances in MRI guided radiotherapy is the concept of adaptive therapy, adapting to position, which is really, not that different than what's been enabled in CAT scan based technologies, but adapting to shape and into motion. So we'll be adopting those aspects of technological advantages afforded by MRI, but also by taking advantage of the energy and spectrum of the MRI device and the fact that it is always on and always collecting data, we will be taking the data stream, measuring the fusion weighted image sequences, which is the first foremost biomarker and using that as part of our adaptive response modification on the daily treatments of rectal cancers and other disease sites.
Host: Can you speak about some of the technologic advances that have increased the safety of radiation therapy treatment for other providers that are counseling their patients? This is always a big question.
Dr. Zlotecki: The technology safety is absolutely inherent in everything that we do. The technology is so advanced, just think of it as even the realms of rocket science safety and airline safety. Those are the kinds of things that we strive for and hope to exceed. The practicality of it for patient care delivery in the treatment of GI cancers, centers on concentrating the focus of the radiation on the tumor site, while very importantly, excluding or achieving avoidance of what we call organs at risk. First step is identifying the position of those normal, healthy tissues and organs, and basically accounting for the fact that in the gastrointestinal tract, they're in a constant state of motion. So that is, the short-term and the long-term advances that are being achieved with the real-time active imaging. And not just in any single fraction of radiotherapy, but from fraction to fraction as, the patient's anatomy and physiology adjusts on a daily basis.
And now as the tumor parameters adjust in response to treatment effect of the day before and the day before, we can better optimize the avoidance of normal health of tissues and the treatment volume that is really needed and really required to cure that tumor and do it safely.
Host: As we wrap up Dr. Zlotecki, and again, this is really interesting technology, what would you like other providers to take away from this podcast? What do you feel are the meaningful end points of what you're doing at UF Health Shands Hospital?
Dr. Zlotecki: First and foremost is we're providing an effective deliverable comprehensive path of treatment for patients within a system that will be efficient and effective. We will be able to safely very, very safely reduce a course of radiotherapy treatment from 25 fractions over five weeks to five fractions in one week and do it with safety and efficacy. Not only will it be taking advantage of the most sophisticated, real time imaging surveillance of the patient and patient anatomy during the course of treatment, but will on a day by day basis, will be taking into account in the treatment planning process, the biometric physiologic responses of the tumor as it is day by day, treated and destroyed by the delivery of radiotherapy.
Host: Thank you so much, Doctor for joining us today and sharing your expertise. To refer your patient, or to listen to more podcasts from our experts, you can always visit UFhealth.org/medmatters. That concludes today's episode of UF Health Med Ed Cast with UF Health Shands Hospital. For updates on the latest medical advancements, breakthroughs and research, follow us on your social channels. I'm Melanie Cole. Thanks so much for joining us today.