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Dr. Calvin Law, chief of Sunnybrook’s Odette Cancer Centre, standing with a traditional radiation therapy machine. Sunnybrook is part of a global consortium set to revolutionize radiation by combining it with real-time MRI guidance to target tumours with extreme precision.

DOUG NICHOLSON

Sunnybrook is pioneering a new radiation technology that will target even the most elusive forms of cancer.

There's hope on the horizon for those affected by some of the toughest cancers to treat, such as pancreatic cancer. A revolutionary radiation technology coming to Sunnybrook Health Sciences Centre in 2016 promises to target hard-to-treat tumours much more effectively than before.

Soon doctors at Sunnybrook's Odette Cancer Centre will be able to watch a beam of radiation move through a patient's body in real time and direct that beam precisely at a tumour. In the past, they could only estimate where a tumour might be based on images taken before the radiation treatment begins. The technology is called MR-Linac. It is the world's first machine to combine radiation and high-resolution magnetic resonance imaging (MRI). This hybrid technology will let doctors at the Odette Cancer Centre target tumours and monitor their response to radiation with unprecedented precision – even as a tumour moves – thanks to the machine's real-time MRI guidance.

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In Canada, pancreatic cancer is one of the deadliest cancers, with only an eight-per-cent survival rate five years after diagnosis. By comparison, the survival rate for prostate cancer patients is 96 per cent. Now, the MR-Linac's ability to target pancreatic cancer and other hard-toreach gastrointestinal cancers could be a real breakthrough. "One of the reasons the MR-Linac is so important with the pancreas is because it is a moving organ that changes its shape," says Dr. Arjun Sahgal, head of Sunnybrook's Cancer Ablation Therapy program. "With the MR-Linac, because we will be able to see the pancreas and watch how it's moving and changing, we can actually target it with radiation so much better."

The current standard in external- beam radiotherapy is to look at tumours with imaging scans before the patient enters the radiation suite. Doctors then determine the radiation dosage and where it will be targeted. "We rely on a predefined location of the tumour based on CT scans to generate the radiation plan, and simply anticipate where the tumour will be during each treatment day," explains Dr. Calvin Law, chief of the Odette Cancer Centre, one of Canada's largest and most advanced cancer programs.

"It has not yet been possible to see the tumour right before and, more importantly, during treatment. The inability to correct for that limitation has always held us back. So now with the MR-Linac we will be able to hit the target exactly. We're not going to let these tumours hide anymore."

Thanks to the machine's MRI-guided precision, physicians will be better able to avoid radiating and harming healthy tissue that surrounds tumours.

“With the MR-Linac, we will be able to hit the target exactly. We’re not going to let these tumours hide anymore.”
Dr. Calvin Law, Chief, Odette Cancer Centre

"It greatly improves our ability to target the tumour, to deliver higher doses than we have before, to cure the cancers, and to minimize the exposure to the normal tissue," says Dr. Sahgal. "And we shorten treatment times. We can actually get treatments done in a week or two, as opposed to six to even nine weeks of radiation."

As treatment progresses, doctors will be able to adapt to changes in tumours – for example, increasing or reducing dosage or, if a tumour is not responding at all, opting for surgery.

Installation of an MR-Linac is one of the major initiatives within the Cancer Ablation Therapy program, which harnesses a range of precision therapies to destroy tumours without the need for invasive surgery.

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"We will use the MR-Linac to treat a wide range of cancers, from pancreatic to prostate to breast to incurable brain cancers. It will help for almost all of our patients," says Dr. Greg Czarnota, head of the Odette Cancer Research Program.

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Until now, the barrier to combining high-definition MRI and the simultaneous delivery of radiation has been that the MRI's magnet would interfere with the radiation beams. But the MR-Linac's developers, Elekta and Philips, have found a way to control the interference.

"It's going to be a brand new paradigm in radiation oncology and in radiation biology, because we're going to be able to see and understand the mechanisms of tumour response in ways we have not been able to do before," says Dr. Sahgal. "It's going to allow us to really expand our understanding of what we're doing and how we can do it better."

The Odette Cancer Centre is the only Canadian member of a seven-member international consortium that is collaborating with Elekta and Philips to finalize development of the MR-Linac. Other institutions within this select group include the MD Anderson Cancer Center in Houston, Texas and the University Medical Center Utrecht in the Netherlands.

Internationally recognized for his expertise in treating brain and spine cancers, Dr. Sahgal was hand-picked by the consortium to lead the group's research and testing of the MR-Linac for the treatment of brain tumours. Once the machine is installed, he and his team will design, test and recommend best practices for use of MRIguided radiation on brain tumours.

As the first and only Canadian centre to be able to offer MRI-guided radiation to patients, Sunnybrook's team will remain at the forefront of cancer care, and an invaluable source of expertise and teaching for cancer ablation specialists across the country.

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"This technology is going to allow people to have their treatments faster, and will result in improved quality of life," says Dr. Law. "More importantly, for those who can't be treated today, this will define how we're going to treat them tomorrow."

A truly global effort
Sunnybrook isn’t just acquiring a groundbreaking MR-Linac. It’s helping to finalize the technology ahead of its commercial release.

The Odette Cancer Centre, along with a consortium of international partners, will assist in the testing of the machine created by Elekta and Philips, two global health-care technology leaders. This partnership will lead to clinical trials that provide patients with the chance to access innovative therapies.

“We will be the first in Canada to deliver external-beam radiation guided in real time by MRI. Our responsibility now is to advance the whole field of external-beam radiotherapy, which is exactly what we’re going to do,” says Dr. Sahgal, head of Sunnybrook’s Cancer Ablation Therapy program.

It’s a passionate cause that requires great dedication from the team. “We have a major research program here in the department of radiation oncology where almost 40 per cent of our staff on any one day is working on the MR-Linac project,” says Dr. Sahgal.

Preparing a new suite to house the MR-Linac is proving to be an engineering feat. “It’s a massive machine; it’s a massive undertaking in terms of construction and development,” he says. “It’s going to require a hole in our ceiling, bringing in this massive machine through two floors into a radiation facility. We’re committed to that type of massive construction feat because we believe in this technology.”

Sunnybrook isn’t doing it alone. “The Ontario government believed in this project, and supported us financially, so that we could get our legs off the ground and then build on it,” says Dr. Sahgal. “Private donors, too, have been indispensable to the effort and continue to enable our mission of advancing radiation oncology with MRI.”

The consortium of global partners is installing MR-Linacs one by one and Sunnybrook hopes to have theirs in 2016.

“We’re so excited about the future. We’re trying to bring it here as fast as we can,” says Dr. Law. “Now it’s real. Hope is there.”

This is the last part of a three-part series on new high-precision cancerradiation technologies coming to Sunnybrook in 2016.

This content was produced by The Globe and Mail's advertising department. The Globe's editorial department was not involved in its creation.

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