A new, more effective option for radiation therapy is coming for cancer patients at UW Health, one that experts hope will not only make treatment more affordable, but also more empowering for patients.
The University of Wisconsin-Madison affiliated health system announced Tuesday it has struck a deal with Leo Cancer Care, a Middleton-based medical products company, to be the first medical center in the world to use the company’s new radiation device.
The device, dubbed “Marie” in honor of radiotherapy pioneer and Nobel Prize-winner Marie Curie, allows patients to receive radiation treatment while sitting upright, instead of the usual way of lying flat on their backs. And, instead of rotating hundreds of tons of metal around the patient to deliver the radiation beams, Marie rotates the patients, turning their bodies to the precise angle at which the radiation needs to be delivered to treat the person’s cancer.
UW Health expects to start treating patients with the device in 2024, when construction on its new cancer treatment center is scheduled to be complete.
There are several benefits to treating cancer patients while they’re sitting upright, said Paul Harari, chair of UW’s Department of Human Oncology.
One is that sitting upright is a more natural position for the body. When a patient lies down, their organs move, making it harder to target only the cancer.
He used the example of breast cancer patients: when they lie on their backs, their breasts flatten against their chest. Especially for patients with left breast cancer, that puts the area needing treatment very close to healthy heart and lung tissue.
“Now you’re bringing radiation beams from angles, and we’re always calculating: OK, we gave 6% of the dose to a sliver of the lung, and we gave 1% of the dose to the heart, because it’s right there,” Harari said.
With the patient upright, the breast can be held away from the body, delivering virtually no radiation to the other organs.
“That old theme of everybody lies on a table for X-rays and treatment, it’s really time we broke that into the modern era,” he said.
A more affordable option
There are two types of radiation therapy available today. The most common option worldwide uses X-rays to deliver radiation by intersecting multiple beams on the tumor.
The more sophisticated option, which the Marie device and others use, is a high-energy proton beam. It is much more precise and has a lower threat of hitting other areas of the body.
The proton therapy is one doctors rely on to treat particularly complicated cancers, like those near vital organs. It is also preferred worldwide when treating children, because they can face lifelong growth and development issues if radiation hits areas beyond the cancer, Harari said.
But proton therapy is expensive. That fact brings out the other appeal of Leo Cancer Care’s technology: While there are other devices that deliver proton beam radiation, the cost of doing so with the Marie is roughly cut in half.
That’s in part because the cost of more traditional devices comes not only from the technology itself, but also because building infrastructure has to be strong enough to bear the weight of the equipment.
The Marie’s footprint is about 16 times smaller than the devices that require patients to lie down, said Stephen Towe, Leo Cancer Care’s CEO. A project to install the upright radiation device generally comes out to about $20 million, compared to $40 million with the devices in which patients lie down, he said.
“This is a way of making proton therapy truly affordable for the masses,” Towe said. “There’s only 250 proton therapy rooms in the world today. There are 15,000 (X-ray beam machines). And the only reason for that disparity is cost.”
Towe called Leo Cancer Care a Wisconsin “success story,” noting the Wisconsin Alumni Research Foundation is an investor in the company and Leo’s co-founder is UW-Madison Emeritus Professor Thomas “Rock” Mackie, a biomedical engineer.
Harari agreed that the technology could be “a game-changer,” and that other hospitals will be watching closely to see if the technology will be something they too want to invest in.
A new way of doing things
Harari — who has been treating cancer patients for 35 years — said the idea of lying people on their backs for radiation treatment harkens back to an early way of delivering radiation therapy to cancer patients.
Lying patients down for radiation treatments was necessary in the era before CT scans made it so doctors could look inside a patient’s body to pinpoint a growing cancer. Because of that, cancer patients were generally diagnosed much closer to death. Lying them down was, at least in part, to put them at ease.
“I think it is true that the reason people lie down is not because it is better for them to be lying down,” Harari said. “It’s a way in which it was conceptualized to do so.”
The idea behind sitting patients upright — in addition to saving money and being more precise — ultimately comes down to giving patients agency and allowing them to look their doctor in the eye as they battle the disease together.
It’s more humane, Harari said.
For older patients, who make up the majority of cancer cases, sitting up can be more comfortable than lying on a hard surface for the treatments, which can run from five to 30 minutes at a time.
And for young children — who can have such a hard time lying still that they need general anesthesia in order to receive the treatment — Harari hopes the upright technology will make it so doctors can strap a child in the chair, flip on a cartoon, and do the whole procedure without having to deal with the sedation, the breathing tubes and the hours of recovery afterward.
Given that focus on the patient experience, both Harari and Towe said they’ll ultimately be looking for signs of the technology’s success in the quality of life that cancer survivors have after being treated using the machine.
The chance of having a treatment that is less likely to damage healthy parts of the body can make a difference on so much, Harari said, including allowing more people to work, have children, and just generally live life.
“We’re trying to create something, a movement really, to be a more human way to deliver radiation therapy,” Towe said. “To try to put some of the control back in the hands of the patient, take them away from feeling like a passenger and truly like someone who is involved in the treatment.”