Technology

In rural areas, access to quality cancer care is especially challenging. The cumbersome process of traveling long distances for care is exacerbated by the symptoms associated with disease, leaving many rural cancer patients undertreated. However, a relatively new telecommunication technology offers one way to overcome the geographic barriers faced by rural Americans. Cancer Care & Economics (CC&E) spoke with Ryan J. Spaulding, PhD, director of the Center for Telemedicine and Telehealth at Kansas University Medical Center (KUMC), Kansas City, about how telemedicine helps serve patients in rural Kansas.

A device that displays a holograph-like 3-dimensional (3D) image, created from a CT, MRI, or PET dataset, holds promise for more accurate radiotherapy treatment planning (see image on page 1). James C. H. Chu, PhD, professor of radiation oncology, Rush University Medical Center, presented results of a pilot study of the Perspecta Spatial 3D System, developed by Actuality Systems, Inc. (Bedford, Massachusetts), at the 48th Annual Meeting of the American Society for Therapeutic Radiology and Oncology

A novel laser engineered to home in on tiny tumors may someday enhance early detection of cancers in breast, skin, and other tissues, researchers report.

The health care industry increasingly relies on information technology for a growing variety of professional purposes. According to national surveys, medical professionals spend at least 50 minutes each night doing Internet-based research, and 21% of physicians use e-mail to communicate with their patients. In this "Spotlight on Technology," CC&E reports on an Internet provider that recently launched a new domain specifically designed to help oncologists enhance the clinical/business performance of their practices.

Recognizing a need to upgrade and modernize our health care delivery system, Congress included provisions in the Medicare Modernization Act (MMA) of 2003 intended to foster the widespread adoption of health information technologies. Cancer Care & Economics (CC&E) recently spoke with David Merritt, an expert on health information technology (HIT), about how electronic innovations can reduce the medical errors and costly inefficiencies that burden our health care system.

Surgery for cancer carries concerns of tumor dissemination related to tumor manipulation, tumor violation, and wound seeding. Minimally invasive surgery is now standard for several benign conditions, such as symptomatic cholelithiasis and surgical therapy of gastroesophageal reflux. With the minimally invasive surgery explosion of the 1990s, virtually every procedure traditionally performed via laparotomy has been performed successfully with laparoscopic methods, including pancreaticoduodenectomy for cancer. Shortly after the first descriptions of laparoscopic-assisted colectomy, reports of port-site tumor recurrences surfaced, raising concerns of using pneumoperitoneum-based surgery for malignancy. This review covers the development of laparoscopic surgery for cancer. Historical perspectives elucidate factors that helped shape the current state of the art. Theoretical concerns are discussed regarding surgery-induced immune suppression and its potential effects on tumor recurrence with both open and laparoscopic approaches. The concerns of laparoscopic port-site wound metastases are addressed, with a critical evaluation of the literature. Finally, a technical discussion of laparoscopic-assisted resections of hepatic and pancreatic tumors details patient selection, operative approach, and existing data for these operations.

The National Cancer Institute (NCI) and the National Human Genome Research Institute (NHGRI), both part of the NationalI nstitutes of Health (NIH), have launched a comprehensive effort to accelerate our understanding of the molecular basis of cancer through the application of genome analysis technologies, especially large-scale genome sequencing.

Stereotatic body radiation therapy (SBRT) is a rapidly evolving cancertreatment method in which concepts and techniques previously developedfor brain tumor radiosurgery are adapted to eradicate tumorselsewhere in the body. The spatial accuracy, conformality, and steepradiation dose gradients of radiosurgery, which have been critical to itssuccess in the treatment of intracranial tumors, are applied in SBRT totreat a variety of extracranial tumors. Early results demonstrate excellentresponse rates and low toxicity with a variety of hypofractionateddose regimens and localization/immobilization techniques. This articleprovides an overview of the rationale and results of SBRT for specificindications, descriptions of some methods of treatment delivery, anddiscussion of potential areas of future investigation.

This is a period of rapid developments in radiotherapy for malignantdisease. New methods of targeting tumors with computed tomography(CT) virtual simulation, magnetic resonance imaging (MRI), andpositron-emission tomography (PET) fusion provide the clinician withinformation heretofore unknown. Linear accelerators (linacs) withmultileaf collimation (MLC) have replaced lead-alloy blocks. Indeed,new attachments to the linacs allow small, pencil beams of radiation tobe emitted as the linac gantry rotates around the patient, conforming tothree-dimensional (3D) targets as never before. Planning for these deliverysystems now takes the form of "inverse planning," with CT informationused to map targets and the structures to be avoided. In thearea of brachytherapy, techniques utilizing the 3D information providedby the new imaging modalities have been perfected. Permanentseed prostate implants and high-dose-rate (HDR) irradiation techniquestargeting bronchial, head and neck, biliary, gynecologic, and otheranatomic targets are now commonplace radiotherapy tools. CT-guidedpermanent seed implants are being investigated, and a new method oftreating early breast cancer with HDR brachytherapy via a ballooncatheter placed in the lumpectomized cavity is coming to the forefront.Newer modalities for the treatment of malignant and benign diseaseusing stereotactic systems and body radiosurgery are being developed.Targeted radionuclides using microspheres that contain radioemittersand other monoclonal antibody systems tagged with radioemitters havebeen recently approved for use by the Food and Drug Administration.

NEW ORLEANS-For certain types of patients with brain metastases, the addition of stereotactic radiosurgery after whole brain radiation therapy improved survival as well as local control, performance status, and steroid dependency, according to a phase III study by the Radiation Therapy Oncology Group (RTOG). Lead investigator Paul W. Sperduto, MD, of Methodist Hospital, Minneapolis, presented the results at the 44th Annual Meeting of the American Society for Therapeutic Radiation and Oncology (abstract plenary 5).