“Turn left in one mile … recalculating route.”
Drivers who have heard the reassuring voice of a GPS navigator in unfamiliar terrain probably are familiar with those phrases — and are likely grateful for the turn-by-turn guidance this technological wonder provides in helping them arrive safely at their destinations. Before the arrival of the GPS on automobile dashboards, navigating new territory often meant driving miles out of one’s way in search of the correct route (not to mention a fair amount of exasperation behind the wheel). But now in the modern era, wrong turns are largely a thing of the past, with GPS technology capable of pinpointing location continuously and telling drivers exactly how to get from point A to point B.
In the medical arena, that same technology also is now being put to good use, enabling doctors to navigate a different kind of route — one that leads to a patient’s organ, where more targeted treatment can be delivered to patients with cancer. Known as Calypso, this revolutionary real-time tumor tracking technology was approved by the U.S. Food and Drug Administration in 2006 for use in the prostate, and is currently under consideration for treating other cancers as well.
The first hospital in the region to offer Calypso technology, Martha Jefferson spent last summer and fall installing the system’s software and equipment and training staff, and this winter the first patient reaped the benefits of this innovative treatment.
Advanced Technology, Targeted Treatment
Craig LaMountain, a 65-year-old Greene County resident, was the first person to be treated at Martha Jefferson with the new Calypso technology. While some patients might have been a bit hesitant about being the first to undergo such a novel treatment, LaMountain was eminently confident in the technology and the Martha Jefferson Cancer Center staff.
“I was diagnosed with prostate cancer in August 2012, but I waited until Martha Jefferson was ready to use the Calypso technology to start my treatment,” reflected LaMountain. “I know many people start to worry when they hear the word ‘cancer,’ and of course, that was one of my initial thoughts as well. However, after learning that Martha Jefferson had this technology, I decided to wait for training to be completed so I could be treated with Calypso. I was confident I’d receive excellent care.”
During the waiting period, prior to being treated, LaMountain did his homework. He learned about how patients with his type of cancer received treatment prior to the arrival of Calypso, and how the innovative technology would enable his doctors to take prostate cancer treatment to a whole new level.
“Before we had access to Calypso, we would do an initial targeting session and mark the tumor we needed to radiate using implanted fiducial markers, and then we’d do the radiation treatment the next day,” noted Dr. Sylvia Hendrix, radiation oncologist in the Martha Jefferson Cancer Center. “We had to proceed with the hope that things wouldn’t change from those initial markers, but we knew that wasn’t necessarily the case — internal organs are always moving due to normal physiologic events like eating, breathing and coughing.”
With Calypso, much more precise, up-to-the minute information is available to assist doctors as they prepare for treatment. The Calypso system uses three tiny electromagnetic transponders, each smaller than a grain of rice, that are implanted into the organ during a simple outpatient procedure. Then, when the time for treatment arrives, the radiation therapist positions the linear accelerator (the machine that provides the radiation), and the transponders transmit harmless radio signals to show the organ’s exact location. This tracking capability allows the clinician to make adjustments if the tumor target moves, helping caregivers to target cancers in the organ more precisely.
“With Calypso’s monitoring system, which alerts us if anything has moved or shifted, we’re expecting to see fewer side effects of radiation treatment,” said Hendrix. “The higher degree of precision allows us greater confidence that the beams are hitting the target, so we can effectively treat a smaller area. And the more focused we are around the target, the less likely we are to hit other organs.”
Undergoing Calypso treatment does require a significant time commitment. LaMountain was at the Martha Jefferson Cancer Center five days a week for a total of 42 treatments, with each session lasting about 30 minutes. But for LaMountain, having access to such advanced treatment technology was well worth the time.
“It sounds like a lot of time, but it really hasn’t slowed me down at all. I’ve experienced no side effects, and when I leave treatment I go home and do a full day’s work.”
Minimizing Side Effects, Maximizing Lifestyle
For many patients undergoing treatment for prostate cancer in years past, one of the greatest concerns has been the potential for side effects that could occur due to damage from radiation therapy. Urologists now believe, however, thanks to the new Calypso technology, that patients will benefit both in the short term and down the road.
“The narrower the area targeted with radiation, the better able we are to minimize the side effects of prostate cancer treatment, including incontinence, impotence and loss of bowel function,” noted Dr. Julian Fagerli, a urologist at Urological Associates. “I see people come in 10–20 years after radiation treatment who are demonstrating complications from that treatment. Those complications are associated with the scatter of radiation hitting the adjacent organs, and the Calypso system will minimize that form of scatter. Ultimately, this kind of tracking system can improve a patient’s quality of life both during and after radiation treatment.”
In fact, studies have shown that with the Calypso system, doctors can apply a higher dose of radiation while actually decreasing side effects.
“Calypso is synergistic with our new RapidArc® therapy (see sidebar),” added Hendrix. “The combination of more precise targeting with shortened exposure to radiation will be powerful in minimizing side effects and eradicating the cancer. The combined developments are so powerful; we expect this to be the standard of care in the future.”
While the Calypso technology should yield significant benefits, there are some patients for whom the new system may not be the best option. Because Calypso relies on radio signals from the implanted beacons, patients who are very overweight or who have metal implants or pacemakers are not eligible for treatment with the system.
“The Calypso system really is a GPS system for the body,” said Hendrix. “A GPS is most valuable when you make a wrong turn — it flags you before you’ve gone 30 miles out of your way and gets you back on track. Being able to ‘see’ the organ, reposition the beams and focus in on the target more precisely really can make a clinical difference for patients.”
As for LaMountain, now finished with his course of treatment, he’s very happy with his decision to take advantage of Calypso’s unique benefits. While he recognizes that none of us can live forever, he’s confident that — thanks to Calypso — he won’t have to worry about prostate cancer while he enjoys his golden years ahead of him.
“I am thankful I had the opportunity to reap the benefits of Calypso,” commented LaMountain. “Because of the new technology, I’ve beaten my prostate cancer and am happy to be back to my normal life again.”