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New software systems for patient-friendly cancer radiotherapy

The new large-scale cooperative project SPARTA is aimed at developing adaptive, intelligent and flexibly expandable software systems for the improved radiotherapy of cancer. The Heidelberg Institute of Radiation Oncology (HIRO), which integrates the common research interests of all institutions in Heidelberg active in the field of radiotherapy, plays a pivotal role in the project.

The research project “Software Platform for Adaptive, Multimodal Radio- and Particle Therapy with Autarkic Extendibility” (SPARTA) commenced on April 1st, 2013. Scientists from ten German institutions are developing novel software systems to support clinicians during planning and application of radiation therapy and making radiation therapy more efficient, safe and effective. The project is funded by the German Federal Ministry of Education and Research with grants totalling eight million euros, of which one third is injected into HIRO, the Heidelberg Institute of Radiation Oncology which brings together the Department of Radiotherapy Research at the German Cancer Research Center (DKFZ), Heidelberg University Hospital and the Heidelberg Ion-Beam Therapy Center (HIT). 

A difficult balancing act

Besides surgery and chemotherapy, radiation therapy is currently one of the most important treatment methods for cancer. At present, around half of all cancer patients are treated with photon or particle ion beams. The goal is to expose the tumours to a strong dose of targeted radiation without affecting surrounding healthy tissue. However, the targeted destruction is somewhat limited, especially when malignant tumours within or adjacent to radiation-sensitive organs like the eyes, brain, spinal marrow or lungs require treatment. Researchers like Prof. Dr. Wolfgang Schlegel from the Department of Medical Physics in Radiation Oncology at the DKFZ have been working for many decades on the improvement of tumour treatment methods. Under Schlegel’s leadership and in cooperation with medical technology companies, highly complex collimators were developed. These collimators enable several beams from different directions to become more aligned in a specific direction. The goal is to apply the highest possible radiation dose to the tumour cells without damaging surrounding healthy tissue.

Tumours in the vicinity of sensitive tissue structures are currently mostly treated with a method known as “intensity-modulated” radiation therapy. Rather than exposing a tumour to several strong photon beams, many individually dosed beams from different directions are made to coincide at a specific location. The beams are targeted to overlap in the tumour, with the result that the highest dose is only administered at this location. The surrounding healthy tissue remains only marginally affected. In practice, however, this method is somewhat limited because a single application of such radiation has very little effect. Over a series of weeks, patients undergo several treatments. During this time, the patient's body and the tumour can change. Moreover, the tumour inevitably shifts as the patient breathes during radiation. All this affects the target of the radiation and increases the risk that beams partially miss the tumor and instead damage healthy tissue.

SPARTA’s goals

The objective of SPARTA is to counteract these difficulties by developing novel, adaptive and expandable software systems that make radiation therapy more efficient, safe and effective. The Fraunhofer Institute for Medical Image Computing MEVIS, which is the coordinator of the project, summarises the project goals as follows:

  • Precise measurement of individual variations. Computer-supported imaging and sensor systems should be able to precisely measure any change in patients’ anatomy over the weeks of treatment and during radiation.
  • Precise dosage estimation. The software should be able to compare the original radiation plan to variations that arise between or during treatment sessions, allowing clinicians to reliably determine the cumulative dose that a tumour has received after a certain number of treatments.
  • Intelligent adaptation of the radiation plan. The programme should be able to judiciously adapt a radiation plan to measured changes and to expected variations between and during each patient’s treatment. Moreover, planning should become adaptive, and be capable of simple and flexible adjustment. The programme also needs to be expandable to meet future requirements. 
  • Detailed analysis of the tumour. Computed tomography will be used to determine the position of a tumour. Magnetic resonance imaging (MRI) and positron emission tomography (PET) will be used to determine structure and activity of a tumour. The researchers will assess the benefit of such procedures for more precise and efficient radiation therapy planning. 

Optimisation of radiation therapy

SPARTA’s project goals are exactly in line with those of HIRO: the improvement of cancer therapy by applying radiation therapy that has been optimised based on physical and molecular biology investigations. The Heidelberg researchers all have defined tasks in this large-scale project. Researchers at the DKFZ are developing algorithms and software that calculate the cumulative radiation dose received by a patient after a certain number of treatments from daily values determined with imaging methods. Changes in the position of tumours, of cancers in the head-neck area, for example, between individual treatments will be determined through clinical examinations and radiation adjusted with automated correction systems. Radio-oncologists from the DKFZ and Heidelberg University Hospital will carry out clinical trials in order to assess ways to optimise the planning of prostate cancer radiation using different types of imaging methods. The SPARTA projects at the DKFZ are coordinated by radiologist Dr. Dr. Christian Thieke; the SPARTA projects at Heidelberg University and HIT are coordinated by Prof. Dr. Dr. Jürgen Peter Debus, medical director of the Department of Clinical Radiology/Radiation Therapy at Heidelberg University Hospital.

The National Center for Radiation Research in Oncology Dresden/Heidelberg

Der Postgraduierten-Studiengang "Advanced Physical Methods in Radiotherapy" (APMR) vermittelt neben der Theorie auch praktisches Wissen. © HIRO

The Heidelberg Institute of Radiation Oncology (HIR), which is directed by Profs. Debus and Schlegel, is a worldwide unique interdisciplinary alliance of clinicians and scientists in the field of radiation medicine. Its activities range from basic research to clinical studies and clinical care and involve all areas of diagnostic and therapeutic radio-oncology, radiation physics, medical informatics and radiation biology. HIRO scientists also play a key role in the postgraduate course “Advanced Physical Methods in Radiotherapy” (APMR) offered by the Medical Faculty of Heidelberg University. 

In 2010, the German Minister of Education and Research appointed HIRO and the OncoRay centre (a joint institution of the Dresden Technical University, University Hospital and the Dresden-Rossendorf Research Centre) “National Centre for Radiation Research in Oncology”. The two sites complement each other perfectly. According to the chairman of the DKFZ, Prof. Dr. Dr. h.c. Otmar Wiestler, together the two institutions cover the entire range of radiation therapy research. He also highlighted that such strategic partnerships need to be expanded to include partners from industry in order to be competitive on the international level.

The SPARTA project, which involves OncoRay and other academic partners, also has this as an objective. Additionally, SPARTA brings on board industrial companies, including the Siemens group and Precisis AG, a small medical device manufacturer based in Walldorf near Heidelberg that develops high-precision devices and software for use in neurosurgery and radiotherapy.

Website address: https://www.gesundheitsindustrie-bw.de/en/article/news/new-software-systems-for-patient-friendly-cancer-radiotherapy