Adaptive Intelligence in Prostate Cancer Radiation With Christopher Iannuzzi, MD

Hartford HealthCare’s Fairfield Cancer Center, the first designated Memorial Sloan Kettering (MSK) Care Partner, is pioneering the use of adaptive radiation for prostate cancer with the Varian Ethos Radiation Therapy System, which utilizes adaptive intelligence to personalize treatments in real time. In this discussion, Dr. Christopher Iannuzzi, Medical Director of Radiation Oncology and Chair of Oncology at St. Vincent’s Medical Center, outlines how adaptive intelligence is refining treatment precision and patient experience in prostate cancer.

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MSKCC Care Partner Model

As an MSK Care Partner, Fairfield Cancer Center offers the same standards of care. “How a patient is worked up, treated, and followed is the same whether you’re at MSK or at our cancer center,” Dr. Iannuzzi said. He underscored ongoing audits and rigorous quality review to sustain the highest standards of care.

What Is Adaptive Intelligence?

“Adaptive intelligence is a concept of adaptive planning and artificial intelligence,” Dr. Iannuzzi explained. “We leverage those two technologies to be able to deliver a very precise and personalized radiation plan for patients.” This cutting-edge technology enables real-time plan optimization based on current anatomy and imaging.

How the Ethos System Works

Unlike static plans derived from computed tomography (CT) days or weeks before treatment is initiated, Ethos acquires a new image at each visit and auto-contours the tumor and organs at risk. “Every day that a patient comes in, a new image is taken, and the system rapidly develops a new plan on the same day,” said Dr. Iannuzzi. This enables the radiation dose to be tailored to daily variations.

Impact on Outcomes

Greater geometric accuracy can enhance radiation dosing while sparing adjacent structures. “If you have more precision and more accuracy, then you are delivering a more effective dose to the tumor and less of a dose to critical normal structures in that area,” Dr. Iannuzzi underscored. “That should lead to better outcomes, better cancer cure rates, and fewer side effects from the treatment.”

Candidate Selection and Current Use

The Fairfield Cancer Center currently uses Ethos to deliver stereotactic body radiation therapy (SBRT), which delivers high-dose radiation over the course of five treatments. Dr. Iannuzzi notes that Ethos is most beneficial for patients whose tumors are next to organs that may shift while in clinic. “If there are differences in how the rectum or the bladder are filling, we can make these fine adjustments from treatment to treatment.” In the future, the use of Ethos is planned to be expanded to patients with pancreatic, rectal, and gynecologic cancers.

Whole-Person Care in Prostate Cancer

Dr. Iannuzzi urged guideline-informed screening and treatment planning conversations using a shared decision-making model. He also reiterated the benefits of holistic care provided at Fairfield. “We want people to know that not only will they get the best technology and clinical expertise, but that we’ve built our cancer center with the idea of taking care of the whole individual.”

Key Takeaways

Adaptive intelligence can improve dosing precision and reduce toxicity in prostate radiation therapy.
MSK Care Partner status ensures protocol alignment, audits, and quality oversight.
Ethos is well-suited for patients whose tumors are near mobile organs.
Clinicians should promote shared decision-making in prostate cancer therapy planning and consider patient-centric, holistic care settings.

About Dr. Iannuzzi

Christopher Iannuzzi, MD, is the Medical Director of Radiation Oncology and Chairperson of Oncology at St. Vincent’s Medical Center and Fairfield Cancer Institute at Hartford HealthCare in Connecticut. He specializes in all aspects of radiation oncology, with particular clinical and research interests in prostate cancer radiation therapy.