Improving quality and utilisation of breast cancer care in regional NSW: Professor Joerg Lehmann's mission to improve radiotherapy

By NSW Regional Cancer Research Network (NSWRCRN) posted 24-10-2023 10:50 AM


Professor Joerg Lehmann and his team are working towards a more precise and harm-limiting method of radiation delivery for breast cancer patients. 


‘Radiotherapy is an effective treatment for breast cancer both in the early stages and in palliation for locally advanced disease’ says Professor Lehmann, a Principal Medical Physics Specialist at Calvary Mater Newcastle and Conjoint Professor at the University of Newcastle, ‘However, while radiation plays a crucial role in treating breast cancer, research indicates that incidental exposure to the heart and lungs during treatment may lead to potential long-term risk’.


Professor Lehmann is the recipient of a NSW Regional Cancer Research Network research grant to introduce refined breath hold measurement methods into breast cancer radiotherapy treatment undertaken in regional settings and to collect important clinical evidence to help optimise its integration into the clinical workflow. Important to Professor Lehmann and his team is the delivery of radiation approaches that support improving outcomes for breast cancer patients living outside of metro areas.


Through the accurate monitoring of the patient’s breath hold during breast radiotherapy, damage to the heart during radiation treatment can be decreased. Deep Inspiration Breath Hold Therapy (DIBH) optimises radiation treatment on the breast by minimising exposure to the heart and surrounding healthy tissues. The technique takes advantage of the patient's natural anatomy during deep inhalation during which the lungs expand, and the diaphragm flattens, positioning the heart further from the radiation field. Although DIBH is a standard of care for left-sided breast cancer radiation, enhancements in measurement accuracy and accessibility are needed. 


Professor Lehmann and his team have already developed a real-time monitoring system called Live EPID based Inspiration Level Assessment” (LEILA), which tracks a patient’s internal anatomical structures, such as the breast – lung interface, during breast cancer radiation. When combined with DIBH therapy, LEILA can help to ensure that the breast receives the highest curative dose while avoiding irradiation of the heart. 


“Images created with our system verify whether the patient is in the correct position in real-time. We're effectively watching a movie throughout the treatment, ensuring the correct position is held" Professor Lehmann explains. “The system can detect misalignments and promptly alert the user to stop the treatment beam if it risks hitting the heart.” Importantly, the LEILA system employs hardware that already exists on most modern machines, making it an accessible and affordable option for local radiation services. 


The potential impact of this technology is immense. Professor Lehmann envisions his team’s approach will reduce side effects on the heart and even increase cure rates. Significantly for patients, the system's precision may enable a major reduction in the number of treatments required, potentially reducing the number of treatment days for the current 16-25 down to just 5 days. This is because the approach provides clinicians with greater certainty when treating patients. For patients in regional areas a reduction in treatment days has flow-on beneficial impacts, reducing the time and costs of repeated long journeys to access treatment.


“Women living in rural NSW have been found to have worst cancer survival outcomes. Radiation therapy is an effective treatment; however, it is under-utilised particularly in Australia’s regional and rural areas where resources are limited, and standards of care may not be optimised. The implementation of the LEILA system can help reduce this disparity, by improving access and quality of breast cancer radiation therapy in regional NSW, ultimately increasing survival and quality of life for patients” Professor Lehmann adds.


The NSW Regional Cancer Research Network is funded by the Cancer Institute NSW through a Translational Cancer Research Capacity Building Grant and established through NSW Regional Health Partners.