Through research and the use of groundbreaking radiation treatment, Baptist Health Miami Cancer Institute is providing hope — and potentially longer lifespans — for patients with inoperable pancreatic cancer.

The Institute has been at the international forefront of using MRI-guided technology to safely deliver precisely targeted doses of radiation to pancreatic tumors, using a condensed treatment period of five outpatient sessions or less.

“Within the last few years, we’ve seen dramatic advances in the technologies that allow us to give extremely high doses of radiation that can completely obliterate or eradicate tumors,” says Michael Chuong, M.D., medical director of the Institute’s Department of Radiation Oncology. “We here at Miami Cancer Institute have been one of the early pioneers of this technology that allows us to offer exceptionally sophisticated treatments for even the most complex cancer and have much higher success rates. This is something that has not become available at most cancer centers throughout the United States, or even internationally.”

When surgery is impossible, radiation can provide an alternative. In 2018, Miami Cancer Institute was the second center in the U.S. to treat patients with the MRIdian Linac, the first FDA-approved MR-guided radiation therapy system. Since then, the Institute has become one of the most experienced centers treating inoperable pancreas cancer and other challenging cancers with this advanced device. The Institute also is a leader in research aimed at defining novel clinical indications and best treatment techniques for MRIdian Linac.

A Good Outcome For a Pancreatic Cancer Patient

The treatment gave patient Doug Woolard, the retired athletic director from the University of South Florida in Tampa, something he thought he was running out of: an opportunity to see his grandchildren grow, time to enjoy fishing and boating, and freedom from pain caused by an abdominal tumor that recurred after extensive treatment elsewhere for pancreatic cancer. “I have a chance to continue enjoying myself, enjoying my family, enjoying life,” Mr. Woolard says. “I don't think I'd have that chance if I hadn't come here.”

Mr. Woolard — who had already undergone a Whipple procedure, liver ablation and extensive chemotherapy — drove across Florida from his home in Clearwater for treatment at Miami Cancer Institute when he was unable to get further care closer to home. He was referred to Dr. Chuong. “They said he's one of the leading persons not only in the nation, but in the entire world, who is very proficient at this, to the point where he actually goes around and teaches other radiation oncologists this procedure,” Mr. Woolard says. “I said, ‘I'm in! Count me in!’”

After five sessions of highly focused radiation treatments that lasted about 45 minutes each, Mr. Woolard and his wife drove back home.

“I'm really excited to say that his scans since then have shown that he has no evidence of any active cancer in his body,” Dr. Chuong says. “Not only did he tolerate the treatment without any major side effects, but the pain that he had from the tumor before we treated him also completely went away and has never come back. Perhaps most importantly, the tumor we treated went away and has not reoccurred after several years.”

Mr. Woolard’s tumor was challenging because it  was it wrapped around some critical blood vessels and was up against his small intestines, Dr. Chuong says. “This is something that just a few short years ago we thought not to be possible.”

Details on the Treatment

MRIdian Linac “marries” the technology used for radiation treatments with magnetic resonance imaging, allowing continuous real-time monitoring as therapy is administered. Unlike MRI systems used in diagnostic radiology, the MRIdian Linac’s high-definition imaging capability was purpose-built to address specific challenges including beam distortion, skin toxicity and other safety concerns that can occur when high magnetic fields interact with radiation beams.

“It allows us to deliver pinpoint radiation to tumors in the abdomen in such a way that has never been possible before,” Dr. Chuong says. “Through this precision and accuracy, we are able to deliver such a high dose of radiation that we can potentially completely eradicate even very large tumors.”

Throughout treatment, MRI scans help track changes in the anatomy each day and also adjusts for even small changes during breathing, allowing very precise targeting of tumors such as those located in the lung, liver and pancreas.

Patients are able to start treatment potentially several weeks sooner than with traditional radiation, which first requires the placement of small metal fiducial markers as surrogates for tumor position that are poorly visualized using CT scans. With MRIdian, the tumor itself can be clearly seen with MRI, making fiducial marker placement unnecessary.

Institute physician-researchers contributed to new international guidelines on radiation dosing and targeting strategies recently published in the International Journal of Radiation Oncology, Biology, Physics.

At the 2024 meeting of the European Society for Radiotherapy and Oncology (ESTRO), Dr. Chuong presented research from the Phase 2 Trial of Stereotactic MRI-guided Adaptive Radiation Therapy in One Fraction (SMART ONE). Dr. Chuong, the lead physician for the MRI-guided radiation program at Miami Cancer Institute, co-led an international multicenter trial for patients with inoperable pancreatic cancer.

In the Phase II SMART trial, physicians used noninvasive MRI technology to deliver very high ablative radiation doses for advanced pancreatic tumors in only five outpatient sessions. The study investigators published encouraging results that 53.6 percent of patients with inoperable pancreatic cancer were still alive after two years. In comparison, just 20 percent of patients who receive chemotherapy and standard radiation therapy are expected to live two years after diagnosis.

The success of the SMART trial has paved the way for the multi-center phase 3 LAP-ABLATE trial (NCT05585554) being led by Dr. Chuong and other internationally recognized pancreas cancer experts. Patients eligible for enrollment include those with locally advanced pancreatic cancer with no evidence of tumor growth after initial chemotherapy. They will be randomized 2:1 to receive ablative radiation therapy using the MRIdian Linac or no ablative radiation therapy.

“When we consider treatment with higher doses, it’s not just the technology that makes the difference; it is pairing the technology with expertise to deliver the treatment appropriately,” Dr. Chuong says. “As one of the first adopters of this technology in the United States and worldwide, Miami Cancer Institute has substantial experience treating patients with the most difficult tumors. We’ve had patients be referred from across the world, as far as Thailand and Brazil, as well as domestic patients from other academically renowned institutions that don’t have this technology.”

Success in cases such as Mr. Woolard’s are very gratifying as they pave the way for future advances.

“The fact that we could potentially change the treatment paradigm for patients with certain cancers who are not surgical candidates without causing toxicity is incredible,” Dr. Chuong says. “We're really excited by the outcomes that we've seenWe can help patients get through treatment in a relatively short period of time, with excellent quality of life, minimal side effects and the potential to live longer.”