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3-D Conformal Radiation Therapy
3-D Conformal Radiation Therapy is a specialized planning technique that uses advances in 3-D treatment planning to determine the configuration of a radiation beam so that it precisely conforms to the targeted tumor. This treatment planning allows for the integration of data from multiple diagnostic tests such as CT scans, MRI scans, and PET scans to determine the absolute location of the tumor and the vital normal tissues around it. This makes it possible to conform radiation into the tumor while missing critical normal surrounding tissue even more so than with standard treatment planning. The ability to limit the volume of tissue treated, allows the delivery of a higher dose of radiation than that used in standard treatment to the targeted tumor, increasing the ability to kill the tumor cells while delivering less radiation to nearby normal tissues.
Brachytherapy (Internal Radiation)
There are several types of internal radiation or brachytherapy techniques that may be given as the only radiation treatment or in conjunction with external beam radiation. Brachytherapy is often used in the treatment of cancers of the cervix, endometrium, prostate, and head and neck areas. Some treatments require hospitalization and others are performed on an outpatient basis.
Brachytherapy is the temporary or permanent placement of a radioactive source either on or within body tissues or cavities. This treatment allows the delivery of a high dose of radiation to a small area while sparing the amount of surrounding normal tissue that is irradiated. There are two types of bracytherapy:
High Dose Rate (HDR)
High dose rate or HDR brachytherapy treatments utilize radioactive materials that are placed temporarily in body tissues or cavities. These implants are done with high intensity sources that move within the radiation machine, travel to the tissue or cavity being treated, and then are removed within minutes.
Small catheters are placed in the area requiring treatment. The end of the catheter will be connected to a special machine. Once connected, the staff will leave the treatment room. They will be able to communicate with you through the intercom system and will be watching you at all times via the video monitor. The machine will be turned on to allow the radioactive sources to travel from the machine to the tissue or cavity being treated. Once the radioactive sources have been in place long enough to deliver the treatment dose (usually less than 15 minutes) they will travel back to the machine housing. After the sources return to the machine, the staff will re-enter the room and verify the radioactive materials have all been removed. The machine is then disconnected from the end of the catheter and there will be no radioactivity remaining in your body.
Low Dose Rate (LDR)
Low dose rate or LDR brachytherapy treatments utilize radioactive materials that are placed either temporarily or permanently in body tissues or cavities. These implants are done with moderate intensity sources that are maintained within the tissue or cavity for several hours, days or permanently.
Cone Beam CT
This technology gets its name from the cone-shaped beam of X-rays used to collect a complete image. Unlike conventional CT, which takes a series of thin-sliced X-ray images and then stacks them together to create a complete picture, cone beam CT produces a more sophisticated image in less time and with less X-ray exposure. Cone-beam CT is an emerging technology with many advantages over conventional CT scans, such as fast volume coverage speed, efficient use of x-ray power, and sufficient data for exact 3D image reconstruction.
Cone-beam CT enhances the role of treatment, simulation, verification, and planning. It has the capability of acquiring and reconstructing 3D volumetric data in one gantry rotation. This technology allows for more precise targeting of the area to be treated as the image is taken while you are in the treatment position just before the actual treatment is given.
Image Guided Radiation Therapy (IGRT)
Image Guided Radiation Therapy involves conformal radiation treatment guided by specialized imaging tests, such as CT scans, ultrasound or stereoscopic X-rays. These images are taken in the treatment room just before the patient is given the radiation treatment. IGRT allows radiation to be delivered to tumors, using a variety of automated tracking systems, with more precision than was traditionally possible.
High-resolution imagery is obtained daily to pinpoint tumor sites, adjust patient positioning when necessary, and complete a treatment, all within the standard treatment time period. We can detect movement in normal structures or changes in tumor location or size by obtaining daily images. This permits the physician to precisely locate the tumor while the patient is in the treatment position. This minimizes the volume of healthy tissue exposed to radiation during treatment, yet allows the delivery of higher doses of radiation to the tumor volume.
Intensity Modulated Radiation Therapy (IMRT)
Intensity Modulated Radiation Therapy is an advanced mode of high precision radiotherapy utilizing a sophisticated dose calculation to design and deliver precisely targeted radiation. Dozens of uniquely shaped radiation fields are delivered to the patient using various angles and approaches. IMRT allows for the radiation dose to conform more precisely to the shape of the tumor by modulating or controlling the intensity of the radiation beam.
IMRT can create high dose volumes that are uniquely shaped, sparing critical normal issues that are extremely close to and surrounded by the tumor. The radiation oncologist along with the radiation physicist carefully evaluates the treatment plan to avoid normal tissues while adjusting radiation doses to the tumor.
Currently, IMRT is most useful in treating small, fairly stationary tumors surrounded by a large volume of normal tissue and/or critical structures that are especially close to the targeted tumor. Types of tumors that may be treated with IMRT include brain, head & neck cancer, prostate, and spinal cord. Many tumors are too large or too mobile to be treated with IMRT.
MammoSite® (APBI)
For some women who have breast conserving surgery, a new alternative in treatment is partial-breast irradiation. It works by delivering radiation from inside the lumpectomy cavity (the space left after the tumor is removed) directly to the tissue surrounding the cavity where the cancer is most likely to recur.
Accelerated Partial Breast Irradiation or APBI, is a 2-stage process: balloon placement and radiation delivery. After the surgeon performs the lumpectomy, an uninflated balloon connected to a catheter, is placed inside the cavity where the tumor was and a portion of the catheter remains outside of your breast. Once in place, the balloon is inflated with a sterile salt water solution to fit snugly into your lumpectomy cavity. The balloon remains inflated for the entire time you are receiving radiation therapy (usually 5 days).
APBI is delivered on an outpatient basis twice a day for 5 days. During radiation therapy, the portion of the catheter that remains outside your breast will be connected to a computer-controlled machine. A tiny radioactive seed will travel from the machine, through the catheter and into the inflated balloon inside your breast. The seed will remain in the balloon and deliver radiation for about 10 minutes. The seed is then retracted back into the machine. The machine is disconnected from the catheter and your treatment session is complete. No radiation will remain in your breast between treatments or after your final treatment. Usually on the same day as your final radiation treatment, the balloon will be deflated and easily removed.
RapidArc® Radiotherapy
RapidArc™ delivers treatments using a linear accelerator, equipped with an On-Board Imager® kV imaging system for using images to guide patient placement and treatment delivery. The linear accelerator rotates around the patient to deliver radiation treatments from nearly any angle. During a RapidArc treatment, radiation is shaped and reshaped as it is delivered continuously from virtually every angle in a 360-degree revolution around the patient.
Prior to delivering treatment, the exact location, size, and shape of the patient’s tumor is visually observed utilizing the machine’s On-Board Imager. After imaging is completed, the images are reviewed by the therapist and the patient’s position can be adjusted so that an accurate treatment can be delivered. Any adjustments to the patient’s position are made automatically by the treatment table.
A RapidArc radiotherapy treatment is delivered in less than two minutes and with just one turn of the machine around the patient. RapidArc treats the entire tumor with pinpoint accuracy by shaping and modulating a highly focused treatment beam so that it targets the tumor precisely, sparing surrounding healthy tissues.
Stereotactic Radiotherapy (SRS - SBRT)
Stereotactic Radiotherapy is a technique that allows for the treatment of benign and malignant tumors. This type of treatment is known as stereotactic radiotherapy (SRS) when used to treat tumors in the brain, and stereotactic body radiotherapy (SBRT) when used to treat tumors in the body. The radiation beam is precisely directed allowing the radiation oncologist to spare more surrounding tissue than with standard external beam therapy. This additional precision is attained through rigid immobilization of the body part being treated, such as with a head frame that is used in the treatment of brain tumors.
Although usually performed in a single treatment, fractionated radiotherapy (delivery of up to five treatments), is sometimes required. Stereotactic Radiotherapy may be the only treatment used if the affected area is very small. In addition to treating malignant tumors, this method has also been shown to be beneficial for the treatment of some non-cancerous conditions, including functional disorders such as ateriovenous malformations (AVM’s) and trigeminal neuralgia.
TomoTherapy®
TomoTherapy literally means "slice therapy," and gets its name from tomography, or cross-sectional imaging. The TomoTherapy Hi·Art System® delivers a very sophisticated form of intensity-modulated radiotherapy (IMRT), and combines treatment planning, CT image-guided patient positioning, and treatment delivery into one integrated system.
The equipment used for TomoTherapy looks similar to a computed tomography (CT) system. The patient lies on a treatment table that moves continuously through a rotating ring gantry which houses the linear accelerator. Radiation treatment is delivered in the shape of a fan beam as the ring is turning. With the treatment table moving at the same time the gantry is rotating, the radiation beam makes a spiral (or helical) pattern around the patient, targeting tumors with optimal levels of radiation while minimizing the dose to healthy tissues.
TomoTherapy allows the radiation treatment beam to be projected into the tumor continuously as it rotates, rather than having a limited number of fixed beams, each providing the total dose necessary to irradiate the tumor. With the TomoTherapy Hi·Art System®, radiation oncologists can adjust the size, shape, and intensity of the radiation beam to target the radiation to the size, shape, and location of the patient's tumor.
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