High-Dose Radiation (HDR) Brachytherapy

Brachytherapy remains an integral component in the treatment of cancer in both an outpatient and an inpatient setting. It involves the placement of either permanent seeds or hollow needles into the tumor though which a radioactive source can irradiate tumor from the inside out. By placing these needles into the tumor, we can avoid irradiating surrounding critical organs. The operator must be well trained to perform these highly technical procedures, and we at the CCI remain at the forefront of these procedures. We have been trained to perform procedures such as intracavitary and interstitial brachytherapy for prostate, cervical, endometrial, breast and sarcomatous tumors. In addition, with the use of high dose rate brachytherapy, we have dramatically reduced the treatment times to minutes. With the help of our physics team, we are the leading experts in the South Bay in performing these highly specialized techniques. Examples of brachytherapy procedures performed include:

• Breast Cancer: Multi-catheter balloon placement for Accelerated Partial Breast Irradiation

• Prostate Cancer: Permanent seed placement using Iodine-125 brachytherapy seeds or high dose rate brachytherapy using the Syed-Neblett Template

• Cervical Cancer: High dose rate brachytherapy using the tandem and ovoid system. For locally advanced disease, we use interstitial brachytherapy using the Syed Neblett template. We are currently one of the hand full of centers capable of performing this procedure using this template in the entire nation.

• Endometrial Cancer: Vaginal cylinder brachytherapy <TOP>

Intensity Modulated Radiation Therapy (IMRT)

Intensity-modulated radiation therapy (IMRT) is an advanced mode of high-precision radiotherapy that utilizes computer-controlled linear accelerators to deliver precise radiation doses to a malignant tumor. IMRT allows for the radiation dose to conform more precisely to the three-dimensional (3-D) shape of the tumor by modulating´┐Żor controlling´┐Żthe intensity of the radiation beam. This is done by dividing this beam into thousands of small pencil sized beamlets. IMRT also allows higher radiation doses while minimizing the dose to surrounding normal critical structures. Treatment is carefully planned by using 3-D computed tomography (CT) images of the patient in conjunction with computerized dose calculations to determine the dose intensity pattern that will best conform to the tumor shape. Typically, combinations of several intensity-modulated fields coming from different beam directions produce the desired treatment plan.

Because the ratio of normal tissue dose to tumor dose is reduced to a minimum with the IMRT approach, higher and more effective radiation doses can safely be delivered to tumors with fewer side effects compared with conventional radiotherapy techniques. IMRT also has the potential to reduce treatment toxicity, even when doses are not increased. IMRT does require longer daily treatment times, however with Volumetric Modulated Arc Therapy (VMAT) (a newer way of delivering IMRT) treatment times have been reduced substantially.

Currently, IMRT is being used most extensively to treat cancers of the prostate, head and neck,and central nervous system. IMRT has also been used in limited situations to treat breast, thyroid, lung, as well as in gastrointestinal, gynecologic malignancies and certain types of sarcomas. IMRT may also be beneficial for treating pediatric malignancies.

Radiation therapy, including IMRT, stops cancer cells from dividing and growing, thus slowing or stopping tumor growth. In many cases, radiation therapy is capable of killing all of the cancer cells, thus shrinking or eliminating tumors. <TOP>

Imaged-guided Radiation Therapy (IGRT)

• Advanced technology that targets tumors more accurately and delivers radiation more precisely.
• Pre-treatment imaging allows visualization of internal anatomy and allows fine adjustment prior to treatment delivery.
• Provides real-time precision and accommodates changes in tumor and surrounding anatomy over the full course of treatment.

Intensity Modulated Radiation Therapy (IMRT) is a very accurate method of delivering radiation in a highly conformal and homogenous manner. This allows us to sculpt our radiation around the target and avoid surrounding critical organs. It is often used for prostate, gynecologic, head and neck and gastrointestinal malignancies. However, without proper visualization of the target prior to each radiation treatment, the risk of missing the target due to organ motion remains quite high. Our Elekta Infinity allows us to obtain a CT scan just prior to each treatment. This in turn allows us to know exactly where the tumor target is just before treatment. If the tumor is not within our target field, we can shift the patient position accordingly. This results in very precise localization and treatment, and patients can rest assured that they received the most accurate treatments. <TOP>

Volumetric intensity modulated arc therapy (VMAT)

• Specialized method of IMRT allows more rapid delivery of radiation and reduction of treatment time. This in turn increases patient comfort and reduces patient motion during treatment. <TOP>

LUNG symmetry

• A new approach to cancer treatment that addresses the effects of respiratory and organ motion. • Technique enables margin reduction without complex set-up or external markers and maximizes symmetrical dose distribution to moving targets. • Includes 4-D image acquisition to find the weighted average position of the tumor for each treatment. Lung Cancer is the leading cause of cancer mortality. Radiotherapy plays a central role in the treatment of this aggressive tumor. However, many of these patients have decreased lung function and the sparing of surrounding lung tissue is paramount. This can be successfully performed using an advanced technique of localizing the tumor called Lung Symmetry.

Lung Symmetry is a method of localizing the lung cancer that allows us to track the movement of the tumor as the patient breathes in and out. This allows us to shrink and conform our radiation volumes exactly around the tumor. This in turn, decreases the dose to the surrounding structures such as lung, heart, esophagus and spinal cord. This leads to decreased treatment toxicity and increased patient outcomes. Please click on this link below to view lung symmetry demonstration. <TOP>

3D CT Planning

• Cancer Care Institute has a wide bore General Electric state of the art CT simulation scanner, allowing the physicians and staff to be able to visualize the target area and surrounding organs in 3 dimensional space. This also allows our most advanced treatment planning system to make over 1 trillion calculations to create the most precise radiation dose plans using the CT scan obtained. This wide bore CT allows us to scan the patient in the actual treatment position, allowing for highly reproducible treatments. <TOP>

Stereotactic Body Radiation Therapy (SBRT)

• SBRT is a form of stereotactic radiosurgery that uses a linear accelerator (Linac) to treat tumors in specific parts of the body such as spine, lung and liver. SBRT is often used in patients that have recurred after prior radiotherapy, have unrespectable tumors or when a tumor is next to or within an organ that is extremely sensitive to radiation.

Oftentimes, patients with early stage lung cancer are not suitable candidates for curative surgery. When this occurs, SBRT is an excellent alternative that has been found to be just as effective. Like SRS, it involves the use of highly conformal beams that converge on our target. This decreases the dose to surrounding structures and thereby allows us to escalate the dose of radiation safely with decreased toxicity. This results in increased eradication of tumor cells and increased local control.

However, SBRT has been used in several other tumors as well, including:
• Early stage lung cancer
• Liver metastases
• Hepatocellular carcinoma
• Spinal Tumors <TOP>