Treatment Options & Radiation Innovations
CTRC is constantly making advances in cancer treatment. Two such examples in the area of radiotherapy are called intensity modulated radiation therapy (IMRT) and high dose rate (HDR) brachytherapy that is used for various types of treatment including gynecological, prostate and breast cancer.
The CTRC has a state of the art PET/CT scanner. This scanner combines the sensitivity of positron emission tomography (PET) with the utility of computed tomography (CT) into one scanner, allowing physicians to get much more information while only scanning the patient one time. When diagnosing and treating cancer, it is important to know where the cancer cells are located, but it is also important to know where the healthy tissue is in relation to the cancer cells. PET images are used to locate actively growing cancer cells and are more sensitive to cancer cells than CT scans, but they do not provide information about healthy tissue. CT images are used to show all of the internal structures inside the body, including healthy tissue and cancer cells. By using one machine to take both scans at once, a computer can combine the two sets of images and show the physician exactly where the cancer cells are relative to the normal and healthy tissue.
4D CT Scanning
The CTRC has the ability to perform 4D CT scans along with the standard CT scans. Typically, CT scans show patient anatomy at a point of time. The scan will show the physician where the internal tissues and organs were at the time the scan was performed, but they do not show how the organs move inside the patient when the patient breathes. For organs that tend to move, this is very important information the physicians did not have access to until 4D scans. A 4D CT scan is a CT scan that is taken over a longer time period, and it allows the physician to see exactly how the organs and tissues move inside the patient while the patient breathes. This is critical when a radiation oncologist is deciding how to treat a patient, and it allows the radiation oncologist the ability to track the tumor while the patient breathes to make sure that the tumor is receiving the correct amount of radiation.
With 4D CT information, physicians can see how much a tumor moves while the patient breathes. With this information and with CTRC’s new respiratory gating technology, radiation treatments can be monitored to more accurately focus the radiation on the tumor while giving less radiation to healthy tissue. The patient’s breathing is monitored, allowing physicians to know exactly where the tumor is during the breathing cycle. This information is then used to control the radiation treatment by turning the radiation on only when the area for treatment is within the planned radiation field. This enables the physicians to give more radiation accurately to the treatment area which increases the probability of controlling the cancer while reducing the risk of side effects.
External Beam Therapy
In our facilities, radiation treatments are delivered using photon and electron beams produced by seven state-of-the art linear accelerators. The beams are shaped to conformally treat the tumor while minimizing the dose to healthy tissue and organs. Intensity modulated radiotherapy (IMRT) was pioneered at CTRC along with multi-modality (CT, PET and MRI guided) planning. Those tools allow us to optimize the treatment design and to improve on treatment outcome.
IMRT is a sophisticated and effective radiation delivery system. It shapes the intensity of the radiation to deliver varying doses of radiation to small areas of tissue, conforming to the specific three-dimensional shape of almost any tumor. Doctors can deliver enough radiation to kill a tumor while sparing healthy surrounding tissue. Some IMRT techniques deliver a higher dose of radiation to the patient each day, potentially shortening the duration of the overall treatment and improving the potential for success. IMRT therapy may also lead to fewer side effects during treatment. The CTRC has delivered over 20,000 IMRT treatments and is among the most experienced IMRT centers in the world.
Helical tomotherapy (Highly Integrated and Adaptive Radiotherapy – HiART System) is an evolutionary form of external beam radiotherapy. Tomotherapy delivers a very sophisticated form of IMRT and integrates treatment planning, patient positioning, and treatment delivery in one system. CTRC is one of the first cancer centers in the U.S. to adopt this new technology.
Brachytherapy is a method of using radiation to treat cancer by placing radioactive sources inside the tumor. It treats tumors from the inside out which results in more radiation to the tumor and less radiation to healthy tissue. Brachytherapy has been used for a variety of tumor types and sites.
In low dose rate (LDR) brachytherapy, small amounts of radiation are given over a long period of time. Radioactive sources, like cesium-137 or iridium-192, are placed in small tubes or needles and implanted into the tumor. The patient stays in the hospital for a few days or can be immediately discharged, depending on the isotope used. This form of therapy is especially useful for tumors where very high and localized radiation is needed to eliminate the cancer cells. LDR brachytherapy is often used for gynecological cancer and prostate cancer.
In high dose rate (HDR) brachytherapy, large amounts of radiation are given over a short period of time. Small tubes or needles are implanted into the tumor and then a small radioactive iridium source in inserted into the tubes or needles for a short period of time (5 minutes – 30 minutes). The source is then removed, the tubes or needles are removed, and the patient is discharged. HDR brachytherapy is often used for gynecological cancer, breast cancer, and prostate cancer.
Breast Cancer Brachytherapy - MammoSite®
The CTRC is a leader in delivering MammoSite, an innovative radiation treatment option for breast cancer. MammoSite is a form of partial breast irradiation that is appropriate for some early stage breast cancer patients. Radiation therapy with MammoSite can be completed in 5 days. This procedure delivers radiation from within the body, minimizing the effects of radiation on nearby healthy tissues. Relatively quick and simple to perform, MammoSite uses only a single catheter with an inflatable balloon at its tip. A radioactive source is temporarily inserted into the inflated balloon. MammoSite patients are treated twice a day for five days as opposed to conventional external beam radiation therapy which is usually given over six to seven weeks to the whole breast. As with any medical procedure, it is important for women to discuss treatment options with their physician to determine what is right for them.
Prostrate Cancer Brachytherapy
Brachytherapy is a treatment for early stage prostate cancer, when the cancer is confined to the prostate gland. CTRC continues to lead in the planning and delivery of brachytherapy radioactive seed implants for prostate cancer. Prostate brachytherapy involves implanting tiny pellets containing radioactive iodine or palladium into the prostate tumor where the pellets give off radiation over time.
Using transrectal ultrasound (TRUS), an image of the prostate is visible on a monitor, and used for guidance when placing up to 100 seeds or more into the prostate. There is no need for a surgical incision. Instead, the radioactive seeds (which are smaller than a grain of rice) are contained in thin needles that are passed into the prostate gland through the skin between the scrotum and anus (Perineum). This is usually performed under either a spinal or general anesthetic. As the needles penetrate through the prostate they are seen on the monitor and can be accurately guided to their final position.
The radioactivity of the pellets slowly decays during the months after the operation, and there are few long-term risks associated with this treatment.
Facilities And Radiation Therapies
The CTRC is an open-staffed shared facility where both university and private practice radiation oncologists treat patients. Multi-modality clinics in head and neck, CNS, thoracic, and breast cancer are held weekly. The CTRC is a modern, well-equipped, state-of-the-art radiation therapy center. Capabilities include: