Radiation therapy is non-invasive treatment that uses high-energy X-rays to kill cancer cells. Radiation therapy can help you in your fight against cancer. It begins with a session to discuss treatment with your doctor. If you and your doctor decide on radiation, you will return for a simulation. The simulation is a planning session that helps the doctor target your cancer. He or she will design a radiation plan to protect normal tissues. When the simulation and plan are completed, you will begin your daily treatments. Treatment is usually once daily Monday to Friday. It takes less than a half an hour. Sometimes you may need radiation twice a day, with usually 6 hours between treatments. After the course of radiation is complete, you will be scheduled for follow-up appointments. This is to make sure the cancer is under control. The follow-ups will also make sure that any side effects from the treatment are taken care of.
Types of Radiation Therapy at CHI Health
AccuBoost® for Breast Cancer
- The breast is imaged using mammography equipment to identify the lumpectomy site in need of the boost dose. The power of the AccuBoost treatment is that the imaging equipment and radiation delivery system are combined in one platform, giving physicians the ability to accurately target the site and eliminate any guess-work.
- The AccuBoost applicators are positioned on the opposing sides of the breast to deliver a focused radiation field to the lumpectomy site.
- In the next step, the x-ray system is reoriented to target the radiation to the lumpectomy site from a different direction.
- A higher dose is accumulated in the target tissue while sparing the dose to normal skin and tissues.
AccuBoost directs the radiation parallel to the chest wall, reducing the exposure to the organs below the chest wall when compared to traditional treatment. This is especially important when undergoing treatment of the left breast where radiation below the chest wall can reach the heart as well as the lungs.
Brachytherapy involves placing some flexible plastic catheters (tiny tubes) into the breast. The treatment program at CHI Health uses 5 days of partial breast brachytherapy (temporary radiation implant) instead of 5 - 7 weeks of external beam radiotherapy. Brachytherapy has the advantages of being a shorter treatment, and irradiating less of the body.
The outpatient procedure is performed by a board-certified radiation oncologist and is done under ultrasound guidance. Nine times over the following 5 days, the catheters are briefly connected to our high-dose-rate brachytherapy machine for an internal radiation treatment through the catheters. These treatments take about 15 minutes each and are painless. On the last day, the catheters are easily removed, and you will be able to go home. During the 5 days of treatment you will be an outpatient, you will not be radioactive and you can do most of your usual activities.
CHI Health has strict eligibility guidelines for patients who are candidates for partial breast irradiation. Please contact your physician for more information.
High Dose Rate (HDR) Brachytherapy is used quite frequently in our department. A small sealed radioactive source (Iridium-192) is placed in very close proximity or inside the area requiring radiation treatment. The radiation from the iridium-192 is very localized to the area around the source while healthy tissue farther from the source receives a much reduced dose. The advantage of brachytherapy is that the tumor can be treated with very high doses of localized radiation while reducing the probability of unnecessary damage to nearby healthy tissue. This treatment is very effective for benign or malignant skin cancers. It is also used for lung and gynecological treatments. A big part of our HDR program is the use of the Accuboost system used for image guided breast irradiation. Women with early stage breast cancer often choose to have a lumpectomy. To minimize the chance of cancer recurrence, doctors usually recommend a course of radiotherapy. The course of radiotherapy may include the use of Accuboost which is an IGRT system designed to easily locate the site of the surgical tumor bed and reduce the radiation dose to the heart and lungs.
Cyberknife Robotic Radiosurgery is a non-invasive alternative to surgery for the treatment of both cancerous and non-cancerous tumors anywhere in the body, including the prostate, lung, brain, spine, liver, pancreas and kidney. This system delivers high dose radiation to tumors with extreme accuracy. CyberKnife treatment involves no cutting but uses robotics to provide a pain-free, non-surgical option for patients who have inoperable or surgically complex tumors, or who may be looking for an alternative to surgery. CyberKnife delivers an intense dose of radiation from more than 1,000 different points surrounding the cancer. That intensity and pinpoint accuracy means patients typically need fewer than five treatments and have far fewer side effects than other radiation treatments.
External Beam Therapy
External Beam Therapy includes the use of a linear accelerator as part of the cancer treatment to control or kill malignant cells. It may also be used as part of adjuvant therapy, to prevent tumor recurrence after surgery (for example, early stages of breast cancer). Radiation therapy is often used along with chemotherapy, and has been used before, during, and after chemotherapy in susceptible cancers.
Image-guided radiation therapy is special imaging technology that allows the Radiation Therapists to image the tumor immediately before the radiation is delivered, while the patient is positioned on the treatment table. These images are taken using an On-Board Imager and then evaluated by the doctor using specialized software and compared to the reference images taken during simulation. Any necessary adjustments are then made to the patient's position and/or radiation beams in order to more precisely target radiation at the tumor.
Intensity Modulated Therapy
Intensity Modulated Radiation Therapy uses a computer to control the linear accelerator allowing precise delivery of the radiation dose to the malignant tumor. Treatment is carefully planned using computed tomography (CT) or magnetic resonance (MRI) scans. 3D images of the patient are used in conjunction with computerized dose calculations to determine the dose intensity pattern that best conforms to the patient’s tumor size and shape. This custom tailored radiation dose maximizes tumor dose while minimizing dose to adjacent normal tissue.
Respiratory Gating is used when there is a concern that the tumor may move during treatment due to normal patient breathing patterns. This system allows the radiation beam to be “gated” or turned on and off in response to tumor motion. No other radiation therapy department in Lincoln has respiratory gating.
Selective Internal Therapy
Selective Internal Radiation Therapy is used by Interventional Radiologists at CHI Health for the treatment of tumors in the liver. When it is not possible to surgically remove these tumors, radioactive microspheres are infused via a small catheter into the portal vein to deliver yttrium-90 directly into the liver tumors. Clinical trials have demonstrated safety and efficacy of Y-90 treatment of both primary and metastatic liver malignancies.
TomoTherapy® Hi·Art® (Highly Integrated Adaptive Radiotherapy) System, allows doctors to check the location of tumors before each treatment, then deliver painless, precise radiation therapy resulting in unmatched accuracy for cancer patients, especially those with breast, lung and prostate tumors.
TomoTherapy combines Intensity Modulated Radiotherapy (IMRT) with a computerized tomography (CT) scanner allowing doctors to view the treatment area in three dimensions. This 3D technology allows physicians to verify the position of the tumor before each treatment session, so adjustments can be made on the spot to make sure that radiation is delivered exactly where it should be.
The unique CT scanner design delivers radiation continuously from every angle, unlike traditional radiation therapy equipment which projects radiation from only a few directions. TomoTherapy transforms a single beam of radiation into tens of thousands of tiny beamlets aimed directly at the tumor in a 360 degree delivery pattern. This helical delivery allows for unprecedented precision, meaning less damage to surrounding healthy tissue. Some of the benefits of TomoTherapy are:
- Does not require a lengthy set-up process
- Targets large, small and multiple lesions
- Thousands of rotating beamlets allow for precise delivery treatment
- Locates tumors before each treatment
- Minimizes radiation to surrounding healthy tissue
Our department uses radiation therapy for several applications in non-malignant conditions, such as the treatment of trigeminal neuralgia, acoustic neuromas, severe thyroid eye disease, prevention of keloid scar growth, and heterotopic ossification.