Our Radiation Therapy department uses ionizing radiation to treat many types of cancer (both malignant and non-malignant) with the intent to either cure the disease or for palliative care. We use all three main divisions of radiation therapy: external beam therapy (XRT), brachytherapy, and radioisotope therapy. The differences relate to how the radiation is administered. XRT is directed from outside the body at distance of about 1 meter. Brachytherapy uses sealed radioactive sources placed in close proximity to the tumor, and systemic radioisotopes are given by infusion or oral ingestion.
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.
Our Radiation Therapy department is the only site in Lincoln accredited by the American College of Radiology. We have state-of-the-art technology including Intensity Modulated Radiation Therapy, Image Guided Radiation Therapy, Respiratory Gating, Cyberknife radiosurgery, High-dose rate brachytherapy, and Selective Internal Radiation Therapy.
Intensity Modulated Radiation 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.
Image-guided radiation therapy
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.
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.for
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.
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.
Treating the Breast while Sparing the Heart
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.
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.
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.
Selective Internal Radiation Therapy
Selective Internal Radiation Therapy is used by Interventional Radiologists at CHI Saint Elizabeth 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.
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.