Innovative Radiation Oncology Treatments
Radiation Oncology is often the first line of attack in eradicating tumor cells. At California Pacific Medical Center we offer the innovative treatment modalities to treat a wide variety of malignancies. Radiation oncology services include both conventional and leading-edge approaches to cancer treatment and care. California Pacific offers services on some of the most modern radiation oncology equipment available.3D Conformal Radiation Therapy | Brachytherapy Program | Breast Cancer Radiation Oncology Treatments | Cone Beam CT (CBCT) | Image-Guided Radiation Therapy (IGRT) | Intensity-Modulated Radiation Therapy (IMRT) | RapidArc Radiation Therapy | Respiratory Gating | Stereotactic Radiosurgery & Radiotherapy
3D Conformal Radiation Therapy
A CT scan is used to obtain a detailed 3D description of a patient's internal anatomy. The 3D information is used to create models of the tumor volume and any organs needing protection during the radiation treatment. The goal is to shape the spatial distribution of the prescribed radiation dose so that it matches the shape of the 3D image of the cancerous tumor cells as closely as possible, thereby minimizing radiation to surrounding healthy tissue.
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Brachytherapy and high-dose rate brachytherapy for treating prostate cancer involves the transrectal ultrasound (TRUS) guided placement of radioactive seeds directly into the prostate gland. This technique allows a higher and more directed dose of radiation to be delivered, essentially treating the tumor from the inside out rather than from the outside in. Decreased radiation doses to the surrounding normal tissue lowers the risk of long-term side effects.
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Breast Cancer Radiation Oncology Treatments
Although whole breast irradiation has a long track record of success in preventing breast cancer recurrence, if breast cancer is diagnosed early and has not spread to lymph glands. We work with you to determine the best treatment options for your breast cancer.
Intraoperative Radiation Therapy (IORT)
Intra-operative radiation (IORT) therapy allows us to deliver a concentrated dose of radiation to the tumor site immediately after removal while in the operating room, helping to eradicate the microscopic tumor cells that may be left behind. For a small group of patients, IORT may be the only radiation treatment they need – largely dependent on the patient’s age, tumor size, lymph node status and tumor characteristics.
Short-course Breast Radiation Oncology
For many women who have had breast tumors removed by lumpectomy (to preserve the breast), short-course radiation therapy has proven to be a safe and effective treatment option. Standard adjuvant radiation treatment for breast cancer usually is delivered everyday over six to seven weeks. The short-course therapy is up to three weeks shorter and causes fewer side-effects. Although the shorter course is attractive, it is only recommended for women who have had a lumpectomy and whose breast cancer has been diagnosed early.
Partial Breast Radiation Oncology
Also for women who have had breast cancers removed by lumpectomy, multi-catheter brachytherapy, balloon catheter brachytherapy (MammoSite), and three-dimensional (3D) conformal external beam radiation are partial breast radiotherapy options. Partial breast radiation oncology is limited to the lumpectomy cavity plus a margin of surrounding healthy tissues.
During multicatheter brachytherapy, doctors insert approximately 15 – 20 hollow tubes into the tumor site. Radioactive seeds are inserted into the tubes and left for approximately 5 – 10 minutes. The seeds are removed after each treatment, however the tubes remain in place for the duration of the radiation treatment, usually seven to 14 days.
The balloon catheter brachytherapy method uses a catheter (tube) with a balloon to fill the space where the breast tumor was removed. The small balloon is inflated with fluid and remains in place until the treatment is completed. During treatment a radiation pellet is inserted into the center of the balloon (via catheter) for about 5 – 10 minutes at a time. The seed is removed after each treatment and given twice a day for usually five days. The position and shape of the balloon is checked prior to each treatment.
3D conformal external beam radiation delivers a targeted radiation beam from outside the breast. A 3D model of the targeted area is generated using CT planning techniques. The radiation beams are programmed to hit only the site where the tumor was removed via lumpectomy and a small margin of healthy tissue. This technique spars a considerable amount of healthy tissue.
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Cone Beam CT (CBCT)
Cone beam CT improves tumor targeting using high-resolution, low-dose digital imaging in the treatment room. This allows our radiation therapists to confidently manage treatment and target tumor movement — both before and during treatments. The use of kV imaging can result in lower patient dose and better image quality than megavoltage imaging.
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Image-Guided Radiation Therapy (IGRT)
IGRT coordinates the radiation treatment plan with three-dimensional (3D) images to enhance radiation beam accuracy on targeted tumors. The high-resolution images produced by the IGRT On-Board Imager™ enables clinicians more precise treatment delivery and planning, improving radiation beam accuracy by pinpointing tumor location with unprecedented speed. Increased precision ensures targeted accuracy, avoiding surrounding critical structures. A tighter tissue margin spars surrounding healthy tissues and allows a bigger radiation therapy dose delivery rate directly to the targeted tumor. A larger radiation dose destroys cancer cells quicker without increasing treatment side effects. This application helps deliver adequate radiation for tumor elimination while minimizing radiation exposure of healthy tissue.
Tumors move during radiotherapy due to biological reasons such as breathing, swallowing and bladder filling. By combining scanning and radiation equipment to produce real-time images of the patient’s organs in the treatment position at the treatment time optimizes the accuracy and precision of the radiotherapy. Using the IGRT On-Board Imager we verify tumor location prior to each treatment and make any needed adjustments. IGRT is used for treating any cancer responding to radiation therapy outside the head.
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Intensity-Modulated Radiation Therapy (IMRT)
IMRT is an advanced type of high-precision conformal radiation. IMRT utilizes computer-controlled X-ray accelerators to deliver three-dimensional (3D) radiation beams conformed closely to the shape of the tumor. This precise targeting enables physicians to control the intensity of the radiation beam dose distribution within a given area. Therefore, IMRT allows a much higher radiation dose focused within the tumor while minimizing the radiation dose delivered to the surrounding normal critical structures and tissue. Multileaf collimators or beams can be turned on or off, or be blocked during treatment, varying the radiation beam intensity across the targeted field.
Treatment is carefully planned, often over several days, using 3D computed tomography (CT) with computerized dose calculations to determine the dose intensity pattern that best conforms to the tumor shape. IMRT combined with 3D CT, called inverse treatment planning, creates the custom-tailored radiation dose consisting of several hundred small beams of varying intensities that pass through normal tissue without doing significant damage, but converge to give a precise doses of radiation at the tumor site.
IMRT is being used to safely treat prostate, head and neck, central nervous system, breast, thyroid, lung, and gynecologic cancers.
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RapidArc Radiation Therapy
Our radiation oncologists use RapidArc®
Radiation Therapy to deliver precise treatments in shorter times than conventional intensity-modulated radiation therapy (IMRT). Used for all types of cancer—including cancer of the prostate, head and neck, and gastrointestinal system—this treatment delivers a radiation dose to the whole volume, rather than slice by slice—and in 80% less time than conventional IMRT.
Patients can benefit from this treatment as it delivers a higher dose of radiation in less time with fewer treatments.
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Respiratory gating technology is used to synchronize radiation delivery with the patient’s breathing. The goal is to spare healthy tissue and structure while treating tumors with high-dose radiation therapy. With each breath, tumors move, sometimes up to two inches. Respiratory gating technology minimizes the dose of radiation delivered to healthy tissues by using a multislice, four-dimensional CT scanner and computers capable of storing and manipulating multiple CT images. Our experts measure the patient's range of motion during respiration and customize the treatment field to the patient. During treatment, the radiation beam is continuously turned on and off to synchronize delivery of radiation during the optimal point of the patient's respiration cycle. Thus, delivering radiation to the tumor between the breathing cycle, when there is the least amount of movement.
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Stereotactic Radiosurgery & Radiotherapy
Stereotactic Radiosurgery and Radiotherapy deliver precise finely collimated beams of radiation to intracranial and extra-cranial lesions. This treatment modality can be an alternative to, or used in conjunction with open surgery. Both single fraction radiosurgery and multiple-fraction radiotherapy treatments are intended to improve a patient’s quality of life and decrease treatment related complications, by minimizing radiation dose to surrounding normal tissues.
Using the Exac Trac® Stereotactic Ablative Brain Radiation (SABR) Knife, we are able to treat brain, prostate, lung, spine or pancreas cancers using the fastest stereotactic radiosurgery (SRS) treatments available. With the ExacTrac® SABR Knife frameless radiosurgery treatments, using automatic setup and Trilogy’s delivery system, most patients are in and out of the treatment room within 15 to 25 minutes and in one to five treatment sessions.
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