IGRT
Radiation Therapy

“They answered every question I had except how I can thank them.”

What Is Radiation Therapy And How Does It Work?

Radiation Therapy is cancer’s worst nightmare. It uses high-energy X-rays or particles to change the genetic makeup of these cells and take advantage of their rapid growth cycle. So now when they try to multiply, they die. The whole goal of radiation therapy is to damage as many cancer cells as possible, while limiting harm to healthy tissue. Since healthy cells grow and divide much slower than cancer cells, normal tissues have more time to recover and are not as adversely affected by radiation. The majority of normal cells can recover from the effects of radiation and function properly. The method used to deliver radiation depends on the treatment goal and what part of the body is involved. Some methods allow the radiation to penetrate the body more deeply, while other methods are better suited to treat smaller or larger areas. Each treatment plan is tailored to each individual patient. Radiation therapy may be used alone, or combined with surgery and/or chemotherapy.

When Is Radiation Therapy Used?

Radiation therapy is now used in more than half of all cancer patients. Unlike chemotherapy, it doesn’t involve drugs and affects only the cells in the area being treated. It may be used in early stage cancers to cure or control the disease, before surgery to shrink the tumor, or after surgery to prevent the cancer from coming back. In some cases, radiation is also used to treat symptoms such as pain caused by cancer that has spread from the original site.

No matter what the solid type of tumor, radiation can generally be used to treat it. It can be beneficial for cancers of the brain, larynx, gynecological areas, breast, lung, pancreas, skin, prostate, stomach, spine, uterus, or soft-tissue sarcomas.

In prophylactic radiation therapy, radiation is given to areas that do not have cancer to prevent cancer cells from growing in that area. When radiation is given to help reduce symptoms such as pain from cancer that has spread to the bones or other parts of the body, it is called palliative radiation therapy.

What Are The Main Types Of Radiation Therapy And What Kind Will I Receive?

Most people who are treated with radiation therapy for cancer receive external beam radiation therapy, which is delivered by a machine outside the body. There are many factors that determine the best technique to use on your type of cancer – for instance, its location, how deep into the body the radiation needs to go, your medical history and health, and whether you will have other types of cancer treatment.

External Radiation Therapy

The most widely used method of delivering radiation is external (or external beam) radiation therapy. Just like the name says, external radiation is focused from a source outside the body onto the area affected by the cancer. Imagine getting an X-ray, but for a longer time. Don’t worry, radiation goes right through you and is not housed in your body. While a variety of machines deliver external radiation, the most common is a linear accelerator (or linac). The beauty of this treatment is that the X-rays destroy cancer cells while limiting any effect on surrounding normal tissue. Simulation, Treatment Planning, Plan Verification, and Treatment Delivery are the four parts to external beam therapy.

What's Involved In Planning My Treatment?

Once you take a physical exam and your medical history and test results are reviewed, you will be scheduled for a Simulation session. You’ll be asked to lie still on a CT scan table by the radiation therapist as cross-sectional images of your anatomy are obtained. They’ll use these to know the exact place in your body to aim the radiation. After this, the doctor checks the size of the tumor, the normal tissues in the area and also the areas where the tumor is more likely to spread. To help you remain still during treatment and to ensure that the radiation beam is aimed correctly, “immobilization devices” may be custom-made for you. The therapist also marks the field with freckle-sized dots with tiny permanent specks like a tattoo.

Next, the dosimetrist, radiation physicist and radiation oncologist use a Treatment Planning computer system to figure out the radiation dose, delivery time and treatment technique. Your doctor makes sense out of all the relevant information and decides how much radiation is needed, how it will be given, and how many treatments you need.

How Long Does The Treatment Take And What Happens During Each Visit?

In general, external radiation therapy usually is given for a period of 3 to 9 weeks. The treatments are once a day, 4-5 days a week. The number of treatments you’ll need and the total dose of radiation depend on the size, type and location of your cancer, your general health, and any other treatments you are receiving.

You won’t feel a thing during radiation therapy treatments. While the treatment appointments may last from 15 to 30 minutes, the actual time of each treatment is only a few minutes. The rest of the time is used to set up the equipment and place you in the correct position. Your job is easy. You just lie still and relax on a treatment table positioned under the radiation machine.

After you are in position, the radiation therapist leaves the room and turns on the machine. You can still communicate with them thanks to closed circuit television and intercom. As the therapist aims the machine at the treatment area from different angles, the machine will make humming noises, but you will feel nothing unusual. The machine can be stopped at any time, so if you have any questions or concerns, just ask your therapist.

What Are: 3-D Conformal Radiation Therapy? IMRT? Tomotherapy?

Although these sound like a lot of mumbo-jumbo, all of these terms refer to specific advanced cancer treatment planning and delivery technologies. Each one enables our doctors to protect normal tissues so that the highest possible dose of radiation can be safely delivered to the tumor. Thanks to these tools, we have the most accurate and specific information to plan your treatment and deliver the radiation exactly where it is needed.

Intensity Modulated Radiation Therapy (IMRT) is a 3D CRT-based delivery technique that varies the shape and intensity of the radiation beam and allows doctors to further lessen injury to normal body tissues.

TomoTherapy® is the newest concept in radiation therapy that breathes new life into how we fight cancer. Its revolutionary 360-degree treatment system delivers tens of thousands of zeroed-in beamlets to kill cancer cells while minimizing radiation exposure to healthy tissue.

A New “Giant Leap” In Radiation Therapy Treatment

IGRT Patients Gain The TomoTherapy® Advantage
In October 2007, The Institute for Image Guided Radio Therapy (Institute IGRT) became one of the first radiation centers in the Northeastern U.S. and one of only 30 centers around the world to offer the newest and most precise radiation therapy technology to our patients. TomoTherapy® represents the future of radiation therapy. While conventional radiation therapy machines have been adapted and readapted to keep up with advances in the field, the TomoTherapy® HI-ART System® was developed from scratch with fresh thinking at the University of Wisconsin. The leap in technology from traditional radiation therapy is overwhelming. As a result, TomoTherapy delivers unprecedented precision when treating targeted areas, which reduces the radiation dose to normal tissues and potential side effects.

No type of cancer is safe from TomoTherapy. It has broad applications in treating cancer of the prostate, breast, lung, brain, head and neck, bone and soft tissue, as well as lymphomas and multiple myeloma. It also gives new life to patients who have reached their maximum tolerance dose of traditional radiation, or who have tumors in hard-to-reach areas. To find out if TomoTherapy is the right treatment option for you, call us at (914) 848-8950.

The TomoTherapy Concept
Cancer research has advanced; why shouldn’t the radiation therapy used to treat your disease evolve as well? Unlike in the past where two machines were required to perform two essential functions, TomoTherapy® HI-ART System® functions as both a scanner to provide visual information about the anatomical target area and surrounding tissues, and a radiation delivery machine. The fact that TomoTherapy integrates both functions into one process and one machine enables it to deliver a much higher level of treatment precision.

While the TomoTherapy® HI-ART System® machine resembles a CT scanner, it is light years ahead. TomoTherapy comes at cancer from a whole different angle (360 degrees to be exact). The TomoTherapy linac delivers tens of thousands of zeroed-in beamlets of energy precisely to your unique target area. Standard linear accelerators only deliver radiation from a few fixed directions. Because TomoTherapy’s beams are directed from 360 degrees around a spiral, a much more accurate dose is focused on the tumor and less on surrounding tissues.

Thanks to TomoTherapy’s CT imaging, we can guide treatment based on what the patient’s anatomy looks like today, not last week or last month. TomoTherapy linear accelerators allows us to image internal soft-tissue anatomy, so we can now verify the precise position of your tumor and any sensitive organs before each day's treatments, as well as the radiation dose deposited. The computers in the TomoTherapy® HI-ART System® provide treatment planning that is both conformal (targeting tumor structures) and conformal avoidance (sparing sensitive structures). What this means to you is better and safer treatment, particularly for tumors that are close to critical structures, or those that can change shape or shift from day to day.

Since it’s an all-in-one system, the TomoTherapy HI-ART System® eliminates the need for a simulator, separate treatment planning computers, block cutting and compensator molding facility, and portal imaging systems. Precise Positioning: The TomoTherapy HI-ART System® uses special verification CT to confirm and then pinpoint the patient's tumor before each treatment fraction, so the clinician can adjust the plan at any time during the course of treatment. Precise Planning: The TomoTherapy HI-ART System® uses a treatment planning optimizer, which is a breeze to use compared to conventional treatment planning systems. Precise Delivery: Unlike conventional radiotherapy that delivers a wide beam of radiation from just two or three directions, the TomoTherapy HI-ART System® combines sophisticated IMRT with a spiral 360-degree delivery. This way, the desired radiation goes precisely on the tumor, and less radiation gets deposited on surrounding healthy tissue. System Integration: Summary courtesy of TomoTherapy Inc. For detailed information, visit www.tomotherapy.com.

Side Effects Of Radiation Therapy

Side effects from cancer treatment are as individual as the patients we treat. Yet they are dramatically less than they were years ago. Side effects from radiation therapy vary and depend on factors such as the individual patient, the size of the treatment area, the part of the body being treated, the type of cancer, and any other illnesses the patient may have. Before your treatment begins, your therapy team will discuss with you in detail any side effects you might experience.

Unlike chemotherapy, radiation therapy affects only the tissues exposed to radiation. The majority of patients will feel fatigued and notice skin changes, which can result from external radiation treatment to any part of the body. In some cases, people report no side effects at all. Most side effects are nothing to worry about, and can be controlled with diet or medication.

Side Effects Common To All Treatment Areas
The most common side effect of radiation to any part of the body is fatigue. It sets in after a few weeks of therapy. You can reduce stress and help your body cope with the treatment by getting plenty of rest and pacing your activities. If you feel like it, exercise is recommended in moderation. You will get stronger gradually after treatment has been completed. In very few cases, radiation therapy can cause anemia, which contributes to fatigue. Your blood counts may be checked for this condition.

External radiation can make skin in any area treated become dry, red, tender and itchy. It looks a lot like sunburn, or in the later stages of treatment, a suntan. Everyone reacts differently, and the intensity varies depending on the area treated and the total dose of radiation delivered. The more severe reactions tend to occur in areas of the body with curved surfaces, such as the jaw and neck, or folds under the breast. Sometimes patients who have undergone chemotherapy are more prone to sensitive skin reactions. As the course of treatment comes to an end, some skin areas may become moist and “weepy” (moist reaction). Most skin reactions disappear a few weeks after treatment ends.

Breast
If you are receiving radiation treatment to the breast, you may experience skin changes in the treated area. While under treatment, unfamiliar sensations in the breast are common. After radiation therapy, your breast may be firmer, larger due to fluid buildup, or smaller due to tissue changes. In some cases, the skin of the breast is more sensitive or less sensitive after treatment.

Chest
If you are receiving radiation treatment to the chest area, you may experience skin changes in the treated area. You may have a sore throat and a hard time swallowing, or may develop a dry cough. Occasionally, patients experience indigestion while receiving treatment. At the conclusion of treatment, you may experience symptoms due to inflammation of the lung, such as cough, fever or shortness of breath. Since radiation treatment can lower the number of blood cells, blood counts are monitored before, during and after therapy.

Abdomen
If you are receiving radiation treatment to the abdominal area (for kidney, stomach, pancreatic and some colorectal cancers), you may experience skin changes. Permanent darkening of the skin or hair loss in the treated area is common. Sometimes patients experience nausea, vomiting or diarrhea, which can all be controlled with medication. On occasion, you may experience indigestion while receiving treatment. In women, the menstrual periods stop after radiation treatment to the abdomen. Since radiation treatment can lower the number of blood cells, blood counts are monitored before, during and after therapy.

Pelvis
If you are receiving radiation treatment to the pelvic area (for gynecologic, prostate, bladder and some colorectal cancers), you may experience skin changes. Permanent darkening of the skin or hair loss in the treated area is common. Some patients may experience diarrhea, urinary discomfort and urgency, or rectal fullness/burning. In cases where we treat colorectal or prostate cancer, patients may experience rectal bleeding (bloody stools). In certain gynecologic cancers, the vagina may become dry, narrower and less flexible, making intercourse painful. Vaginal narrowing may be prevented by vaginal dilation. In women, the menstrual periods stop after radiation treatment to the pelvis. In both sexes, a loss of fertility can occur. If you are treated for prostate cancer, you may experience impotence. Since radiation treatment can lower the number of blood cells, blood counts are monitored before, during and after therapy.

Head And Neck
If you are receiving radiation treatment to the head and neck area, you may experience skin changes. Permanent darkening of the skin or hair loss is common. You may develop irritation of the tissues in the mouth and throat, which may become sensitive or painful. Other side effects include a reduction in the amount of saliva produced, leading to mouth dryness, or changes in the saliva itself, such as thickening. You may lose your sense of taste or have difficulty swallowing. Some patients can become hoarse or experience the sensation of a lump or obstruction in the throat.

Brain
If you are receiving radiation treatment for brain cancer, you may experience reddening, itching or darkening of the skin of the ears and scalp. Temporary or permanent hair loss is common. In some cases, you may feel nauseous for several hours after treatment. In rare cases, headaches are felt. Occasionally, patients feel sleepy toward the conclusion of the treatment course. Short-term memory loss and a sensation of fullness in the ears or “popping” type sounds are other side effects that may be experienced.