Radiation Therapies

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Radiation Therapies

There have been many advances on conventional radiotherapy in recent years, particularly in the introduction of image guided treatments, and there are many competing proprietary technologies. We list here a few of these that are in use at the advanced treatment centres today.

Trilogy® radiotherapy

With the Trilogy® radiotherapy system, the width of the radiation beam can be adapted to the volume of the tumour and it also has 'stereotactic' abilities in some body areas. This enables it to fix the location of the tumour before and during each treatment session.

The tumour can therefore be targeted more accurately than with conventional radiotherapy. Not only does this reduce damage to surrounding healthy tissue, but it enables greater power to be used, which shortens each treatment session.

Trilogy stereotactic radiotherapy

TomoTherapy® Hi-Art® system

The ring gantry-based TomoTherapy® platform combines integrated CT imaging with conformal radiation therapy to deliver sophisticated radiation treatments with speed and precision while reducing radiation exposure to surrounding healthy tissue.

The Hi·Art® treatment system delivers helical (continuous 360º) IMRT (intensity modulated radiotherapy that uses tens of thousands of narrow beamlets, all targeting the tumour and individually optimised to contribute to the total required dose.

TomoTherapy HiArt system

Radiation therapy is now a very common form of treatment for many forms of cancer, either alone or in conjunction with surgery or other treatments, but this takes a wide variety of forms.

External radiotherapy is usually applied over several weeks, but still some patients prefer to travel for treatment. There are two main reasons for this.

External radiotherapy

■	Advanced radiotherapy systems target tumours more accurately, reducing the impact on the surrounding tissue.
■	In many countries patients report long delays for radiotherapy, and this can even apply for private patients. No-one likes to have to wait when they have cancer, but centres like Klinik Hirslanden in Zurich, Switzerland offer radiotherapy almost immediately. In practice this means that radiotherapy can start as soon as you can arrange to be there.

These are examples of new generation IGRT (image guided) amd IMRT (intensity modulated) radiotherapy devices, found in advanced treatment centres today, but there are others.

Intraoperative radiotherapy (IORT)

Originally developed with brain tumours in mind, this is now more commonly used for breast cancer. Treatment is given in a single dose during open surgery, directly to the tumour bed, rather than through the skin and intervening tissue some time after the operation.

Intrabeam®

This not only saves radiation burn and damage to healthy tissue but can also cut weeks from conventional external radiotherapy by delivering 20-30% of the total required radiation in a single dose.

Visit the IORT for Breast Cancer page on our web site MHL Clinics for more details of breast treatments. Intraoperative radiotherapy is also used for other soft tissue sarcomas such as rectum, stomach, pancreas, kidney and gynaecological tumours.

One of the leading stereotactic radiotherapy systems is Intrabeam® from Carl Zeiss Meditec and another is Mobetron® from IntraOp Medical Corp

Advanced Radiation Therapy Centres

Visit the Cancer Treatment Centres page, which also covers centres offering surgical and medical oncology options.

Note: MHL has no contractual or financial relationship with any of the manufacturers listed on this page.

Radiosurgery

This is very different to radiotherapy. Radiosurgery uses radiation beams of much higher power and greater precision than radiotherapy, with the result that treatments can be reduced to as little as a single session of 45-90 minutes.

CyberKnife®

The leading system of radiosurgery is CyberKnife® and we have a separate web site dedicated to this and providing an on-line enquiry form for a choice of centres. CyberKnife is not suitable for all tumours but it can be the only form of treatment available for complex tumours in sensitive locations and it may offer an alternative to open surgery.

Visit the CyberKnife page for more details

Even with advanced tumours or the recurrence of a tumour following radiotherapy, brachytherapy offers patients considerable advantages. It may be used alone or in conjunction with traditional radiotherapy and/or chemotherapy.

Brachytherapy therefore allows a higher radiation dose to be administered in the shortest possible time. The total duration of treatment is, in general, reduced from six weeks to one week. A further advantage is the significantly lower radiation exposure of patients compared to traditional radiotherapy.

Here the radiation source is placed in direct contact with the tumour. The advantage is that the radiation takes effect directly in the malignant tissue. This means that the fall-off of in the radiation dose in the surrounding tissue is much higher than with external radiotherapy.

Brachytherapy

Ion-beam therapy is an extension of proton therapy where, in addition to protons, ions of carbon, oxygen and helium are used. These carry much greater mass, so scattering of the beam is greatly reduced and high doses of destructive radiation can be delivered with unprecedented accuracy

Total radiation delivered can therefore be up to 20% higher than with conventional radiotherapy and this difference can be sufficient to kill some tumours which otherwise resist and survive radiotherapy.

Ion-Beam Therapy

Proton Therapy

Visit the proton therapy page for more details.

Proton therapy uses protons (hydrogen ions) instead of X-rays and the radiation is confined much more closely within the target area. This avoids many distressing side effects of conventional radiotherapy and it reduces the risk of new cancers developing in later life, due to the effects of the radiation treatment, so it is especially beneficial for children.

Low power proton therapy has been used for eye treatments for some time, because the radiation does not penetrate to sensitive areas beyond the target tumour. Now higher power systems using proton scanning allow for extremely accurate targeting of even deep tumours, whilst greatly reducing the exposure of adjacent areas to damaging radiation.

Proton therapy requires fewer daily treatments and can also be used in sensitive areas where conventional radiotherapy is impossible.

Proton scanning system for greater accuracy

Synergy® radiation therapy system

The Synergy system brings 3D image guidance into the treatment set up process, with imaging tools to visualise tumour targets, normal tissue and their movement between and during fractions. Imaging can be performed with the patient in the treatment position to optimise patient setup.

The accuracy achieved means that most treatments can be completed within one week, rather than several weeks for conventional radiotherapy.

Key imaging tools include 3D and 4D volumetric cone-beam imaging for soft tissue, 2D real-time, fluoroscopic-like imaging for targets that move frequently and 2D kV imaging for standard and orthogonal planar imaging. A 40 x 40 cm uninterrupted field size simplifies and refines treatment of larger-field targets.

Synergy® radiation therapy

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