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RADIATION THERAPY

Radiotherapy is a non-invasive modality of cancer treatment required by 50 - 60% of patients. It is least traumatic and most cost effective. It can be given alone as well as concomitantly with surgery / chemotherapy. The radiation therapy has evolved in the last decade with innumerable innovations in delivering safe, efficient and quality radiation with minimal dose and in shortest time by using the V-MAT technology. It is usually given by external beam (Linear Accelerators) or internally by using Brachytherapy. Before radiation therapy is started, a detailed custom made treatment planning is done for each and every patient.

TREATMENT PLANNING FOR RADIATION

It is an elaborate process requiring preparation of cast / mould for immobilization of the patient and contrast CT Scanning at 3 mm - 5 mm cuts of the tumour. C. T. images are directly transferred to the treatment Planning System. On the basis of the images, contouring of the tumour is made on each section of CT scan along with critical structures. A prescription is worked out on the basis of tumour volume, nature of tumour and general condition of the patient etc.. Physicist works out optimal field projection to the tumour area with minimal radiation to critical structures through Varian/ Elekta software developed for each type of treatment protocol like IGRT, IMRT, SBRT or SRS / SRT etc.

These plans are jointly reviewed by Radiation Oncologist and Physicist and the best option is accepted for execution of treatment. Patient is then taken up for treatment. Once again the field verification (confirmation of accurate treatment position) is done through portal imaging on KV (or) MV basis which is incorporated in the Linear Accelerator.

Treatment Delivery

Radiation Therapy is given as a fractional treatment whereby the patient receives a daily dose of radiation, five days a week for six to seven weeks for radical treatment. At each daily treatment, the linear Accelerator is rotated around the patient so that the entire tumor receives an optimal radiation dose. The geometry and intensity of the radiation field is adjusted to match the size and shape of the tumor and the type of cancer. Treatment beam is shaped using a multileaf collimator (MLC) within the Linear Accelerator head that functions like the aperture of a camera.

Department of Radiation Oncology

Department of Radiation Oncology at Dharamshila Hospital And Research Centre was started with cobalt machine in 1994 and High Dose Rate Brachytherapy was added in 1997. Department has been continuously adding newer technologies by commissioning Siemen's Dual Energy Primus Linear Accelerator in 2002, Varian's Clinac DBX in 2005 with IMRT capabilities and has now added Elekta Synergy with V MAT in 2010 with IGRT, IMRT, SBRT or SRS / SRT capabilities.

This constant pace of innovation yields the potential for greater accuracy, short treatment time, reduced integral dose (one tenth, to prevent damages to healthy tissues surrounding the tumour), increased tumour control probability and above all possibility of modulating the radiation intensity with single or multiple arcs.

HIGHLIGHTS OF LINEAR ACCELERATORS

Our Linear Accelerators have capability to deliver Image Guided Radiation Therapy (IGRT), Intensity Modulated Radiation Therapy (IMRT), Stereotactic Radio surgery(SRS), Stereotactic Radio Therapy (SRT) and Stereotactic Body Radiation Therapy (SBRT) with 4,6,15, MV Photons and 4, 6, 8, 10, 12, 15 and 18 Mev Electrons. The Cutting edge technology comes with the following features :

Volumetric Modulated Arc Therapy (V-MAT)

It is a next generation arc therapy technique that has established new standards for Radiation Therapy by reducing the treatment delivery time to few minutes. This reduces the potential for patient motion and enables better patient comfort and tolerance. It is most suitable for very sick patients, elderly and children.

V MAT gives

  • full 40cmX40cm Uninterrupted field size
  • variable gantry Rotation speed
  • continuous collimator angle optimizations
  • single or multiple superimposing arcs
  • coplanar or non coplanar arcs
  • active leakage Reduction
Multileaf collimators with dynamic movement - Sophisticated IGRT and IMRT tools, including microleaf collimators for SRS, SBRT

Portal imaging and CBCT for patient position verification

Record and verify system

Database storage about the treatment and its parameters

Very fast delivery of IMRT plans

Sequence mode imaging allowing true evaluation of patient motion during treatment position.

Inspiring clinical confidence for IGRT

Elekta Synergy is the first and most advanced multifunctional Linear Accelerator which enables clinicians to image and treat patients at the same frame of reference. Clinicians can visualize soft tissue details in any part of the body.

The ability to image at the point of treatment and in the treatment position reduces issues related to organ movement and inspires the clinical confidence to pursue IGRT delivery. This brings 4D adaptive IGRT into routine clinical use.

Elekta Synergy Volume view, offers two potential benefits:-
  • The ability to minimize side effects of RT by reducing the margins previously set to account for uncertainties of target dimensions, location and movement.
  • The potential to adopt dose escalation and hyper fractionation regimes with the confidence that 3D plan will be delivered as an accurately targeted 3D treatment.

Imaging and Positioning

Our Linear Accelerators offer both MV, KV and Xvi imaging at the time of treatment. High conformance radiation treatment modalities require precise positioning, immobilization and organ motion management. To address the issue of motion management, Dharamshila Hospital offers range of solutions for the entire body i.e. Body Fix, Active Breathing Coordinator, Head fix, SRS / SRT frame etc.

RADIATION APPLICATIONS

IMRT (Intensity Modulated Radiation Therapy)

This highly complex and promising techniques was started at Dharamshila Hospital in 2005. Now, IMRT is being delivered through V-MAT techniques in a continuous arc around patient effectively, from infinite delivery angles; reducing the integral dose to one tenth and treatment time to few minutes. IMRT is used for tumours arising from Head and Neck, Brain, Lungs, Lymphomas and Gynecological cancers.

IGRT (Image Guided Radiation Therapy)

IGRT has been evolved to enable clinicians to treat the tumors that move along with respiration or have internal motion. IGRT provides a very effective means for mitigating the risk of tumor motion. Real time image guidance and adoptive radiation therapy involves constantly imaging the motion of the tumour during treatment delivery and changing beam delivery on the fly to compensate for unpredicted motion. IGRT is most suitable for tumors of the lung, prostate, urinary bladder, breast and mobile portion of tongue.

Stereotactic Radio surgery (SRS)

SRS is a non invasive procedure, best suited for treating intracranial tumours, vascular malformations and small extracranial lesions. Significantly higher surgical doses of radiation are delivered over significantly shorter treatment sessions (1 - 5) with a curative intent in contrast to treatment with cyberknife, which is palliative. The benefit lies in the potential for better tumour control with higher doses, as well as the sharper dose profile used to targeting cancerous tissue while sparing surrounding healthy critical structures.

Stereotactic Body Radiation Therapy (SBRT)

SBRT is used for patients with spinal, paraspinal and lung tumors. It is mainly used for small tumors in the body where a high precision dose delivery is needed to avoid long term morbidity.

Brachytherapy

Brachy means near, therapy means treatment. Brachytherapy is delivered by placing the radiation sources (Ir192) near the tumour. Our multichannel Microselectron HDR with TCS remote after loading system is a dedicated machine which delivers radiation in and around tumour. Brachytherapy can be given as under :
  • Intracavitary for cancer cervix, cancer uterus.
  • Intra luminal for cancer Oesophagus and bronchus
  • Interstitial for Breast Cancer, soft tissue sarcoma (after initial surgery), prostate, pancreatic tumour etc.
  • Surface mould for superficial cancers specially skin cancer.

Patient's surveillance during Radiotherapy

Radiotherapy produce some side effects which are directly related to volume of tumour, dose of radiation and anatomical sites. All these side effects are temporary and subside on completion of radiotherapy. Weekly clinical evaluation round is done by oncologist to see the overall progress of treatment and any associated problems. On completion of treatment, patient is provided with the summery of treatment.

BENEFITS OF VMAT TECHNOLOGY

For Patients

  • Personalized, Safe, Efficient and High Quality Radiation
  • Enhanced dose conformance as per tumour size, shape and Pathology
  • Reduced (1/10th) total radiation dose to prevent occurrence of second primary tumours.
  • Reduced treatment time (1/6th) to prevent inconvenience.
  • Minimal side effects / complications
  • Higher tumour control probability

For Physicians

  • Portal imaging and CBCT for patient position verification.
  • Largest (40 cm X 40 cm) uninterrupted field size.
  • Sequence mode imaging allowing true evaluation of patient motion during treatment.
  • Image and treat patients at the same frame of reference, visualizing soft tissue details.
  • Ultralow dose and 3D Volumetric Imaging to minimize treatment margins without compromising safety.
  • Modulating radiation intensity with single / multiple super imposing arcs.
  • 4D adaptive IGRT and fastest delivery of IMRT plans.

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