Treatments

The goal of three-dimensional conformal radiotherapy (3D-CRT) is to deliver a dose that conforms to the shape of the tumors, while sparing surrounding healthy tissue. This approach uses 3D images in the treatment planning process and is (often more precise) than conventional radiotherapy. With this approach, CT and/or MRI images are used to define the areas of treatment and to distinguish the tumor from normal structures. With this data, the physician can develop a complex treatment plans that delivers most concentrated dose of radiation within the confines of the tumor. 3D-CRT is used to treat tumors that in the past might have been considered too close to vital organs and structures for radiation therapy.

The explicit inclusion of the temporal changes in anatomy during imaging, planning and delivery of radiotherapy.  Completing 4D CT Imaging is the acquisition of a sequence of cat scan imaging over consecutive phases of a breathing cycle, i.e. inspiration, expiration, normal breathing. This imaging technique allows for the physics team to complete a 4D Treatment plan designing treatment on CT image sets obtained for each phase of the breathing cycle. Utilizing the 4D Treatment plan allows the therapy team to deliver the radiation dose throughout the breathing cycle. 

Adaptive Radiation Therapy (ART) allows physicians to continually modify a patient’s treatment plan based on new measurements of tumor size or the tumor cavity, and any relevant changes in the patient’s own anatomy.  Because adaptive radiation therapy systematically monitors these and other important variables, our experts can make significant adjustments in the field of treatment, and in dosage of radiation given, early on. This approach allows us to customize the therapy to the individual patient, and target radiation therapy with greater accuracy and precision. 

Brachytherapy is a radiation therapy modality that allows the escalation of radiation dose while sparing normal tissues. Increased radiation dose has been shown in many situations to provide improved results by improving local tumor control. Brachytherapy involves the placement of radioactive sources ("seeds" or wires) either in tumors (interstitial implants) or near tumors (intracavitary therapy and mold therapy). The radiation is emitted outward, unlike external beam radiotherapy, where radiation must transverse normal tissue in order to reach the tumor. The word "brachytherapy" means "short therapy", appropriately implying that the radiation is limited to short distances. This results in decreased toxicity and/or allows the escalation of radiation dose. Brachytherapy can be used intraoperatively in situations where surgery is not possible or not optimal or in situations where prior dose-limiting external radiotherapy has already been given. Combined approaches of surgery and brachytherapy can often improve the results of surgery alone in a variety of malignancies.

At Columbia University Irving Medical Center, brachytherapy has successfully been used to treat a variety of tumors, including tumors of the cervix, esophagus, biliary tract, pancreas, head and neck, soft tissue sarcomas, and prostate cancer. Efforts are currently under way to optimize the use of brachytherapy by altering dose rate and fractionation. High dose rate, low dose rate, and pulsed dose rate techniques are being explored. Novel approaches combining chemotherapy with external beam radiotherapy and brachytherapy may improve the results in treatment of a variety of tumors.

Thoracic
Endobronchial brachytherapy is an innovative form of radiation therapy that uses high-dose rate (HDR) brachytherapy to destroy tumors in the lungs or throat, via the bronchial tubes.

Gynecological
Radiation can also be delivered with lose dose rate (LDR) or high dose rate (HDR ulitizing a vaginal cylinder applicator or with the tandem and ovoids applicator. You and your doctor will determine which type of radiation and applicator are right for you.

Prostate
Radioactive seed implantation is when tiny radioactive particles no larger than a grain of rice are implanted directly into the treatment cavity. These seeds are implanted directly into, or in very close proxcimity, to the tumor which allows them to deliver high doses of radiation to the tumor without affecting the normal healthy tissues around it.

IORT
Intraoperative Radiation Therapy (IORT) delivers a single highly target dose of radiation directly to the lumpectomy cavity during breast surgery---immediately after a tumor is removed. Focusing the radiation in that cavity rather than applying radiation to the whole breast is as effective as whole breast radiation, according to research comparing the two methods. Watch NBC and ABC news reports on this innovative therapy here and here.

Eye Plaque
Plaque brachytherapy is the most widely used treatment for choroidal melanoma and delivers a highly concentrated radiation dose to the tumor (with relatively less radiation to surrounding healthy tissues). The radioactive plaque can also be called a “radiation implant” or “radioactive source.”

Yttrium 90
Working with the Interventional Radiologist Y-90 utilizes thousands of radioactive beads injected directly safely into the arteries that supply blood to the tumor. These radioactive beads are made of either plastic or glass known as either Theraspheres or SIR-Spheres.

A novel imaging technology called CTVision helps to reduce radiation to critical body structures. The CT scanner pivots around the patient, taking a series of pictures that pinpoint the exact location to receive radiation therapy. This technique is also called “CT on Rails.” This approach results in more precise positioning of the patient and the ability for more precise targeting of the tumor. This is one of many new techniques that allow physicians to reduce the amount of radiation delivered during therapy.

External Beam Radiation Therapy involves a series of daily outpatient treatments to accurately deliver radiation to the breast. Painless radiation treatments are delivered in a series of daily sessions. Each treatment will last less than 30 minutes, Monday through Friday, for five to seven weeks. The usual course of radiation treats only the breast, although treatment of the lymph nodes around the collarbone or the underarm area is sometimes needed.

The Gamma Knife is a safe, non-invasive device for treating deep–seated brain tumors and Arteriovenous Malformations (AVM's). With this emerging technology, many conditions, including those that were once considered inoperable, can now be treated without the need for an incision and with little or no pain.

The Gamma Knife is not a knife as its name implies. It is a highly sophisticated system that delivers up to 201 beams of gamma radiation, with pinpoint accuracy,  to an abnormality within the brain. When concentrated, the rays provide enough radiation to treat the diseased area effectively. Yet the low intensity of each single beam ensures the safety of the surrounding healthy brain tissue.

The Procedure

On the day of treatment, the patient is fitted into a metal frame, called a stereotactic headframe.  Open on all sides, it allows physicians to precisely target the abnormality throughout the several procedures. First patient’s brain is screened with images taken with by MRI (Magnetic Resonance Imaging), a CT scan or angiogram. This determines the size and position of the tumor or AVM.

Once the imaging studies are completed, physicians use a computer program to help plan the course of treatment.

The target area of the brain and the appropriate radiation dosage are quickly established. Now ready for the Gamma Knife, the patient lies down. The head frame is now positioned inside a large metal helmet, called a collimator. Next, the patient slides into the Gamma Knife's sphere, which contains the source of radiation.  The collimator then directs radiation to the pre-determined points in the patient's brain.

Treatment usually consists of a series of exposures, each lasting approximately 10 minutes. Patients experience little or no discomfort, and most are able to to home the day of the procedure.

Gamma Knife Benefits

With the Gamma Knife, post-treatment complications are greatly reduced when compared to open surgery (or other types of radiation?). Further, areas of the brain for which other therapies are ineffective can be successfully treated. The Gamma Knife's precision and safety make it a highly appropriate choice for both pediatric and adult patients.

The range of diseases effectively treated by the Gamma Knife includes:

• Vascular lesions such as arteriovenous malformations (AVMs)
• Acoustic neuroma
• Meningioma
• Pituitary Tumors
• Pineal Tumors
• Metastases
• Glial and astrocytic tumors
• Skull base tumors
• Other benign and malignant tumors
• Trigeminal neuralgia

The use of the Gamma Knife continues to expand, as a result of ongoing research and development.

Learn More About Gamma Knife Radiosurgery From Our Columbia Neurosurgeons

Hypofractionated Breast Radiotherapy is a revolutionary breakthrough regarding breast cancer treatment. This technique reduces treatment time by half—3 weeks of treatment instead of the traditional 6 week course.

Image Guided Radiation Therapy (IGRT) allows physicians to take a series of images during radiation treatment.  These images can help improve the accuracy of radiation therapy in selected patients.

Tumors that move during the breathing cycle, such as those within the lung or liver, can present a challenge for conventional radiation treatment–as moving targets, they are harder to "hit" with a focused beam of radiation. In order to properly treat these tumors, a wider field must be targeted.

Respiratory gating is a technology that allows the radiation oncologist to monitor the patient's breathing pattern during the treatment. The radiation bean can then be turned on only during a specific segment of the breathing cycle.  With this approach, the effects of respiratory motion can be significantly reduced, or even eliminated. This allows for more accurate targeting of the tumor, and may also reduce the amount of radiation received by the surrounding healthy tissue.

Intensity-modulated radiation therapy (IMRT) is an advanced form of three-dimensional conformal radiotherapy (3DCRT).  In addition to using multiple shaped portals from which the radiation beams emanate, the intensity of the beams within each portal is spatially modulated using sophisticated software and hardware. This enables an optimized dose distribution to be delivered to the three-dimensional tumor volume while maintaining constraints of avoiding close or overlapping normal structures. IMRT is often used for the treatment of tumors that are in close proximity to normal organs that are more sensitive to radiation.  For example, IMRT is often used in the treatment of prostate cancer to achieve high tumor control with significantly reduced rectal toxicity.

Intraoperative Radiation Therapy (IORT) delivers a single highly target dose of radiation directly to the lumpectomy cavity during breast surgery—immediately after a tumor is removed. Focusing the radiation in that cavity rather than applying radiation to the whole breast is as effective as whole breast radiation, according to research comparing the two methods. Watch NBC and ABC news reports on this innovative therapy.

Provides radiation in the form of a single highly focused beam applied in multiple sweeps around the brain lesion, and is suitable for larger tumors. This method also permits multiple smaller-dose, or fractionated radiotherapy, which offers advantages for some patients.

Doctors are studying ways to deliver radiation to only the affected portion the breast. Available in a few clinics for a very select group of patients, these techniques are used after a lumpectomy to deliver radiation to the tumor site rather than the entire breast.

Breast brachytherapy involves placing flexible plastic tubes called catheters or a balloon into the breast. Over one to five days, the catheters or the balloon are connected to a brachytherapy machine so high doses of radiation can treat the nearby breast tissue.

Other partial breast treatments include 3-D conformal Irradiation and Intra-operative Radiation Therapy (IORT) delivered in the course of surgery (lumpectomy).

Precise delivery of radiation to a tumor while sparing normal surrounding tissues. This technique achieves a higher dose than what could be given with conventional techniques.

Both SRS and SBRT can be used to treat pediatric cancers, as well as those that occur in adults.

Stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT). Stereotactic radiosurgery are new procedures that allow physicians to deliver high doses of radiation to the tumor site while sparing healthy issues.

SRS is not an actual surgery—it is the ability to deliver radiation to the target site from a variety of different angles, based on 3D imaging. In some cases,image-guided radiation therapy (IGRT) may be used to pinpoint the location of the tumor before and/or during the radiation treatment.

The advantages over conventional radiation therapy are as follows. SRS can nr used to treat extremely small tumors or those located in hard-to-reach places. The treatment time is significantly shorter. And while the therapy can often be completed in a single day, radiation oncologist may recommend multiple treatments, depending upon the size of the tumor.

Stereotactic radiosurgery is generally used to treat brain and spinal cancers.

Stereotactic body radiation therapy (SBRT) offers the same benefits as stereotactic radiosurgery and is used to treat a wide variety of cancers.

Total body irradiation (TBI) is used at Columbia University Medical Center as part of the conditioning regimen prior to allogeneic (from a matched donor) bone marrow transplantation for leukemias and lymphomas.

Often allogeneic stem cells (ie.) are used for the reconstitution of the immune system after high-dose therapy. Allogeneic cells (from a brother/sister or from an unrelated HLA-matched donor) provide a therapeutic benefit since their immune function plays a role in fighting the patient’s cancer. Total body irradiation aids in the acceptance, of these foreign immune cells.

Better supportive care, refinements and improvements in total body irradiation technique and chemotherapy regimens, and new insights into immune cell therapeutics, all contribute to the more effective management of these patients.

Volumetric Arc Therapy (VMAT) or RapidArc is the most advanced form of Intensity modulated radiotherapy (IMRT) which allows for precise delivery of the radiation beam in a 360-degree rotation of the grantry. VMAT allows for treatment times from 2 minutes up to 10 minutes; much better than conventional IMRT treatment plans that allow for multiple treatment fields in which the gantry stops multiple times delivering separate radiation beams. VMAT utilizes special software and an advanced linear accelerator to deliver these treatments daily. This treatment is more comfortable for patients because they spend less time in their designed treatment positions. This allows patients to be able to have access to daily radiation treatment and be back to their normal routine in a quick amount of time.