radiation oncology · 2012-01-09 · nurses, a nutritionist, a physician liaison, a patient...

Radiation Oncology

Radiation OncologyTemple University Hospital offers the region’s most comprehensive array of treatments and

technologies for benign and cancerous conditionsthat require radiation therapy.

The Department of Radiation Oncology is part of the Temple Cancer Center. Every patient receives customized treatment planning andtherapy using the safest, most precise and

effective treatment strategies.

Temple’s Commitment to Safety & QualityRadiation is invisible but its effects, both good and bad, are not. That’s why at Temple we constantly monitor daily treatment records and keep a detailed registry of all patientoutcomes. We also regularly test our equipment, refine our safety checklists, and monitorour daily procedures.

This attention to detail goes on behind the scenes, but it is essential. As radiationtechnology grows more powerful and complex, the standards and safeguards must keeppace. At Temple, you can be sure they do. Here is evidence of our program quality:

Accredited by both the Joint Commission and the American College of Surgeons’Commission on Cancer

Certified to participate in government-sponsored research

Qualified to train new doctors in advanced oncology

Licensed by state and professional radiation therapy groups

Recognized as a “Center of Excellence” by Elekta (one of the world’s largest radiation technology companies)

Feel free to contact us to learn more about our doctors, our decades of experience, our special services and our full range of treatments. We will help you consider all the alternatives.

For more information, visit our web site at cancercenter.templehealth.org

For more information about Radiation Oncology at Templeor to schedule an appointment, call 1-800-TempleMED (836-7536)

Curtis Miyamoto, MD

Chairman and ProfessorDepartment of Radiation Oncology

Temple University Hospital

Bizhan Micaily, MD, FACR

Associate Chairman and ProfessorDepartment of Radiation Oncology

Temple University Hospital

10-62TU_RadOncBroTxt-F2_Layout 1 5/5/11 6:55 PM Page 1

HOW I S RAD IAT ION G IVEN?

Most often, radiation is generated from a linear accelerator that delivershigh-energy beams directly to the target tumor.

After careful treatment planning, the course of radiation therapy is divided intosmall doses of focused beams, usually given once or twice per day, five timesper week, over several weeks. This type of external radiation therapy ispainless for the patient.

For some patients, a small device is placed inside the body during a procedurecalled brachytherapy.

Whatever the type of radiation therapy, detailed information is given to eachpatient about:

How to prepare for radiation therapy

The number of treatments required

What to expect during each treatment

Possible side effects

Long-term results

DOES RAD IAT ION DAMAGE HEALTHY CELLS?

Radiation often must pass through skin and other organs to reach a tumor,potentially damaging healthy cells near the treatment area and causing sideeffects such as nausea, fatigue and skin problems. However, with today’stechnology, radiation therapy can be highly focused on the tumor to avoidexposing the surrounding area to damaging energy. Treatment is more preciseand much safer than just five or ten years ago.

There are also body devices and drugs that help protect healthy cells fromradiation. Because of these improvements, increasing numbers of people—about a million cancer patients every year—now receive radiation therapy.

About Radiation Oncology

WHAT I S RAD IAT ION THERAPY?

Radiation damages the DNA of cancer cells and prevents them from growing,dividing and spreading. The goal of radiation therapy is to eradicate or shrinktumors or to treat pain or other symptoms caused by cancer. Althoughradiation therapy is sometimes used alone, it is most often combined withchemotherapy, hormone therapy or surgery.

More than half of all patients with cancer receive radiation as an adjuvanttherapy to prevent a recurrence of cancer after surgery or chemotherapy. Thedecision to use radiation and its possible benefits should be discussed with aradiation oncologist.

Surgery has a limited role in the treatment of some cancers. In fact, it is notoften used for advanced lung cancer, head and neck cancer, cervical or vaginalcancer, or skin cancer.

Radiation therapy is a reasonable alternative for many early cancers, such asthose of the lung, bladder, cervix or breast.

Radiation is also used to treat some non-cancer conditions such ashemangiomas, and to prevent the formation of heterotopic bone and keloids.

32

10-62TU_RadOncBroTxt-F_Layout 1 4/28/11 2:51 PM Page 2

WHAT ARE THE POSS IBLE S IDE E F FECTS?

The chances of side effects vary from patient to patient, depending on tumorlocation, radiation dose and factors such as other diseases or medications.Some patients have no side effects at all.

The most common side effects of radiation therapy are fatigue, hair loss and/orskin irritation in the treatment area, and nausea. For example, a patient withhead and neck cancer may develop mouth sores or lose some hair; a patientwith breast cancer may develop skin irritation on the chest; and a patient withstomach or colon cancer may have diarrhea and nausea.

If side effects do occur, they may start after two or three weeks of treatmentsand fade away in the weeks after the final treatment.

These side effects can be prevented or managed with medications, dosereductions and good advice on nutrition, skin and hair care, mouth and teethcleaning and lifestyle or stress management.

In rare cases, radiation can cause more severe and permanent side effects suchas damage to the lungs, heart, bowel, bladder or other organs. There is also asmall risk that the radiation treatment may actually cause, years later, a newcancer. These risks are related to the dose intensity, the location of the radiationtherapy and the expertise and quality controls of the radiation therapy program.

The risk of possible side effects must be weighed against the potential benefits of radiation therapy and should be discussed before starting treatment.

Questions for Patients to Ask the Radiation Oncologist

What type of radiation therapy are you recommending?

What is the purpose of this radiation therapy?

What are the chances it will work?

What other treatments (like surgery or chemotherapy) will I get?

What will happen if I do nothing?

Are there other treatment options?

How many daily treatments will I need?

What happens during each treatment?

What are the likely side effects?


For more information about Radiation Oncology at Temple or to schedule an appointment, call 1-800-TempleMED (836-7536)

WHO I S PART OF A RAD IAT ION THERAPY TEAM?

A team of specialists is needed to deliver radiation therapy.

The radiation oncologist is the physician who evaluates patients anddesigns the radiation therapy plan. The plan includes the radiation type,strength, doses, duration and target for each patient. The doctor monitors thepatient’s progress during and after treatment

The radiation physicist is a highly trained specialist who ensures that thelinear accelerators and attached computers are working perfectly before eachtreatment so that the radiation is delivered accurately

The dosimetrist understands the characteristics and clinical relevance ofradiation oncology treatment and planning equipment, and has the educationand experience needed to generate radiation dose calculations and dosedistributions. Dosimetrists frequently act as liaison between medicalphysicists and other members of the radiation therapy team

The radiation therapist is a certified technician who positions the patientfor each scheduled radiation dose and follows the exact therapy plan toadminister each daily treatment

The radiation therapy nurse helps to educate and prepare patients fortreatments. The nurse also assists in managing other issues such as drugtherapy or side effects

WHAT K IND OF RAD IAT ION THERAPY WILL BE G IVEN?

Radiation therapy is carefully planned to fit each patient’s unique situation. The radiation oncologist will do a physical exam, perform tests, review all testresults and consult with other specialists. After talking with the patient aboutall available options, the radiation oncologist creates a customized, detailedplan for therapy and discusses it with the patient. If the patient decides to haveradiation therapy, there may be “practice runs” to pinpoint the tumor location.If the tumor target is clear, daily treatments begin.

54


A variety of other Temple-based support and educational services are availablefor patients and their families:

Access to patient support groups, including groups for patients with specifictypes of cancer

Assistance with the daily details of radiation therapy, including scheduling,meal and wait/recovery planning, transportation and lodging

Referrals for mental health, stress management or pastoral care

Financial counseling to help with insurance or other money issues

Opportunities to participate in Temple research clinical trials

Interpreters for non-English speaking patients

Temple’s full-time radiation therapy team includes four physicists, three medicaldosimetrists, 13 therapists, three social workers, three radiation oncologynurses, a nutritionist, a physician liaison, a patient navigator, two clinicalresearch coordinators, an IT systems manager and administrative support staff.

Radiation Oncology at Temple

The Department of Radiation Oncology at Temple University Hospital is led bytwo of the most experienced radiation oncologists in the Mid-Atlantic region.They are skilled in customizing radiation therapy for patients at all stages andwith all types of cancer—including lung, breast, prostate, gastrointestinal, headand neck, brain and gynecologic—as well as non-cancer conditions.

About half of all patients coming to the Temple Cancer Center requireradiation therapy.

TEMPLE ’ S RAD IAT ION THERAPY SERV ICES

Every patient at Temple receives a comprehensive, individualized program ofcare—from initial consultation to treatment and follow-up visits—that employsappropriate and highly targeted radiation treatments that are carefully plannedand monitored. We take all the time needed to provide this specialized therapyin a clear, thoughtful and compassionate manner.

Temple’s radiation therapists and nurses educate patients, deliver the prescribedtherapy and assist and reassure patients during therapy. Consultations withother members of the Temple Cancer Center—including medical and surgicaloncologists, neurosurgeons, radiologists, pharmacists and pain managementspecialists—are easily arranged.

76

“It’s not about the technology, it’s about the patients.”

“At Temple, every member of our Department of RadiationOncology is focused on giving patients the absolute best care. We succeed at this not only because we have advancedtechnologies—which we do—but because we are skilled inworking as a team. In the end, it’s our teamwork and our focus on each patient as an individual that allows us to plan and targetevery course of therapy carefully and appropriately. That’s how weachieve the best outcome possible every time for every patient.”

Curtis Miyamoto, MDChairman and Professor, Temple Radiation Oncology

10-62TU_RadOncBroTxt-F_Layout 1 4/28/11 2:51 PM

Brachytherapy: Placing low-dose or high-dose radiation sources inside the body,either temporarily or permanently, can boost the radiation dose to the tumor.

During brachytherapy, a small device is placed close to or inside the tumor,most often during an outpatient procedure. The device is later afterloaded withradioactive sources which remain in place for a period of time—sometimespermanently. Some patients need several sessions. Some patients may need tobe hospitalized during this type of internal radiation therapy.

Temple has one of the most experienced and sophisticated programs in theregion. Our radiation oncologists together have more than 60 years ofclinical experience in delivering brachytherapy.

Hyperthermia: Heating tumor cells incombination with radiation therapy can help shrink tumors and relieve symptoms for patients who have failed priorconventional treatment, includingradiation, surgery or chemotherapy. Thistreatment offers hope where previously there may have been limited or no options.

Hyperthermia is indicated for use inconjunction with radiation therapy to treatrecurrent tumors located within a fewcentimeters of the surface of the body,such as tumors of the prostate or breast, headand neck, basal cell and squamous cell skincancers and recurrent melanomas. Sarcomas in soft tissue or lymphatics may alsobe eligible. Hyperthermia can be delivered both superficially and interstitially.

Treatment is done on an outpatient basis and usually consists of three to five weeks of daily external radiation and two sessions of hyperthermia perweek over the same time period, administered prior to the radiation. Thehyperthermia treatment lasts for 45 to 60 minutes and is very well tolerated.

Temple’s radiation oncologists have more than 20 years experience with hyperthermia.

Total and Sub-total Skin Electron Beam Therapy (TSEB): This treatment isdirected at a large surface, or the entire surface, of the body. The radiationpenetrates the outer layers of the skin without affecting deeper organs or tissue. Temple is the most experienced center in the region to offer thistherapy to patients with rare cancers and conditions such as Cutaneous T-cell and Cutaneous B-cell Lymphoma and Kaposi’s sarcoma.

Our breadth of experience with total and sub-total electron beam therapy—and Dr. Micaily’s design of a unique positioning device specifically forTSEB—have established Temple as a regional referral center for otheruniversity medical centers.

9

RAD IAT ION TREATMENT MODAL IT I ES : PREC I S ION , SAFETY, E F FECT IVENESS

Three-dimensional Conformal Radiation Therapy (3D-CRT): The radiationbeam is absolutely tailored to the shape and configuration of the tumor toavoid nearby normal critical structures.

Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy(SBRT): High doses of tightly-focused radiation beams can destroy tiny tumorsor lesions intracranially (SRS) or extracranially (SBRT) with pinpoint precision,often in just a few treatments.

Intensity Modulated Radiation Therapy (IMRT): IMRT allows Templespecialists to customize the shape and the intensity of the radiation. Theradiation beam can not only be shaped but also modulated, giving higherdoses to the tumor and lower doses wherever sensitive structures are nearby.

Our specialists and technicians have used IMRT for nearly ten years and arehighly skilled in all the complex adjustments needed to deliver safe andeffective treatment.

VMAT (Volumetric Modulated Arc Therapy): Sophisticated tools furtherenhance precision by monitoring the treatment in real time to ensure that thedose is delivered as precisely as the radiation oncologist prescribes it.

When clinically appropriate, VMAT offers patients dramatically shortertreatment times than other intensity modulated radiation therapy (IMRT)—asfast as two minutes. Faster treatments improve patient comfort by reducing thetime spent on the treatment table. Since treatment times are so short, the riskof clinically significant motion is greatly reduced.

Image Guided Radiation Therapy (IGRT): CT-based image guidance equipment mounted directly on the linear accelerators allows fine-tunedadjustments of radiation to accommodate any slight movement of thetumor during treatment.

Temple has used this technique since 2005, making us one of the mostexperienced IGRT centers in the region.

8


The Department of Radiation Oncology at Temple houses three Elekta linearaccelerators, including a Synergy® S, a Gamma Knife® 4C, a dedicated CTscanner, a Nucletron 32-channel microSelectron® HDR brachytherapy unit, anda BSD hyperthermia unit.

A dedicated CT Scanner offers patients the convenience of receiving theirtreatment planning CT scans in the Radiation Oncology department.

The Leksell 4C Gamma Knife merges CT, MRI, angiograms, and PET scans toensure precise treatment of brain lesions, arteriovenous malformations(AVMs) and trigeminal neuralgia. This sophisticated unit focuseshundreds of separate cobalt radiation beams at the brain target, allowingsafer, faster and more effective therapy.

The Elekta Synergy S is an integrated 3D volume imaging system that allowsclinicians to address the time lag between imaging and treatment delivery to enhance accuracy. Any necessary adjustments in the patient’s position canbe made immediately to ensure that the radiation is directed precisely at thetarget at all times.

Tumors, lesions and malformations throughout the body, as well as sites within the brain, can be treated with the Synergy S.

VMAT: VMAT is the only arc therapy solution that can deliver treatments in either one or several rotations of the linear accelerator. The goal is toprovide an optimal clinical result for each individual patient. Temple’s VMAT solution uses patent-protected technology for safely and efficientlydelivering multiple arcs.

The Nucletron 32-channel microSelectron® HDR Brachytherapy Unitcombines 3D treatment planning with image fusion capabilities and varietiesof CT/MRI-compatible applicators.

The BSD Hyperthermia System uses focused microwave energy to heat atumor, at levels that are usually safe for normal cells, to damage cancer cells.The treatment can be performed superficially or interstitially. This technologyis the most advanced CT- and MRI-compatible treatment planning anddelivery system available.

Temple’s Technology

1110


Research and Clinical Trials

All Temple radiation oncology faculty engage in medical research, muchof it in collaboration with the Temple Cancer Center, the Fox ChaseCancer Center and large national and international research groups.

BAS IC RESEARCHBasic research involves understanding how radiation impacts healthycells and cancer cells. Most of the research is practical—aimed atimproving current therapies and creating completely new therapies,particularly in the areas of breast and brain cancers.

For example, Temple researchers are testing the combined effect ofselective growth inhibitors in conjunction with radiation therapy inGlioblastoma multiforme brain tumors.

They are working on the discovery of a panel of novel genetic markerswhich may diagnose metastasized mammary cancers, and aredeveloping a simple mouth rinse that might reduce the chance of thepainful mouth sores that occur after some types of radiation therapy.

PHYS ICS RESEARCHPhysicists in the Department of Radiation Oncology conduct research in thefollowing areas: Integration of various imaging modalities in diagnosis, planning and treatmentof localized diseases, with special interest in image-guided radiotherapy (IGRT)of cancer using 3D-4D optical imaging, cone-beam-CT, functional MRI andautomatic image registration

Patient-specific metabolic model and location-dependent motion mechanismin nuclear medicine imaging (PET and SPECT) for early detection and precisedelineation of lung cancer

Stereotactic radiosurgery and fractionated stereotactic radiotherapy of brain,lung, spine and liver tumors

Biological models in treatment planning optimization, intensity modulatedradiation therapy (IMRT), thermal dose and hyper-thermal therapy techniques

Dosimetry and techniques of molecular and gene therapy, as well as theircombination with radiotherapy

CL IN ICAL TR IALSMany patients volunteer for clinical trials at Temple. This allows them to learnabout—and sometimes receive—new therapies and understand that they arehelping to create better therapies for future patients.

To further our goal of providing the widest range of treatment options and thehighest quality of care for our patients, the Temple Cancer Center participates invarious Radiation Therapy Oncology Group (RTOG) and Gynecologic OncologyGroup (GOG) clinical trials. These studies, sponsored by the National CancerInstitute, seek to improve the use of radiation therapy for the treatment of headand neck, lung, prostate, breast, ovarian and cervical cancers.

12


DEPARTMENT OF RAD IAT ION ONCOLOGYAT TEMPLE UN IVERS I TY HOSP I TAL

Contact Information

ADDRESS

Radiation OncologyTemple University HospitalAmbulatory Care Center3401 N. Broad StreetPhiladelphia, PA 19140

Clinical Area4th Floor (Zone D)

Treatment AreaLower Level SB (Zone D)

HOURS

8:00 AM to 4:30 PM

PHONE NUMBERS

Appointments: 1-800-TempleMED (836-7536)

Administration: 215 707-4233

Scheduling: 215 707-2083

Physician Liaison: 267-972-6473

FAX NUMBERS

Administration: 215 707-8062

Clinical Area: 215 707-8809

Treatment Area: 215 707-1584

Physician Liaison: 215-226-8292

For more information about Radiation Therapy at Templeor to schedule an appointment, call1-800-TempleMED (836-7536)


For more information about Radiation Oncology at Templeor to schedule an appointment, call1-800-TempleMED (836-7536)

3401 N. Broad Street Philadelphia, PA 19140

radiation oncology · 2012-01-09 · nurses, a nutritionist, a physician liaison, a patient...

Documents