Radiation Services of the Kugelman Cancer Center
Intensity Modulated Radiation Therapy (IMRT)
Intensity modulated radiation therapy (IMRT), a form of external radiation, is a sophisticated treatment that allows doctors to target tumors with a concentrated dose of high energy rays tailored to the precise size, shape and depth of the tumor. Radiation oncologists at the Kugelman Cancer Center were the first in Northwest Florida to offer IMRT. It is available at the Kugelman Cancer Center at Baptist Hospital and the Gulf Breeze Oncology Center at Gulf Breeze Hospital. It involves a three-dimensional radiation therapy known as IMRT and a scanner capable of spotting changes both in bodily structures and in the way cells use nutrients such as sugar and oxygen. By combining these technologies, Baptist Hospital doctors can pinpoint tumors – some so small they normally would escape detection – and target them with radiation doses that match their exact size, shape and intensity.
The scanner is a two-in-one imaging system that combines PET scans – or positron emission tomography – with CT scans. PET scans detect changes in the metabolism of cells. These changes can happen before physical changes take place, making PET an excellent tool for early diagnosis. CT – or computed tomography – uses X-rays and high-speed computers to provide doctors with a non-surgical way of looking inside the body. It rapidly produces two-dimensional pictures that are translated into 3-D images for in-depth evaluation by radiologists.
By providing both anatomic and metabolic information from a single procedure, PET/CT allows doctors to spot increased cell activity while relating it to the body’s internal anatomy. This technology helps doctors to more quickly determine whether someone has cancer, if it is spreading, whether treatment is working or if there’s been a recurrence. PET/CT not only improves a physician’s ability to diagnose and monitor disease, it also helps predict the likely outcome of various treatment choices and identify the best options available.
Radiation oncologists at Baptist Hospital quickly recognized the potential benefits of using PET/CT in combination with IMRT. Intensity modulated radiation therapy transmits thousands of tiny radiation beams in patterns conforming exactly to the tumor being targeted. By precisely matching IMRT’s radiation to the exquisite detail of PET/CT in their treatment planning system, the risk of toxicity or damage to healthy tissue is greatly reduced. This allows doctors to concentrate treatment intensity on cancers with higher, more effective doses, resulting in better outcomes and improved quality of life for patients.
It takes cooperation between physicians and technologists of different departments to combine PET/CT with IMRT. Since PET/CT has a diagnostic function and IMRT is used for treatment, they operate in separate locations and departments. For the two systems to work together, however, patients must be positioned in exactly the same way for both the scan and radiation treatment. Identical tables and customized plastic body or head molds position the patient to ensure alignment — but Baptist Hospital’s award-winning culture of service excellence makes the process work.
The system has already been used to treat head-and-neck cancers, but radiation oncologists foresee its application for other malignancies, especially cancers of the esophagus, pancreas and lung — one of the three most frequently treated cancers treated at Baptist Hospital.
Image Guided Radiation Therapy (IGRT)
For the first time in Northwest Florida, radiation oncologists can circumvent a problem that has long complicated the treatment of cancer. Baptist Hospital’s fully robotic, on-board imaging system allows therapeutic radiation to be precisely delivered to the targeted tumor regardless of whether the tumor has shifted location.
This image-guided radiation therapy, or IGRT, enables the use of higher, more effective doses of radiation because there is far less risk that the radiation will damage nearby healthy tissue. IGRT deploys higher, more effective doses of radiation because there is far less risk that the radiation will damage nearby healthy tissue.
Standard radiation therapy often is limited by normal shifts within the human anatomy. Tissues and organs can settle differently each time a patient climbs onto a treatment table. Weight fluctuations over the course of multiple treatments also can cause significant changes in tumor location. Even normal breathing will change a tumor’s locale by several centimeters.
Radiation oncologists traditionally have compensated for tumor movement by enlarging treatment areas, exposing more healthy tissue to the cell-killing effects of radiation. Therefore, doses typically are lowered to avoid complications.
Manufactured by Varian Medical Systems, the on-board imaging system is mounted on the treatment machine itself. The device produces high-resolution images while tracking tumor motion for the delivery of the radiation. Using a technique known as “respiratory gating,” the radiation therapy is synchronized with the patient’s breathing patterns. The technique enables doctors to more safely use radiation to treat lung and other cancers of the chest.
Just prior to treatment, a radiation therapist places a small reflective cube on the patient’s chest. A video camera tracks the cube’s up-and-down movement as the patient breathes. The treatment is then synchronized with the patient’s normal breathing pattern, so that radiation is delivered to the tumor area only during a pre-determined part of the respiratory cycle, corresponding to when the tumor is in a particular position within the body. The beam is automatically shut off if the patient coughs or the normal cycle is interrupted.
Stereotactic Radiosurgery (SRS) or Radiotherapy
Stereotactic Radiosurgery (SRS) is a one-day, single treatment, outpatient procedure that delivers a focused dose of radiation to the target. With this treatment, the lesion location is determined by MRI scans and /or CT scans, a 3-D treatment plan is established, and then multiple precisely-guided radiation beams from the LINAC equipment treat the tumor in a single treatment.
A SRS procedure is completed in a few hours and actual dose administration time is typically less than 45 minutes. Currently, SRS is appropriate for a variety of malignant and benign brain tumors as well as other brain disorders. When this same equipment and process is used to deliver a similarly accurate treatment in multiple fractions over several days it is called Stereotactic Radiotherapy.
Usually intravenous this medication is given to patients by a doctor primarily for cancer that has spread to the bones.
Radioactive spheres for treatment of the liver cancer (SirSpheres)
Radioactive beads injected by physician through a catheter placed in the lover (hepatic) artery for treatment of cancer in the liver.
For more information about these treatments contact the Baptist Cancer Institute at 850.469.2222.