Radiation Therapy Information

Radiation Therapy

Radiation therapy is a powerful treatment option in the fight against cancer, using targeted energy to eliminate cancer cells and shrink tumors. There are two main types of radiation therapy: External and Internal. 

External radiation therapy, the more commonly used method, delivers precise doses of radiation to the affected area from outside the body. 

Internal radiation therapy, or brachytherapy, places a radiation source directly inside or near the tumor for highly localized treatment. Both methods are designed to maximize effectiveness while minimizing exposure to surrounding healthy tissue, providing patients with a comprehensive approach to care.

External Radiation Therapy and Imaging Equipment

The MCA Radiation Oncology Department uses state-of-the-art equipment and techniques to provide the best possible care. Here are some of the technologies and methods we use:

Imaging Equipment

Computed Tomography (CT)

• CT Simulation: Used to plan precise radiation treatments.
• Diagnostic CT Imaging: Helps diagnose and monitor various conditions.

CT Simulation Techniques

• 3D Simulation: Create detailed three-dimensional images for treatment planning.
• 4D CT Simulation: Adds the dimension of time to 3D images, accounting for movement (e.g., breathing).
• Virtual Simulations: Uses advanced software to simulate treatment plans.

Positron Emission Tomography /Computed Tomography (CT)

• A PET/CT scan combines information with a CT scan to create a highly detailed image of a patient’s tumor, which is then used to precisely target the treatment, allowing for more accurate and effective treatment while minimizing damage to healthy tissue; essentially, the PET scan provides functional information about the tumor’s activity, while the CT scan provide anatomical details, enabling a more precise treatment.

External Radiation Therapy

• Conventional 2D and 3D Treatments: Standard radiation techniques to target tumors.
• Electron Treatments: Use electrons for treating superficial tumors.
• Intensity Modulated Radiation Therapy (IMRT): Delivers precise radiation doses to the tumor while minimizing exposure to surrounding tissue.
• Stereotactic Body Radiotherapy (SBRT): High-dose radiation targeted at small, well-defined tumors in the body.
• Stereotactic Radiosurgery (SRS): A non-surgical radiation therapy used to treat abnormalities and small tumors in the brain.
• Stereotactic Radiotherapy (SRT): Similar to SRS, but delivered in multiple sessions.
• Volumetric Modulated Arc Therapy (VMAT)/Rapid ARC: Advanced technique that delivers radiation in a single or multi-arc treatment, providing efficient and effective therapy.

Image-Guided Radiation Therapy

• Electronic Portal Imaging Device (EPID): Provides real-time imaging to ensure accurate delivery of radiation.
• Onboard Imaging: Includes Cone Beam CT, Kilovoltage Imaging, and Fluoroscopy to improve precision during treatment.

Respiratory Gating

• Deep Inspiration Breath Hold Technique: Helps protect healthy tissue by controlling breathing during radiation therapy.

Brachytherapy Procedures

• High Dose Rate (HDR) Brachytherapy: Delivers high doses of radiation from implants placed close to the tumor.
• Breast Cancer HDR (SAVI): A specific HDR applicator inserted in surgery for treating breast cancer.
• Gynecological HDR: The radiation is delivered through an applicator that is inserted internally and is removed once treatment is complete. Treatments are given three to five fractions. This outpatient procedure often requires sedation, so you will need a driver for each of these visits.

Radiation Electronic Medical Record (EMR)

• ARIA: A comprehensive EMR for managing patient information and treatment plans.

Radiation Treatment Planning System

• ECLIPSE: Advanced software used to create precise radiation treatment plans tailored to each patient’s needs.

Radiation Protection for Prostate Cancer Treatment

SpaceOAR® Hydrogel
Placed between the prostate and rectum, SpaceOAR® Hydrogel reduces rectal injury in men receiving prostate cancer radiation therapy by acting as a spacer — pushing the rectum away from the prostate, out of the high-dose radiation region.

Barrigel™ Hyaluronic Acid Rectal Spacer is another gel placed between the rectal wall and the prostate to minimize dose to the rectum. Post-implant an MRI can assist the Radiation Oncologist and the Dosimetry team while contouring during the treatment planning phase to significantly reduce prostate radiation side effects. Ask your Radiation Oncologist or Urologist about which gel will be utilized in your care. Click the link for more information.

Type of Radiation Therapy Treatments

External Beam Radiation Therapy

External beam radiation therapy uses high-intensity beams of radiation, directed at a very specific area of the body, to kill cancer cells and shrink tumors. We offer multiple types of external beam radiation therapy, tailored to each patient’s specific type of cancer and its location.

Types of Radiation Therapy

Image-Guided Radiation Therapy (IGRT)

Image-Guided Radiation Therapy (IGRT) is an advanced radiation treatment that combines imaging and treatment capabilities on a single machine. Tumors can move, so IGRT allows a radiation oncologist and the radiation therapists to see and track the tumor at the time of treatment. This enables very fine adjustments to the patient’s position, greatly increasing the precision and accuracy of radiation therapy. Knowing exactly where the tumor is allows clinicians to target only the tumor, sparing the surrounding normal tissue. This accuracy results in higher radiation doses to the tumor, increasing the likelihood of controlling or eliminating the cancer.

Intensity Modulated Radiation Therapy (IMRT)

Intensity Modulated Radiation Therapy (IMRT) is an advanced form of radiation treatment that allows radiation oncologists and the radiation cancer care team to precisely target tumor cells. This noninvasive therapy uses Computed Tomography (CT) or other imaging modalities to create three-dimensional diagnostic images and map treatment plans. IMRT delivers tightly focused radiation beams of varying intensity to cancerous tumors without the use of needles, tubes, or catheters. Varying the intensity of these beams enhances IMRTs ability to maximize the dosage to the tumor while minimizing the amount of radiation affecting surrounding healthy tissue.

What is IMRT (Intensity Modulated Radiation Therapy)?

Intensity Modulated Radiation Therapy (IMRT) is an advanced form of 3D conformal radiation treatment that involves varying (modulating) the intensity of the radiation beams used to treat cancer. This technology enables the oncologists, dosimetrists, and physicists to shape the radiation beams precisely to the tumor and control their intensity throughout the treatment area. This means the radiation dose can be higher in the most aggressive parts of the tumor and lower in areas near healthy tissues and structures.

Conventional Radiation Therapy targets a uniform shape over the entire area to cover the tumor, often irradiating some healthy tissue and providing an even dose across the entire target area

Why is IMRT Used?

• Better Tumor Control: IMRT delivers higher doses directly to the tumor while sparing surrounding healthy tissue.
• Less Damage to Healthy Tissues: By minimizing exposure to healthy tissues and structures, IMRT results in fewer side effects.
• Improved Quality of Life: Patients experience more manageable side effects and better overall outcomes.
• Expanded Treatment Options: IMRT allows for the treatment of tumors located near vital organs and structures that were previously considered untreatable.

IMRT is commonly used to treat tumors in areas such as the prostate, spine, lung, breast, kidney, pancreas, liver, larynx, sinus, head and neck, and brain.

How is IMRT Planned and Delivered?

IMRT begins with an intensive, computerized treatment planning process coordinated by a team of radiation oncology experts, radiation oncologist, dosimetrists, and physics. The process includes:

• Tumor Mapping: A radiation oncologist uses 3D scanning images to outline the tumor’s shape, size, and location.
• Treatment Planning: A dosimetrist creates a personalized treatment plan using specialized software, optimizing it based on the physician’s dose instructions and diagnostic images and is checked and monitored during treatment by a physicist.
• Patient Immobilization: Customized devices ensure consistent patient positioning during each treatment session.
• Beam Shaping: A linear accelerator generates high-energy radiation, and a multi-leaf collimator shapes and modulates the radiation beams according to the treatment plan.
• CT Simulation: The initial step involves a consultation, a CT scan while positioned for treatment, and skin markings for precise targeting. Verification imaging is done prior to the first treatment to ensure accuracy.

Three-Dimensional (3D) Conformal Radiation Therapy (CRT)

3D conformal radiation therapy uses advanced technology to precisely target a tumor by shaping radiation beams based on its exact dimensions. This precision helps minimize damage to nearby healthy tissue and organs. CRT is used to treat various cancers, including those of the breast, lung, spine, extremities, and gastrointestinal tract.

Stereotactic Body Radiotherapy (SBRT)

SBRT is an advanced radiation technology used to treat small to medium-sized tumors in the body, including the lung, liver, abdomen, spine, prostate, head and neck. Detailed imaging, computerized 3D treatment planning, and precise coordination ensure that the radiation dose is delivered with extreme accuracy, minimizing effects on nearby organs.

• Gated Radiation Therapy: Uses respiratory gating to deliver radiation precisely while accounting for the patient’s breath cycle
• SBRT:  Involves creating  localization devices, such as a mask or vacloks ®, to ensure accuracy. The treatment is performed with a linear accelerator and a multi-leaf collimator, allowing for radiation sculpting in three or four dimensions. After consultation and consent, the CT simulation includes body positioning, imaging, skin marking, and a verification simulation to create a precise treatment plan.

Stereotactic Radiosurgery (SRS)

SRS is a non-surgical procedure that delivers highly targeted radiation doses to tumors, especially in the brain. It is ideal for treating inoperable tumors with minimal damage to surrounding tissue.

Internal Radiation Therapy

• High Dose Rate (HDR)  Brachytherapy
• Low Dose Rate Brachytherapy

High Dose Rate (HDR) Brachytherapy

High Dose Rate (HDR) internal radiation therapy, also known as brachytherapy, utilizes radioactive material inserted into applicators within body cavities or tissues in close proximity to the tumor, allowing for a high dose of radiation to be delivered precisely to the tumor. HDR brachytherapy is a temporary implant conducted in an outpatient setting and minimizes treatment time. A CT scan is performed while the implant is inserted to verify the exact catheter or applicator placement, resulting in a radiation dose with one-millimeter accuracy that significantly spares radiation exposure to surrounding healthy tissue and critical organs. Internal radiation therapy delivers a higher dose of radiation directly to the cancerous area than external radiation treatments. Internal radiation therapy may be utilized to treat breast, prostate, skin and gynecological cancers. 

What is HDR Brachytherapy?

• High Dose Rate (HDR) brachytherapy is a radiation treatment that allows physicians to deliver precise radiation treatment directly to a patient’s cancerous tumors utilizing catheters, thin, flexible needles or applicators inserted into a body cavity or directly into the tissue.
• It is a computer-controlled delivery system that optimizes dose distribution to the target.
• HDR brachytherapy is frequently used in the treatment of breast, cervical, and uterine cancers, intraluminal treatment of certain lung cancers causing bronchial obstructions and obstructing esophageal cancers.  It has also recently been shown to be effective for treatment of early-stage prostate cancer.

Why is HDR used?

• HDR brachytherapy delivers radiation with extreme precision.  Advanced imaging allows catheters to be precisely located so the intended dose can be delivered to a position with 1-millimeter accuracy.
• HDR brachytherapy can often be delivered on an outpatient basis and no radioactive material is left in the body.
• Treatment times are typically several minutes in duration instead of several days that are required for low dose rate brachytherapy.
• Because radiation is delivered directly to the tumor, a higher dose is used, yet exposure to surrounding healthy tissue is limited.  HDR brachytherapy results in less than a two percent chance of permanent damage to any of the adjacent normal tissue.

How is HDR Brachytherapy treatment planned and delivered?

• The physician determines whether HDR brachytherapy will be administered through a thin catheter, a flexible needle placed through the skin, or through applicators that are inserted into a body cavity such as the breast, lung, GYN, or esophagus.
• If deemed a candidate, breast patients will have a SAVI ™device inserted by a surgeon prior to starting their HDR treatments. For GYN patients, a smit sleeve is surgically placed prior to starting HDR.
• Patients are treated as an outpatient, with sedation, if needed..
• When catheters are used, treatment will be delivered twice a day, six hours apart for five days for breast patients.  
• Following a computed tomography (CT) scan of the treatment area, a three-dimensional (3D) reconstruction of the target organ/cancer and adjacent tissue is made to confirm placement of the implant device and plan the delivery sequence of the radioactive source for ideal dose distribution.
• The HDR brachytherapy equipment is programmed with the patient’s specific treatment and connected to the implant device with transfer tubes.
• Each treatment will last between 10-15 minutes, and during the treatment, the physician and clinical staff continually monitor and communicate with the patient directly outside the treatment room.
• When treatment is complete, the radioactive source is retracted back into the HDR brachytherapy machine, and the transfer tubes are disconnected.  For intracavitary implants, treatments will be given two times per week, are removed, and the patient is allowed to return home after the procedure.  Patients having sedation will need a driver to take them home each treatment.
• Transfer tubes need to be added for what is being removed.

Low Dose Rate Brachytherapy

Low Dose Rate (LDR) internal radiation therapy involves the use of radioactive materials inserted into body tissue near the tumor to deliver high-dose radiation in a permanent or temporary application. LDR brachytherapy is most often used to treat prostate and gynecologic cancers.

Accreditation

Missouri Cancer Associates is honored to hold the Radiation Oncology Practice Accreditation (ROPA) from the American College of Radiology (ACR) in radiation oncology, computed tomography and Nuclear Medicine (PET). Learn more about this accreditation. 

Look for the ACR Gold Seal of accreditation. You can rest assured that the facility will meet the highest level of patient safety standards and image quality.

When you seek out facilities that display ACR accreditation seals, you know:

• Our facility has voluntarily gone through a vigorous review process to ensure that we meet nationally accepted standards of care.
• Our personnel are well qualified, through education and certification, to perform medical imaging, interpret your images, and administer your radiation therapy treatments.
• Our equipment is appropriate for the test or treatment you will receive, and our facility meets or exceeds quality assurance and safety guidelines set by the ACR.To learn more about radiation safety and procedures, visit www.radiologyinfo.org.

Meet the Staff

To learn more about our radiation oncologists:

Dr. Mark Bryer

Dr. Harold Johnson

Dr. Reed Cope

Dr. Andrew Leiker

To learn more about our medical oncologists:

Dr. Elangovan Balakrishnan

Dr. Uma Ramadoss

Dr. Mark Tungesvik

Dr. Liana Makarian

Dr. Andrew Iliff

Dr. Alexandre Tungesvik

Dr. Caleb Smith

Should I Get a Second Opinion?

You should feel confident in your diagnosis and the physician leading your treatment. Our physicians at Missouri Cancer Associates provide second opinions for all types of cancer diagnoses and treatment plans. To schedule a second opinion, please Call (866) 601-1364 Monday-Friday from 8 a.m. to 4 p.m. to make an appointment on schedule online: Request a New Appointment (smartsheet.com)

MCA offers treatment for Advanced Prostate Cancer Patients

Radiopharmaceuticals

This treatment uses drugs containing radioactive elements to target prostate-specific membrane antigen (PSMA), a protein found in large amounts on prostate cancer cells. This treatment attaches to PSMA and delivers radiation directly to the cancer cells. This can be used to treat prostate cancer that has spread and has already been treated with hormone therapy or chemotherapy. The drug is given as an injection or an infusion once every six weeks for up to six doses.

PSMA Therapy for Advanced Prostate Cancer

Advanced prostate cancer, also called metastatic prostate cancer, begins in the prostate gland and spreads to other parts of the body. Long-term survival (5 to 10 years after diagnosis) from prostate cancer is very high when prostate cancer is diagnosed early and found in only the prostate and nearby parts of the body, but survival duration is significantly shorter after diagnosis of advanced prostate cancer. 

At Missouri Cancer Associates, men with metastatic castration-resistant prostate cancer (mCRPC), an advanced stage of prostate cancer, now have access to a promising treatment that combines new diagnostic imaging technology with a therapy recently approved by the US Food and Drug Administration in March 2022 that targets and destroys prostate cancer cells.

What Advanced Prostate Cancer Patients Can Expect

 If you’ve just received your initial  diagnosis, or the cancer has come back (reoccurred), it is important for your doctor to understand if the cancer is still in the prostate or has spread (metastatic) to the extra-pelvic lymph nodes or bones, or other parts of your body. Knowing this information may help your doctor to determine the appropriate treatment plan.Eligible patients will be scheduled for an imaging PET Scan and an injection of a radioactive tracing agent called Pylarify® which provides clearer and earlier visibility of tumors than other imaging technologies. 

Males with prostate-specific membrane antigen (PSMA)-positive castration-resistant prostate cancer (mCRPC) who have been treated with androgen receptor (AR) pathway inhibition and taxane-based chemotherapy could receive a targeted therapy called Pluvicto™ every 6 weeks for up to 6 treatments, depending on how the patient responds. Pluvicto™ is a targeted therapy that releases radiation into prostate cancer cells, destroying them, while sparing healthy surrounding tissue. The combination of Pylarify® and Pluvicto™ is a breakthrough for advanced prostate cancer patients whose cancer has spread or grown resistant to other forms of treatment. Until recently, these men had limited treatment options but advances in imaging technology and recent clinical trial studies of Pluvicto™ have shown, “significantly extended survival among patients with metastatic castration-resistant prostate cancer.” Men with PSMA+ mCRPC who received Pluvicto™ plus the best standard of care lived a median of 4 months longer: 15.3 months vs. 11.3 months with BSoC (best standard of care) alone.

Prostate Cancer Clinical Trials

A clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. We currently have several clinical trials open for prostate cancer patients diagnosed at various stages of the disease. Talk with your cancer care team to see if a clinical trial is right for you.