Targeting Cancer Tissues With Technology Advantage
At Ruby Hall Clinic we have always strived to provide Cancer care par excellence with world-class technology. In January 2006 we installed Siemens ONCOR Impression, the first Linear Accelerator with IGRT technology. With our expertise in Steriotactic Radiosurgery, this put us in the forefront amongst all radiation Centres in India. With a growing reputation and turnover, we installed a second Linear Accelerator, mainly to provide Stereotactic Body Radiotherapy, with its high dose radiation and UNFLAT beam facility. From a patient’s point of view, with continuous upgrade of technology, we have been able to target cancerous tissues in a better way, without affecting the normal tissues and in fewer sessions. We make a special effort to make sure that the patient is comfortable, physically and psychologically, during the entire course of the treatment. Patients are encouraged to avail help provided by various support groups which are active in the Centre.
Brachytherapy is the delivery of radiation therapy using Radioactive isotope in very close vicinity of the tumour. In this technique, Radiation therapy is delivered by Ir192 (Radioactive high dose rate source). That means a very low dose of radiation is given to surrounding normal structures. Brachytherapy is mainly useful in gynecological malignancies. These procedures are done under short general anesthesia, followed by CT scan based planning and treatment and the patient goes home the same day. Besides this, we have the expertise of interstitial implant brachytherapy for perineum, breast, and extremities. In this technique, special tubes are kept in the tumour bed after surgical removal of tumour and through those tubes high dose of radiation can be given in short duration of time.
It is a conventional treatment offered using a linear accelerator. Although the service is named as conventional, at Ruby Hall Clinic, patients undergo CT scan based planning and port film verification with this technique. Ruby Hall Clinic has the latest high-resolution amorphous silicon portal imager for this purpose.
IMRT is an advanced mode of high precision radiation. In IMRT, MLCs are used to subdivide (modulate) radiation beams into many beamlets aimed at the tumor, from various directions. Also, the intensity of each of these beamlets can be adjusted individually. Thus, it is a specialised form of 3D-CRT that allows radiation to be shaped exactly to fit the’ tumor. Using IMRT, it is possible to further limit the amount of radiation that is received by healthy tissues near the tumor as compared to 3D-CRT. In many situations, this may also allow a relatively higher dose of radiation to be delivered to the tumor, increasing the chance of cure. As this method of treatment delivery is very accurate, proper positioning of the patient becomes crucial. The planning of IMRT procedure takes 2-4 days after immobilisation and the imaging procedure.
It is a special procedure which is used as a conditioning regimen for bone marrow transplant or haematopoetic stem cell transplantation. This is to eradicate any residual Cancer cell in the body and it also helps in achieving immunosuppression so that the host does not reject the donor cell. This procedure helps in improving the success rates of bone marrow transplants. The procedure involves giving radiation to the whole body. The patient is made to stand on a customised instrument. Lens and lungs are shielded under aseptic conditions. The patient receives radiation twice a day for a maximum of 3 consecutive days. We are the only institute to have this facility in Pune.
Tumors are not regular, they come in different shapes and sizes. Three-dimensional conformal radiation therapy or 3D-CRT, uses computers and high definition software with special imaging techniques to map the size, shape, and location of the tumor. Computer Assisted Tomography (CT scans), Magnetic Resonance Imaging (MRI scans) and/or Positron Emission Tomography (PET scans) are used, individually or by fusion, to create detailed, three-dimensional representations of the tumor and the surrounding organs. This therapy uses a multileaf collimator (MLC) to frame precise radiation beam to a targeted area. The MLC is a device with a series of computer-controlled leaf-like plates. As the radiation beams are very precisely directed, adjacent normal tissues receive less radiation and are able to heal quickly. Hence, this treatment is superior to conventional treatment. Time taken for 3D-CRT planning is between 1 and 3 days.
Stereotactic Body Radiotherapy (SBRT) is an emerging image-guided radiation method. SBRT is directed to extremely well-defined targets within the body. SBRT delivers very high doses of radiation precisely to tumor sites within the body with the purpose of improving local control and limiting side effects. SBRT is appropriately used for small lung Cancer or metastasis, small liver tumors or bony tumors in other sites that may not be appropriate for surgical resection or in patients who would not be candidates for surgery. SBRT is generally completed in 3-5 treatment fractions.
At times, small gold fiducial markers are implanted with minimally invasive techniques to provide stereotactic image guidance during radiation therapy. 3D imaging (CT, CT/PET, CT/MR) is used to construct very precise plans minimising radiation dose to normal structures.
Strereotactic Radiosurgery (SRS) is a proven alternative to conventional surgery for the treatment of many lesions in the brain like pituitary adenomas, meningiomas, arteriovenous malformation, etc. In SRS, a pre-planned radiation dose will be delivered in a ” single session”. When multiple sessions of treatment are delivered, it’s called SRT (Stereotactic Radiotherapy).
In Frameless SRS/SRT, a totally noninvasive immobilisation procedure is adopted to deliver SRS and SRT treatments while maintaining the same accuracy as used in frame-based conventional SRS/SRT treatments. With SRS/SRT, it is possible to produce the effect of surgery while efficiently avoiding the normal tissue complications that usually result during surgery.
With addition to high dose rate on the linac, the time taken for SRS/SRT will be 40% less and therefore the treatment will be faster. Along with cone beam CT Scan imaging during treatment, the accuracy is much better. We are the only Centre in Pune to have this facility.
Image-Guided Radiation Therapy, or IGRT, helps to improve the delivery of radiation. IGRT involves conformal radiation treatment guided by a CT scan (called Cone Beam CT), done in the treatment room just before the patient is given radiation treatment. The imaging information from the planning CT scan done earlier is overlapped on this Cone Beam CT. With this technique, movements of the tumor due to differences in organ filling or breathing or reduction in size can be tracked. Also, even the variation in millimeters in daily positioning of the patient is detected and corrected instantly.
With the addition of carbon target Cone Beam CT imaging, the quality of imaging is much better. Hence IGRT is one of the most advanced forms of radiotherapy today and Ruby Hall Clinic is first to install and use it in India. Treatment with “respiratory gating” is used for tumors that move during respiration such as lung and liver.
|DR. SUMIT BASU||CHIEF RADIATION ONCOLOGIST|
|DR. BHOOSHAN ZADE||SENIOR RADIATION ONCOLOGIST|
|MR. SATHIYANARAYANAN||CHIEF MEDICAL PHYSICIST|
|DR. MANSI MUNSHI GIRME||RADIATION ONCOLOGIST|