Radiation oncology - also called radiation therapy - uses high-energy x-rays to destroy cancer cells while sparing the surrounding normal tissue. Radiation therapy may be used alone, or combined with other cancer treatments such as chemotherapy and surgery. It may be used to treat cancer as well as to ease symptoms of the disease and its treatment. About two-thirds of patients with cancer will receive radiation therapy at some point in the course of their illness.
Types of Cancer Treated
Many common cancer types in children and adults can be effectively treated with radiation therapy. Among these types of cancer are:
- Malignancies of the central nervous system (brain and spinal cord)
- Head and neck malignancies, including cancer of the oral cavity, pharynx and larynx
- Thoracic malignancies, including lung and esophageal cancer
- Breast cancer, following lumpectomy or mastectomy
- Gastrointestinal malignancies, including gastric, pancreatic, rectal and anal cancer
- Genitourinary malignancies, including bladder and prostate cancer
- Gynecologic malignancies, including uterine and cervical cancer
- Non-Hodgkins and Hodgkins lymphomas
- Skin cancers, including melanoma
- Soft tissue and bone sarcomas
- Cancer that has spread (metastasis) beyond the original site
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Radiation Therapy Techniques
Among the advanced radiation oncology treatment techniques available at the MMC Cancer Institute are:
- Three-dimensional conformal external beam radiation therapy (EBRT)
makes it possible to deliver a higher dose of radiation to a tumor with less damage to the surrounding normal tissue. The patient undergoes an initial Cat scan to determine the position of the tumor. Next, the data from the Cat scan is fed into a treatment-planning computer to precisely define and shape the radiation beam to "conform" to the tumor mass. The actual treatment consists of multiple radiation beams from different directions.
- Intensity-modulated radiation therapy (IMRT) View video is a new type of conformal external beam radiation therapy that enables the radiation oncologist to not only more precisely shape the beam to the tumor, but also vary the intensity of the beam as it passes near or through non-cancerous tissues. As a result, a uniform dose of radiation can be delivered to the tumor while sparing toxic doses to nearby critical structures.
- Image-guided radiation therapy (IGRT) is the most advanced form of radiation therapy. Research demonstrates that IGRT provides the best treatment outcomes with fewer, less severe side effects. One of the challenges of delivering radiation to a tumor is that the tumor can move based on the patient's day-to-day position on the treatment table (as well as from breathing). IGRT is IMRT guided by imaging (such as Cat, ultrasound or stereoscopic X-rays) performed in the treatment room just before the patient is given the radiation treatment. It is used to assess the position of a tumor and anatomic structures within the body versus relying on external landmarks. Incorporating IGRT during radiation treatment couples image-guided accuracy with intensity-modulated precision. The result is improved targeting of cancerous tissue, while sparing nearby healthy tissue.
- Stereotactic radiosurgery (SRS) is a non-invasive method of treating brain tumors without the risks of surgery or a long hospital stay. Despite its name, radiosurgery is not actual surgery, but rather a radiation therapy technique that uses highly precise equipment and three-dimensional computer planning to focus a beam of high-dose x-rays on a brain mass. The treatment-planning process is complex and requires a multidisciplinary approach led by the radiation oncologist and neurosurgeon. The actual treatment can last from 30 minutes to two hours. After the procedure, patients are able to return home.
- Low-dose rate (LDR) brachytherapy is a method of placing radioactive implants (either for a temporary or permanent basis) inside the body to deliver a radiation dose to cancerous tissue. With LDR brachytherapy, patients diagnosed with cancer have an applicator placed into or near the tumor while in an operating room or other controlled setting. Radiation pellets or "seeds" are loaded into the applicator to treat a targeted area. In most cases, the applicator and pellets remain in place from a period of hours up to several days. During treatment, patients stay in the hospital and often are confined to bed, and visitors are restricted to avoid radiation exposure. This type of treatment is called low-dose rate because the radiation is delivered slowly over an extended period.
- High-dose rate (HDR) brachytherapy View video, is a technique that delivers a higher dose of radiation in a shorter period of time. This focused approach limits the size of the treatment volume which, in turn, permits the radiation dose to be intensified. This therapy can be used alone or as a boost to standard external beam radiation therapy. MMC was the first hospital in Maine to offer HDR brachytherapy.
Like LDR brachytherapy, the applicator is placed into or near the tumor while the patient is in the operating room or similar setting. The treatment itself, however, is delivered over the span of a few minutes due to the increased strength of the high-dose rate seed. Once treatment is completed, the radiation source automatically returns to the protective storage of the HDR machine and the applicator is removed.
- HDR brachytherapy is used in treating more aggressive prostate cancer as well as lung, gynecological and breast cancers (see partial breast irradiation, below). The number of treatments required varies depending on the tumor site and treatment goal. Candidates for HDR brachytherapy are carefully selected to ensure that the treatment meets their specific needs.
- Accelerated Partial Breast Irradiation (APBI) is a form of HDR brachytherapy that offers more convenience for appropriate patients diagnosed with early-stage breast cancer by shortening radiation therapy from the standard six to seven weeks of treatment to just one week. This technique uses a type of high-dose rate radiation therapy implant. A balloon catheter is placed into the cavity where the breast cancer was surgically removed, and inflated to hold the catheter in place. Once the correct position is verified and other specific criteria are met, the catheter is connected to the HDR machine and the radioactive pellet is placed in the balloon to deliver focused radiation. The treatment lasts just a few minutes, and then the catheter is disconnected.
The APBI regimen involves twice-daily outpatient treatments over a five-day period (compared to daily visits over a six-week period for conventional, whole-breast external beam radiation therapy).
Our Radiation Oncology Experts
The MMC Cancer Institute's Radiation Oncology Department meets stringent national standards for quality, safety and technical excellence, earning it accreditation from the American College of Radiology. We are the only radiation oncology program of its kind in Maine to achieve and maintain this distinction. No other facility in the state offers such a range of the most advanced radiation therapy methods. Our patients have access to the latest, most effective treatment options proven to deliver the best possible outcomes.
Our team of six board-certified radiation oncologists gives patients a remarkable depth of specialized knowledge and experience from physicians with a reputation for excellence. We hold weekly multidisciplinary tumor board conferences for lung, breast, prostate and other site-specific cancers. At these conferences, all the specialists involved in evaluating and treating that type of cancer, including medical oncologists, surgeons, pathologists, radiologists and radiation oncologists review cases and apply their combined expertise to each patient's plan of care.
Most of our registered nurses in the MMC Cancer Institute Radiation Oncology Department at the Scarborough campus are oncology-certified nurses. These nurses have met or exceeded requirements for practice in cancer care, completed education in oncology nursing and possess a tested knowledge of the specialty. Certification in oncology nursing is based on current professional practice, so it validates that a nurse's knowledge is up-to-date.
Another distinguishing aspect of radiation oncology at MMC Cancer Institute is our team of physicists. These behind-the-scenes professionals are the ones responsible for maintaining and calibrating the radiation therapy equipment to ensure that it consistently delivers the accurate dose of radiation.
At the Forefront of Radiation Oncology Research
MMC Cancer Institute is actively involved in radiation oncology research, looking at ways to enhance patients' quality of life and alleviate the side effects related to cancer treatment. MMC Cancer Institute's radiation oncology team is a member of the Radiation Therapy Oncology Group (RTOG), the primary research arm of the American College of Radiology. RTOG is made up of physicians and other researchers from over 300 of the leading academic and community medical facilities around the world, including the MMC Cancer Institute.
The RTOG maintains a roster of active studies devoted to the group's primary disease sites: central nervous system, head and neck, lung, gastrointestinal (esophagus, stomach, pancreas, anal canal and rectum), genitourinary (bladder and prostate), breast and cervix. Access to these investigational protocols is available to appropriate patients.
In addition to opening RTOG trials, radiation oncology is an integral part of other clinical trials such as surgical oncology, neuro oncology, medical oncology and Children's Oncology Group (COG).
The MMC Cancer Institute Radiation Oncology Department provides treatment at four centers located in Scarborough, Portland, Bath and Sanford. This multi-center approach gives patients the convenience of remaining closer to home while undergoing radiation therapy.
Maine Medical Center Cancer Institute
98 Campus Drive
Scarborough, ME 04074
Southern Maine Radiation Therapy Institute at Maine Medical Center
22 Bramhall Street
Portland, ME 04102
Coastal Cancer Treatment Center
175 Congress Avenue
Bath, ME 04530
Cancer Care Center of York County
27 Industrial Avenue
Sanford, ME 04073