Innovative Treatment Options
Hoag Radiation Oncology offers a wide variety of innovative treatment options. Please select any of the following treatment options for more information about Hoag Radiation Oncology services, or call us at 949-764-5528.
3D Conformal Radiation Therapy (3DCRT)
In the past, radiation oncologists could only plan using two dimensions (width and length), due to the limitations in imaging technology. With current advanced imaging and computer technology, radiation oncologists can plan treatment in three dimensions (width, height and depth). This process is known as 3D Conformal Radiation Therapy (3DCRT).
The process starts with a CT scan, which gives a three dimensional picture of the patient's body, including the tumor to be treated as well as all normal anatomy. This picture may be supplemented with additional information from other 3D images such as PET or MRI scans. Using this picture as a map of the body, the radiation oncologist identifies a target to be treated and any sensitive healthy tissue that needs to be avoided. The radiation oncology team then uses powerful computers to design a radiation plan with multiple beams aimed at the target. Each beam is shaped to deliver the maximum dose possible to the target, while avoiding surrounding sensitive structures. Thus, the radiation "conforms" to the target volume. 3DCRT can be very useful when a tumor is close to a sensitive normal structure. (For example, lung cancer close to the spinal cord.) The added precision of 3DCRT allows the radiation oncologist to give more dose to the tumor while limiting exposure of normal tissue to safe levels.
For more information about 3DCRT, please call us at 949-764-5528.
Image-Guided Intensity-Modulated Radiation Therapy (IG-IMRT)
Intensity-Modulated Radiation Therapy (IMRT) uses intricately shaped beams to enhance the techniques used in 3D Conformal Radiation Therapy (3DCRT). In 3DCRT, intensity of the radiation is uniform throughout the shape of the beam. With IMRT, the radiation intensity is non-uniform throughout the beam shape. This non-uniform intensity allows for better control in shaping the radiation delivered to the target volume, while avoiding healthy tissue. (For example, when treating a head and neck cancer while trying to avoid nearby salivary gland and spinal cord.) The complex shaping of radiation using IMRT adds to the capabilities of 3DCRT, and allows the radiation oncologist to give more dose to the tumor while limiting exposure of normal tissue to safe levels.
IMRT can be further enhanced with the use of image-guidance (IG-IMRT). One problem that a radiation oncologist faces is how to position the patients properly for their daily treatments. Tumors aren't always where they are expected because of movement with breathing, expansion of the gastrointenstinal tract with air or other similar factors. In IG-IMRT, an image is taken daily prior to the radiation treatment, and changes in set up are made to ensure that the tumor is targeted appropriately. (For example, to help visualize the target, the radiation oncologist may implant metal markers in the prostate gland.) Our Varian 21EX uses a digital imager to visualize metal markers in a 2D fashion on a daily basis. Alternatively, some machines, such as Tomotherapy, can take a 3D image that shows the tumor and the surrounding anatomy directly in order to achieve the appropriate set up. Such image-guided techniques make treatment more accurate, ensuring that radiation is directed at the appropriate target and away from the adjacent healthy tissue.
For more information about IG-IMRT, please call us at 949-764-5528.
Tomotherapy is a specialized treatment machine specifically designed for Image-Guided Intensity-Modulated Radiation Therapy (IG-IMRT). The concept of treating cancer with radiation is a simple one: irradiate the cancer cells and they die. The challenge, therefore, lies in sparing the healthy tissue surrounding the tumor - that's precisely what Tomotherapy is all about.
Tomotherapy achieves the ability to deliver maximum radiation dose to a target volume while sparing the surrounding healthy tissue by utilizing a CT scanner for daily image guidance to ensure proper patient set-up based on the internal anatomy. The machine's superior ability to modulate the intensity of the radiation to conform around the target volume also significantly decreases the dose to healthy tissue.
"The breakthrough technology that makes Tomotherapy unique is that it combines the capabilities of a standard CT scanner with those of a radiation therapy linear accelerator," explains Radiation Oncologist Peter Chen, M.D. "Like a standard CT scanner, the Tomotherapy source spirals around the patient like a corkscrew, enabling it to take three-dimensional pictures that help doctors to precisely localize treatments. However, instead of the imaging x-rays from a standard CT scanner, the Tomotherapy source, like a linear accelerator, emits cancer-killing megavoltage photons. With both these capabilities in hand, doctors are able to treat patients with unprecedented accuracy."
Traditionally, radiation therapy treated a tumor by focusing relatively large beams of radiation from two to six directions. In contrast, Tomotherapy uses hundreds of pencil beams of radiation, rotating in a spiral around the tumor and hitting it from all directions. As the beam is rotating, the intensity of the radiation is varied, allowing the radiation oncologist to deliver the radiation with incredible precision. In addition, the radiation can be sculpted to fit the shape of the patient's tumor, again providing more precise and effective treatment.
Another radiation treatment challenge lies in the movement of tumors - sometimes as little as a millimeter. The Tomotherapy system can provide 3D CT imaging immediately prior to treatment to verify the location of the patient's tumor. By confirming the precise tumor location, the accuracy of the delivery is greatly increased.
Tomotherapy uses 3D Conformal Radiation Therapy (3DCRT) and IMRT technologies, with the addition of helical delivery and 3D imaging (IG-IMRT) for treatment verification. Find more information on Tomotherapy or call us at 949-764-5528.
Stereotactic Radiation Therapy (SRT) / Stereotactic Body Radiation Therapy (SBRT)
Stereotactic Radiation Therapy (SRT) is an intermediate technique, with many of the characteristics of both Stereotactic Radiosurgery (SRS) and Image-Guided Intensity-Modulated Radiation Therapy (IG-IMRT). When applied outside of the brain, this technique is often called Stereotactic Body Radiation Therapy (SBRT). SRT uses doses higher than standard doses with conventional radiation therapy, but lower that SRS. The length of treatment is also intermediate – typically given in five daily dose fractions.
At Hoag, SRT and SBRT are delivered with the Tomotherapy unit. Tomotherapy is especially suited for SRT/SBRT because of the precise nature of helical IMRT, and the capability to take 3D images for treatment verification. When delivered to the brain, SRT uses a thermoplastic immobilization mask that is molded to the patient's head. In contrast to the rigid head frame of SRS, this mask is applied non-invasively. When delivered to the body (SBRT), the patient is placed in a molded cradle, and wrapped with plastic covering. Suction is applied to hold the patient in a stable position. In both circumstances, 3D imaging is performed prior to each treatment to verify correct positioning. SRT is used to treat benign and malignant tumors of the brain, such as meningiomas, pituitary adenomas, acoustic neuromas, large metastases (spread of cancer from other sites in the body), optic tumors, and gliomas (anaplasticastrocytoma, glioblastomamultiforme). SBRT is used to treat selected tumors in the body, such as spinal lesions, liver metastases and lung metastases.
The Hoag Advantage:
Hoag has a distinct advantage with active SRT/SBRT and SRS programs in the same facility. Our weekly multidisciplinary Neuro-Oncology Tumor Board specialists are therefore able to recommend and carry out optimal treatment regimens within this fully integrated facility assuring the patients the best possible treatment options. For more information about SRT and SBRT, please call us at 949-764-5528.
Stereotactic Radiosurgery (SRS)
Stereotactic Radiosurgery (SRS) is a technique that delivers a single large dose of radiation to a precisely determined target. It is an alternative or adjunct to neurosurgery or conventional radiation.
The term stereotactic refers to a localizing system that uses a rigid head frame attached to the patient's skull for precision set-up. Radiosurgery refers to the highly focused beams of radiation that can be used for the same purposes as conventional surgery, but without ever cutting or opening up the patient. The only invasive portion of the procedure is attaching the head frame to the skull, which requires only local numbing medications and light sedation for comfort. There is virtually no recovery time, and the patients go home in the afternoon of their treatment day. In addition, the highly focused beams deliver a larger single dose than possible with other radiation techniques. This large single dose has been found to be more effective in treating certain tumors and conditions.
SRS is most commonly used to treat benign and malignant tumors of the brain, such as brain metastases (cancer that has spread from other parts of the body), meningiomas, pituitary adenomas, acoustic schwannomas, arteriovenous malformations (AVMs), and malignant gliomas (anaplasticastrocytomas and glioblastomamultiforme). SRS is also used to treat some neurologic conditions such as trigeminal neuroalgia, epilepsy, and Parkinson's Disease.
At Hoag, SRS is performed with the Gamma Knife Perfexion, a highly advanced and specialized radiation machine. SRS performed on the Gamma Knife is also referred to as Gamma Knife Radiosurgery (GKRS).
The Hoag Advantage:
Hoag has a distinct advantage with active SRT/SBRT and SRS programs in the same facility. Our weekly multidisciplinary Neuro-Oncology Tumor Board specialists are therefore able to recommend and carry out optimal treatment regimens within this fully integrated facility assuring the patients the best possible treatment options. For more information, please visit Hoag Gamma Knife Center or call Hoag Radiation Oncology at 949-764-5528.
Hoag is proud to present Gamma Knife Perfexion, the most advanced and specialized radiation machine for Stereotactic Radiosurgery (SRS). Hoag is the first in Southern California to install the premier unit and continues to be the only facility offering Gamma Knife Radiosurgery (GKRS).
Gamma Knife is the most well studied and published technique for delivering SRS and Perfexion is a revolutionary improvement on the existing technology. As compared to previous Gamma Knife units, the Gamma Knife Perfexion has a cylindrical collimator system that increases the ability to treat lesions independent of their location in the brain. The system also greatly improves patient comfort. Additionally, the Gamma Knife Perfexion has been configured for maximal shielding outside of the treatment region, which greatly reduces unwanted exposure to the patient. And, the unique collimator system allows for custom configurations, greatly expanding the ability to shape radiation dose to conform to the target volume increasing the capability of sparing larger areas of normal, healthy tissue. The many technological advances of the Gamma Knife Perfexion translate into a safer, more accurate, and more comfortable treatment.
The Hoag Advantage:
Hoag has a distinct advantage with active SRT/SBRT and SRS programs in the same facility. Our weekly multidisciplinary Neuro-Oncology Tumor Board specialists are therefore able to recommend and carry out optimal treatment regimens within this fully integrated facility assuring the patients the best possible treatment options. For more information, please visit Hoag Gamma Knife Center or call Hoag Radiation Oncology at 949-764-5528.
Superficial Radiation Therapy (Skin Treatment)
Radiation therapy is an extremely effective method of treating (non-melanoma) skin cancer. Non-melanoma skin cancer includes cell type diagnosis of basal cell and squamous cell.
Superficial (on the skin) treatment for skin cancer (non-melanoma) requires the use of a special machine that will treat the skin but not the underlying tissues. Hoag houses just such a machine. Radiation treatment to skin cancer allows the patient to avoid the alternative option of surgery, which often results in scarring.
Although not much information is shared about this effective treatment option, Hoag's experienced radiation oncology team performs more than 1,100 treatments each year.
With this technique, radiation can be delivered to the prostate alone by implanting radioactive seeds (permanent seed implants using Iodine-125 or Palladium-103) or by placing needles temporarily into and around the prostate and inserting radioactive Iridium-192 into the needles under computer control (temporary or High Dose Rate Brachytherapy (HDR).
Both procedures are performed at Hoag. The permanent implant is performed as an outpatient procedure, while the temporary implant requires a two-day hospital admission. The physicians at Hoag began the implant program in August 1997 and have since performed over 500 such implants, making it one of the busiest prostate implant programs in Orange County. The Hoag physicians who perform this innovative technique trained with Dr. Peter Grimm of the Seattle Prostate Institute. And Hoag physicians continue to practice using the techniques and guidelines established by this pioneering group in Seattle.
The recommended type of implant depends on a number of factors such as the stage of the tumor, size of the prostate, urinary symptoms before the procedure, whether there has been prior prostate surgery and the appearance of the tumor upon biopsy. Brachytherapy is also sometimes combined with a shortened course of external beam radiation therapy (approx. 5 weeks). In all cases of temporary implantation, five weeks of external beam radiation is delivered in addition to the implant.
Temporary side effects of implants can include: mild discomfort, small amounts of blood in the urine for several days, and an increase in urinary symptoms such as frequency, burning, and urgency. As these urinary symptoms increase, a certain percentage of patients will experience temporary urinary obstruction, which is treated with catheterization. These may peak one to eight weeks following the implant and will gradually improve over a few months. Long term complications can include: impotence, intermittent rectal bleeding and, occasionally, more persistent urinary symptoms.
The major advantages of implants are the ability to give higher radiation doses than can be attained with external beam radiation (including conformal techniques), and confining the treatment more tightly to the prostate, which should lead to better tumor control and fewer long term complications.
At Hoag, we appear to be achieving the same excellent results seen in Seattle, where the procedures have been refined over the past fifteen years. For more information call us at 949-764-5528.
High Dose Rate Brachytherapy - (HDR)
High Dose Rate Brachytherapy (HDR), also referred to as "internal radiation therapy" is a radiation treatment allowing a small radioactive source to be temporarily placed inside numerous types of tumors.
Under computer control the position and timing of source placement can be precisely controlled, allowing the physician to shape the radiation dose to the target. Because of the high dose rate characteristics, brachytherapy treatments can often be delivered on an outpatient basis or with a minimal hospital stay. HDR is used in the treatment of early breast cancer, gynecological (GYN) cancers and less often in other areas of the body. The treatment may be the only radiation given or may be in conjunction with "external radiation therapy".
For more information about HDR, please call us at 949-764-5528.
Mammosite Brachytherapy - Accelerated Partial Breast Treatment (APBT)
Mammosite® Brachytherapy is a treatment option offered to select early stage breast cancer patients in conjunction with a lumpectomy. This treatment option uses a Iridium-192 radioactive source, which delivers radiation to the lumpectomy cavity. At the time of the lumpectomy or shortly after, the surgeon will place a catheter into the cavity, which is used as the vehicle for the radioactive source. This treatment is delivered two times per day for five days. Find information about Mammosite Brachytherapy or call us at 949-764-5528.
Hoag is proud to now offer CyberKnife® as a technologically advanced treatment option in the fight against cancer.
Hoag is collaborating with Newport Diagnostic Center (NDC) to offer another minimally-invasive treatment option as part of Hoag’s comprehensive, personalized and integrated approach to cancer treatment. The CyberKnife® offers a renewed sense of hope to patients who may not be surgical candidates, while often providing an excellent adjunct therapy for those patients undergoing cancer surgery.
The CyberKnife is an FDA-cleared, non-invasive, robotic radiosurgery system that treats both cancerous and non-cancerous tumors with sub-millimeter accuracy. In the care of Hoag-affiliated Radiation Oncologist Amanda Schwer, M.D., patients are treated in single or fractioned doses (typically in 1-5 sessions) by delivering multiple beams of precisely directed radiation that converge upon the tumor, minimizing damage to surrounding healthy tissue. With the unique ability to provide sub-millimeter precision and thereby spare healthy tissue, the CyberKnife is often capable of safely delivering curative doses in cases which were previously considered untreatable. The CyberKnife is capable of treating tumors and lesions located in the brain, spine, prostate, lung, liver and pancreas; virtually anywhere in the body.
Should your patient be faced with a cancer diagnosis, you can be assured that Hoag will deliver the best treatment option for each specific patient. Hoag also offers other minimally-invasive alternatives to surgical cancerous tumor removal including Gamma Knife Perfexion®. Hoag has one of the only Gamma Knife Perfexions® in Southern California and is the only provider in Orange County offering both the CyberKnife and the Gamma Knife; the two most technologically advanced stereotactic radiosurgery systems in the world.
Through this new alliance, Hoag and Newport Diagnostic Center are jointly providing CyberKnife radiosurgery in Newport Beach at 1605 Avocado Avenue. Newport Diagnostic Center established the world’s first outpatient CyberKnife center and has been delivering CyberKnife treatments to qualified patients since 1996. For more information, or to determine if your patient is qualified for CyberKnife, please contact Hazem Chehabi, M.D., medical director of Newport Diagnostic Center or Amanda Schwer, M.D., Hoag-affiliated Radiation Oncologist, at 949-467-3061.
Superficial Radiation Treatment for Skin Cancers
Superficial radiation is a non-invasive radiation therapy option for certain individuals with skin cancers or benign conditions. As opposed to other traditional methods of skin cancer treatment, which include surgically removing the cancerous/benign area, superficial radiation treatment is administered through low-energy X-ray technology. This treatment type is optimal for lesions on the face, since it produces better cosmetic results, with minimal scarring and pigment alteration.
Hoag Cancer Institute utilizes the latest technology in superficial radiation – the Xstrahl 150. The Xstrahl 150 X-ray system is a superficial treatment unit ideal for treating surface skin lesions including basal and squamous cell carcinoma. In addition to the face, this treatment modality is best used on larger lesions and may be used in conjunction with surgery for high-risk patients at risk for recurrence following surgery.
“Superficial radiation techniques are an excellent alternative to the treatment of skin cancers,” states Radiation Oncologist Craig Cox, M.D., D.A.B.R. “This non-invasive option can offer high cure rates and positive cosmetic results in selected patients.”
Clinical conditions that the Xstrahl 150 can treat, include:
• Basal cell carcinoma
• Squamous cell carcinoma
• Keloid scars
• Dermatological conditions
• Mycosis fungoides
To learn more about superficial radiation treatment, please call Hoag Radiation Oncology at 949-764-5528.