About Tomotherapy
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Radiation treatment uses high energy X-rays to change the genetic makeup of cancer
cells and take advantage of their rapid growth cycle. By ruining their genetic material,
the cancer cells die as they attempt to multiply. The goal of radiation treatment is to
eradicate all the cancer cells and avoid or minimize harm to the surrounding healthy
tissues. Since cells of normal tissue divide much more slowly compared with cancer cells,
they have much more time to recover and divide, and are not as adversely affected by
radiation. The majority of normal cells can recover from the effects of radiation and
function properly. Each radiation treatment is tailored to each individual patient.
Radiation may be used alone, after surgery, or with or without hormonal therapy.
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Radiation therapy is used in about half of patients with
prostate cancer. Just about anyone with prostate cancer
is a candidate for radiation treatment. It’s generally
reserved for patients who are older or with other
medical problems. It’s also used sometimes after surgery
to prevent or treat tumor recurrence despite surgery.
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Tomotherapy is the most advanced concept in radiation therapy. It employs a
360-degree revolutionary treatment system to deliver tens of thousands of
radiation beamlets. The beamlets are focused precisely to your unique target
area, to kill the prostate cancer cells while minimizing radiation exposure
to healthy tissue. It is a form of external radiation which passes through
you from the outside. It is also a form of intensity modulated radiation
therapy (IMRT), as well as image guided radiation therapy (IGRT), but more
precise to the moment (within seconds). Each day prior to treatment, the
Tomo unit develops its own CAT scan and we can guide treatment based on
what your prostate looks like that minute, not last week or last month.
This makes it easier to target only your prostate and minimize radiation
to surrounding critical structures, such as the bladder and rectum. Linear
accelerators, in contrast, are not able to image the prostate, rectum and
bladder directly, the reason we picked the Tomotherapy machine.
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There are several forms of radiation available for
prostate cancer, including brachytherapy and external
beam therapy. In brachytherapy, radiation is delivered
from the inside out using seeds or rods. Seeds type
brachytherapy, also referred to as low dose
brachytherapy, is acceptable as a single treatment
modality only for patients with low risk prostate
cancer. It is administered in the operating room under
anesthesia, and patients go home the same day. The
radioactive seeds are implanted into the prostate using
trans-rectal ultrasound guidance in order to ascertain
proper placement. The seeds lose their radioactivity
over the course of a few months, though it’s safe for
the patient and family members even while the seeds are
radioactive.
High dose-rate brachytherapy is also administered in the
operating room under anesthesia, however in this type of
treatment, permanent seeds are not implanted. Rather,
temporary rods are placed in the perineum. These rods
are hollow and are used to load and unload seeds three
times over a 36 hour period while the patient remains
in-hospital. This modality is most often recommended to
patients with intermediate or high risk disease, and is
typically administered in conjunction with some form of
external beam radiation treatment, generally completed
before the high dose-rate brachytherapy is administered.
External radiation therapy is available in several different types:
- Linear Accelerator: this machine delivers
high-energy photons or x-rays to treat deep-seated
tumors, as in the prostate. (It also may deliver
electrons to treat superficial tumors, unrelated to
prostate disease). The imaging with this modality is
not directly coupled to the delivery of radiation,
however, prior to treatment of the prostate with
this modality, three permanent non-radioactive seeds
are inserted into the prostate under local
anesthesia. Each day prior to treatment the linear
accelerator images the seeds, an indirect method of
targeting the prostate. Thus, unlike Tomotherapy,
the prostate, bladder and rectum cannot be seen
directly.
- CyberKnife: The Cyberknife System is a
computer-controlled, robotic radiation delivery
system that attacks tumors with high doses of
radiation from many directions or angles with
sub-millimeter accuracy. With stereotactic
radio-surgery there is no incision, cutting or
anesthesia. Radiosurgery does not remove the tumor
or lesions, but instead, uses the high doses of
focused radiation to destroy tumor cells and stop
the growth of cancer cells. At the core of the
Cyberknife System is technology that continuously
and automatically tracks the tumor's and patient's
position - including his or her respiratory motion.
It uses this information to guide and position the
radiation beams to target the tumor, while carefully
sparing the surrounding healthy tissue. Treatment of
prostate cancer with the Cyberknife has not been
compared to other forms of radiation and we do not,
therefore, consider it to be a standard of care for
prostate cancer.
- Three-dimensional conformal radiation therapy:
this method of external beam radiation includes
delivery of ionizing radiation from several
different directions, all converging onto the
central target (prostate). In this way, the
cumulative dose of radiation to the prostate is
high, whereas the radiation dose to the surrounding
non-cancerous tissues is low. This method is similar
in principle to Tomo therapy, but with only several
portals 3DCT is less conformal, and it lacks the
immediacy of image guided techniques available in
Tomo. In other words, 3DCT is less precise than
Tomo.
- Proton Beam: Protons are a form of radiation
with a charged particle which theoretically can be
better aimed than an x-ray, and have been shown to
be advantageous in the treatment of certain
pediatric brain or spinal cord tumors. However, no
studies to date have shown any such advantage over
IMRT or Tomo Therapy in the treatment of prostate
cancer.
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The process begins with consultation, first with
your urologist, and then with one of our radiation
oncologists. If all are in agreement, you will be
scheduled for a Simulation session. You’ll be asked
to lie still on a CAT scan table by the radiation
therapist as cross-sectional images of your anatomy
are obtained. They’ll use these to learn the exact
location of your prostate relative to the
surrounding structures. To help you remain still
during treatment and to ensure that the radiation
beam is aimed correctly, “immobilization devices”
will be custom-made for you. You will be marked with
speck-sized tattoo dots to assist in the daily
focalization of your anatomy.
Next, the dosimetrist, radiation physicist and
radiation oncologist use a treatment planning
computer system to determine the radiation dose,
delivery time and treatment technique. The radiation
oncologist uses all the relevant information to
decide how much radiation is needed, how it will be
given, and how many treatments you need.
In general, treatment is delivered once a day, 5
days a week.
The actual radiation therapy treatments are
completely painless. While the treatment
appointments may last about an hour, the actual time
of each treatment is only a few minutes. The rest of
the time is used to set up the equipment and place
you in the correct position. Your job is easy. You
just lie still and relax on a treatment table
positioned in the radiation machine.
After you are in position, the radiation
therapist leaves the room and turns on the machine.
You can still communicate via the closed circuit
television and intercom. You will feel nothing
unusual. The CAT scan performed prior to the
treatment will take 2-3 minutes, after which the
treatment will be delivered over the same time
period.
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The New York Times published two lengthy articles on
radiation in February, 2010. The first covered two very
unfortunate mis-administrations that occurred in New
York, using conventional linear accelerators. The second
touched on additional mistreatments in the U.S. and
questioned the “vulnerability of patient safeguards” as
new technology is developed to fight cancer.
At the Garden State Prostate Cancer Center, providing
safe and high quality radiation therapy is our highest
priority. We take pride in our commitment to quality. We
go beyond what is required to ensure patient safety and
treatment accuracy.
The Garden State Prostate Cancer Center uses Tomo Therapy
for the treatment of prostate cancer rather than the
conventional radiation therapy that was highlighted in
the news articles. Tomo Therapy radiation treatments are
performed using the system’s integrated daily
pre-treatment CT imaging capabilities. This is the only
treatment machine that non-invasively images the
prostate, bladder and rectum immediately prior to each
treatment to guarantee proper targeting of the treatment
volume. The Radiation Therapists make day to day
adjustments based on bladder and rectum changes. This
ensures the accuracy of the treatment target each day.
We only treat prostate cancer, making our staff and the
Center highly specialized and proficient in the
treatment of this disease. Our clinicians are all Board
Certified and State licensed. Our Physicists, Medical
Dosimetrist, Radiation Therapists, and Registered Nurses
are also all board-certified and / or State licensed.
The Prostate Cancer Center at Garden State Urology has
had, since its inception, multiple safeguards in place
to ensure patient safety when undergoing treatments.
They are:
- Daily and monthly Quality Assurance testing on
the Tomo Therapy machine to assure dose accuracy and
the proper functioning of the mechanics of the
machine.
- After the initial Planning or CT-Simulation
(CT-Sim), the Radiation Oncologist meets with the
Medical Physicists and defines or draws a treatment
volume for that patient. The following day, a second
radiation oncologist looks at that treatment volume
and double checks it. If they both agree with the
treatment volume, the work begins to create a
treatment plan for that patient. Any disagreements
are reconciled prior to creating a treatment plan.
- Prior to the first radiation treatment our
Physicists conduct quality assurance testing using a
phantom. A phantom simulates a patient and measures
the radiation dose and distribution of that dose.
The quality assurance testing will confirm that the
dose and distribution is correct for that individual
patient.
- Before a patient’s first treatment, the Chief
Therapist reviews the patient’s full chart for all
proper documentation, and does a final review of the
treatment plan.
- On the day of treatment, the Radiation
Therapists also review the chart and treatment plan.
When the patient is ready for treatment, the
following safety measures are employed:
- The patient is properly identified, including a
photograph ID
- At least 2 Radiation Therapists are involved in
treatment at all times
- The daily scan and registration [of the
treatment target] are reviewed on-site by one of the
Radiation Oncologists
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GARDEN STATE UROLOGY IS ACCREDITED BY THE AMERICAN COLLEGE OF RADIOLOGY
Garden State Urology is proud to provide its patients with the most modern and integrated healthcare experience through its state-of-the art,
accredited facilities. If you are undergoing radiation therapy, the following information is provided to assist you in your treatment.
What should I know about radiation therapy treatments?
- Will my treatments be given by qualified physicians and staff?
- Does the facility have the equipment I need to receive safe and up-to-date cancer treatment?
- Is the facility accredited by the American College of Radiology (ACR)?
Why should I have my treatments at an accredited facility?
A diagnosis of cancer is usually a life-changing experience for patients and their loved ones. As they seek treatment for their disease, cancer
patients need to know that they are receiving safe and appropriate care. To achieve ACR accreditation, our facility’s personnel qualifications,
equipment requirements quality assurance and quality control procedures have gone through a rigorous review process and have met specific qualifications.
It’s important for patients to know that every aspect of the ACR accreditation process is overseen by board-certified, expert radiation oncologists and medical physicists.
What does ACR accreditation mean?
- 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 administer your radiation therapy treatments.
- Our equipment is appropriate for the treatment you will receive, and our facility meets or exceeds quality assurance and safety guidelines.
What does the accreditation seal mean?
When you see the ACR seal you can rest assured that your treatment will be done at a facility that has met the highest level of quality and radiation safety.
The facility and its personnel have gone through a comprehensive review to earn accreditation status by the American College of Radiology (ACR), a national
professional organization serving more than 36,000 diagnostic/interventional radiologists, radiation oncologists, nuclear medicine physicians and medical physicists.
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