If radiation therapy is part of your treatment program, you will receive treatment at Samaritan Regional Cancer Center (SRCC) in Corvallis. The goal of radiation therapy is to get a high enough dose of radiation into the body to kill the cancer cells while sparing the surrounding healthy tissue from damage. Several different radiation therapy techniques have been developed to accomplish this. Depending on the location, size and type of your tumor or tumors, you may receive one or a combination of these techniques. Your cancer treatment team will work with you to determine which treatment and how much radiation is best for you.
During external beam radiation therapy, the most common type of radiation therapy, a beam of radiation is directed through the skin to a tumor and the immediate surrounding area in order to destroy the main tumor and any nearby cancer cells. To minimize side effects, the treatments are typically given every day for a number of weeks.
The radiation beam comes from a machine located outside of your body that does not touch your skin or the tumor. Receiving external beam radiation is similar to having an X-ray taken. It is a painless, bloodless procedure. The most common type of machine used to deliver external beam radiation therapy is called a linear accelerator, sometimes called a "linac." It produces a beam of high-energy X-rays or electrons. Using sophisticated treatment planning software, your radiation oncology treatment team plans the size and shape of the beam, as well as how it is directed at your body, to effectively treat your tumor while sparing the normal tissue surrounding the cancer cells.
Several special types of external beam therapy are discussed below. These are used for particular types of cancer, and your radiation oncologist will recommend one of these treatments if he or she believes it will help you.
Tumors usually have an irregular shape. Three-dimensional conformal radiation therapy (3D-CRT) uses sophisticated computers and computer assisted tomography scans (CT or CAT scans) and/or magnetic resonance imaging scans (MR or MRI scans) to create detailed, three-dimensional representations of the tumor and surrounding organs. Your radiation oncologist can then shape the radiation beams exactly to the size and shape of your tumor. The tools used to shape the radiation beams are multileaf collimators or blocks. Because the radiation beams are very precisely directed, nearby normal tissue receives less radiation exposure.
Intensity modulated radiation therapy (IMRT) is a specialized form of 3D-CRT that allows radiation to be more exactly shaped to fit your tumor. With IMRT, the radiation beam can be broken up into many "beamlets," and the intensity of each beamlet can be adjusted individually. Using IMRT, it may be possible to further limit the exact amount of radiation that is received by normal tissues that are near the tumor. In some situations, this may also allow a higher dose of radiation to be delivered to the tumor, increasing the chance of a cure.
At Samaritan Regional Cancer Center, the radiation oncologists use image-guided radiation therapy (IGRT) to help them better deliver the radiation dose to the cancer. Normal structures and tumors can move between treatments due to differences in organ filling or movements while breathing. IGRT is conformal radiation treatment guided by imaging equipment, such as CT, ultrasound or stereoscopic X-rays, taken in the treatment room just before the patient is given the radiation treatment. All patients first undergo a CT scan as part of the planning process. The digital information from the CT scan is then transmitted to the console in the treatment room to allow doctors to compare the earlier image with the images taken just before treatment. During IGRT, doctors "fuse" these images to see if the treatment needs to be changed. This allows doctors to better target the cancer while avoiding nearby healthy tissue. In some cases, doctors will implant a tiny piece of material called a fiducial marker near or in the tumor to help them localize the tumor during IGRT.
With the acquisition of an Electronic Brachytherapy (eBx) system, radiation oncology can now offer an alternative therapy choice to women with specific forms of breast cancer. Accelerated Partial Breast Irradiation (APBI) can reduce the treatment time for radiation therapy to ten fractions, over five days, and lessen the treatment area to just the lumpectomy site.
Once a patient has been identified as a viable candidate, eBx treatments require the cooperation of both the surgeon and radiation oncologist. The breast surgeon performs a lumpectomy and then uses slim laparoscopic tools to guide a deflated balloon into the resulting cavity. That balloon is connected to a catheter, which remains outside the body during the entire radiation treatment period. Once in place, the balloon is inflated, through the catheter, with saline solution until it fits snugly into the lumpectomy cavity. A medical physicist and a radiation oncologist will use CT images and sophisticated software to create a unique treatment plan.
During radiation treatments, the radiation oncologist connects the catheter to the eBx system, which delivers the optimal radiation dose based off a pre-calculated plan. Because the dose is delivered electronically using a miniaturized X-ray source rather than a decaying isotope, the patient needs only a small flexible X-ray shield draped over her breast. Typically, each session will last for 30 minutes and will be delivered once in the morning and once in the afternoon for five consecutive days. When the last radiation session is completed, the balloon is deflated and slipped out of the surgical cavity. The fact that these treatments are performed internally means that we can minimize radiation exposure to healthy tissue and organs and minimize side effects.