Some of the most sophisticated cancer treatment methods are available at the OSUCCC - James, enabling our team to manage advanced and complex diseases more successfully and with fewer side effects for our patients. Tumor-targeting imaging technologies available to our patients include:
The NEW Varian TrueBeam Linear Accelerator
The Varian TrueBeam is a new system that gives oncologists and multidisciplinary teams the power to manage challenging cancers with unparalleled ease and precision anywhere in the body, including the lung, abdomen, breast, head and neck. It is a radically new solution that is faster, is more powerful and that seamlessly integrates respiratory gating, imaging and treatment techniques. The TrueBeam system is innovative, intelligent and intuitive, leading to better tumor localization and increased patient safety.
The TrueBeam rotates around the patient to deliver a prescribed radiation dose from nearly any angle. It combines imaging, beam delivery and sophisticated RapidArc technology to accurately and precisely target tumors with great speed. Real-time imaging tools allow clinicians to "see" the tumor they are about to treat and respiratory gating enables clinicians to synchronize beam delivery with patient respiration.
The TrueBeam Linear Accelerator at the James Cancer Hospital is equipped with Brainlab technology, including ExacTrac® Frameless Radiosurgery, which replaces frame-based treatments. This offers highly accurate delivery of single fraction treatments for improved patient comfort. The ExacTrac also features robotic patient alignment, which automatically corrects rotational misalignments and delivers the most accurate patient setups.
The TrueBeam is capable of all conventional radiation therapies, Image Guided Radiation Therapy (IGRT), as well as Intensity Modulated Radiation Therapy (IGRT). Its automated technologies will ensure the patient receives the same focused radiation directly to the tumor each day of treatment, making treatment easier, safer, and more effective.
Types of Treatment
External Beam Radiation Therapy
External beam radiation therapy is a method of delivering high energy X-rays that easily penetrate the body to reach the tumor. The treatment is delivered with a linear accelerator (Linac). During patient treatment, the Linac rotates to several different angles around the patient to deliver individually shaped beams to the tumor target. These beams are closely adjusted (conformed) to converge on the tumor to deliver the planned dose of radiation (conformal radiation therapy).
Intensity Modulated Radiation Therapy
Intensity Modulated Radiation Therapy (IMRT) is a type of external beam radiation therapy. IMRT can deliver escalated doses, not only by conforming more focused, but also by “painting” the dose of radiation around the tumor. This enables improved therapeutic ratio. Multiple fields converge on the tumor target and the radiation dose within each field is individually modulated to include the tumor target and exclude normal tissues. Therefore, higher radiation doses can be given to the tumor tissue, while normal tissues are protected more effectively than with conventional conformal radiation. This delivery method of radiation therapy is quickly becoming the first choice in head-and-neck and prostate cancer, and is expanding to the treatment of many other tumors.
Stereotactic Body Radiation Therapy
Stereotactic Body Radiation Therapy (SBRT) has emerged as an image-guided radiation therapy modality that employs advanced radiation therapy planning and imaging-guided, high-precision localization techniques. SBRT delivers high doses of radiation to selected body sites within a few treatments. Its effectiveness has been demonstrated in medically-inoperable early-stage lung cancer, liver tumors, spinal tumors and other cancers. The radiation oncologists and physicists at The James are highly trained experts in the delivery of SBRT. Our team has several peer-reviewed scientific articles about SBRT and is also a contributor to the only textbook dedicated to SBRT for spinal tumors.
Image-Guided Radiation Therapy
Image-Guided Radiation Therapy (IGRT) uses the delivery method of IMRT combined with image guidance at the time of radiation treatment delivery. This therapy technique can overcome day-to-day motion of the tumor target and normal tissues by providing accurate localization of the target with millimeter precision. This targeted localization is performed daily with the use of CT imaging obtained directly by the treatment machine (cone-beam CT) before therapy. The treatment fields are then adjusted accordingly just prior to the actual radiation therapy delivery. Because of the higher precision in therapy delivery, safety margins of normal tissue around the tumor target can be significantly decreased. IGRT enables the delivery of higher doses to the tumor (dose escalation) with the potential to improve cancer control and, at the same time, reduces treatment-related side effects and complications.
Stereotactic Radiosurgery and Fractionated Stereotactic Radiotherapy
In stereotactic radiosurgery (SRS), a single, very large radiation dose is given with high-precision millimeter accuracy to a small target (tumor) in a highly focused fashion. One option of stereotactic radiosurgery is the Gamma Knife. With this specialized treatment machine, 201 tiny, Cobalt-60 radioactive sources precisely direct radiation beams, which all converge in one focus. Complex computations are carried out to create a personalized treatment plan for each patient and each tumor. This treatment is delivered in a single day. SRS can also be given with our Linac-based delivery systems, called Linac-based radiation surgery. Linac-based stereotactic radiotherapy broadens the stereotactic radiation therapy options: with the Linac-based stereotactic approach, treatment is not limited to a single fraction, but the same high-precision dose delivery can be performed for multiple treatments. This is often preferable for larger tumors or tumors very close to critical normal tissues. While a single large dose of radiation can only be given to relatively small targets, larger tumors can be treated with similar high precision using fractionated stereotactic radiation therapy (FSRT). Specialized attachments are added to the Linac and the treatments can be spread out over several days.
Brachytherapy, Image-guided Brachytherapy
Brachytherapy applies the radiation from the inside of the patient or tumor. Radioactive sources are placed within or around a tumor using special applicators. These sources may remain in the tumor region temporarily (temporary brachytherapy implant) or permanently (permanent brachytherapy implant). The OSUCCC–James provides a wide range of brachytherapy options. Insertion of temporary brachytherapy implants can typically be given as outpatient procedures, and are often high-dose-rate (HDR) brachytherapy procedures. Alternatively, when low-dose rate brachytherapy (LDR) procedures are performed, they generally require hospital admission. Both options are available at the OSUCCC–James. In addition, we provide image-guided brachytherapy using CT, MRI or both. This allows more precise localization of the tumor region for brachytherapy and a highly-personalized dose prescription for the patient’s individual tumor and normal tissue characteristics.
Intraoperative Radiation Therapy
In some tumors, normal tissues are very close to the tumor region. The only way to protect those normal tissues from radiation is to deliver radiation therapy during surgery, when these normal tissues can be temporarily moved out of the way. Only a few centers in the country offer intraoperative radiation therapy (IORT). The James has two options for intraoperative therapy that are tailored to each patient's individual situation: electron beam IORT, with a dedicated Linac in the operating room (Mobetron) and intraoperative high-dose-rate brachytherapy, with custom-designed brachytherapy delivered during surgery to the operative tumor bed.
For more information, call The Department of Radiation Oncology at (614) 293-0672