Radiation Oncology

Radiation Oncology

At Millennium Physicians we use the most advanced radiation equipment and technology to treat cancer. This technology allows for less irradiation to normal tissue, thereby reducing the toxicity of radiotherapy and improving our patients’ quality of life. With a variety of the latest techniques in radiation oncology, it is possible for us to deliver a higher radiation dose to the tumor and increase the likelihood of cure.

Our board certified Radiation Oncologists will work with your primary doctor and other cancer specialists, such as surgeons and medical oncologists, to oversee your care and provide the most effective outcome based on your cancer type.

Radiation therapy, or radiotherapy, is the use of various forms of radiation to safely and effectively treat cancer and other diseases. Radiation therapy works by damaging the genetic material within cancer cells. Once this happens, the cancer cells are not able to grow and spread. When these damaged cancer cells die, the body naturally removes them. Normal cells are also affected by radiation, but they are able to repair themselves in a way that cancer cells cannot. Your radiation oncologist will develop a plan to deliver the radiation to the tumor area, shielding as much surrounding normal tissue as possible.

It is important for you to discuss the goal of your treatment with your radiation oncologist. The goal of radiation therapy is to deliver enough radiation to kill the cancer cells while preventing damage to healthy tissue. There are several ways to do this. Depending on the location, size and type of cancer, you may receive one or a combination of techniques. Your treatment team will help you decide which treatments are best for you. Radiation therapy may be used to:

  • Eliminate tumors that have not spread to other parts of your body.
  • Reduce the risk that cancer will return after you undergo surgery or chemotherapy by killing cancer cells that might remain.
  • Shrink the tumor before surgery.
  • Shrink tumors that are harming your quality of life, such as a lung tumor that is causing problems with breathing.
  • Relieve pain by reducing the size of a tumor.
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We currently offer the following radiation services:

Brachytherapy

is the placement of radioactive sources in or just next to the tumor. During brachytherapy, the radioactive sources may be left in place permanently or only temporarily, depending upon your cancer.

Dynamic Targeting® Image Guided Radiation Therapy (IGRT):

takes into consideration patient body movement or breathing when delivering accurate radiation. This way, it can treat and target a patient’s tumor with more precision while avoiding nearby healthy tissue.

Electronic Brachytherapy (eBx)

Skin eBx is an advanced, patient-friendly option for NMSC treatment. Skin eBx provides an effective and convenient alternative to surgery allowing patients to return to normal activities immediately with no downtime. While surgery is considered to be the standard of care for NMSC, for some patients, surgery is not an option or a preference. A completely non-invasive approach, no cutting, bleeding or stitching is required with skin. Skin eBx uses a miniaturized x-ray source to deliver a precise radiation dose to your cancer lesion. This targeted treatment directs the radiation to the size and shape of the cancerous area, carefully destroying cancer cells and sparing surrounding healthy tissue. 

Intensity-Modulated Radiation Therapy (IMRT)

is a specialized form of 3-D CRT that allows radiation to be specifically shaped to cover the tumor and spare more normal tissue. 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 amount of radiation received by healthy tissue near the tumor. In some situations, this may also safely allow a higher dose of radiation to be delivered to the tumor.

Optune for High Grade Glioma

Optune is a wearable, portable, FDA-approved treatment for glioblastoma (GBM). When it is turned on, it creates low-intensity, wave-like electric fields called Tumor Treating Fields (TTFields). TTFields interfere with GBM tumor cell division. This action slows or stops GBM tumor cells from dividing and may destroy them .

Optune treats where the GBM tumor is located and TTFields do not enter the bloodstream like a drug. So, Optune does not significantly increase chemotherapy-related side effects compared with chemotherapy alone.

If you have newly diagnosed GBM, Optune is used together with chemotherapy after surgery and radiation. If you have recurrent GBM, Optune is used alone, once treatment options like surgery and radiation have been exhausted. Continuous treatment with Optune can be received almost anywhere. If your doctor approves, you can administer Optune during your daily routine.

Partial Breast Irradiation (PBI)

reduces treatment time and spares healthy tissue from exposure to unnecessary radiation compared to whole breast radiation.

Radiopharmaceuticals

Radiopharmaceuticals are radionuclide compounds that have preferential uptake into bone and thereby deliver a concentrated dose of radiation to bony metastases.

Radiopharmaceuticals are radioisotopes bound to biological molecules able to target specific organs, tissues or cells within the human body. These radioactive drugs can be used for the diagnosis and, increasingly, for the therapy of diseases.

  • Zevalin (ibritumomab tiuxetan)
    Zevalin is a short-course treatment that is delivered over 7 - 9 days and is typically administered in an outpatient setting. The Zevalin regimen includes two immunotherapy agents, rituximab—a treatment you may be familiar with from your first-line treatment—and ibritumomab. Both are man-made antibodies. Different from radiation administered outside your body, Zevalin is delivered to certain targeted and neighboring cells in your body. Zevalin can affect cells up to a 5 mm radius around targeted B-cells—that’s about the thickness of three pennies stacked. Zevalin is delivered to certain targeted and neighboring cells in your body.
  • Xofigo® (Radium 223)
    Xofigo® is used to treat prostate cancer that is resistant to medical or surgical treatments that lower testosterone and has spread to your bones with symptoms, but not to other parts of your body. Xofigo® gives off radiation that helps kill cancer cells and contains the radioactive material radium 223. It goes to areas in your bones that are growing quickly, just like calcium does. Bone metastases are one of those rapidly growing areas. Even though Xofigo® gives off a strong energy, it has a short range that does limited damage to healthy cells around it – Xofigo® can be absorbed by other organs, primarily the bone marrow and digestive system, which may result in side effects in those healthy tissues.
  • Quadramet® (Samarium 153)
    Quadramet® is an injectable radiopharmaceutical used to treat bone pain associated with certain kinds of cancer. It is primarily used to treat the pain associated with osteoblastic and mixed bone metastases confirmed on a radionuclide bone scan and has demonstrated efficacy in patients with prostate, breast and other primary cancers.1,2,3 Quadramet® may manage cancer bone pain with relief as early as one week. 1,2
  • References
    • Sartor O. et al., Samarium-153-Lexidronam Complex Treatment of Painful bone Metastases In Hormone-Refractory Prostate Cancer, UROLOGY, 2004;63:940-945.
    • Quadramet® [Package Insert]. N. Billerica, MA: Lantheus Medical Imaging, Inc: 2014.
    • Morris M. et al., Phase I Study of Samarium-153 Lexidronam With docetaxel in Castration-Resistant Metastatic Prostate Cancer, Journal of Clinical Oncology, 2009;27:2436-2442.

Stereotactic Body Radiation Therapy (SBRT)

Stereotactic Body Radiation Therapy (SBRT) is a treatment procedure similar to central nervous system (CNS) stereotactic radiosurgery, except that it deals with tumors outside of the central nervous system.

A stereotactic radiation treatment for the body means that a specially designed coordinate-system is used for the exact localization of the tumors in the body in order to treat it with limited but highly precise treatment fields. SBRT involves the delivery of a single high dose radiation treatment or a few fractionated radiation treatments (usually up to 5 treatments).

A high potent biological dose of radiation is delivered to the tumor, improving the cure rates for the tumor, in a manner previously not achievable by standard conventional radiation therapy.

Similarly, because this specialized form of radiation involves the use of multiple radiation beam angles, expert Radiation Oncologists specialized in this technique are able to safely deliver high doses of radiation, with very sharp dose gradient outside the tumor and into the surrounding normal tissue.

Stereotactic Radiosurgery (SRS):

Stereotactic radiosurgery (SRS) uses many precisely focused radiation beams to treat tumors and other problems in the brain, neck, lungs, liver, spine and other parts of the body.

It is not surgery in the traditional sense because there’s no incision. Instead, stereotactic radiosurgery uses 3D imaging to target high doses of radiation to the affected area with minimal impact on the surrounding healthy tissue. Like other forms of radiation, stereotactic radiosurgery works by damaging the DNA of the targeted cells. The affected cells then lose the ability to reproduce, which causes tumors to shrink.

Stereotactic radiosurgery of the brain and spine is typically completed in a single session. Body radiosurgery is used to treat lung, liver, adrenal and other soft tissue tumors, and treatment typically involves multiple (three to five) sessions.

Volumetric Arc Therapy (VMAT)

Volumetric Arc Therapy (VMAT) or RapidArc® Radiotherapy Technology is an advanced form of IMRT that delivers a precisely-sculpted 3D dose distribution with a 360-degree rotation of the gantry in a single or multi-arc treatment. Unlike conventional IMRT treatments, during which the machine must rotate several times around the patient or make repeated stops and starts to treat the tumor from a number of different angles, VMAT / RapidArc® can deliver the dose to the entire tumor in a 360-degree rotation, typically in less than two minutes.

RapidArc® uses special software and an advanced linear accelerator from Varian to deliver IMRT treatments up to eight times faster than what was previously possible. The algorithm ensures treatment precision, helping to spare surrounding healthy tissue. RapidArc® is made possible by software innovations that may be used with Varian manufactured treatment technology. RapidArc® consists of two components:

(1) treatment planning and (2) treatment delivery and is used for both radiotherapy and radiosurgery patients. Volumetric modulated arc therapy differs from existing techniques like helical IMRT or intensity-modulated arc therapy (IMAT) because it delivers dose to the whole volume, rather than slice by slice. And the treatment planning algorithm ensures the treatment precision, helping to minimize dose to surrounding healthy tissue.

3D Conformal Radiation Therapy (3D CRT)

begins with a complex 3D data configuration of the patient’s tumor and adjacent vital organs. Then, the generated computer images are used to focus radiation around the tumor to execute precision treatment.

What are the side effects of radiation therapy?

Most of the side effects of radiation therapy are limited to the area being treated. Short-term side effects are related to injury to normal rapidly dividing cells. They are usually temporary, mild and treatable. These symptoms typically begin by the second or third week of treatment. They may last for a few weeks after the final radiation treatment and typically go away one month after completing radiation therapy.

The short-term side effect most often reported by patients receiving radiation therapy is fatigue. The fatigue experienced is usually mild or moderate and differs for each patient. Patients may be able to continue all or a portion of their normal daily activities. However, receiving treatment for cancer often requires considerable mental and physical effort. Whenever possible, try to take time during your treatments to rest and relax. If you experience discomfort or other symptoms during or after your treatment, be sure to tell your radiation oncology team. They may be able to recommend strategies, prescribe medication or suggest changes to your diet to help.

Long-term side effects of radiation therapy may occur in any normal tissues in the irradiated area. With careful radiation therapy planning using improved technologies, serious long-term side effects are uncommon. The risk of long-term side effects depend on the area receiving radiation as well as the radiation dose being given. It is best to discuss the specific risks of long-term side effects with your radiation oncologist.

Source: ASTRO (American Society for Radiation Oncology)

How can patients best care for themselves during radiation therapy?

  • Get plenty of rest
  • Follow the doctor’s orders
  • Eat a balanced, nutritious diet
  • Stay hydrated
  • Treat skin exposure to radiation with extra care
  • Seek out support
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Millennium Physicians is a QOPI® Certified Practice. Certification by the QOPI Certification Program (QCPTM) is an acknowledgement that this practice meets certain defined quality and safety standards in the administration of cancer care.

Meet Our Radiation Oncology Team:

Jason E. Berilgen, MD

Dr. Jason E. Berilgen

Jeffrey Dinh, MD

Dr. Jeffrey Dinh

Nena Mirkovic, MD

Dr. Nena Mirkovic

Umang H. Patel, MD

Dr. Umang H. Patel

Millennium Radiation Centers are located in Kingwood, The Woodlands and Tomball. Not all services offered are available at each location, so please call for more details.

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