As technologies continue to advance, radiation therapy to treat cancer will allow for more accurate treatment and smaller treatment volumes, thereby greatly improving outcomes for patients.

What advances have occurred in radiation technology?

Over the past few decades, developments in imaging modalities (CT, MRI, PET), computers and information technology have revolutionized modern radiation technology. With the use of advanced imaging, physicians can now see exactly where tumors are within the body. This allows physicians to target a much smaller area that used to be possible with only plain film x-rays, where an entire region would need to be treated to account for that uncertainty. Powerful computer programs help to create complex treatment plans by a technique known as intensity modulated radiation therapy (IMRT) that shapes the radiation dose to treat cancer while avoiding critical structures. All of this has resulted in improved cancer outcomes and fewer side effects for patients undergoing radiation treatments.

What types of cancer are treated with radiation therapy?

Radiation therapy is a critical component in the treatment of a wide variety of cancers. Some of the most common cancers treated with radiation therapy include prostate, breast, lung, head and neck, gastrointestinal and central nervous system. Sometimes radiation therapy is the primary treatment used to eradicate a tumor, as is often the case with prostate, lung and certain head and neck cancers. In most cases, chemotherapy may be given together with radiation therapy. In other situations, radiation therapy might be used to eliminate microscopic cancer cells before or after surgery is performed. This is usually the case with breast cancer. Radiation therapy can also be important in calming symptoms when cancer has spread. Examples of this would include helping with pain when cancer has spread to bones, averting bleeding from a tumor in the lung, esophagus and stomach, or helping prevent neurologic symptoms, if cancer has spread to the brain or spinal cord.

How is lung cancer treated?

Surgery, systemic therapy (chemotherapy and other medicines) and radiation therapy all play important roles in the treatment of lung cancer, depending on the stage and type. One development that has been revolutionary for patients with early stage lung cancers who are not candidates for surgery is a technique called stereotactic body radiation therapy (SBRT). With SBRT, a patient can receive powerful doses of radiation therapy in three to five treatments over a week, precisely targeted to a lung tumor. SBRT is often very effective with minimal side effects. More advanced forms of lung cancer that has spread to lymph modes (stage III) can be treated using a combination of chemotherapy and radiation therapy. This treats a larger volume of tissue and is typically delivered in 30-35 fractions of radiation given over the course of six to seven weeks.

How are brain tumors treated?

The treatment of tumors in the brain depends on what type of tumor it is, where it is located and whether it started in the brain, or spread there from another part of the body. For patients with an aggressive cancer that started in the brain, surgery is often recommended (if possible) followed by several weeks of radiation therapy, often with chemotherapy. For cancer that has spread to the brain, radiation therapy may be used to treat the entire brain, or if there are a limited number of brain metastases (usually 1-4), a targeted treatment to treat those tumors using a technique called stereotactic radio surgery (SRS) may be used. This technique uses one to five fractions of powerful radiation therapy, accurately aimed at a tumor. SRS is very effective, causes minimal side effects and has really improved treatment outcomes for many patients with cancer that has spread to the brain.

Are there newer treatments in radiation therapy that have evolved over time?

Intensity modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT) and stereotactic radiosurgery (SRS) have all resulted in enormous advances for patients, particularly in terms of improving cancer outcomes and minimizing side effects. The use of image guidance (often performed using a CT scanner built within a linear accelerator) at the time of radiation delivery has helped to ensure that each patient is being treated with maximal accuracy during every treatment. In certain situations, a patient may have to hold their breath during treatment in order to help minimize a radiation dose to their heart. Physicians are also starting to treat certain lung cancer patients using “gated” treatment, whereby a machine is turned on only during particular portions of the respiratory cycle, which sometimes allows for smaller treatment volumes and sparing of normal lung tissue.

Dr. Bryan P. Rowe, of Concord Hospital Payson Center for Cancer Care spoke about radiation therapy and how it is used to treat different forms of cancer at a recent “What’s Up Doc?” Donor Lecture Series hosted by Concord Hospital Trust. The monthly series, supported by the Walker Lecture Fund, features members of Concord Hospital’s medical staff speaking to Concord Hospital Trust donors about new and innovative medical treatments and services. You can watch Dr. Rowe’s presentation on Concord Hospital’s YouTube channel at: youtube.com/concordhospital.