St. Vincent Services Cancer Care Cancer Services Radiation Oncology

Radiation Oncology

The Radiation Oncology Departments at HSHS St. Vincent Hospital Cancer Centers are leaders in treating many forms of cancer.

We utilize state-of-the-art radiation therapy equipment and computerized treatment planning systems, including Trilogy™,the world’s most powerful and precise cancer treatment technology at both of our Green Bay locations.

But most importantly, we’re a group of highly qualified professionals with diverse skills who can work in concert. Our cancer center has a proven track record of introducing and successfully implementing new technology long before others in the state. Our team of radiation oncologists, dosimetrists, radiation therapists, registered nurses and radiation physicists all work together toward one common goal: To provide our cancer patients with state-of-the-art therapy in a caring, compassionate environment.

Step 1: Consultation


Most patients are referred to radiation oncology by other specialists who have done tests to determine if cancer is present and if so, at what stage. During the first visit, a radiation oncologist will review the results of previous tests to determine if radiation therapy is a treatment option. The consultation includes a description of how the treatment works and discussion of any possible side effects. The oncologist may order other tests that could include x-ray examinations, blood work or additional imaging studies.

 

Step 2: Radiation Oncology Nurse Visit

A radiation oncology nurse will record pulse, blood pressure, weight, health history, and the history of the present cancer and educate you about what to expect from radiation treatment, including side effects.

Step 3: Simulation

Simulation includes a CT scan of your treatment area and collection of additional technical information used to develop the radiation treatment plan. You will be positioned for the CT scan in the same way as for treatment. The therapist will need to mark certain areas of your body to later assist in accurately aiming the radiation at exactly the same spot during each treatment. This process allows the physician, dosimetrist and physicist to develop a treatment plan precisely designed and targeted to you. They will study the images and determine where and how to direct the radiation to achieve the best results.


Step 4: Dosimetry

Radiation oncologists and other members of the treatment team carefully study information from simulation on the location and size of the tumor, surrounding tissues, and organs. The physician reviews the information provided during simulation to determine the appropriate course of treatment. Then the team, with computer-aided technology, develops a plan that provides the safest and most effective treatment.

Step 5: Radiation Treatment

Once the physician and their team have developed the individualized treatment plan, you are ready to begin treatment. This generally occurs 1-7 days after the simulation.

You will be asked to lie on the table or “couch” of the radiation treatment machine; the radiation therapist will help position you. The therapist and oncologist can also move the table to perfectly align you for treatment. These movements are often as little as one millimeter or even less to ensure precise accuracy. Computers and laser beams are also used to help with alignment.

Because radiation is being used, the therapist and physician cannot be in the same room with you during treatment. The radiation therapist closely monitors you during treatment on a television screen and an intercom system allows for constant verbal contact. During treatment, you will be asked to lie very still. The computerized treatment plan, developed and approved by the radiation oncologist and their team, tells the treatment machine precisely how to deliver the radiation at the targeted area. The machine can rotate 360 degrees so the radiation can hit the tumor from different angles. Each treatment is painless and lasts only a few minutes.


Step 6: After Radiation Treatment

Care from our radiation therapy team doesn’t end when radiation treatments are completed. The Radiation Oncologist consults with the patient on the last day of treatment to carefully review and discuss aftercare instructions, possible side effects and what to expect in the days ahead.

Follow-up Appointments: Are scheduled with the Radiation Oncologist and referring physician. In addition, one of our nurses will call a few days after treatment to follow up on any side effects, questions, or concerns.

For more information, call St. Vincent Hospital Cancer Centers, at 920-433-8488.

Types of Radiation Therapy

 

Radiation therapy is one of the most sophisticated and successful treatments for cancer that is available to modern medicine. Depending on the individual patient, radiation therapy may be used alone, or in conjunction with surgery or chemotherapy. For some cancers, it is the treatment of choice; in others it may be used to alleviate stressful symptoms such as pain, obstruction or hemorrhage.

External Beam Radiation Therapy

Delivers beams of radiation from the outside of the body into the area of the body that needs treatment.

Internal Radiation Therapy

Also called Brachytherapy, delivers radiation from inside the body through “seeds,” needles, or a radiation source placed directly to the affected area.

Certain types of radiation are best suited to specific areas of the body. The type of radiation recommended depends upon the location of the tumor, stage of cancer, other patient specific factors and patient preference.

External Beam Therapy

Our Radiation Oncologists can choose from a variety of special technologies that produce ionizing radiation (such as photons or electrons) that destroy cancer cells. St. Vincent Hospital Cancer Centera, use Varian's Trilogy™, at both the St. Vincent and St. Mary’s centers to provide the radiation oncologist with numerous treatment options.

A patient’s external beam treatment schedule will depend entirely on the individual situation. However, patients usually receive external beam therapy once a day, five times a week. Sometimes, a patient is treated twice a day. An entire course of treatment may last from one to eight weeks, depending on the type of cancer and the goal of the treatment.

Intensity Modulated Radiation Therapy (IMRT)

IMRT delivers external beam radiation treatments that allows the doctor to give higher doses of radiation to the cancer while protecting as much normal tissue as possible. The goal for IMRT is to improve cure rates and reduce side effects. The entire IMRT treatment typically takes 20-30 minutes. The time the radiation beam is actually on during treatment is approximately 30 seconds from each direction.

Image Guided Radiation Therapy (IGRT)

Image-guided radiotherapy, is the most advanced form of external beam radiation therapy available. Tumors can move during and between treatments. IGRT uses advanced imaging techniques to verify patient and tumor position at the time of the treatment. This allows clinicians to reduce the amount of tissue irradiated, targeting only the tumor and sparing the surrounding normal tissue. Irradiating less normal tissue improves the patient's quality of life, and may make it possible to deliver higher radiation doses to the tumor and thereby increase the likelihood of controlling tumor growth. IGRT can be combined with IMRT or delivered with traditional external beam radiation therapy. St. Vincent Hospital Cancer Centers were the first in the region to utilize IGRT, first with ultrasound and then with CT scanners that are attached directly to the radiation treatment machine with robotic arms. Our state-of the-art Trilogy™ radiation treatment system represents a new generation in cancer care combining a treatment machine with an imaging machine.

Brachytherapy

Brachytherapy delivers radiation from inside the body through “seeds” or needles, or a radiation source placed directly on the affected area. The source of the radiation can be temporary or permanent. Brachytherapy can be either high dose rate or low dose rate.

The radiation oncologist will decide which type of brachytherapy treatment is recommended based on location, tumor extent and other factors and explain these recommendations.

Brachytherapy techniques offer numerous patient benefits, including:

  • Shorter treatment times
  • More convenience
  • Less possibility of discomfort
  • Better ability to deliver the radiation to the tumor while sparing normal tissues

Brachytherapy can be used to treat several types of cancer. The most common types of cancer treated with brachytherapy include breast, cervical, vaginal, uterine, prostate and pterygium of the eye.

High Dose Rate (HDR) Brachytherapy

HDR procedures are done in a specialized designed room, equipped as a surgical suite, right within the Cancer Center. St. Vincent Hospital Cancer Centers, at St. Vincent Hospital, is the only cancer center is our region to incorporate this level of advanced technology into our cancer center. This provides patients with greater convenience and comfort than having to utilize the hospital’s operating room, while still ensuring patient safety.

The three types of HDR implants are:

  • Intracavitary—an applicator inserted into a body cavity to reach the tumor
  • Intralumenal—catheters are inserted into a “tube” such as the bronchus or esophagus
  • Interstitial—catheters are inserted through the body tissue to encompass the tumor and deliver radiation directly to the tumor area. Anesthesiologists and operating room professionals provide anesthesia or sedation and safely monitor the patient throughout this more complex procedure

HDR techniques offer numerous benefits, including:

  • Shorter treatment times
  • Convenience
  • Less possibility of discomfort
  • Better ability to deliver the radiation to the tumor while sparing normal tissues

Many types of cancer can be treated with HDR. The most frequent include:

  • Breast
  • Gynecologic
  • Prostate
  • Eye

Stereotactic Radiosurgery (SRS)/Stereotactic Body Radiotherapy (SBRT)

 

Stereotactic radiosurgery is a very sophisticated type of external beam radiation therapy treatment in which high doses of radiation are delivered using a very precise beam in five or fewer visits. In spite of the term, radiosurgery, no incision is made and treatment is generally given as an outpatient visit.

With a state-of-the-art radiation-surgery technology, called Trilogy™, our clinicians can precisely pinpoints the exact location of the cancer and treats it with a highly accurate beam of radiation.

  • Small lesions can be treated with radiotherapy, reducing the need for more invasive treatments such as surgery or chemotherapy

  • The use of powerful beams means reduced treatment times

  • The most accurate beam means the most accurate treatment

  • The most advanced patient positioning tools mean the most accurate treatment and a reduction in side effects

  • The ability to deliver treatments that shrink-wrap the radiation dose to the tumor means a reduction in the side effects of the treatment

  • The ability to deliver treatments that shrink-wrap the radiation dose to the tumor means a reduction in the side effects of the treatment.

Rapid ARC/Volumetric ARC Radiotherapy

 

This breakthrough technology speeds up the delivery of external beam radiation therapy and delivers it more precisely as doctors target tumors from every angle with this image-guided IMRT (intensity-modulated radiation therapy) that makes a 360-degree revolution around the patient while delivering the prescribed dose of radiation that spares healthy surrounding tissue while targeting the unique anatomy of the tumor, all in just a few minutes.

The speed of RapidArc makes treatments easier on the patient, lasting less than two minutes long instead of 20 minutes or more, so patients don’t have to hold still as long and are more comfortable. That shortened time translates to more precise treatment.

Because RapidArc technology targets tumors so precisely, it is particularly useful in cancers of the prostate, head and neck and can avoid radiation to critical healthy organs nearby including the spinal cord, brain stem, eyes, optic nerve and chiasm, parotid glands and brain.

RapidArc treatments are delivered using the Trilogy™ medical linear.

The new technology “is a breakthrough that marries advanced imaging allowing us to precisely see the cancer with a high technology treatment delivery system so we can give higher doses of radiation directly to the cancer,” said Radiation Oncologist Dr. Linda Gemer, St. Vincent Hospital Radiation Oncology. “All of this technology is designed for better cancer control and more comfort for the patient.”

Trilogy

 

Our Trilogy linear accelerator represents a new generation in cancer care combining a treatment machine with an imaging machine. That means we can establish exactly where the tumor is, at the moment of treatment, and position patients precisely for delivering radiation doses with sub-millimeter accuracy. Combined with a beam that is both more powerful and more focused, it’s a potent combination.

Patients are positioned on a treatment couch, and a CT (computerized tomography) system mounted on a robotic arm is rotated around the body, to gather images that pinpoint a tumor's exact location. These images are then compared with existing images (MRI, CT or other kinds of scans) in order to determine if the tumor has moved since the last treatment. Because tissues and organs can settle around bones differently each time a patient lies down on a treatment table, tumors can end up in different positions from one treatment session to another.

What makes the Trilogy™ different is that we can use it to offer a variety of treatment modalities, including intensity-modulated radiotherapy, (IMRT), image-guided radiation therapy (IGRT), and stereotactic radiosurgery (SRS), the most advanced treatment modes currently available. That means treating a wide range of cancers: from small lesions and metastases to larger tumors, both intracranial (inside the head) and extracranial (other places in the body, not inside the head). The choice of technique can be customized for each patient at the discretion of the radiation oncologist.

Michael W. Guiou, MD

 

Radiation Oncology

Barbi L. Kaplan-Frenkel, DO

 

Radiation Oncology