Deliver treatment directly to tumor with brachytherapy

Brachytherapy is a type of precise cancer treatment used to deliver high doses of radiation within or next to the cancer. At Goshen Center for Cancer Care, we have a wide variety of tools and advanced techniques to provide this treatment. We use detailed computer mapping to position and ensure radiation applicators are located in the most effective areas to target the cancer. Each treatment takes about 15 minutes. Often only one session is needed, but sometimes it takes five or 10 treatments.

Adaptive radiation treatment through NEW Ethos™ Therapy

By most clinical standards, the process of preparing treatment plans for patients who need radiation therapy can take several days. Precise calculations for tumor targeting and organ sparing are completed prior to the start of treatment. If there are changes to a patient’s anatomy during the course of treatment, a significant delay may occur. With Ethos™ Therapy, artificial intelligence and machine learning can create and adapt plans for physicians’ review within minutes – all while the patient remains on the treatment couch. The goal of adaptive therapy is to better target the tumor, reduce the exposure of radiation to healthy tissue and potentially improve overall outcomes.

Precise radiation delivery to reach tumors accurately

Intensity modulated radiation therapy (IMRT) is a state-of-the-art radiation delivery system that has been called the most significant breakthrough in cancer treatments in the past 30 years.

Our radiation oncologists at Goshen Center for Cancer Care use IMRT to treat difficult-to-reach tumors with high levels of accuracy. Plus, this leading-edge technology can deliver radiation doses up to 40 percent higher than traditional radiation methods would allow in these areas, while sparing 70 percent more of the surrounding healthy tissue.

We also use IMRT to treat patients who have had previous conventional radiation therapy, yet experience recurrent tumors in the treated area.

Benefits of IMRT

• Targets tumor precisely and modulates intensity of pencil-thin beams with laser accuracy
• Minimizes radiation to healthy, sensitive tissue and organs
• Requires fewer treatment visits due to precise, larger doses
• Improves patient outcomes due to accuracy
• Treats tumors that were once untreatable because of location or previous radiation treatments

How IMRT works

Our experts in radiation treatment planning use sophisticated computer software, diagnostic imaging and patient-positioning devices to plan and implement a precise dose of radiation in three dimensions, based on individual tumor size, shape and location. To plan a treatment, 3-D images of a patient’s tumor are used in conjunction with computerized dose calculations to determine a radiation intensity pattern that will best conform to the tumor shape. IMRT then directs narrow beams of radiation at the tumor, varying the shape and intensity of the beams hundreds of times to different parts of the tumor, making it one of the most precise forms of external beam radiation therapy available. As a result, an increased dose of radiation can be delivered to the tumor while sparing nearby healthy organs and tissues.

Unlike traditional radiation therapy, this advanced type of treatment attacks the tumor from 360 degrees, instead of just a half-dozen angles. Plus, the high radiation dose is sculpted to fit the exact shape of the patient’s tumor, treating both large tumors and multiple sites. For some patients, IMRT replaces external beam treatments. However, in most cases, it is used in conjunction with or after another primary treatment. The common course of IMRT treatment is five days a week for six weeks.

Single-dose radiation treatment for breast cancer

If you've received a diagnosis of breast cancer in an early stage, your healthcare provider may offer an integrated treatment option that can save you time and give you peace of mind.

Intra-operative radiation therapy, or IORT, delivers a single, high dose of radiation at the same time as your lumpectomy. It is a precise, targeted radiation treatment that has been shown to be as effective as conventional, external radiation therapy.

IORT saves healthy tissue from exposure to radiation. It also eliminates the need for multiple sessions of traditional radiation treatment after surgery. That means less disruption to daily routines, less travel time and less stress normally associated with cancer treatment.

Targeted radiation delivered during surgery

Our surgical and radiation oncologists at Goshen Center for Cancer Care work together to combine radiation therapy with tumor removal. During surgery, the oncology team delivers localized, targeted radiation directly into the area where the tumor has been removed. The treatment significantly minimizes the radiation exposure of surrounding healthy tissue. It also lowers the risk of recurrence, since the radiation is targeted to the area of the breast that is most at risk for cancer to return.

Benefits of IORT

Oftentimes, patients with breast cancer receive some form of radiation as part of their treatment. For patients who qualify for IORT, this innovative therapy offers a host of benefits.

• Saves time by eliminating multiple weeks of external radiation therapy after surgery
• Reduces side effects compared with standard radiation
• Spares healthy tissue surrounding the breast and nearby organs from radiation exposure

Criteria to qualify for IORT

We follow guidelines set by the American Society for Radiation Oncology to determine if IORT is an appropriate treatment option for a patient. Criteria include:

• Patient age – over 50
• Tumor size – not larger than 2 cm
• Type of breast cancer – estrogen receptor positive

IORT is designed only for patients with early stage breast cancer who have surgery at Goshen Center for Cancer Care. For patients whose cancer has spread to lymph nodes, we follow a different course of treatment that may include traditional radiation therapy or even chemotherapy to first shrink the tumor, followed by surgery and radiation.

Innovative therapies unlike anywhere else

Our integrated approach stretches beyond the standard of care for patients with breast cancer. We offer a wide range of treatment options that we use alone or in combination with conventional and holistic medicines.

• Surgery offers the greatest chance for diagnosis and cure of primary and metastatic breast cancer.
• Chemotherapy and other medical oncology therapies destroy cancer cells, oftentimes with targeted approaches that cause less damage to normal, healthy cells.
• Targeted radiation kills cancer cells and shrinks tumors, while avoiding healthy tissue.
• Integrative therapies reduce stress, enhance the immune system and diminish the side effects of certain medical conditions and conventional treatments.
• Diagnostic services help us detect the cancer, identify its stage and determine treatment options

Unparalleled expertise in one center

Our team of cancer experts is dedicated solely to treating patients who have cancer. These nationally recognized surgical, medical and radiation oncologists along with specialists in interventional radiation and integrative medicine work together to build a treatment plan specifically for you. That means you come to one place for complete, comprehensive cancer care from diagnosis to treatment and support throughout your journey.

Destroying cancer with targeted radiation

We attack tumors from the inside out by targeting radiation directly to cancer cells. With selective internal radiation therapy (SIRT), we can deliver millions of microscopic radioactive beads straight to pinpointed areas. SIRT controls growth of the tumors and can turn inoperable conditions into candidates for surgery.

Our oncologists at Goshen Center for Cancer Care work together to customize SIRT differently than anywhere else. They use a drug with a radioactive isotope to destroy or shrink tumors. Oftentimes tumors shrink to a size that can be removed surgically or ablated. Yet, the treatment minimizes radiation to healthy, sensitive tissue and organs surrounding the liver.

Leading the way with innovation

Goshen Center for Cancer Care is one of the few facilities in the nation, and the only one in the region, to offer patients this treatment for primary and metastatic liver cancer. Through a clinical trial, we were the first in the United States to offer SIRT as a first-line treatment option in patients with metastatic colon cancer to the liver. This study has consistently demonstrated that chemotherapy and SIRT, used in combination, are more effective than chemotherapy alone to fight cancer.

Benefits of SIRT

• Treats cancers that don’t qualify for liver resection or hard-to-reach tumors that were once untreatable
• Targets radiation directly to the tumor to improve patient outcomes
• Delivers 40 times more radiation than conventional treatments
• Minimizes radiation to healthy, sensitive tissue and organs
• Requires fewer treatment visits due to precise, larger doses
• Can be completed in as few as two treatments
• Can be used alone or with chemotherapy to shrink tumors and qualify a patient for surgery

How SIRT works

During SIRT, millions of polymer beads are embedded with the radioactive element Yttrium-90. These beads are then administered into the cancer area through the main blood vessel to the liver. Acting much like a time-release pain pill, these beads (one-third the diameter of a human hair) deliver 40 times more radiation to tumors than conventional therapy. Since the beads are too large to enter the bloodstream, they lodge in the small blood vessels that feed the tumor. Once trapped, they destroy the tumor over a period of weeks. Although the beads reduce the size of the liver tumor, the normal liver tissue remains relatively unaffected. This is important, as healthy liver tissue is extremely sensitive to radiation, previously preventing effective treatment with traditional radiotherapy.

At Goshen Center for Cancer Care, we customize our SIRT treatment differently than anywhere else by creating a patient-specific treatment protocol. Using a special program developed at our facility, we calculate the highest and safest dose of radiation to deliver to the tumors while sparing healthy tissue.

Other types of radionuclide therapy

Our radionuclide therapy program offers a wide range of treatments for various types of cancer, including for lymphoma, bone cancer, thyroid cancer and pancreatic cancer.

The most commonly used radionuclide therapy is the radioactive iodine treatment (RAI) of hyperactive thyroid glands (hyperthyroidism) and thyroid cancer. For thyroid disorders, we integrate radioactive iodine treatment in a comprehensive surgical oncology and endocrinology program.

Radionuclide therapies can effectively control pain associated with cancer that has spread to the bone from prostate, breast, lung or other cancers. We use these therapies when cancer has spread throughout the bones and when traditional treatments fail to control pain.

Recently, we initiated a radioimmunotherapy protocol to treat patients with advanced pancreatic cancer that cannot be treated with surgery.

Delivering high doses of radiation with precision

For certain tumors in the brain, your healthcare provider may recommend a cutting-edge therapy offered at Goshen Center for Cancer Care. Stereotactic radiosurgery (SRS) is a non-surgical radiation therapy that delivers a high dose of radiation in a single treatment without the need for surgery.

Your cancer team of medical, surgical and radiation oncologists and other specialists meet to discuss your diagnosis and review your treatment options. Your doctors will then meet with you and your family to discuss your personal goals and opinions. Since there are different ways to treat many cancers, your preferences are very important.

How stereotactic radiosurgery is delivered

To deliver radiation precisely, it is essential that you can hold completely still while being comfortable. To help with this, we create unique supports molded for your body. One appointment is dedicated to creating these supports, called simulation. To treat tumors in the brain a soft, plastic mask is created. If you are anxious about this process, your doctor may prescribe medications to allow you to better tolerate the mask.

Precise CT images are obtained and combined with other studies such as MRI scans or PET scans. We use this information and other complex computer calculations to map out a plan to treat the tumor while protecting the normal nearby parts of the body. Once your radiation oncologist approves the treatment plan, our team carefully reviews and conducts testing for quality and safety assurance.

Usually only one treatment is needed, but some tumors need up to five treatments. Treatment typically takes about half an hour, but it could be longer depending on your situation.

Stereotactic body radiotherapy

When stereotactic radiosurgery is used to treat tumors outside the brain, is it often called stereotactic body radiotherapy (SBRT). This treatment can be used to treat certain tumors in the lungs, liver, pancreas or near the spine. There are other parts of the body that can be treated this way too.

How stereotactic body radiation therapy is delivered

At the time of simulation, unique supports are created to position you comfortably while limiting the motion of the tumor. For tumors in the lung, special CT imaging techniques are used to track how your tumor moves as you breathe. Other tumors require their own special imaging techniques. Images from other tests such as MRI scans and PET scans may be combined to plan your treatment.

The same type of detailed treatment planning and testing is performed as was described previously. Although some tumors outside the brain can be treated in one session, most of the time it takes up to five treatments to adequately treat your cancer while protecting the rest of your body. Each session usually takes about half an hour.

Our goal is to cure your cancer with the minimum of side effects. Stereotactic treatments often enable us to do this.

Targeted radiation therapy

Precise forms of radiation therapy give us ways to destroy cancer cells from many different directions. Called tomotherapy, we use this advanced technology to aim small, focused radiation beams at the tumor from thousands of positions. This pinpoints cancerous masses and delivers optimal doses to the specific area. Nearby organs and healthy tissue receive less radiation, unlike conventional methods.

Here at Goshen Center for Cancer Care, we use a PET/CT scan simulator to precisely map the exact location, shape and size of the tumor, which further improves the effectiveness of treatment.

Precise radiation therapy

Our expert radiation oncology team uses tomotherapy to treat cancer that was once considered untreatable. This therapy can treat multiple tumors simultaneously and with such accuracy that nearby organs and healthy tissues remain undamaged. For example, we can use tomotherapy to treat throat cancer, while avoiding the salivary gland. While treating cancer of the pancreas, we can avoid the kidneys. We can treat a spinal bone while avoiding the spinal cord, even when the area had prior radiation treatment. Tomotherapy can treat large or small tumors, one region or several regions, and provides the same dose or multiple, different dosages.

Benefits of tomotherapy

• Minimizes radiation to surrounding healthy tissue and organs
• Causes fewer side effects than traditional radiation
• Requires fewer treatment visits due to more precise, larger doses
• Improves patient outcomes due to accuracy
• Delivers painless and precise radiation to the tumor
• Uses high-energy X-ray beam for clearer images
• Allows adjustments to deliver correct dosing at each treatment
• Treats tumors once considered untreatable due to their location or because they had previous radiation

How tomotherapy works

Tomotherapy combines intensity modulated radiation therapy (IMRT) with CT scanning technology to direct radiation beams at the tumor from thousands of positions. This pinpoints radiation on cancerous masses and delivers optimal doses to the specific area. By using the highest dose of radiation to kill tumor cells, this treatment causes less damage to nearby organs and healthy tissue.

We use sophisticated software diagnostic imaging and patient-positioning devices to develop a treatment plan tailored to each patient's condition. These tools help us plan, implement and revise a precise dose of radiation in three dimensions, based on individual tumor size, shape and location.

To plan treatment, we use 3-D images of a patient’s tumor in conjunction with computerized dose calculations. They allow us to determine a radiation intensity pattern that best conforms to the tumor shape. Tomotherapy directs very small beams of radiation, varying in shape, angle and intensity, hundreds of times to different parts of the tumor. Its precision makes it one of the most accurate forms of external beam radiation therapy available.

The radiation system completes a quick CT scan to ensure the patient is aligned perfectly. Rotating radiation beams, each varying in intensity and direction, converge on the tumor from 360 degrees, while the patient's couch simultaneously moves into the tomotherapy unit. A powerful multiple-processor computer calculates the treatment plan, sculpts the radiation dose and coordinates treatment delivery. To further streamline the process, all of a patient’s records are conveniently stored within the equipment. Tomotherapy is painless, and it usually lasts only a few minutes.

During tomotherapy, it’s important to accurately position and immobilize the patient to ensure the most precise treatment is given. This may be done with special head frames (if the head or brain is being treated), or with advanced imaging devices, such as electronic portal imaging and scanning ultrasound. These positioning tools provide updated, daily information about the location of the tumor in relation to surrounding organs. This is especially important with some organs, such as the prostate, which moves due to normal daily volume changes in the bladder and rectum.

CT/PET scan simulator

For tomotherapy to be effective, the anatomical position of the tumor and surrounding healthy tissues must be accurately defined.

Following the treatment planning process, the patient has a simulation (or practice run) to confirm the location of the tumor. This trial also ensures that the appropriate radiation dosage and delivery have been calculated. The patient is placed in an immobilization device, the treatment plan is entered, and computed tomography (CT) and positron emission tomography (PET) scans are taken. The CT scan shows the body’s anatomic structure. The PET scan shows how the body is functioning. When combined into a PET/CT image, the patient’s complete picture is revealed. And more important, any irregularities or miscalculations can be discovered before the radiation treatment is started. This includes the application of immobilization devices, beam modification devices, approved field arrangements and other treatment variables.

Unlike traditional CT scans or fluoroscopic simulations, PET/CT simulation enables radiation oncologists to use information on both the tumor’s location and activity to precisely pinpoint the radiation to only where it’s needed. PET/CT simulation differs from a conventional PET/CT scan by the use of a special immobilization device that’s necessary for radiation treatment.