Advanced Radiation Technology
with Robert Brookland, MD
Radiation therapy has long been an effective treatment tool for various kinds of cancer. Radiation kills cancer by damaging cells so they can’t repair themselves or continue to divide and increase in numbers. Generally, healthy cells, even if they are damaged by radiation, can repair or replace themselves.
Robert Brookland, MD, radiation oncologist at Greater Baltimore Medical Center, says, “Today we have exciting new technologies that offer radiation delivery that is much more sophisticated and effective than in the past.”
Most forms of cancer can be treated with radiation. In particular, prostate, breast, lung, colon, and rectal cancer respond very well to radiation. Gynecological cancers and cancers of the head and neck are also often very effectively treated with radiation therapy; however, different tissues and organs in the body have different radiation tolerance levels so once an area is treated, the patient’s doctor will need to consider whether future radiation treatments are appropriate.
Dr. Brookland points out that treatment approaches need to be individualized for each patient’s type of cancer and specific situation. Factors considered include the patient’s general health, age, and stage of cancer. For instance, if a person who is otherwise healthy has an early stage lung cancer, then the standard protocol may be surgery; however, there are many variables that can alter that approach. Perhaps the person is not a good surgical candidate or perhaps their cancer is more advanced and surgery alone would not be adequate to treat the disease effectively. Then radiation or chemotherapy or a combination of both may be the treatment of choice. Radiation is also frequently used either before or after surgery.
At GBMC, in cases where there are a variety of treatment options, a multi-disciplinary conference, which includes radiation oncologists, medical oncologists, surgeons, radiologists and pathologists, is usually held to discuss a patient's possible treatment approaches.
Recently, new technology has greatly improved cancer treatments. Radiation can be more targeted, which means it can be delivered in higher doses that are more effective in killing cancer cells with much less damage to normal tissues.
As an example of improved treatment, Dr. Brookland says that twenty years ago, when he first came to GBMC, patients with prostate cancer would receive between 35 to 37 radiation treatments. Today those same patients would probably receive 43 treatments in much higher doses, making their treatment more effective with fewer side effects. The machine that delivers radiation today is called a linear accelerator and, in combination with sophisticated software, it generates very high dose x-ray therapy that can target the specific area where the cancer is located, sparing the normal issues that are close by. Two of these approaches are called Intensity Modulated Radiation Therapy (IMRT) and Three Dimensional Conformal Radiation Therapy (3-D CRT).
Another new technology is called Image Guided Radiation Therapy (IGRT). This approach is used for many types of cancer and typically involves ultrasound, which uses high frequency sound waves to produce images of the cancer’s location from inside the body, allowing the radiation to be very precisely targeted each day for treatment. Dr. Brookland says, “IGRT is an effective way for us to target radiation in high doses.”
An additional new technology, Stereotactic Radio Surgery (SRS), uses extremely high amounts of radiation in just a few or even in single doses to target small areas, such as small tumors in the brain. Because of its location, a tumor may not be able to be removed surgically or perhaps only part of it can be removed, so SRS is used to treat the cancer, while reducing risks of serious complications.
At GBMC, radiation treatments are delivered with a team approach. The team includes oncology-certified nurses who work directly with educating and supporting patients; specially trained radiation therapy technologists who actually administer the treatments; and physicists and dosimetrists who contribute to treatment planning and equipment maintenance. The physicians who supervise the team and manage these sophisticated treatments are board-certified and highly trained in the use of all forms of radiation in the treatment of cancer.
Dr. Brookland says, “The vast majority of our patients are treated with cure as the goal. Today’s radiation therapy is highly effective and very well tolerated by most patients. They are able to incorporate the treatments into their regular routines, taking care of their families and even working fulltime.”
