Depending on the specifics of your case, our radiation therapy team may use one or more of the following state-of-the-art treatments to treat your cancer.
Intensity-Modulated Radiation Therapy (IMRT)
Intensity-modulated radiation therapy (IMRT) is one of the most precise forms of external beam radiation therapy available. IMRT delivers three-dimensional (3D) radiation beams that conform precisely to the shape of the tumor. The IMRT treatment technique also varies the intensity of radiation delivered to different areas, so that a much higher radiation dose can be focused on the tumor, while minimizing the dose to surrounding healthy tissue and critical structures.
Since tumors, especially lung and liver tumors, often move during treatment as a result of breathing and other involuntary body movements, we include respiratory gating technology into your treatment to adjust for tumor motion. The respiratory gating technology senses and accounts for motion as you breathe, only delivering radiation when your tumor is precisely in the path of the treatment beam. If your tumor moves out of the area of the treatment beam, the radiation is automatically interrupted to protect your healthy tissue.
A course of treatment for IMRT typically consists of five treatments per week, over five to eight weeks. The treatments last approximately 15 minutes each, and are performed on an outpatient basis. Some of the most common conditions we treat with IMRT include prostate, head and neck, breast, thyroid, lung, and gynecologic cancers.
Volumetric Modulated Arc Therapy (VMAT)
As the first and only cancer care provider in Contra Costa County to offer RapidArc VMAT with the Varian Trilogy linear, we have been leading the way with this advanced treatment option. RapidArc VMAT delivers highly precise IMRT with one to three revolutions (arc) of the machine reducing the standard 30-minute treatment delivery time by at least half. Faster treatment enables greater precision, since there is less chance of you moving during treatment delivery, and it makes it a more comfortable experience for you. We primarily use this treatment for head and neck cancer, lung cancer, liver cancer, pancreatic cancer, prostate cancer and anal cancer.
Stereotactic Radiosurgery (SRS)
Our radiation program was the first in Northern California to offer frameless stereotactic radiosurgery (SRS). Our treatment system uses the Varian TrueBeam System specially designed for high precision delivery of radiation. Cross-beam imaging, automated positioning of the treatment couch and micro-multileaf collimation were specifically added to deliver the most accurate radiation delivery available. With micro-multileaf collimation, our doctors can precisely shape the radiation fields around your tumor, greatly reducing the amount of radiation delivered to normal tissue and critical structures. The state-of-the-art robotic 6D couch allows automated, precise positioning of a patient due to six degrees of motion. Some radiosurgery systems use a frame mounted with pins screwed into the patient’ skull to deliver the radiation. However, the TrueBeam technology we use is frameless and minimally invasive, which means we can perform your treatment on an outpatient basis. With SRS, we also use IGRT, often real time imaging, to monitor your position throughout treatment. SRS is used to treat a wide variety of cancerous and non-cancerous conditions. Learn more about SRS.
Stereotactic Body Radiation Therapy (SBRT)
Using Varian TrueBeam technology with micro-multileaf collimation and the Varian® Trilogy linear accelerators, SBRT delivers precisely targeted, high doses of radiation to tumors in other parts of the body outside of the brain. SBRT is frequently used in the treatment of spine tumors and Stage I lung cancer. It is typically performed 3-5 times over the course of a couple weeks on a convenient outpatient basis, which means you don’t need to stay at the hospital during your course of treatment. Learn more about SBRT.
Image-Guided Radiation Therapy (IGRT)
IGRT is a treatment planning technology that uses a variety of advanced 2-D, 3-D and 4-D imaging techniques on a daily basis to track and record the location of your tumor, since tumors may move, change size, and change shape throughout the course of your treatment. Based on the daily measurements, your doctor can configure and adjust your radiation immediately before each treatment. IGRT enables us to deliver your radiation with pinpoint accuracy, which benefits you with reduced side effects, and maximum preservation of your surrounding healthy tissue. IGRT may be used to help treat a wide variety of cancers including brain, spine, prostate, thoracic, lung, breast, head and neck cancers, as well as arteriovenous malformations in the brain.
Additionally, for tumors that move during treatment as a result of breathing and other involuntary body movements, we use respiratory gating technology with your treatments to adjust for tumor motion in real-time. The respiratory gating technology senses and accounts for motion as you breathe, only delivering radiation when your tumor is precisely in the path of the treatment beam. If your tumor moves out of the area of the treatment beam, the radiation is automatically interrupted to protect your healthy tissue.
Recently there have been major advancements in being able to reduce the number of treatment sessions (hypofractionation) to treat various cancers. Breast, prostate and lung treatments have been the cancers most dramatically affected by this trend. Our physicians are experts in evaluating the appropriateness and safety of these new hypofractionation treatment regimens. At John Muir Health you will be offered treatment, only if safe and effective, with the fewest treatment sessions—and disruptions to your life—as possible.
High-Dose-Rate (HDR) Brachytherapy
HDR brachytherapy uses temporary implants to deliver a highly intense source of radiation directly to the tumor site. The radioactive sources are placed into your body using catheters, needles, or other applicators for a brief period of time and then removed. It’s typical to receive the total dose in a series of 2-10 treatment sessions, also known as fractions. HDR brachytherapy has proven to be a highly successful treatment for prostate cancer and breast cancer. Other common areas treated with HDR brachytherapy include the cervix, endometrium, head, neck, bronchus, and esophagus.
Low-Dose-Rate (LDR) brachytherapy
LDR brachytherapy is primary used to treat early stage prostate cancer. In this procedure, radioactive 'seeds' about the size of a grain of rice are permanently inserted directly into the prostate gland. From 50 to more than 100 individual seeds may be placed in a single session. The temporarily radioactive seeds then deliver radiation to the prostate slowly over several weeks.
Accelerated Partial-Breast Irradiation (APBI)
Accelerated partial breast irradiation (APBI) is a therapy performed after a breast tumor has been surgically removed to ensure that any microscopic cancer cells left behind are destroyed. Unlike whole breast radiation, APBI only delivers radiation to the area where the tumor was removed, sparing healthy tissue from unnecessary radiation. APBI also offers the significant advantage of shortened treatment time, from several weeks (whole breast) to just five days (partial breast). In properly selected patients with early stage breast cancer, clinical trials have shown that APBI is as effective as standard whole-breast radiation in preventing recurrence.
With APBI, a catheter with a balloon at the tip is inserted into the cavity where your tumor was removed. Radioactive seeds are administered through the catheter to the targeted area, twice a day for five days. Each treatment lasts approximately 10-15 minutes and is done on an outpatient basis. The catheter stays in place for the entire treatment period. However, no radiation remains in your body between treatments or after the final treatment. After the last treatment, we deflate the balloon and remove the catheter.
APBI may also be delivered as external beam irradiation without the internal catheter. The treatment is still twice daily for 5 days.
Intraoperative Radiation Therapy (IORT)
IORT delivers a concentrated dose of radiation during cancer surgery, rather than as a separate treatment. Immediately after tumor the tumor has been removed, IORT is administered to destroy any microscopic cancer cells that may have been left behind. Compared to conventional radiation therapy, IORT has the advantage of being able to deliver higher effective doses of radiation, as your surgeon can temporarily move nearby organs or shield them from radiation exposure. Due to the concentrated dose of radiation given during surgery, many patients benefit from not needing any further radiation treatment.