In our third installment discussing different types of radiation treatment we will look into more details around image-guided radiotherapy, IGRT. Treatment using IGRT is a bit different than previous therapies we have discussed because CT scans continue to be utilized throughout treatment to look for reduction in tumor size as well as other changes. Using several scanned images allows the radiation oncologist to adjust treatment for changes in the position of the patient and adjust the amount of radiation needed. IGRT leads to an increase in treatment accuracy while allowing for a decrease in radiation exposure to the tissue surrounding the tumor.
There are two main types of IGRT, stereotactic radiation and radio-surgery, such as SBRT, Gamma-Knife and Cyber-knife. Stereotactic radiotherapy is similar to IMRT except that it involved fewer treatments, fractions. It delivers a high dose of radiation directly into a tumor. It delivers the radiation in a number of different angles to focus radiation all at one small area. Radio-surgery involves a single fraction whereas stereotactic radiation involves two to five fractions. Most often this treatment is used for lesions within the brain. This minimizes effects to normal tissue, which radiation passes through while delivering a large dose of radiation to a single point where the beams all come together. The large number of beams angle in order to deliver radiation to a single point when precise targeting of the tumor is required.
Stereotactice radiation, also known as SBRT, is used most often for treating areas such as the lung, prostate, liver, brain and bone. With the advancements in technology, computer imaging and patient stabilization radiation oncologists are able to offer treatment in fewer fractions. The higher dose of radiation is delivered to the tumor while the outlying areas receive less and less harmful doses of radiation. This type of treatment is often given with the use of linear accelerators and cyber-knife systems. Cyber-knife is basically a linear accelerator placed on a robotic arm allowing for more freedom in movement.
Radio-surgery is most often used in the treatment of brain tumors. The brain does not move so there are not the problems with motion that are run into with other cancer treatments. An MRI scan is used to localize the tumor and a frame is used to position the head with great accuracy. Radio-surgery requires both neurosurgeons and radiation oncologists during planning and treatment. Lesions that are smaller than five centimeters can be treated using radio-surgery.
This series has outlined numerous types of radiotherapy along with the cancers best treated with each technique. More detailed information on linear accelerators and how they can be used in the treatment of cancers is available online.
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