RADIATION ONCOLOGY SERVICES

Radiation therapy is a common and effective treatment for cancer that uses high-energy rays to destroy cancer cells. The primary mechanism involves damaging the DNA within these cells. When radiation hits the DNA, it creates breaks in the DNA, which prevents the cancer cells from growing, dividing, and multiplying. Unlike normal cells, cancer cells have a reduced ability to repair this damage, leading to their eventual death. The treatment is meticulously planned to focus on the cancerous area, minimizing exposure to healthy tissues and reducing side effects. This targeted approach ensures that the maximum dose of radiation is delivered to the tumor while sparing as much of the surrounding normal tissue as possible.

Radiation therapy is a versatile treatment that can be used to treat a wide variety of tumors. Some of the common types of tumors that can be treated with radiation therapy include:

1. Head and Neck Cancers: These include cancers of the throat, larynx, tongue, and nasal cavity.
2. Breast Cancer: Often treated with radiation therapy after surgery to eliminate any remaining cancer cells.
3. Prostate Cancer: Frequently treated with external beam radiation therapy or brachytherapy.
4. Cervical Cancer: Radiation therapy is often used in conjunction with chemotherapy.
5. Lung Cancer: Radiation therapy can be used alone or in combination with surgery and chemotherapy.
6. Brain Tumors: Both primary brain tumors and metastatic brain tumors can be treated with radiation therapy.
7. Rectal and Anal Cancers: Treated with radiation therapy, often combined with chemotherapy.
8. Lymphomas: Both Hodgkin and non-Hodgkin lymphomas can be treated with radiation therapy.
9. Skin Cancer: Certain types of skin cancer can be effectively treated with radiation therapy.
10. Pancreatic Cancer: Radiation therapy is sometimes used in combination with other treatments.

These are just a few examples, and many other types of tumors can also be treated with radiation therapy. The specific approach and type of radiation used depend on the location, size, and stage of the tumor, as well as the patient’s overall health and treatment goals.

At the Radiation Oncology Department of Rajiv Gandhi Cancer Institute & Research Centre, we are committed to providing the highest quality care through our extensive range of state-of-the-art radiation therapy machines and equipment. While we boast an impressive array of advanced technology, our primary focus is on delivering the treatment that is most suitable for your unique condition.

Our team of highly experienced and skilled radiation oncologists will conduct a thorough evaluation of your specific case, taking into account your overall health, the type and stage of your cancer, and the precise characteristics of your tumor. This meticulous assessment ensures that we select the optimal machine and treatment technique tailored specifically to your needs.

Our department houses a variety of cutting-edge machines and equipment designed to cater to diverse cancer treatment needs:

1. Linear Accelerators:
   1. TrueBeam: Offers high-precision radiation therapy with advanced imaging capabilities, allowing for accurate targeting of tumors.
   2. RapidArc: Delivers volumetric modulated arc therapy (VMAT), enabling faster and more efficient treatments with high precision.
   3. Synergy: Equipped with advanced imaging technology, it provides precise and adaptive treatments.
2. CyberKnife: A robotic radiosurgery system that delivers highly accurate, non-invasive treatment for tumors anywhere in the body, including the brain, spine, and lungs. It offers sub-millimeter precision, making it ideal for treating complex cases.
3. Tomotherapy: Combines helical CT imaging with precise radiation delivery, allowing for continuous 360-degree treatment. It is especially effective for treating large or irregularly shaped tumors.
4. CT Simulator: Provides detailed imaging for treatment planning, ensuring that radiation therapy is accurately targeted to the tumor while sparing healthy tissues. It is essential for creating personalized treatment plans.
5. Brachytherapy Units: Delivers internal radiation therapy by placing radioactive sources directly inside or near the tumor. This allows for high doses of radiation to be delivered to the tumor while minimizing exposure to surrounding healthy tissues.

Whether it’s the unparalleled precision of CyberKnife, the advanced adaptability of Synergy, the rapid efficiency of RapidArc, or the comprehensive imaging capabilities of Tomotherapy, we will choose the most effective and appropriate method to treat your cancer. Our goal is to provide personalized, high-quality radiation therapy that maximizes treatment effectiveness while minimizing side effects.

Rest assured, at our department, you will receive care that is specifically designed for you, utilizing the most suitable technology to support your journey towards recovery. Our commitment is to deliver exceptional treatment that prioritizes your well-being, offering you the best possible outcomes and the highest standards of care.

1. IMRT (Intensity-Modulated Radiation Therapy): A technique that allows for precise modulation of radiation beams to conform to the shape of the tumor, delivering higher doses to the tumor while protecting nearby healthy tissues.
2. Arc Therapy: Also known as volumetric modulated arc therapy (VMAT), this advanced technique involves the radiation machine rotating around the patient, continuously shaping and modulating the radiation beam to conform to the tumor’s shape from multiple angles. This allows for highly targeted and efficient treatment, often reducing overall treatment time.
3. IGRT (Image-Guided Radiation Therapy): Utilizes advanced imaging techniques to guide and adjust the radiation beams in real-time, ensuring accurate delivery of radiation to the tumor during each session.
4. DIBH (Deep Inspiration Breath Hold) Technique: Designed to minimize radiation exposure to healthy tissues, particularly the heart and lungs, by having the patient take a deep breath and hold it during treatment. This technique is especially beneficial for patients undergoing radiation therapy for breast cancer.
5. Motion Management Techniques: These are crucial to account for natural movements of the body, such as breathing, ensuring that the radiation dose precisely targets the tumor while minimizing exposure to surrounding healthy tissues.
6. SRS (Stereotactic Radiosurgery): A non-invasive technique that delivers a high dose of radiation to small, well-defined tumors, typically in the brain, providing an alternative to surgical procedures.
7. SBRT (Stereotactic Body Radiation Therapy): Delivers high doses of radiation to tumors in the body (outside the brain) with extreme precision over fewer treatment sessions, particularly effective for treating early-stage lung cancer and other localized tumors.

Our comprehensive array of advanced radiation therapy equipment ensures that we can provide personalized, precise, and effective treatment for a wide range of cancers. Our highly skilled team of radiation oncologists, medical physicists, dosimetrists, and radiation therapists work together to utilize these technologies to their fullest potential, offering our patients the best possible outcomes.

Radiation therapy is a versatile and targeted treatment tailored to your specific needs. Its primary objective is to eradicate cancer cells while preserving as much normal tissue as possible, achieving a delicate balance between effectiveness and safety. You are being offered radiation therapy for one of the following reasons:

1. Curative Intent: The goal is to completely eliminate the cancer, aiming for a full recovery.
2. Combination Therapy: Radiation therapy is often used alongside other treatments such as surgery, chemotherapy, or immunotherapy to enhance overall treatment outcomes.
3. Palliative Intent: When cure is not possible, radiation therapy can relieve symptoms and improve the quality of life.

By precisely targeting the tumor, radiation therapy helps reduce the risk of cancer recurrence, supports long-term remission, and ultimately contributes to better survival rates and overall patient well-being.

Radiation therapy will be carefully planned and executed for you. Understanding the process can help you feel more comfortable and prepared. Here are the typical steps involved:

Step 1: Consultation with Radiation Oncologist

The consultation process is designed to ensure that you are fully informed about your diagnosis and treatment options, and that you feel supported and prepared for the next steps in your cancer treatment journey.

1. Initial Appointment Scheduling: You or your referring physician will schedule an appointment with a radiation oncologist. We will gather all necessary medical records, imaging, and pathology reports for review.
2. Medical History Review: The radiation oncologist will review your complete medical history, including previous treatments, surgeries, and any existing medical conditions.
3. Physical Examination: A thorough physical examination will be conducted to assess your overall health and the specific area affected by cancer. This helps us understand the extent of the disease and any physical symptoms you might have.
4. Discussion of Diagnosis: The radiation oncologist will explain your diagnosis in detail, including the type, stage, and location of the cancer. The oncologist will discuss how radiation therapy can help in treating your specific type of cancer.
5. Treatment Options: Various treatment options will be presented, which might include radiation therapy alone or in combination with other treatments like surgery or chemotherapy. The benefits, risks, and potential side effects of each option will be explained to you.
6. Personalized Treatment Plan: A preliminary treatment plan will be outlined based on your diagnosis and overall health. The plan includes the type of radiation therapy recommended, the number of sessions, and the expected duration of treatment.
7. Patient Questions and Concerns: You are encouraged to ask any questions or express concerns about the treatment. The radiation oncologist will provide clear, understandable answers to help you make informed decisions about your care.
8. Informed Consent: Detailed information about the proposed treatment, including potential side effects and outcomes, will be provided. You will be asked to sign an informed consent form, acknowledging that you understand the treatment plan and agree to proceed.
9. Coordination of Care: The radiation oncologist will coordinate with other members of your healthcare team
10. Next Steps and Preparation: Radiation oncologist will give you instructions on how to prepare for the upcoming simulation and treatment sessions. Any necessary pre-treatment tests or procedures will be scheduled to ensure you are ready for your treatment.

Step 2: Simulation Process

1. Initial Setup:

1. 1. You will be positioned on a treatment table, usually lying flat.
   2. The radiation therapist will help you get into the correct position to ensure accuracy during treatment.

2. Imaging:

1. 1. Detailed CT imaging will be taken.
   2. This scan will create a precise map of the treatment area, showing the size, shape, and location of the tumor.

3. Immobilization Devices:

1. 1. Custom immobilization devices such as molds, masks, or cushions may be used.
   2. These devices help you stay in the exact same position during each treatment session.

4. Marking the Treatment Area:

1. 1. Temporary or permanent marks (small tattoos) may be placed on your skin.
   2. These marks serve as reference points to ensure the radiation is delivered accurately to the same area each time.

5. Planning Scans:

1. 1. The imaging data is sent to a computer where a detailed treatment plan is created.
   2. The radiation oncologist and dosimetrist use the scans to define the precise treatment area and avoid healthy tissues.

6. Verification:

1. 1. The setup is verified to ensure everything is correctly aligned.
   2. Adjustments may be made to improve accuracy and comfort.

7. Documentation:

1. 1. All the details from the simulation session are documented.
   2. This information is used to guide the actual treatment sessions.

The simulation process is crucial for the success of radiation therapy, ensuring that the treatment is both effective and safe.

Step 3: Radiotherapy Planning

1. Data Collection:

1. 1. The imaging scans from the simulation session are collected and reviewed.
   2. Detailed images (CT, MRI, PET) provide a precise map of the tumor and surrounding tissues.

2. Defining the Treatment Area:

1. 1. The radiation oncologist outlines the tumor (target volume) and nearby critical structures (organs at risk) on the imaging scans.
   2. This ensures that the radiation is directed precisely to the tumor while sparing healthy tissues as much as possible.

3. Dose Calculation:

1. 1. A medical physicist calculates the optimal radiation dose to effectively treat the tumor.
   2. Advanced computer software is used to determine how much radiation will be delivered to each part of the treatment area.

4. Treatment Technique Selection:

1. 1. The appropriate radiation delivery technique is chosen based on the tumor’s location and type.
   2. Options include Intensity-Modulated Radiation Therapy (IMRT), Image-Guided Radiation Therapy (IGRT), Stereotactic Radiosurgery (SRS), Stereotactic Body Radiation Therapy (SBRT), and others.

5. Beam Configuration:

1. 1. The number, angles, and shapes of the radiation beams are planned.
   2. This configuration ensures the radiation dose conforms closely to the tumor shape, minimizing exposure to healthy tissues.

6. Simulation Verification:

1. 1. A verification simulation may be conducted to ensure the treatment plan works as intended.
   2. This step checks the accuracy of the positioning and dose delivery before actual treatment begins.

7. Plan Approval:

1. 1. The treatment plan is reviewed and approved by the radiation oncologist, medical physicist, and dosimetrist.
   2. Any necessary adjustments are made to optimize the plan.

8. Patient Education:

1. 1. The treatment team explains the plan to the patient, including the number of sessions and what to expect.
   2. Instructions on how to prepare for each session are provided.

9. Quality Assurance:

1. 1. Final checks are performed to ensure the equipment is correctly set up to deliver the prescribed dose.
   2. Quality assurance tests are conducted to verify the accuracy and safety of the treatment plan.

The treatment planning process is crucial for delivering precise and effective radiation therapy, ensuring the best possible outcomes for patients.

Step 4: Radiotherapy Delivery

1. Patient Positioning:
   1. You will be positioned on the treatment table using the same position and immobilization devices from the simulation.
   2. The radiation therapist ensures you are aligned correctly according to the marks or tattoos made during the simulation.
2. Imaging for Verification:
   1. Before each session, imaging such as X-rays or CT scans may be taken to confirm precise positioning.
   2. These images help the therapist verify that the radiation beams will target the tumor accurately.
3. Adjustments:
   1. If necessary, small adjustments are made to your position based on the verification images.
   2. This ensures that the radiation is delivered precisely to the planned treatment area.
4. Radiation Delivery:
   1. The radiation machine, often a linear accelerator, is programmed with your treatment plan.
   2. The machine moves around you to deliver radiation from different angles, precisely targeting the tumor while sparing healthy tissues.
5. Monitoring:
   1. During the treatment, the radiation therapist monitors you from a control room.
   2. You will be in constant communication with the therapist through an intercom system.
6. Session Duration:
   1. Each treatment session typically lasts about 10-30 minutes, though the actual radiation delivery may take only a few minutes.
   2. The rest of the time is spent on positioning, verification, and adjustments.
7. Painless Procedure:
   1. Radiation therapy is painless; you will not feel the radiation during the treatment.
   2. You will need to remain still to ensure accurate delivery.
8. Frequency of Treatments:
   1. Treatment is usually given five days a week (Monday through Friday) for several weeks, depending on your specific treatment plan.
   2. The number of sessions varies based on the type and stage of cancer.
9. Regular Check-ins:
   1. Throughout your treatment course, you will have regular check-ins with your radiation oncologist and healthcare team.
   2. These visits help monitor your progress and manage any side effects you might experience.
10. Post-Treatment Care:
    1. After completing the treatment course, follow-up appointments are scheduled to assess the effectiveness of the therapy.
    2. Ongoing monitoring ensures any late side effects are managed and that the cancer has responded to the treatment.

The treatment delivery process is meticulously planned and executed to ensure that you receive the most effective and safe radiation therapy possible.

Step 5: Monitoring and Follow-up

1. Regular Check-ins During Treatment:
   1. Throughout the course of radiation therapy, you will have scheduled appointments with your radiation oncologist.
   2. These check-ins usually occur once a week to monitor your progress and manage any side effects.
2. Symptom Assessment:
   1. During these visits, the oncologist will ask about any symptoms or side effects you are experiencing.
   2. Your overall health and well-being are evaluated to ensure you are tolerating the treatment well.
3. Physical Examination:
   1. A physical exam may be performed to assess any physical changes and to check the treatment area for any reactions to the radiation.
   2. This helps in early detection and management of side effects.
4. Side Effect Management:
   1. If you are experiencing side effects, the oncologist will provide recommendations and prescriptions to manage them.
   2. Adjustments to the treatment plan may be made if necessary to reduce discomfort and improve your quality of life.
5. Imaging and Tests:
   1. Periodic imaging studies, such as X-rays, CT scans, or MRIs, may be conducted to monitor the tumor’s response to treatment.
   2. Blood tests and other diagnostic tests may also be performed to assess your overall health.
6. Treatment Plan Adjustments:
   1. Based on the monitoring results, the oncologist may adjust the treatment plan to enhance its effectiveness or to address any issues.
   2. This ensures that the treatment remains optimal and responsive to your needs.
7. Post-Treatment Follow-up:
   1. After completing the course of radiation therapy, follow-up appointments are scheduled to monitor your recovery and the long-term effects of the treatment.
   2. These visits are crucial for assessing the effectiveness of the therapy and for early detection of any recurrence.
8. Long-term Monitoring:
   1. Long-term follow-up care is planned to monitor for late side effects and to ensure the cancer remains under control.
   2. Regular check-ups, imaging, and lab tests are part of this ongoing care.
9. Coordination with Other Healthcare Providers:
   1. The radiation oncologist will communicate with your other healthcare providers, such as your primary care physician, medical oncologist, and surgeon, to ensure comprehensive care.
   2. This multidisciplinary approach helps in managing your overall health and addressing any issues promptly.
10. Patient Education and Support:
    1. Continuous education about managing side effects, maintaining a healthy lifestyle, and recognizing signs of recurrence is provided.
    2. Support services, such as counseling, nutrition advice, and support groups, may be recommended to help you cope with the emotional and physical aspects of cancer treatment.

Monitoring and follow-up are essential components of radiation therapy, ensuring that the treatment is effective, side effects are managed, and your overall health is continuously supported throughout the cancer treatment journey.