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LEADING EDGE TREATMENT TECHNOLOGY

options / cancer therapy
Surgery is employed to confirm the presence of cancer. At this time, either a biopsy is taken or all or part of a cancerous tumor is removed.

Chemotherapy is the use of drugs, usually given by mouth or injection to kill cancer cells. Chemotherapy is systemic, i.e., that it travels through the entire blood stream.

Gene Therapy is the insertion of normal or genetically altered genes into cells, usually to replace defective cells.

Assessing DX Onco - Oncotype DX - is a diagnostic assay that measures the likelihood of breast cancer recurrence in women with newly diagnosed, early stage breast cancer. It also assesses the benefit from certain types of chemotherapy.

Radiation Therapy is the use of high-energy radiation to destroy cancer cells. Radiation is a local treatment, i.e., the radiation is directed to a designated area of the body.

Many times people are treated with a combination of these methods. The best treatment for each individual is determined by a variety of factors, including the type of cancer involved, where it is located and how extensive it is. The newest technology available is called CyberKnife®. CyberKnife® is the areas first precision robotic radiosurgery system that is painless, completely noninvasive and is designed to treat tumors anywhere in the body. It delivers doses of radiation precisely to the tumor, thereby limiting surrounding tissue damage.

Immunotherapy is a treatment to stimulate or restore the ability of the immune system to fight cancer, infections, and other diseases. Immunotherapy is also used to lessen certain side effects that may be caused by cancer treatment. Sometimes called biological therapy, biotherapy, biological response modifier therapy, and BRM therapy, the main premise is stimulating the patient’s immune system to attack the malignant tumor cells that are responsible for the disease. This can be either through immunization of the patient, in which case the patient’s own immune system is trained to recognize tumor cells as targets to be destroyed, or through the administration of therapeutic antibodies as drugs, in which case the patient’s immune system is recruited to destroy tumor cells by the therapeutic antibodies.

pre-treatment diagnostics
PET/CT
Positron emission tomography, also called PET imaging or a PET scan, is a diagnostic examination that involves the acquisition of physiologic images based on the detection of radiation from the emission of positrons. Positrons are tiny particles emitted from a radioactive substance administered to the patient. The subsequent images of the human body developed with this technique are used to evaluate a variety of diseases.

CT scans can identify prostate enlargement and show the size and shape of the gland, but they are not as effective when assessing the extent of cancer or visualizing cancer within the gland itself. While CT scans provide less defined images of the outer prostatic contour and internal architecture, CT images do accurately delineate the spatial relationship between the prostate, rectum and public bones. More contemporary spiral or helical CT scans provide greater resolution while taking less time to acquire the information.

The Center's GE High Speed Helical CT Scanner captures high resolution images of the prostate, seminal vesicles, bladder, urethra and rectum, which are required to accurately design your individual treatment plan. More advanced imaging techniques such as magnetic resonance imaging (MRI), bone scan, or ProstaScint scan may also be beneficial in more complex situations.

MRI
Magnetic resonance imaging (MRI) uses radiofrequency waves and a strong magnetic field rather than x-rays to provide remarkably clear and detailed pictures of internal organs and tissues. The technique has proven very valuable for the diagnosis of a broad range of pathologic conditions in all parts of the body including cancer, heart and vascular disease, stroke, and joint and musculoskeletal disorders. MRI requires specialized equipment and expertise and allows evaluation of some body structures that may not be as visible with other imaging methods.

MRI is a painless, non-invasive technique usually takes about 45 minutes.

Laboratory Studies
A number of other lab tests help to determine whether or not some form of hormonal therapy may be indicated, in the short term or at a later date. These tests include those that measure levels of Testosterone (total and bio-available), DHT (dihydrotestosterone), DHEA-S (dehydroepiandrosterone sulfate), Estradiol, Prolactin, LH (Luteinizing Hormone) and Androstenedione. Other evaluative procedures such as Urine Pyrilinks-D (Dpd), N-telopeptide (serum or urine), and Bone Specific Alkaline Phosphates, are often used in addition to a Bone Mineral Density (BMD) test to establish a baseline for bone integrity. This is especially important for patients undergoing hormonal therapy, which can cause bone loss or resorption. At CCCB, a quantitative computerized tomography (QCT) scan is preferred over the Dual Energy X-ray Absorptiometry (DEXA) scan, as the QCT provides more accurate results. Additional tests, such as a urine cytology study and NMP-22 bladder cancer marker, may be used to evaluate for other malignancies. Tests such as IGF-1 and 2L-6 may be included in a systemic evaluation.

There are other areas within the pathology itself which we may want to examine. Whether or not a cancer has attached itself to a nerve (perineural invasion or PNI) is important because we know that a nerve typically tracts throughout the gland and outside of the gland, and that it can act as something of a conduit for the cancer. In addition, genetic markers like bcl2, p27, p53, and MIB-1 may help to determine the aggressiveness of tumors.

Tumor Markers
Depending on the specifics of the case, a number of tests may be indicated and are commonly used at CCCB to help determine types of cancer present in the body. These tests look for a specific substance sometimes found in the blood, other body fluids, or tissues. A high level of tumor marker may mean that a certain type of cancer is in the body. Some of these tests, or markers, may be used to identify mutant tumor populations, or aggressive tumors in patients without elevated PSAs.

Markers of this type include
CA 125 - Ovarian cancer
CA 15-3 - Breast cancer
CEA - (carcinogen antigen) Ovarian, lung, breast, pancreas, and gastrointestinal tract cancers
NSE (Neuron Specific Enolase) -
CGA (Chromagranin A) -
PSA- Prostate cancer

advanced imaging
64-slice CT Scanner
With spiral—or helical—CT, refinements in detector technology support faster, higher-quality image acquisition with less radiation exposure. The current spiral CT scans are called multidetector CT and are 64-slice systems. These instruments providefaster scanning & higher resolution images. Using 64-slice scanner systems the radiologist can acquire 128 image slices per second. A spiral scan can usually be obtained during a single breath hold. This allows scanning of the chest or abdomen in 10 seconds or less. Such speed is beneficial in all patients but especially in populations in which the length of scanning was often problematic, such as elderly, pediatric or critically-ill patients. The multidetector CT also allows applications like CT angiography to be more successful.

With conventional CT, small lesions may frequently go undetected when a patient breathes differently on consecutive scans, as a lesion may be missed by unequal spacing between scans. The speed of spiral scanning and a single breath hold increase the rate of lesion detection.

external beam therapy
What is it? - External beam therapy is a form of therapy that uses radiation delivered by an external source (machine) and directs it to a target area to be radiated. EBT is the radiation therapy option used for most cancer patients.

How does it work? - External radiation therapy at Cancer Care Centers is delivered by a high energy Linear Accelerator. These machines produce therapeutic x-rays, both photons and electrons, with various ranges of energies. The beam is generated outside the body by a linear accelerator and is targeted to the tumor site. The cancer cells are destroyed, and with careful treatment planning, the surrounding normal tissues are spared. EBRT may use conventional photons, protons, neutrons or electrons. In contrast to EBRT, brachytherapy utilizes radiation sources (seeds) that are internal, implanted in the target tissue. These machines are checked daily prior to treatments, to ensure that they are working properly.

igrt / (4d ig-imrt)
IGRT enables our doctors to locate the tumor before each dose of radiation is administered while the patient is in their treatment position. IGRT utilizes high resolution x-rays to pinpoint internal tumor sites seconds before treatment and then automatically corrects position for optimum treatment.

imrt
Intensity Modulated Radiation Therapy (IMRT) is an advanced mode of high precision radiotherapy that utilizes computer controlled x-ray accelerators to deliver doses of radiation to a tumor or specific area of the tumor. It then delivers more tightly focused radiation beams to cancerous tumors than is possible with conventional radiotherapy. IMRT is designed to deliver the radiation dose to conform to the 3-dimensional (3-D) shape of the tumor by modulating, or controlling, the intensity of the radiation beam to focus a high radiation dose to the tumor, while minimizing radiation exposure to the healthy surrounding tissues.

Consequently, the technique can increase the rate of tumor control while significantly reducing adverse side effects. IMRT allows the physicians to escalate the radiation dose to cancer cells, and in some cases, even more precisely to specific metabolically active regions within a tumor, while keeping the dose to the surrounding tissues as low as possible. An analogy might be painting with a paintbrush as compared to using an airbrush and masking tape to protect outlying areas. The airbrush allows you to deposit variable amounts of paint in a highly controlled fashion. IMRT does something similar with radiation.

brachytherapy
What is it? - Brachytherapy is a type of radiation therapy used to treat cancer. Unlike external beam therapy, in which high-energy x-ray beams generated by a machine are directed at the tumor from outside the body, brachytherapy involves placing a radioactive material directly inside the body. Brachytherapy allows a physician to use a dose of radiation to treat a specific area and in a shorter time than is possible with external radiation.

How does it work? - High-dose rate (HDR) brachytherapy is an outpatient procedure. A specific dose of radiation is delivered through a remote-controlled machine to the tumor. This treatment may be repeated two times in a day before the delivery device is removed and the patient returns home. Patients may receive up to 10 separate HDR brachytherapy treatments over a one week period. At cancer care centers we use HDR for mammosites, intracavitary, intraluminal, and endobroncial treatments.

In low-dose rate (LDR) brachytherapy, the patient is treated with radiation delivered at a continuous rate over several hours or days. This technique of implanting radioactive seeds or pellets (Palladium-103 or Iodine-125) directly into the prostate, either alone or in combination with external beam radiation therapy allow as the doctor to deliver a high dose of radiation to the tumor while sparring the surrounding tissues. A patient receiving (LDR) brachytherapy is treated as an outpatient at a surgery center nearby.