Columbus Regional Hospital has expanded the types of radiation treatments it offers cancer patients, adding services that target more precisely cancerous tissue and decrease the number of procedures needed in the treatment process.
The hospital has added:
Stereotactic body radiosurgery
It uses an advanced mapping system to precisely locate the tumor and deliver highly concentrated, highly focused radiation treatment.Prone breast board radiationThe positioning capability allows a patient’s breast tissue to fall away from the body, keeping radiation away from vital organs and focusing it solely on the tumor in the breast.
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High-dose rate brachytherapy
Radioactive seeds or sources are placed in or near the tumor itself, giving a high radiation dose to the tumor while reducing the radiation exposure in the surrounding healthy tissues.Columbus Regional’s expansion of services also included the addition of Drs. Kevin McMullen and John Cox, radiation oncologists who joined the hospital in the spring after working in the Indiana University Health network. Both have experience with brachytherapy, and McMullen has an extensive background with stereotactic radiosurgery.
The hospital’s new offerings put it at the leading edge for treatments, and allows patients to receive these treatments close to home, McMullen said. Previously, patients had to travel to hospitals in Indianapolis or Louisville to receive the treatments, he said.
“(Hospital leadership) really wanted to be on the forefront more than simply keeping up. I think that it was a change in the stance of leadership about where they wanted to be in terms of the type of care that is delivered,” McMullen said.
Stereotactic body radiosurgery therapy is a way to deliver a high dose of radiation with accuracy of within a millimeter using image guidance. A pencil-beam laser is delivered from the hospital’s TrueBeam linear accelerator, McMullen said.“Many of those patients can be treated in a single session,” McMullen said.
The therapy was primarily developed for the brain but also can be used for the lung, adrenal gland, liver and spine.
Traditionally, radiation treatments covered the entire brain, causing short- and long-term side effects. However, the majority of patients are now candidates for stereotactic body radiosurgery therapy, which limits the dose administered to the rest of the brain.
Columbus Regional spent about $1.5 million on upgrades to offer its new radiation treatments. The costs covered staff and equipment, such as a robotic table that controls degree and angle a patient is stationed for the delivery of the dose, McMullen said.
Standard radiation delivered by a linear accelerator is teletherapy. “Tele” is the Greek root for “far.” “Brachy” is the Greek root for “near.” Brachytherapy is radiation treatment that is performed on or inside a patient.Brachytherapy can be performed on the skin, breast, lung, prostate, cervix or uterus, for example, and in short courses of therapy instead longer courses over multiple weeks.
The benefit is that it provided an alternative option to operations that could leave the skin deformed, McMullen said. Also, elderly or frail patients who may not have been able to withstand a surgery may be candidates for brachytherapy, he said.
Columbus Regional has used brachytherapy on a patient’s ring finger to treat a skin cancer that otherwise might have required seven weeks of treatment or possibly amputation, Cox said.
Prostate treatment by brachytherapy can involve low-dose iodine seeds that deliver the full dose over six months, or a high-dose involving catheters placed into the prostate to deliver the treatment, Cox said.
Studies are showing that brachytherapy can cause protein-specific antigen (PSA) scores to drop by 70-80 percent at eight-year follow-up exams, Cox added.
“We want you to have a great survivorship, and often brachytherapy is the best way because it puts the radiation directly near the target,” Cox said.
Another type of treatment Columbus Regional offers is accelerated partial breast brachytherapy.
A device shaped like a football and about the size of walnut is placed into a breast cavity after a lump is removed. The SAVI device has a series of catheters, through which the radiation is delivered. The device allows doctors to create a customized cloud of radiation dose inside the patient of any shape needed, McMullen said.
The other benefit is that the therapy involves 10 treatments over five days, McMullen said.
Not all women are candidates for accelerated partial breast brachytherapy because the cavity has to be small and in the right location, for example, and some women need to have the entire breast treated, McMullen said.
Prone breast treatment
The use of a special foam breast board allows patients to be treated on their stomachs so breast tissue falls away from the body, and keeps radiation doses away from organs such as the heart and lungs, McMullen said.“That’s really important for them long-term for survivorship,” he said.
Previously, patients were on their backs during treatment, which increased the exposure of vital organs to radiation and made patient setup more challenging. The foam breast board aids in setting up patients correctly for treatment, McMullen said.