BASKENT UNIVERSITY HOSPITAL KONYA

Radiation therapy uses high-energy radiation to kill cancer cells by damaging their DNA.

A patient may receive radiation therapy before, during, or after surgery, depending on the type of cancer being treated. Some patients receive radiation therapy alone, and some receive radiation therapy in combination with chemotherapy.For this reason high technology and computer assisted devices are used for effective treatment

All the patients do not need to have radiation therapy. Patients are first evaluated by our specialists and then it is decided if they should get radiation therapy depending on the type and the progress of the diesease and other treatments the patient might be having. The type of the radiation therapy, its length and dose is also determined by our specialist doctor.

The first step of the radiotherapy is the detailed clinical check up. The tumor or the suspected area is first determined and the treatment is performed by simulation method. Simulation is done by conventional Simulator. With Patients who are going to receive simple area treatment, conventional Simulator, for complex area treatment CT or PET CT Simulator devices are used. Images that come through CT are transferred into computerised treatment planning system and the area which is going to be treated are marked by our specialist doctors. Radiation therapy physician is the person who is in charge of the dose of the treatment and also of the general maintenance of the radiaotherapy devices. Physician and the specialist doctor work together to determine the right dose and the best treatment plan with the help of a 3-D computer system. With the help of computerised planning system it is possible to perform 3-D conformal radiation therapy, intensity modulated radiation therapy (IMRT), and volumetric modulated arch therapy (VMAT).

Elekta Access Linear Accelator Device is a device with its accelarating treatment technology. It is commonly used in IMRT, IGRT, GAMA-KNIFE-SRT/SRS treatment methods. It is a very high prestige device installed in our hospital first time ever in Turkey.

Access technology can be used in the treatment of all cancer types. Its high technology enables us to take a tomography (cone beam computerised tomography) of the location of the tumor, before the start of the treatment. It also enables us to screen the progress of the tissues which makes it possible to reduce the side effects in the healthy cells. Elekta provides a high chance of recovery, reducing the side effects at the same time.

Başkent University Hospital is the first center ever in Turkey, to start using Monaco Treatment Planning System. It uses Monte Carlo Dose Calculation System which is recognised as the best and most realistic possible planning system.

TREATMENT METHODS PERFORMED AT BAŞKENT UNIVERSITY RADIATION ONCHOLOGY DEPARTMENT

IMRT (Intensity Modulated Radiation Therapy)

IGRT (Image guided radiation therapy)

VMAT (Volumetric Modulated Arch Therapy)

GAMA-KNIFE SRT/SRS

SBRT (Stereo tactic Radiation Therapy)

3B-KRT (3-D Conformal Radiation Therapy)

3D-HDR (3-D High Dose Rate Brachy Therapy)

HDR (High Dose Rate Brachy Therapy)

TBI (Total Body Irradiation)

How Does Radiotherapy Work?

Radiation therapy kills cancer cells by damaging their DNA (the molecules inside cells that carrygenetic information and pass it from one generation to the next) Radiation therapy can either damage DNA directly or create charged particles (free radicals) within the cells that can in turn damage the DNA.

Cancer cells whose DNA is damaged beyond repair stop dividing or die. When the damaged cells die, they are broken down and eliminated by the body’s natural processes.

Radiation therapy can also damage normal cells, leading to side effects .However unlike the tumor cells, normal cells can quickly recover from the side effects of radiation therapy. That is the reason why doctors divide the total treatment dose in days and patients receive it in small doses. Doctors while aiming to treat the tumor area as much as they can, also aim to protect the normal tissues. That is why the treatment is divided into daily doses.

What Are The Aims And Benefits Of Radiatation Terapy?

The aim of radiotherapy is to kill or stop the growth of the tumor cells. It can be used to treat tumors in any area of the body. Most of the cancer patients are treated by radioptherapy and for most of them radiotherapy could be the only treatment option. Most cancer patients got free of their tumors thanks to the radiotherapy performed together along with the other tumor treatment options.
It is a locally performed treatment. It only affects the tumor in the given area of the body. Sometimes doctors suggest radiotherapy in addition to chemotherapy or biological treatments which can reach the whole body via blood channels.

Below are the ways radiotherapy is used for cancer treatment
Palliative Radiation Treatment This is a treatment used to to ease the pain of the patient. Depending on the size and the type of the tumor, It is performed in high doses, in short periods of time. It relieves symptoms and reduce the suffering caused by cancer. The average treatment is usually 2 weeks, in some cases a week long or even just 1 day treatments could also be performed. Many cancer patients reported that their quality of life got much better and pain was much more bearable after the palliative treatment.

Curative Radiation Treatment The main aim of this therapy is to cure the disease and to prevent the recurrance of the tumor in the local area. This is a high dose therapy. The average treatment would be approximately 5 to 7 weeks and depending on the type and the size of the tumor , it could be less than 5 weeks or longer than 7 weeks.

There are different types of curative therapy

Adjuvant Treatment In order to achieve the most effective cancer curative results, radiation treatment is frequently used as adjuvant therapy to other treatments. Radiation treatment may be administered before or after surgical treatment or together along with chemotherapy in order to prevent the recurrance of the tumor in the area.

It is very commonly performed in the treatment of brain tumors, larenx tumors, breast cancer, stomach cancers, rectum cancers and cervix cancers.

Neo-adjuvant Treatment The main aim of this treatment is reducing the size of the tumor to provide the conditions for a more conservative surgery and to keep the local area under control. It is very commonly performed in rectum cancer, lung cancer, and soft tissue tumors.

Definitive Treatment This is the treatment in which radiation therapy is performed together alone with chemotherapy. No surgical therapy is involved unless there is a case of recurrance. It is commonly prefferred in nasopharynx cancer, early stage glottic larinx cancer, cervix cancer, prostate cancer, and lung cancer.

What Are The Risks Of Radiation Therapy?

Radiation therapy can damage normal cells as well as cancer cells. Therefore, treatment must be carefully planned to minimize side effects. The side affects of the treatment arise due to the damage given to the healthy cells. Most of these side affects vanish after the treatment either by itself or by taking certain type of medication.
Most of these side effects are very well recognised by the doctors and nurses and could easily be treated. These side affects are always acceptable compared to the benefits of the destroying the tumor cells.
Radiation given to the patient is only effective in the radiation treatment room, after the treatment is finished and the patient leaves the treatment room, there is no risk of the patient diffusing radiation to his/her surrounding.

How Is Radiation Therapy Performed?

There are two methods of performing radiation therapy, external-beam radiation therapy or internal radio therapy, commonly known as brachy therapy. For some patients both may be necessary.
For most of the patients needing radiation therapy for the treatment of tumors, external radiation therapy is used. During external radiation therapy sessions, patients are treated by photon beams. During the application patients donot feel any pain. It is usually performed at a hospital with special devices and machines. The high energy radiation beams provided by these machines and devives are reflected towards the tumor and the area around it. Some devices work better on tumors which are on the surface of the skin, some are beter in the treatment of tumors which are deeper down the skin.
Many types of external-beam radiation therapy are delivered using a machine called a linear accelerator (also called a LINAC). A LINAC uses electricity to form a stream of fast-moving subatomic particles. This creates high-energy radiation that may be used to treat cancer.

Internal radiation therapy (brachytherapy) is radiation delivered from radiation sources (radioactive materials) placed inside or on the body . This kind of therapy is less commonly used compared to external therapy.

In brachytherapy, radioactive isotopes are sealed in tiny pellets or “seeds.” These seeds are placed in patients using delivery devices, such as needles, catheters or some other type of carrier. As the isotopes decay naturally, they give off radiation that damages nearby cancer cells.

If left in place, after a few weeks or months, the isotopes decay completely and no longer give off radiation. The seeds will not cause harm if they are left in the body .

Brachytherapy may be able to deliver higher doses of radiation to some cancers than external-beam radiation therapy while causing less damage to normal tissue.

Here are the types of brachytherapy commonly used in clinics.

Intracavitary branchytherapy During intracavitary radiation, the material is placed in a cavity (space) in the body, such as the uterus. It is commonly used in cervix cancer and endometrium cancer.

Intraluminal branchytherapy This is a treatment method performed in organs with two open ends like a tube. It is used to prevent the blockage caused by the tumor. It is commonly used in lung cancer treatment.

Interstitial brachytherapy During interstitial brachytherapy, devices containing radioactive material are inserted directly into body tissue. It is commonly used in the treatment of for prostate cancers, breast cancer, and soft tissue tumors.

For tumors located on the surface, catheters and radioactive sources are placed in moulds specifically prepared for this purpose. This type of treatment is mostly used in skin and lip tumors

Who Performs Radiation Therapy Treatments?

Not all the patients need to receive radiation therapy. Patients are first evaluated by the specialists and then it is decided if they should receive radiation therapy depending on the type and the progress of the diesease and other treatments the patient might be receiving. The type of the radiation therapy, its length and dose is also determined by the specialist doctor.The first step of the radiotherapy is the detailed clinical check up. The tumor or the suspected area is first determined and the treatment is performed by simulation method. Simulation is done by conventional Simulator. With Patients who are going to receive simple area treatment, conventional Simulator, for complex area treatment CT or PET CT Simulator devices are used. Images that come through CT are transferred into computerised treatment planning system and the area which is going to be treated are marked by the specialist doctors.
Radiation therapy physician is the person who is in charge of the dose of the treatment and also of the general maintenance of the radiaotherapy devices.Physician and the specialist doctor work together to determine the right dose and the best treatment plan with the help of a 3-D computer system. With the help of computerised planning system it is possible to perform 3-D conformal radiation therapy, intensity modulated radiation therapy (IMRT), and volumetric modulated arch therapy (VMAT).

IMPORTANT INFORMATION

Radiation therapy cause no pain.
Radiation therapy doesn’t make you radioactive. You donot distribute radiation to your surrounding.
Treatment is usually performed everyday except Saturdays and Sundays.
The actual treatment lasts only a couple minutes, however each session may take up to 15-20 mins.
It is very essential to get enough rest and to follow a stable diet during the treatment.
Side effects of radiation therapy is usually temporary and differs depending on the area it is being performed. Your doctor will inform you about the type of therapy you need to receive. Please donot hesitate to ask any questions in your mind.

TREATMENT METHODS PERFORMED AT BAŞKENT UNIVERSITY MEDICAL FACULTY RADIATION ONCHOLOGY DEPARTMENT

IMRT (Intensity Modulated Radiation Therapy)
IGRT (Image guided radiation therapy)
VMAT (Volumetric Modulated Arch Therapy)
GAMA-KNIFE SRT/SRS
SBRT (Stereo tactic Radiation Therapy)
3B-KRT (3-D Conformal Radiation Therapy)
3D-HDR (3-D High Dose Rate Brachy Therapy)
HDR (High Dose Rate Brachy Therapy)
TBI (Total Body Irradiation)

DEVICES AND MACHINES USED AT BAŞKENT UNIVERSITY MEDICAL FACULTY RADIATION ONCHOLOGY DEPARTMENT

Elekta Access Linear Accelator Device
It is a device with its accelarating treatment technology. It is commonşy used in IMRT, IGRT, GAMA-KNIFE-SRT/ and SRS treatment methods. It is a very high prestige device installed in our hospital first time ever in Turkey.

Elekta provides a high chance of recovery, reducing the side effects at the same time.

VARIAN VARYSOURCE BRACHYTHERAPY DEVICE

Brachytherapy works by precisely targeting the cancerous tumor from inside the body. It is a type of radiptherapy that is given to the tumors or the risky areas via catheders in the area. Brachytherapy enables us to use higher doses of radiation than external beam therapy and also enables us to protect the tissues surrounding the area.

It is very commonly used to treat the blockage in lungs, throax and gall bladder. Also used paliatively in late stage uterus and cervical cancer to ease the pain.

Today brachtherapy is mostly used to complete dose of the external beam radiation therapy. We have been performing brachtherapy since 2007 in treatment of uterus, cervix, lung, throax and gallbladder problems. We are starting perfroming brachytherapy soon in the treatment of breast cancer, too.

It is performed by computerised planning and a high dose of radiation could be given to the tumor tissues, while the surrounding organs are not harmed by it. This causes less side effects to the patient. We have been performing conformal brachytherapy as a standart method since 2008. It is not available in all the hospitals. Because it requires qualified, experienced staff to operate and perform it. We perform it on the patients referred to us from other hospitals in our region and out of our town, as well as our own local patients.

PET-BT BASED RADIATION THERAPY PLANNING

PET-BT is an imaging system to measure and screen the determinants that the tumor may have deteriorated. Considered to our devices, It has a high reputation in determining the size of the primary tumor and also imaging the possible side tumors and their roots which is very difficult to screen in other imaging devices.

This enables the doctors to determine the aimed volume and prevent unnecessary radiation therapy.

PET-BT is also very important in evaluating the aftermath of the treatment and in differentiating between the side effects caused by the treatment and the relapse of a new problem.
Our center is probably one of the best equipped and exerienced centers in using PET-BT imaging system whether for treatment planning or phasing the disease.

ELEKTA AXESS and GAMMA KNIFE STEREOTACTIC RADIOTHERAPY and RADIOSURGERY

Stereotactic radiosurgery (SRT) is a form of radiation therapy that focuses high-powered x-rays (1 to 5 fraction) on a small area of the body. Other types of radiation therapy are more likely to affect nearby healthy tissue. Stereotactic radiosurgery better targets the abnormal area.

Despite its name, radiosurgery is a treatment, not a surgical procedure. It causes no pain and no bleeding. Patient can go home on the same day.

Gammaknife in our center is mostly used to treat tumors inside the skull, hypophysis adenomas, functional diseases and arteriovenous malformations.

Elekta Axess device is not only used to treat tumors in the skull but to treat any tumor which could be located anywhere in the body.SRT and SRC whether used as a primary treatment or as part of a treatment plan or used as an additional dose after the external beam therapy is known to be very effective to keep the diesease under control without effecting the patients’ quality of life negatively.

As an example, about 50 % of the pancreas cancers are known to relapse after the conventional radiation therapy and chemotherapy treatments. However with SRC, this ratio is less than 10 %.

SRC or SRT is also an alternative in treatments of early stage lung cancers which is not suitable for surgery for various reasons.