Radiation Oncology: A Medical department as a scientific and clinic discipline devoted to recruit specialists and to research the physical and biological grounds of radiotherapy, treatment with ionizing radiation (individually or with other modalities) of cancer and sometimes other certain diseases other than cancer.
Radiotherapy: This is a method of treatment by directing the ionizing radiation (particle or wave type) of cancerous tissues.
Purpose of Radiotherapy: Purpose is to completely eliminate the tumor without damaging the normal tissues around the tumor in structural and functional aspect.
Purpose of Using Radiotherapy at Cancer Treatment
- Curative Radiotherapy: This is the treatment, of which complete recovery is expected from the patients having primary disease or local-regional diseases. Radiation dosage administered to such patients is at high curative level.
- Palliative Radiotherapy: This is a treatment implemented for the purpose of eliminating or preventing the findings endangering the life of patients and giving severe discomfort such as pain to the patient. Most significant benefit expected from such treatments is to increase the life quality of the patient. Area receiving radiotherapy is narrower and the dosage administered is less than curative treatment.
- Prophylactic Radiotherapy: This is a radiotherapy implemented for the purpose of reducing the metastases rates that may occur at tumors having 50% or more spreading possibility.
Management of Patients Applying to Radiation Oncology Clinic
Cancer treatment must be planned at tumor councils within a multidisciplinary approach. Therefore, diagnosis, treatment and follow up phases of patients, type and time of the treatment to be implemented are planned and they are allowed to be carried out in a discipline. At tumor councils, tumor surgeons, radiation oncologist, medical oncologist, pathology specialist, radiology specialist, nuclear medicine specialist and when necessary dietician and psychologist must be available. Radiotherapy of cancer patients requires team work. Within this team, Radiation oncology specialist, Medical Physics Specialist, Radiotherapy Technician and Oncology Nurse are available. It is very important for the individuals within the team to work in harmony, to assist each other, to follow up patient planning and treatment for more accurate, faster and sustainable radiotherapy. A patient having cancer diagnosis and making application to Radiation Oncology Clinic before or after implementing certain treatments directly with other disciplines or evaluation at multidisciplinary tumor council for the treatment is first examined by Radiation Oncology Specialist and a preliminary evaluation process is performed for radiotherapy implementation. In this preliminary evaluation, pathology report (may not be required for certain rare conditions), type, dimension, characteristics with other cell structure (histopathologic) characteristics, location of tumor and monitoring methods such as ultrasound, computerized tomography, magnetic resonance and PET-CT are inspected, if necessary, new examinations are performed.
Radiation Oncologist inspects the results of examination and tests and if he diagnosis for radiotherapy indication, decision shall be made to determine whether the treatment is curative, palliative or prophylactic. Then, radiation oncologist determines the type of treatment (external treatment, brachytherapy or combination of both) target tumor volume containing the primary tumor or tumor bedding and the areas having the spreading risk, selection of treatment machine, treatment planning, daily dosage and total dosage to be administered to the patient. After all these parameters are determined by the physician, patient is commenced to be prepared for the treatment. Firstly during the commencement of radiotherapy phase, it is necessary to perform planning tomography individually and/or combined with MR and/or PET-CT . Before performing planning tomography, processes such as thermoplastic head and/or neck masks to stabilize the patient, vacuum bed application to provide immobilization, breast board applications according to cancer treatment zone. Providing patient stabilization is one of the most significant phases of radiotherapy. Therefore, patient is taken to the radiotherapy always at the same position. For 3 dimensional conformal RT or IMRT/VMAT + IGRT or SRS/SRT/SBRT + IGRT stereotactical radiotherapy of the patient, risky organs that may be affected by the side effects of radiation, tumor and tumor bedding and if necessary lymph nodes are individually contoured on the images transferred to treatment planning system. Treatment planning is made by the Medical Physics Specialist within the framework of dosages determined for risky organs and tumor by the physician.
After the performed plans are evaluated, treatment is commenced by performing the set-up application, in which patient, physician, medical physics specialist and radiotherapy technician to be together with IGRT method through imaging (determining the areas while starting the treatment and implementing the treatment on correct zones). Period from the application of patient to the radiotherapy unit until the commencement of the treatment must be materialized maximum in 1 week if no additional test is requested. Total duration of the treatment changes between 1-40 business days according to condition whether the treatment is palliative, prophylactic or curative. Daily treatment periods is approximately between 3-15 minutes. Risk of various side effects in connection with the radiotherapy is reduced due to cutting edge technology devices. It is the principle to follow up, determine the side effects experienced and to complete the radiotherapy of the patient without any problem whether treating as inpatient and/or outpatient. Linear accelerator (Linac) used in our clinic is a device called VERSA HD of ELEKTA as first in Turkey and used at limited centers in the world. VERSA HD is new generation groundbreaking radiation treatment technology for certain tumor treatments and changing the standards at cancer treatment.
Radiosurgery based on linear accelerator is a superior device that is capable of operating with radiation and provides possibility with high sensitivity the treatment of any patient having radiotherapy indication.
Through the collimator structure having leakage dosage impermeability less than 5 times of closest competitor, it protects intact organs and has the least percentage for the risk of secondary cancer formation.
It covers the shape of target volume better and reduces the amount of dosage to be received by intact organs because of having 160 area former (MLC) the highest numbers in the area.
It also reduces the treatment duration compared to its competitors because of having highest MLC (area former) speed in its area.
Dosages administered to the patient are calculated in most accurate manner through the treatment planning system having Monte Carlo algorithm capable of performing precise calculations accepted by the whole world.
Through the (FFF) energies providing opportunity for unfiltered treatment, it may reach the dosage speed 4 times of the filtered energies. It is able to implement treatment in fast and precise manner for patients to receive radiosurgery (surgery with radiation).
It protects the intact organs in maximum level while administering dosage to target volume through inhalation follow-up allowing 4 dimensional treatment. System only performs radiation between determined inhalation phase intervals and automatically ceases radiation at other inhalation phases. Inhalation monitoring constituting great importance for patients having mainly liver, lung and left breast cancer, is available at limited number of clinics in our country. System in our hospital is one of the cutting edge technology inhalation monitoring systems and this system is only available in our hospital countrywide. System automatically determines the patient movements that may occur during the treatment and prevents overdosing of intact organs.