Digestive System Cancers

Radiation Oncology

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The Departments of Radiation Oncology, work together with surgeons, medical oncologists, interventional radiologists, and gastroenterologists to provide patients with the most comprehensive multidisciplinary management of digestive system cancers available. The most current and effective treatment approaches are provided in ultramodern settings where patient privacy and comfort are foremost.

There are two main types of radiation treatments external and internal that can be used based on the needs of the patient. External beam radiation is delivered using a linear accelerator that produces high energy x-ray or electron beams that are aimed at the diseased tissues. Internal radiation or brachytherapy uses radioactive seeds placed within or next to the area to be treated.

We treat cancers of the digestive tract including esophagus, stomach, intestine, colon, rectum, anus, pancreas, liver and hepato-biliary system cancers.

External Beam Radiotherapy

External beam radiation is the most common form of radiotherapy. It uses a linear accelerator to aim a beam of radiation at the diseased tissue. Each actual treatment lasts a few minutes and is administered over a number of weeks, five days a week. There is no discomfort during the actual radiation treatment. Radiotherapy hardware, software, treatment planning and delivery methods have advanced dramatically in recent years. These advances allow us to more accurately target the cancer with higher doses of radiation, while minimizing damage to adjacent healthy tissue. NewYork-Presbyterian Hospital utilizes the following state-of-the-art treatment techniques during our external beam treatments for digestive cancers as required by the individual needs of each patient.

Intensity Modulated Radiation Therapy (IMRT): We at NewYork Presbyterian Hospital use IMRT to treat digestive system cancers because of its ability to precisely vary or modulate the intensity of the radiation beam to match the shape of the tumor. This very accurate method assures that the entire tumor is properly treated and the exposure to normal tissue is minimized. The minimal exposure of normal tissues minimizes unwanted side effects. The treatment is given 5 days a week for 6 to 7 weeks.

3-Dimensional Conformal Radiotherapy (3D-CRT): 3D-CRT techniques are also frequently used to ensure that all the parts of each tumor are completely treated in all 3 dimensions. It combines multiple radiation treatment fields to deliver very precise doses of radiation while minimizing the dose to the surrounding normal tissue.

4D Treatment Planning: The 4D method of treatment planning is often used for liver treatments because the liver is located just under the diaphragm causing it to be in continuous motion from breathing. Because of this motion, it a challenge to assure that the tumor does not move in and out of the treatment field as a patient breaths. 4D is a relatively new planning method that accounts for this movement.

Stereotactic Body Radiotherapy (SBRT): SBRT is often used to treat cancer that has metastasized to the liver. During SBRT, each patient is gently and comfortably placed in a frame with special measuring devices that allow the treatment team to exactly locate the area to be treated in relation to the frame. Later, the patient is treated using that same frame to guide pencil thin beams of radiation to target the diseased area in continuous arcs. This non-invasive, very precise treatment is given once or twice a week for 3 to 6 weeks.

Advanced Imaging Techniques: At NewYork-Presbyterian Hospital, we also often use technology that combines or "fuses" Magnetic Resonance Images (MRI), Positron Emission Tomography (PET) and CAT Scan images to help us determine the geometric and metabolic characteristics of each tumor. This process allows for better treatment planning and maximizing the benefit of radiation therapy.

Brachytherapy

Radioactive Microspheres: NewYork-Presbyterian Hospital offers a relatively new type of treatment for liver cancer that utilizes radioactive microspheres. We collaborate with interventional radiologists to inject microscopic spheres that have a radioactive substance attached to them. These spheres collect in the area of the cancer and deliver a dose of radiation to treat the tumor. There is no discomfort from the spheres themselves.

Seed Implants: NewYork-Presbyterian Hospital Radiation Oncology is one of a few centers in the country to offer intraoperative seed implants for pancreas, liver, biliary tract and other digestive cancers. During this procedure, radioactive seeds are placed in diseased tissue during an operation to remove a tumor. They may be placed in areas where it is difficult or impossible to achieve complete surgical removal of all the diseased tissue or in patients for whom a more aggressive surgery may be considered too risky. The seeds give off their radiation over the next weeks and months to treat any remaining disease.

High-Dose-Rate (HDR) Brachytherapy: During HDR treatments, a tiny highly radioactive source is computer guided through a catheter to the area to be treated. It is left in place for a few minutes to deliver a therapeutic dose of radiation and then removed. There is little or no discomfort. This type of HDR treatment is often used to treat cancers of the esophagus or bile ducts. Patients who need additional radiation but cannot get additional conventional radiation because of prior treatment, also benefit from this type of therapy.