Services
Long Island Radiation Therapy
Radiation Oncology
Long Island Radiation Therapy (LIRT), a division of NRAD, is a comprehensive oncology practice specializing in the delivery of state-of-the-art Radiation Oncology treatments. Each of the four treatment locations offers sophisticated and powerful state-of-the-art equipment capable of treating virtually every kind of cancer or malignancy. Treatments offered through the practice include Image Guided Radiotherapy (IGRT); Intensity Modulated Radiotherapy (IMRT), Brain and Body Stereotactic Radiosurgery, High and Low dose brachytherapy, as well as many other treatments. Unique to the patient experience at NRAD is the seamless integration of cutting edge diagnostic and therapeutic treatment strategies. Competent and compassionate physician and office staff are often sited as one of the greatest assets of the practice.
-FAQs: Frequently Asked Questions
-LOCATIONS: Long Island Radiation Therapy locations
-PHYSICIANS: LIRT Radiation Oncologists
-COMMONLY USED RADIATION ONCOLOGY TERMS: Definitions
TOMOTHERAPY [hyperlink to definition page]. We are pleased to offer treatment on either of our two highly sophisticated Tomotherapy Hi-Art LINAC (linear accelerator) Units. The varied location of these units offers patients advanced technology, geographic convenience and flexibility when selecting their treatment.
TOMOTHERAPY LINACS (Tomotherapy Linear Accelerators) are designed to perform both IMRT (Intensity Modulated Radiation Therapy) and IGRT (Image Guided Radiation Therapy).
- A built-in CT scanner provides CT guidance for each treatment, to align not only bony anatomy but also soft tissue anatomy (e.g. the prostate or a lung tumor) ensuring precise delivery of radiation before any treatment is given (IGRT).
- The Linear Accelerator, which delivers the photon beam treatment, rotates around the patient as the patient is moving into the beam, which simplifies treatment of long radiation fields.
- Continuous modulation of the beam permits very flexible dose delivery, minimizing dose to critical organs such as spine and optic nerves (IMRT).
- Tomotherapy can treat multiple tumors at once, without having to repeat the initial patient setup for each tumor and, remarkably, can deliver different doses simultaneously to different tumors.
- Inverse Planning capability ensures critical organ dose limitations will not be exceeded, while still delivering the required dose to the targeted tumor.
- Continuous CT Monitoring assesses tumor response to radiation therapy. Treatment planning is quickly readjusted to account for decreasing tumor size and change in shape in response to radiation treatment.
VARIAN’S RAPIDARC
– One of the newest in the Varian line of Linacs, the RapidArc is equipped for both IMRT and IGRT, and also has a full range of electrons. This LINAC has both the superior capability and range to fulfill all radiation therapy needs from superficial skin treatment to complex treatment for virtually any tumor.
- The rapidity of treatment makes this LINAC ideal for Stereotactic Body Radiation Therapy (SBRT), achieving the safe delivery of multiple (2-6) large doses of radiation for lung, liver and paraspinal tumors.
- The VMAT (Volumetric Modulated Arc Therapy) technique is designed to treat the entire tumor in a single 360 degree rotation.
- Built in Cone Beam CT scanning delivers both IGRT and IMRT and allows for shorter treatment time, while improving the flexibility and conformality of dose distribution.
SIEMENS PRIMUS LINAC – The Siemens Linac is a dual energy LINAC with a full range of electrons and, on-board kV imaging, providing a reliable option for all types of standard radiation treatments. Equipped with Exac-Trac, it provides IGRT and IMRT capability as well as electrons for treatment of superficial tumors.
BRACHYTHERAPY – NRAD/LIRT physicians are very experienced in the use of brachytherapy in the treatment of a wide variety of tumors. Brachytherapy involves the implanting of radioactive sources directly into a tumor. The sources can be placed permanently, such as prostate implants, or can be placed temporarily, such as in breast brachytherapy using Contura or MammoSite balloon applicators. These can give a full course of partial breast radiation in just 5 days as an outpatient. Skin applicators can also be used to give superficial doses of radiation to skin cancers, while at the same time minimizing the dose to deeper underlying tissues.
4-D PLANNING AND TREATMENT – NRAD now has the capability of dynamic treatment planning, accounting for the movement of certain tumors during respiration.
- This is especially valuable in the treatment of lung and abdominal cancers and utilizes the sophisticated General Electric 4-D Planning System.
4-D Planning not only increases targeting accuracy, but also decreases the radiation dose to surrounding normal tissue. The tumor alone thereby receives a safe increase in targeted dose.
Accelerated Partial Breast Radiotherapy
Over the past twenty years, radiation treatments (RT) have been routinely offered to women following limited breast cancer surgery (lumpectomy). Lumpectomy followed by radiotherapy to the whole breast is equally effective to mastectomy, for patients with early stage disease. Although, effective, conventional RT treatment typically involves daily radiotherapy treatments (M-F) for a period of 6-7 weeks.
Clinical trials are ongoing to determine if more limited radiation treatments can provide long-term results comparable to those seen with conventional radiotherapy. The more limited form of radiotherapy is termed partial breast irradiation. When the RT is delivered in a shorter period of time (typically with higher doses of radiation each day), the term accelerated partial breast irradiation (APBI) is used. Many cancer centers throughout the United States have published their experience using this form of therapy. APBI can be administered using either internal or external radiotherapy. Internal radiation treatments typically involve placement of a small “balloon-like” applicator into the surgical excision site (lumpectomy cavity).
Savi device placed Mammosite device placed
into lumpectomy cavity into lumpectomy cavity
This applicator contains either a single central channel or multiple channels, which allows a tiny radiation source to be introduced into the system. The process of using radiation sources near or within tumor is termed “brachytherapy.” The machine used for this type of breast treatment delivers the radiation dose in a short period of time (approximately 10-15 minutes). Because the radiation source is strong enough to deliver the treatment is a short period of time, it is termed a “high dose rate” (HDR) brachytherapy. HDR therapy for breast cancer patients consists of 10 sessions. Two sessions are administered each day with a minimum of 5-6 hours between each session. On the last day of treatment, the physician removes the balloon device from the patient and the cavity slowly closes over time. Current treatment options include the use of all commercially available breast catheters, including Mammosite, Contura, and Savi.
APBI can also include the use of more limited radiation fields that are tailored to reduce the amount of adjacent breast tissue within the treatment area. As the volume of breast tissue irradiated is less, patients receive a twice daily treatment. In turn, the treatment time is lessened when compared to convention breast radiotherapy (i.e. 6-7 weeksà 2-3 weeks).
But APBI is not for everyone. The American Society for Radiation Oncology (ASTRO) ha further delineated a list of criteria, which identify patients who are optimum candidates for this procedure. The guidelines, which were published in mid-2009, include the following:
1) patient age 60 years or older; 2) tumor size of 2 cm or less; 3) tumor stage T1, negative margins of at least 2 mm; 4) pathologically negative nodes; 5) positive estrogen-receptor status; 6) absence of lymphovascular space invasion; 7) no multicentricity. Patients with ductal carcinoma in situ (DCIS) are excluded.
Women with multiple tumors or cancers that involve the lymph nodes are more likely to benefit from standard whole breast external beam radiation, which delivers a uniform dose to the entire affected area following mastectomy or lumpectomy. This approach may utilize intensity modulated radiation therapy (IMRT), which often results in a more uniform dose and reduces "hot spots" in the breast. A current national clinical trial is investigating potential future applications of APBI in younger women and cases where cancer has spread to the lymph nodes.
ACCUBOOST
NRAD and LIRT are pleased to announce the arrival of Accuboost. Accuboost is a technologically advanced method of treating women with breast cancer. Women who elect to undergo breast conserving surgery (lumpectomy), following the diagnosis of breast cancer will require post-operative radiotherapy. Conventional therapy is delivered in two phases. The first involves treatment to the breast in its entirety. The second component is focused radiation directed to the surgical cavity. Typically, this is done use electron beam therapy. Although CT planning is used to create the boost treatment, daily imaging is not performed to confirm target localization.
Accuboost is a new approach to the boost phase of post-lumpectomy radiotherapy. It uses techniques employed in mammography. The same numbers of treatments are offered with this technology as are delivered using electron treatments (seven); however, daily image guidance, using mammographic techniques is employed to ensure accurate target localization. Low compression mammographic images are obtained prior to each treatment session. The Radiation Oncology physician localizes the exact region for treatment prior to each daily treatment. Accuboost offers less radiation to dose sensitive normal tissue, including the heart and lungs. Daily treatment times are approximately 30-40 minutes and are performed in a relaxed and comfortable treatment environment.
Ask your doctor if you are a candidate for Accuboost therapy.
Additional information is available at: http://www.accuboost.com/
