TeletherapyExternal beam radiotherapy (external) destroys cancer cells by using radiation directed linear accelerator. The most common type of external radiotherapy is the use of high energy X-rays - photon beams, at least - of protons or electrons. Radiation therapy destroys cancer cells in the treatment area.

Treatment is carried out in the radiotherapy apparatus via branch resembling a large X-ray machine. In most cases, it uses a linear accelerator, which uses electricity to generate light.

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During therapy, there is no contact with the equipment, the patient feels no pain. In the future, there may be some discomfort or pain from side effects. Before therapy the doctor discusses with the patient the potential short-term and long-term adverse effects of treatment. Most of them are temporary, and in most cases are well controlled with medication.

In the process of planning and monitoring treatment, doctors use a variety of tests, including X-ray, CT, MRI or PET. Planned high dose irradiation of the tumor. It is important that the area around the tumors were included in this zone. This increases the effectiveness of therapy. Doctors try to reduce the radiotherapy dose to the surrounding healthy tissue, to reduce the risk of possible unintended consequences.

The operating principle of teletherapy

Radiation therapy damages the DNA of tumor cells - the genetic code that determines how the body's cells will behave. During treatment, or it is a direct DNA damage or are charged particles - free radicals, damaging the genetic code.

Malignant cells stop growing and die is damaged carrier of genetic information. Organism destroys them and disposes of waste. Healthy cells in the treatment area may also be damaged, but they usually have a high capacity to repair itself.

Factions in the external beam radiotherapy

Radiation therapy directed at the destruction of the cancer and the possible healing of the body, called a radical or curative. The total radiation dose is usually divided into smaller - faction. This allows healthy cells to recover between treatments. Thus, the fraction - is a series of sessions.

External radiation, aimed at alleviating the symptoms of cancer is called palliative. This type of therapy requires fewer fractions are sometimes sufficiently audio processing. Palliative therapy is accompanied by a reduced number of undesirable effects.

The course of external beam radiation therapy

During the preparation of the course of treatment the doctor takes into account the type of cancer, its location, previously traveled or planned treatment, the general state of health. Those. Radiation therapy is an individual.

The course is aimed at treatment of cancer, typically lasts from 1 to 6 weeks, but may be longer. The doctor will tell for sure about the length.

Many people assigned treatment during the week, with a break at the weekend. There are other modes - 3 times a week or 2 times, including weekends.

In accordance with the type of cancer and its localization the doctor selects the type of radiation therapy. This can be a conformal radiation therapy, intensity modulated (IMRT), with the visual inspection (igrt), 4-dimensional radiotherapy (4D-RT), stereotactic radiotherapy, proton therapy.

Planning for external beam radiotherapy

Before you begin treatment, the team of radiation oncologists makes careful planning. This means work directed to determine the required volume and radiation treatment zones. Because cancer cells sometimes can spread in the tissue adjacent to the tumor, this area will also be included physician in the treatment zone. In addition, the amendment will be made to the possible movement of the tumor during treatment due to respiration or movement of the body's organs.

This training ensures that the tumor will receive a prescribed dose of radiation, while a smaller amount of radiation is given to healthy tissue. area of ​​the body that is exposed to external radiation, is called the field of radiation therapy. Part of healthy tissue located immediately around the tumor, will be exposed to the same radiation dose, but doctors will seek to reduce as far as possible the risk of adverse effects of therapy.

planning stages due to the type of cancer and its localization. The physician takes into account the type of malignant tumor, its location, size; how close it is to the radiation-sensitive structures; how deeply the radiation must penetrate deep into the body; overall health, and medical history.

Sometimes in the process of preparation it takes more than one meeting. It depends on the size and location of the tumor. It is important to ask all the questions. The more the patient will be aware of the treatment, the better to deal with it.

Planning radiation therapy

Designation process can take from 15 minutes to two hours. Is scanned by CT, MRI or PET, it renders the tumor and the structure around it. On the skin markers that capture the exact position of tumors can be supplied.

The radiation oncologist alters the size and shape of the body in the intended treatment area. Sometimes, further action is needed to get a clearer picture of the structures of the body:

  1. Appointed by the injection of a dye to visualize the kidneys.
  2. Use special wires placed around the tumor.
  3. Assigned colorant in liquid form to visualize the bladder.
  4. When planning for external beam radiotherapy to the chest area is assigned a liquid barium to better mapping of the esophagus and stomach.

In preparing the doctors can be applied for fixing tattoo tiny precise machining area - 2 or 3 constant sign. Also signs can be applied with indelible ink in the form of small crosses. Over time, they begin to fade.

If you intend to treatment in the head or neck, you may need a special mask, which provide the immobility during treatment. The forms used in the course of therapy arm or leg. Mask and shape are manufactured individually.

Conformal radiotherapy

This type of radiation is also called 3D conformal radiation therapy or 3DCRT. It is used very often.

When conformal radiotherapy specialized CT scanner used in the planning process, at least - other - MRI, for example. It provides a visualization of the treatment area in three dimensions - width, height and depth.

The planning process involves several steps:

  1. The radiotherapy department conducted CT. Also, instead of CT can be performed MRI or PET scan.
  2. Then the computer program generates the radiation beams are very precisely match the shape of the tumor. Doctors make sure to malignancy got into a zone of processing, trying to avoid the impact on healthy tissue as possible. This reduces the risk of side effects.

The skin signs to indicate the desired area can be applied. In the course of treatment can be used plastic mold (for the extremities, with breast cancer) and masks with cancer of the head or neck. They provide immobility during radiotherapy.

When conformal radiation therapy, a small amount of healthy tissue is affected irradiation. Therefore, the risk of adverse effects of treatment below. As with any external irradiation, side effects occur only in the processing zone.

IMRT - radiotherapy with modulated intensity

This is one of the types of conformal radiation therapy, forming beams of radiation that are very closely match the shape of the tumor.

IMRT may be conducted using standard linear accelerator. It has a device called - multileaf collimator. The collimator consists of a thin lead plates, which can move independently. They create a form which corresponds exactly to the treatment area. Lead plates are able to move during the movement of the accelerator around the patient, creating a beam of radiation directed at the tumor, while the accelerator turns. This means that radiation therapy IMRT provides high-dose radiation and reduced tumor - healthy tissues.

Each radiation beam is divided into many small, can change the intensity. This makes it possible - to deliver different doses of radiation.

In addition, IMRT can create a B-shaped (concave) on the edge region of the field of radiation therapy. This avoids high radiation dose structures which may be damaged during treatment. Which reduces the risk of long-term side effects. This is very useful in areas such as the head and neck area - prevents damage to the spinal cord or the salivary glands.

Training

The planning process involves several steps:

  1. The patient undergoes CT. Perhaps as MRI or PET.
  2. Using these images, a team of doctors planning treatment. Apply advanced computerized calculations aimed at determining the dose that will best fit the shape of the tumor. The planning process itself may take longer than other types of radiation therapy.
  3. Treatment area may be marked with special signs. mask and shape are also used to ensure the immobility during treatment.

IMRT may be carried out using a linear accelerator or TomoTherapy.

Tomotherapy - a particular brand of equipment for radiotherapy, which has a built-in scanner. It combines IMRT to modulate the intensity and apparatus for radiotherapy, corrected by the images (IGRT). treatment procedure takes 15 minutes or more.

Volumetric modulated arc radiation therapy (VMAT)

VMAT - a new type of IMRT techniques. radiotherapy equipment rotates around the patient in hodelecheniya. Constantly changing the intensity of the radiation beam. Advantages of techniques:

  • high accuracy;
  • short treatment time;
  • use of a lower total radiation dose.

Indications IMRT radiation therapy

Currently, clinical trials are performed on IMRT use in the treatment of other types of cancers, including breast cancer, head and neck cancer. IMRT - a standard form of treatment for some types of malignant tumors.

In the application of radiotherapy with modulated intensity a very small amount of healthy tissue enters the treatment area. Thus, the risk of adverse effects is low enough. But, unfortunately, they are still there. As with any other external radiotherapy side effects affect only the treated area.

Radiotherapy visually IGRT

IGRT - a type of conformal radiation therapy, having the ability to form beams of radiation around the tumor area.

IGRT uses x-rays and scans, CT similar before and during radiotherapy. By X-ray scanning and imaging performed size, shape and location of the tumor and surrounding tissue and bone.

The planning process is aimed at providing a high tumor dose of radiation. It is important that the treatment zone hit the area surrounding the malignancy. This increases the effectiveness of treatment. It planned a low dose of radiation to surrounding healthy tissue to reduce the likelihood of adverse effects.

Types of radiation therapy with visual inspection

In some areas of the tumor body can change in the course of each treatment. An example would be the prostate gland, which moves depending on whether full or empty the bladder. Therefore, there is a risk that the tumor will not get into the treatment zone. Some types of IGRT allows to scan before each session of radiation therapy.

An example is - 4D-RT - 4-dimensional radiation therapy allows to scan during treatment, and ensure that the tumor is located in the processing zone. This equipment can be adjusted to any changes in the position of tumors during radiotherapy.

Some types of 4D-CT can be switched off automatically if the tumor comes out of the field of radiation therapy. This type of radiation therapy is very useful in the treatment of cancer in traffic areas, such as light irradiation. Radiation is directed, once the tumor is returned into position that can be seen during scanning.

Advantages and possible disadvantages of IGRT

With radiation therapy with visual inspection, doctors are able to irradiate with high precision. It increases the effectiveness of therapy, both for the purpose of healing, and for the purpose of disease control. It also reduces the risk of adverse effects. The disadvantage is that the longer it takes planning. In addition, the duration of each session is also increasing.

planning for IGRT

This process involves several steps:

  1. In the department of radiation therapy a patient undergoes CT. It might also be an MRI or PET scan.
  2. The computer program is developing a process of irradiation in such a way that the beams accurately correspond to the shape of the tumor. Doctors are convinced that the affected area is completely included in the processing area and minimal impact as possible, gets healthy tissue. This reduces the risk of side effects.
  3. Radiation oncologists can mark the treatment area. plastic mold or mask to ensure the immobility of the patient are also used.

Intratumoral or to the small metal tags can be placed around it. During X-ray or CT doctor via the needle enters the gold pellet or rod. These markers can be seen by X-ray or scan, this technique ensures high precision of treatment.

IGRT is usually given by means of a conventional linear accelerator, and specially adapted to the presence of specific computer programs.

Some types of IGRT performed using specially designed equipment - Cyber ​​knife. It has a robotic arm that moves around the patient, providing radiation from different points.

IGRT can also be carried out by TomoTherapy. It combines a CT scanner and equipment for remote radiotherapy. Part of the machine has the ability to rotate around the patient, with the help of CT scanning, and give a specific localized area of ​​exposure.

Treatment procedure takes from 15 to 45 minutes.

IGRT provides less impact on healthy tissue, as compared with other types of radiation therapy. Therefore, the risk of side effects is reduced. However, they still exist and develop in the treatment area.

Stereotactic radiotherapy (SBRT)

This technique, in which the radiation to the tumor comes from many different directions, ensuring high accuracy. Thus, the malignancy gets the maximum dose of radiation, and the surrounding tissue - low, which reduces the likelihood of adverse effects of treatment. It is usually carried out from three to eight treatments.

Stereotactic radiotherapy is used to treat brain tumors as well as for small malignancies in organs such as:

  • lungs;
  • liver (in primary and secondary cancer);
  • The lymph nodes;
  • spinal cord.

Within the framework of clinical trials Stereotactic radiotherapy is used in other types of cancer.

Planning

  1. The patient in radiotherapy department passes CT. It can also be carried out MRI or PET.
  2. A computer program generates beams of radiation that will exactly match the shape of the tumor.
  3. Doctors can mark the skin to accurately mark the treatment area. Also apply special shapes and masks to ensure the immobility during the session. metal markers may be used, which ensures a very precise treatment.

various equipment can be used for stereotactic radiotherapy. The most commonly used linear accelerator. The procedure lasts 15-45 minutes.

Treatment with cyber-knife

Cyber-knife has a robotic arm that moves during treatment, providing a dose of radiation from various directions. Simultaneously, regular scans and test results are fed into a computer. This allows doctors to accurately direct the radiation to the tumor, if it is moved, for example, during exhalation.

Treatment can range from thirty minutes to four hours, the duration determined by the type of cancer, its position in the body. Treatment can be carried out at one time, or it is divided into parts with short breaks.

radiosurgery

Radiosurgery - a type of stereotactic radiotherapy. It provides highly accurate irradiation using extremely high doses of radiation for 1-5 sessions. It is used for certain types of brain tumors. Currently, clinical trials of radiosurgery in the treatment of prostate cancer.

High accuracy reduces the risk of damage to healthy tissue. Therefore, fewer side effects, compared with other types of radiation therapy.

Questions that you can ask your doctor about external beam radiotherapy:

  1. How often you will need to visit the clinic for treatment?
  2. As the course will last long?
  3. How long is each session?
  4. Will visually radiotherapy there be?
  5. conformal radiotherapy Will the recommended?
  6. radiotherapy with intensity modulation will be awarded?
  7. How can I find out the exact treatment area?
  8. Will the treatment area is marked on the body?
  9. skin marking will be permanent?
  10. How long after the planning will be held the first procedure of irradiation?

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