Treatment Options

Consultation

Each of our board certified radiation oncologists are clinically specialized. This means each doctor focuses exclusively on two to three different types of cancer in order to best serve our patients. This focus on a few of the various types of cancer allows our doctors to develop unparalleled expertise. Patients find this special knowledge invaluable to evaluate and select their plans of therapy.

Radiation Oncology Center

Appointments can be made to see our physicians in the Siteman Cancer Center in the medical center’s Center for Advanced Medicine. The following list of physicians and their areas of clinical focus should help choose your radiation oncologist:

Multidisciplinary Clinics

Consultations can be made through the Siteman Cancer Center’s multidisciplinary clinics. In these clinics the patient may see physicians from surgery, medical oncology, radiation oncology, and other specialists to get a complete and thorough evaluation and treatment recommendation.

Treatment Options

We offer the widest range of radiation therapy options in the Midwest, allowing our physicians to tailor treatment to each individual patient’s needs. See below for details.

External beam radiation therapy

The majority of our patients are treated with external beam radiation therapy. This treatment is typically delivered with the use of a linear accelerator, a machine that emits high energy x-rays targeted to the tumor or body region at risk. The duration of treatment ranges from two to eight weeks. The number of treatments will depend on the specific diagnosis and the integration of other treatments such as surgery or chemotherapy.
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Traditional or standard radiation therapy

Treatment techniques that have been developed and refined through years of experience are commonly used to treat many of our patients. We constantly review the results of treatment of our patients at the Mallinckrodt Institute of Radiology and periodically refine our treatment policies to maximize cure rates with minimal side effects or toxicity.

3D Conformal Radiation Therapy (3DCRT)

A new method of planning and delivering radiation therapy, 3D CRT uses patient specific images to create sophisticated treatments aimed at maximizing radiation dose to the areas that need it while sparing adjacent organs and other sensitive tissues. This technology is allowing Mallinckrodt Institute radiation oncologists increase the cure rate for some cancers and reduce side effects for others.

Intensity Modulated Radiation Therapy (IMRT)

IMRT represents a new and increasingly sophisticated method to deliver 3D CRT. Tighter and uniquely shaped radiation dose distributions have the potential to allow greater sparing of critical organs or sensitive tissues. In some cancers of the mouth and throat, IMRT has allowed a high cure rate with sparing of salivary gland function. It is being applied to other cancer sites such as prostate and brain tumors.

Brachytherapy

Brachytherapy refers to the placement of radioactive sources directly into the body to treat cancers. Often the procedure involves placement of devices, tubes or catheters to hold the radioactive sources temporarily for a few hours or days. In other circumstances, the sources are placed into a tumor and left there permanently. Brachytherapy allows the radiation oncologist to deliver very high radiation doses to small volumes of cancer without treating adjacent organs or sensitive tissues.
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Gynecologic cancer

Many cancers of the cervix and uterus are treated with combinations of external beam radiation therapy and brachytherapy. Special devices made of metal and plastic are placed in the uterus or vagina within or adjacent to the location of the cancer. Radioactive sources are then placed inside these devices to deliver a highly focused and controlled dose of radiation to the cancer. In high-dose rate (HDR) radiation treatments, the radioactive sources are placed for just several minutes. These treatments may be repeated 3 to 6 times over the course of a few weeks. In low-dose rate (LDR) radiation treatments, the sources are kept in place over a few days. In those circumstances, you will need to be hospitalized until the treatment is completed and the treatment devices are removed. These treatments are typically given once or twice. The radiation oncologist will decide which technique is best for you.

Prostate cancer

An increasingly popular alternative to radical prostatectomy is prostate brachytherapy. Using ultrasound and x-ray guidance, radioactive sources, smaller than a grain of rice, are inserted directly into the prostate gland during anesthesia. These radioactive Iodine or Palladium seeds remain in the gland permanently and give very high radiation doses to the prostate with acceptably low rates of side effects. Cure rates are comparable to radical prostatectomy and external beam radiation therapy for appropriately selected patients.

Ocular Melamona

This rare form of cancer can effectively be treated with brachytherapy. With the ophthalmologist, a special device or plaque is placed against the eye where these tumors grow. This device is left in place for several days and delivers a high radiation dose to a very small area. This treatment allows the ophthalmologist to cure the melanoma without radical removal of the eye.

Other

Brachytherapy is used in several other types of cancers on an individual basis. Radiation oncologists at the Mallinckrodt Institute of Radiology have successfully used both high dose rate (HDR) and low dose rate (LDR) brachytherapy to treat patients with malignant tumors of the head and neck, brain and soft tissues (sarcomas).

Endocavitary Radiation Therapy

Some patients with early rectal cancers are able to avoid radical surgery and colostomy with the use of endocavitary irradiation. This special treatment is a method of delivering a very high dose of radiation to a small cancer on the surface of the rectum. The treatments are given in very high doses every 2-3 weeks for a total of two outpatient treatments. This treatment is combined with conventional external beam radiation therapy (usually 25 radiation treatments given 7-8 weeks before the endocavitary radiation). The external treatments serve to shrink the rectal cancer and to attack cancer cells that might be in the lymph nodes around the rectum. The endocavitary treatment itself is given using a hand-held x-ray device. The colorectal surgeon and radiation oncologist together target the diseased site and deliver the therapy over a few minutes. In appropriately selected patients, the cure rate for this form of treatment may approach 90% or better. The best candidates for this procedure must have small, minimally invasive cancers.

Radiosurgery

Stereotactic Radiosurgery specifically refers to a procedure whereby x-ray or gamma-ray radiation is aimed at a focal point (e.g. an arteriovenous malformation, a tumor, the site of a functional disorder, etc.). The dose distributions achieved by these techniques assure large doses to the target volume and much lower doses to the surrounding normal tissues. Stereotactic Radiosurgery is typically given as a single treatment.

Gamma Knife

The Gamma Knife is a dedicated radiosurgery device. It contains 201 focused radioactive Cobalt sources that can be aimed at the tumor of disease center with extremely high accuracy and precision. A team made up of a neurosurgeon, radiation oncologist and medical physicist direct these treatments.
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Linac based radiosurgery

There are some circumstances that the Gamma Knife cannot be used to deliver radiosurgery. In these cases, we rely on a linear accelerator to deliver the highly focused dose of radiation.
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Hyperthermia

Heat has been known to be an effective treatment against a number of cancers. When combined with radiation therapy, there may be enhancement of the anti-cancer effects. These treatments are being tested in complicated or advanced cases of breast cancer.

Radio-Immunotherapy

Antibodies directed at cancer cells have been linked to radioactive atoms. These antibodies seek and attach themselves to the cancer cells and deliver a toxic radiation dose to the tumor. These treatments are available for some lymphomas. Radiation oncologists and medical oncologists work together in delivering this therapy.

Total Body Irradiation (Bone Marrow Transplantion)

Bone marrow transplantation is used to treat many types of cancer, including leukemia and lymphomas. Total body irradiation (TBI) is frequently used to prepare patients to accept donated marrow. TBI eliminates the patient’s own marrow along with the malignant cells. It also suppresses their immune system to allow safe engraftment of the new healthy bone marrow. A bone marrow transplant specialist will work with our radiation oncology staff to decide when TBI is appropriate for a patient and coordinate the proper timing and radiation dose.