Each new patient is presented at a multidisciplinary conference to personalize his or her management, including surgery, radiation oncology, chemotherapy, and pathology to take into account specific tumor characteristics. Radiation oncology has active in-situ (original tumor site) and national trials for minimizing the duration and amount of radiation a patient receives to reduce long-term side effects. No one should be over or undertreated.
Siteman is a leader in using shorter radiation durations than the national average with the same outcomes.
External Beam Radiation
Ninety-five percent of radiation treatment at Siteman is external beam from outside the body. Siteman fine-tunes the radiation planning with intensity modulated therapy, using a large-bore CT simulator for 3D or full positioning to precisely target therapy. They were the first in the world to have the ability to do external radiation with MRI guidance, and the first to treat patients with that technology.
ViewRay™ MRI-Guided Radiation Therapy
The ViewRay™ MRI-guided radiation therapy system is a breakthrough technology initially developed at Washington University. The integrated system combines radiation treatments with a continuous magnetic resonance imaging system. View-Ray is a separate, unique radiation machine that combines a low field strength MRI with a Cobalt-60 machine. It is best used to treat specific patients where radiologists are concerned about motion and treating with smaller margins. In cases of brain metastases, primary brain tumors located near sensitive structures and spinal tumors may be treated with this technology.
MR imaging highlights soft tissue better than other imaging techniques. By using MRI to help guide radiation therapy treatments in real time, the radiation oncology team is able to see where the radiation dose is being delivered and determine if any subtle changes are occurring to the tumor or surrounding tissue. The ability for continuous soft-tissue imaging means that a patient’s treatment plan or radiation dose can be adjusted immediately if changes are noted.
ViewRay™ was developed by a Washington University physicist and evaluated by radiation oncologists here. The federal Food and Drug Administration (FDA) approved the technology for use in May 2012. We are the first location in the world to use this advanced cancer treatment technology.
Proton Beam Therapy
The Proton Therapy Center at the Siteman Cancer Center is the only proton therapy center located in Missouri and the surrounding region. It houses the world’s first compact proton beam accelerator, called the Mevion S250™ Proton Beam Therapy System. Radiation oncologists and physicists here helped evaluate the system and developed the patient protocols and quality standards for this advanced technology.
Proton beam therapy’s main advantage is that radiation specialists can control radiation beams by depth, shape and the amount of radiation given. In other external radiation therapies, radiation beams pass through a patient to a defined location and then exit the body on the other side, leaving deposits of radiation all along their path. Because proton therapy allows for depth control, the majority of radiation is held until the beam hits the precise area targeted, and little to no radiation is delivered past the tumor. This treatment is ideal for patients with solid tumors that are located near sensitive structures or tissues, such as the eyes, brain or spinal cord. It is particularly beneficial for children, where precise targeting is critical to avoid impacting growing bones or tissues.
Proton therapy can be used as a solo treatment option or it can be used in combination with other radiation therapies or chemotherapy.
Washington University School of Medicine offered the first Gamma Knife technology in Missouri. This stereotactic radiosurgery enables physicians to treat brain targets that are surgically hard-to-reach or inaccessible with high accuracy and safety in a well-tolerated outpatient procedure. Using a special frame that prevents the patient’s head from moving even a millimeter, the “knife” is made of gamma rays that are focused as 192 radiation beams on precisely defined targets, without an incision and with minimal effects to surrounding healthy tissue. More than 3,400 patients have been treated at the Washington University Gamma Knife Center.
Although it’s not really a knife at all, Gamma Knife radiosurgery is a treatment option for a number of neurosurgical conditions as an alternative to an open neurosurgical procedure. Because it is generally performed on an outpatient basis, it is cost-efficient, preventing lengthy hospital stays, expensive medications, and occasional long-term rehabilitation.
Gamma Knife radiosurgery is indicated for the following types of tumors: intracranial metastatic brain disease, acoustic neuromas or schwannomas, pituitary adenomas, meningiomas.
Hyperfractionated Radiation Therapy
This radiation treatment is delivered with stereotactic precision but divided into small daily doses called fractions given over several weeks, in contrast to the one-day radiosurgery. This technique is used for tumors like gliomas located close to sensitive structures, such as the optic nerves or brain stem.
Radiation Plus Hyperthermia
In the treatment of pineal astrocytic tumors, a novel clinical trial combines external radiation plus hyperthermia (heat) therapy to enhance the effectiveness of the radiation without upping the dosage.
Brachytherapy, installing radioactive seeds into recurrent gliobastomas can deliver focal radiation, reducing the dose to normal structures. Clinical trials are exploring this, along with novel methods for delivering chemotherapy and radiotherapy locally to an infiltrating tumor.