Radiation Therapy is the medical science that employs various types of radiation or x-ray to treat disease. The radiation oncologists at Union Hospital's Hux Cancer Center are board-certified in radiation oncology by the American Board of Radiology.
External Beam Treatment
External beam treatments use 3D virtual reconstruction of the patient's anatomy, including the tumor, from CT image studies and other data sets, to deliver radiation precisely to the tumor. Sophisticated Image Fusion Software assists the physician in visualizing the tumor and surrounding tissues using MRI or nuclear medicine PET image studies, in conjunction with the CT-created data. A treatment process called conformal therapy closely protects normal tissues while maximizing the tumor dose. The conformal delivery of treatment has been employed at the Hux Cancer Center since 1990.
In 2006, the Hux Cancer Center implemented the latest in external beam treatment planning delivery -- IMRT (Intensity Modulated Radiation Therapy). IMRT provides additional treatment options when designing the patient's treatment. In IMRT planning, the physician tells the computer the dose prescribed for the tumor and the limits that can be given to surrounding tissue. The computer then tries millions of possibilities to determine the ideal method of treatment. Multiple, highly collimated beams are used to deliver IMRT treatments. Most patients are now treated with an IMRT process called VMAT which delivers radiation quickly and precisely as the accelerator moves around the patient.
In 2010, the Hux Cancer Center implemented Monaco -- the newest Elekta calculation platform. It uses a Monte Carlo calculation algorithm that is the first commercially available tool to use this methodology. Monte Carlo is considered the "holy grail" of radiation oncology physics because it can predict the interaction of single x-rays within the tissue volume, resulting in a much more accurate calculation over previous systems. The Hux Cancer Center is one of the first radiation therapy facilities in the country to adopt Monaco. Funding for the technology was provided by a grant from the Union Hospital Foundation.
Stereotactic Radiosurgery and Stereotactic Body Radiotherapy
Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiotherapy (SBRT) deliver very precise, localized, high doses of radiation to small tumors. The high dose often increases the chance of longer tumor control and complete destruction of the tumor. Many sites can be effectively treated at our center: Brain, Lung, Spine, Liver, Adrenal, etc. The Hux Cancer Center has actively treated using SRS and SBRT techniques since 2018.
Brachytherapy Treatment
Brachytherapy is a procedure where radioactive material is placed directly inside the tumor. It is used often to treat gynecologic and prostate, as well as other body sites.
For gynecologic brachytherapy, the Varian Eclipse planning system allows the team to simulate the placement of sealed radioactive sources within the patient. The computer calculates and displays the resulting dose distribution within the patient in 3D. Utilizing complex analysis tools, Eclipse provides the ability to adjust the source strength and placement, optimizing the dose distribution while maximizing the dose to the tumor and minimizing the dose to surrounding tissues.
For prostate brachytherapy with radioactive seeds, Varian's Variseed treatment planning system is used. This specialized system is optimized for visualizing, calculating, and evaluating the dose from implanted radioactive seeds in the prostate. It allows for the virtual simulation of the prostate in 3D from either ultrasound or CT images.
Prostate Seed Treatment Planning
For prostate brachytherapy with radioactive seeds, Varian's Variseed treatment planning system is used. This specialized system is optimized for visualizing, calculating, and evaluating the dose from implanted radioactive seeds in the prostate. It allows for the virtual simulation of the prostate in 3D from either ultrasound or CT images.
Radiation Delivery Equipment
The Hux Cancer Center Radiation Oncology Division is equipped with two Varian “TrueBeam” accelerators and a Phillips Big Bore CT simulator. The TrueBeams each have five x-ray energies, allowing for customized treatment for each patient. In addition, the accelerators have 5 electron energies for more superficial treatments. The TrueBeams have matched beams with 120 leaf multi-leaf collimators, allowing the patients to be moved as needed, minimizing treatment waiting times. Both machines are equipped with portal imagers and robotic onboard imagers (OBI), 6-degree-of-freedom couches for patient positioning, and the VisionRT Surface monitoring systems. Both TrueBeams are fully capable of delivering standard and stereotactic treatments.
IGRT (Image Guided Radiotherapy) refers to a process that radiographically evaluates the patient's position prior to treatment to ensure that there is no variation from day to day. This is done using robotic x-ray generators or cone-beam CT scans. IGRT makes treatment delivery as precise as possible. All patients receiving x-ray-based external beam treatments at the Cancer Center are evaluated daily with the IGRT process before their treatment is given.
The Cancer Center employs a full inventory of cesium brachytherapy sources and is licensed for use of all currently available types of implantable radioactive seeds. These are obtained on an as-needed basis. In 2023, The Cancer Center anticipates changing to HDR (high dose remote) afterloading for brachytherapy.
Staff
Our best asset is our staff. All are consummate professionals and dedicated to caring for our patients in a friendly and supportive way. We have three administrative assistants who greet and help patients with the business end of radiation therapy. We have an award-winning and beloved chaplain, Sister Betty Hopf. We have four department-registered nurses, with additional help from two oncology nurse navigators. We have eight certified therapists who deliver daily treatments. We have a department administrator and a part-time registered dietician who sees and helps every patient with dietary needs. Radiation oncologists need great physics support and at Hux, we have the best – Two full-time certified radiation oncology physicists. We participate in the University of Kentucky Medical Physics residency program. Every two years, our physicists begin training the next generation of independent physics providers. Radiation therapy is provided by two full-time oncologists who are part of a large, private practice radiation oncology group. The group (Cancer Care Group) provides a wealth of backup for all the members. Consultation and help with different cases are always available.