It’s always difficult to hear that you or your loved one has been diagnosed with cancer. We hope you can take some comfort in knowing the leader in cancer medicine is right here in your community and ready to help you if you ever need us.
Radiation oncology is a mainstay of cancer treatments, which can be used alone or in combination with surgery or medical oncology. Our radiation oncologists are focused in their subspecialty areas of expertise on certain cancer types. Our radiation oncologists provide gold-standard cancer care that has been proven through research and clinical trials. The depth of experience of our highly specialized team and how it positively impacts care, recovery and outcomes cannot be overstated when it comes to this important time in your life.
METHODS TO ADMINISTER RADIATION THERAPY
The radiation beam is either given from outside the body (externally) or placed inside the body (internally). From these two overarching categories of radiation methods, there are a multitude of procedures for the various types of cancer.
External Radiotherapy
Linear accelerators are used to create the radiation beams, which are then directed to the cancer within the body. The types of radiation beams available for cancer treatments include x-rays, gamma rays and protons. The radiation is deposited into the cancer in a noninvasive process. Over several decades, the technology has evolved and improved exponentially. Now, the radiation oncologists and medical physicists can manipulate the radiation beam by calculating the coordinates of the energy and programming a robotic-assisted radiation delivery system that can precisely wrap around the tumor’s edges in a 3D shape, thereby sparing healthy tissue. Descriptive terminology is used to define these advanced procedures, such as 3D conformal radiation therapy (3DCRT), intensity-modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT), and radiosurgery.
There is an array of commercial technology, such as Edge®, Gamma Knife®, CyberKnife®, Novalis® and Zap®, available from various vendors. Each one is often promoted as the best equipment to administer radiation therapy, which leads to confusion and misunderstanding for patients. Of course, advanced technology is always an important component, but the medical team’s expertise in executing and facilitating treatment far outweighs the equipment’s model.
Advanced Sterotactic Radiotherapy Programs with Radiosurgery and SBRT
At Stony Brook, we have a pioneer in the field leading the department, and our radiation oncologists are also highly trained and proficient in the use of these advanced technologies.Stereotactic radiosurgery (often abbreviated as SRS) is the highest culminated form of these technologies, with an exceptional ability to manipulate the radiation beam to focus on the tumor target, usually given in one to five sessions.
Examples include (but are not limited to):
- Treatment for brain tumor with radiosurgery and immunotherapy prior to surgery
- Radiosurgery of spinal cord compression
- Primary SBRT of breast cancer
- Definitive therapy with SBRT for lung cancer
- Definitive therapy with SBRT for prostate cancer
- Radiosurgery of benign tumors, such as meningioma or acoustic neuroma
- Radiosurgery of non-malignant conditions, such as trigeminal neuralgia
Internal Radiation
The radiation source is placed inside of the cancer within the body. This type of treatment is called brachytherapy. Our radiation oncologists place guiding needles and/or catheters into the tumor site while the patient is under local or general anesthesia. Then, the isotope seeds are placed in the tumor through them. This high-dose-rate (HDR) brachytherapy uses the Iridium-192 radioisotope seed (size of less than 1 mm diameter) by temporarily placing the isotopes in the tumor by a computerized remote-control system through one or several sessions, depending on the type of cancer. The isotopes are then taken out of the body.
Examples include (but are not limited to):
- HDR brachytherapy for prostate cancer, known as implantation, is guided by real-time ultrasound, and hydrogel is placed (created just for this purpose) between the prostate and rectum to protect the rectal wall.
- HDR brachytherapy for interstitial (space between cells in tissue), intracavitary (within a cavity or space) or intraluminal (placed inside) treatment.
- HDR brachytherapy for gynecologic cancer with tandem and ovoid therapy, as well as vaginal brachytherapy and interstitial therapy, guided by CT and MRI scans.
- HDR brachytherapy for skin cancer treatment using 3D printing technology to conform to the skin surface, and also, using an artificial intelligence application of Raman spectroscopy, which noninvasively detects the microscopic extension of the skin cancer.
Theranostics Treatment Program
The program uses a two-level approach to visualize the tumor and treat the cancer with a combination of imaging and the use of radiopharmaceuticals (or radioactive medicine). Since these radiopharmaceuticals can be given by mouth or intravenous infusion, it is also known as Liquid Radiotherapy. These compounds become radiotracers that can selectively find, and then bind, to cancer cells while circulating in the blood, helping to destroy them. Since the radiotracers can find where the cancer cells are located, this process is also known as “smart-targeting cancer cells.”
Examples include (but are not limited to):
- Radioactive Iodine-131 (RAI) Therapy for thyroid cancers • Ra-223 (Xofigo®) intravenous injection for prostate bone metastasis
- Lu-177 PSMA (Pluvicto®) intravenous injection for metastatic prostate cancers • Lu-177 dotatate (Lutathera®) injection for neuroendocrine tumors
- Y-90 Sirsphere® and Therasphere® given selectively to the liver cancer by angiography
- Radioimmunoglobulin Therapy (RIT) is being developed at Stony Brook for hematological cancers, certain childhood cancers, and even benign arthritis.
HIGHLIGHTS
Expertise in Complex Cancers or Recurrent and Progressive Cancers
Our radiation oncologists subspecialize in certain types of cancers and provide a patient’s treatment with the standard of care. If applicable, they can also recommend an appropriate clinical trial for the patient. At Stony Brook, our radiation oncologists are empowered to create their own unique clinical trials and can do so because of their extensive experience with both clinical care and research studies. The Radiation Oncology team is working on additional ongoing clinical trials to further improve the outcomes for our patients. These innovative trials are beneficial to patients having care at Stony Brook.
Our radiation oncologists are also highly experienced in treating extremely complicated cancers, and recurrent or progressive tumors, which return after the initial treatment is over. Patients who have been treated at other hospitals or cancer centers are always welcome to make an appointment with our radiation oncologists to move their treatment here or for a second opinion.
Our radiation oncologists consult with the patient and provide a thorough evaluation of the recurrent cancer status, as well as reviewing the previous treatments that were received. Then, the goals of the proposed treatment will be clearly explained. The type of treatment will vary based on each patient’s unique needs.
Examples:
For brain or spinal cord tumors
“Re-irradiation — or a repeated course of radiation — for a brain or spinal cord tumor is sometimes needed to treat recurrent and/or progressive tumors,” said Samuel Ryu, MD, who is a world-renowned expert for pioneering radiosurgery for brain and spinal cord tumors. “These are complex situations, sometimes with the potential of causing serious functional and neurological abnormalities, which is why extensive experience is necessary to evaluate the condition and make the appropriate treatment decisions.”
Dr. Sam Ryu, Chair, Department of Radiation Oncology
For head and neck cancers
“We evaluate and formulate an intensity-modulated radiation treatment (IMRT) to treat primary or recurrent throat cancers,” said Kartik Mani, MD, PhD. “By nature of throat cancers, one can have severe symptoms with pain, difficulty swallowing and speaking. Our goal is to alleviate side effects, and to keep moisture in the mouth with nutritional support.”
For breast cancers
When there is a recurrence of breast cancer (after the patient was first treated with lumpectomy and radiation) and there is now cancer in the lymph nodes; or surgery is not an option; or patients want to avoid a mastectomy; re-treatment with radiation can be the best option.
“For breast cancer recurrence, we use an SBRT technique, which aims a few, very strong radiation beams precisely into the regrowing breast mass,” said Alexander Stessin, MD, PhD. “We’ve found in our completed clinical trial that the majority of our patients who received this type of SBRT had excellent tumor control in the breast and a good cosmetic outcome.”
Retreatment of prostate cancer
If a patient needs to be retreated for a recurrence of prostate cancer, a thorough evaluation is performed with imaging studies, including the prostate specific membrane antigen (PSMA) positron emission tomography (PET) scans. These help the radiation oncologist and the team determine whether this type of treatment is appropriate for the patient.
Prostate interstitial brachytherapy is usually given in one to two separate procedures. Retreatment can also be performed by SBRT in one to five sessions. By injecting a hydrogel material between the rectum and prostate, it helps to keep the tumor away from the rectal wall, thereby minimizing any complication related to the rectum.
“When we’re ready to perform interstitial brachytherapy, we’re guided by real-time ultrasound images during the procedure, so that the focused radiation to the specific site that has the recurrent cancer can be targeted,” said Alex Slade, MD, PhD. “I can clearly see where to place the guiding needles for the insertion of the radioisotope and locate the prostate cancer itself.”
Retreatment of gynecologic cancer
Gynecologic cancers, including uterine and cervical, can be very complex when they come back a second time. These conditions can be treated with SBRT and/or brachytherapy by placing the radioisotope within the tumor. This type of treatment is usually given in three to five sessions.
“I can place the applicator seamlessly into the uterus or vaginal cavity, which brings the necessary radiation dose to treat the cancer,” said Mark Ashamalla, MD. “We use high-technology fusion images of CT and MRI scans that give us precise dose calculation and visualization of the targeted tumor allowing us to keep the functional outcome.”
For skin cancer
Skin cancer requires both an excellent cosmetic outcome and cancer cure. Our skin brachytherapy program is unique and entirely noninvasive for treatment of basal cell carcinoma, squamous cell carcinoma and localized melanomas. Skin brachytherapy can be used as a stand-alone treatment or after initial surgical removal, such as by Mohs surgery.
We use 3D printing technology to conform to the skin surface and deliver the isotope treatment through the 3D printed molds,” said Renee Cattell, PhD, who is the principal investigator of the clinical trial using the Raman spectroscopy. “We also use Raman spectroscopy with artificial intelligence to detect the invisible microscopic tumor extension under the surrounding normal-looking skin to achieve a cure.”
COUNT ON STONY BROOK
Our Radiation Oncology team is confident in providing high-quality individualized treatment to each patient with a great deal of understanding and compassion. Because we are part of the Cancer Center’s multidisciplinary teams, each patient benefits from the collaborative efforts of a wide range of specialists providing cancer care and any other medically necessary treatment.