The Department of Radiation Oncology at Dana-Farber/Brigham and Women's Cancer Center plays a central role in treating adults and children with cancer at Dana-Farber Cancer Institute, Brigham and Women's Hospital and Children's Hospital. Our care providers work closely together to develop an individualized radiation therapy plan for each patient, and to provide supportive resources before and after treatment.
As part of your cancer care plan, you may be referred for some form of radiation therapy. Radiation therapy is a part of treatment for about two-thirds of patients with cancer.
We understand that the prospect of radiation therapy may make you anxious, particularly with regard to side effects and safety concerns. We want to assure you that your treatment plan will be customized for you and carried out by a team that includes physicians, nurses, radiation therapists, medical physicists, and experts who calculate radiation doses. Learn more about radiation therapy safety.
The Department of Radiation Oncology has two separate units, one at Brigham and Women's Hospital and the other at Dana-Farber, staffed by providers who work at both locations. Our 25 radiation oncologists treat about 2,700 patients annually, in collaboration with the 13 disease-specific treatment center specialists.
In addition, we provide expert, community based radiation oncology services at Dana-Farber/Brigham and Women's Cancer Center at Milford Regional Medical Center and Dana-Farber/Brigham and Women's Cancer Center in clinical affiliation with South Shore Hospital.
Radiation therapy is a fast-moving field that is continually bringing new advances to patients. Our specialists are committed to providing the latest developments that have proven both effective and safe.
Different types of cancer require different radiation therapy approaches. Our clinicians have specialized knowledge in treating each type of cancer for which radiation therapy is indicated, and you will be matched with the most knowledgeable team members for your specific case.
Cancers treated in the Department of Radiation Oncology include breast cancer, gastrointestinal cancers, genitourinary cancers, head and neck cancers, sarcomas, thoracic cancer, lymphoma, and cancers of the central nervous system.
There are two main approaches to radiation therapy that might be a part of your treatment plan.
With external-beam radiation therapy, a machine called a linear accelerator delivers radiation in beams to the area inside the body affected by cancer. With internal radiation therapy, or brachytherapy, tiny pellets of radioactive material are placed directly inside the body near cancer cells.
The Radiation Oncology service at Dana-Farber/Brigham and Women's Cancer Center makes use of the most advanced equipment and techniques to deliver radiation to cancerous areas, while avoiding exposure to normal tissues.
Here are some of the techniques we offer.
Three-dimensional conformal radiation therapy (3D-CRT) uses computer technology to precisely target tumors. Before treatment, a three-dimensional image of the tumor is made and used to program the radiation beams to "conform" to the shape of the tumor. Higher doses of radiation can be used because the normal tissues surrounding the tumor are largely avoided. The 3D-CRT method permits the treatment of tumors that might be considered too close to vital organs to treat with conventional radiation therapy.
Image guided radiation therapy (IGRT) is used to treat tumors in organs that move when you breathe, like the lung or liver. The technology allows the radiation oncologist to monitor the exact tumor location and adjust for changes during treatment, minimizing radiation exposure to healthy tissues.
Intensity modulated radiation therapy (IMRT) allows doctors to customize the radiation dose by varying the amount of radiation given to different parts of the treatment area. This is done in highly accurate, three-dimensional detail, according to the shape, size, and location of the tumor, and helps minimize radiation exposure to normal surrounding organs.
RapidArc™ volumetric modulated radiotherapy can reduce treatment time, typically from 15 minutes to less than five minutes, while delivering precise dose and preserving normal tissues. By monitoring and changing the angle, size, and dose of the radiation beam simultaneously, this technology can deliver radiation to the whole treatment area at once, rather than in small sections.
Total body irradiation (TBI) is radiation given to the entire body at once. It can be used in preparation for bone marrow or stem cell transplants, or as part of high-dose radiation treatment for leukemia and lymphoma. The goal of TBI is to kill any remaining cancer cells in the body, to destroy bone marrow that might harbor cancer cells before a transplant, and to suppress the patient's immune system so that the transplanted tissue is not rejected.
Accelerated whole breast radiation therapy, also called hypofractionated radiation, involves delivering radiation to the breast in fewer but larger daily doses. For appropriate patients, this technique can significantly reduce the treatment course from approximately six weeks to about three weeks, while still effectively treating the cancer.
Accelerated partial breast irradiation (APBI) is a technique that gives radiation to only part of the breast. This allows the treatment to take place over a shorter period of time (one week instead of about six weeks). In addition to being more convenient for patients, APBI gives a lower radiation dose to surrounding normal tissues. Trials are currently ongoing nationwide to determine the long-term efficacy and safety of this technique.
Stereotactic radiosurgery (SRS) differs from conventional external beam radiation in that it uses highly focused, highly accurate x-ray beams to deliver a large dose of radiation in a single treatment. This is possible because of new imaging capabilities that allow precise and accurate setup without the use of an invasive head frame. SRS is used to treat small brain and spinal cord tumors (benign and malignant) and certain blood vessel abnormalities.
Stereotactic body radiation therapy (SBRT) uses the same principles as stereotactic radiosurgery for the brain, but on other areas of the body. Using advanced radiation-delivery equipment combined with imaging technology, the tumor can be monitored at all times during treatment, and high doses of radiation can be delivered with pinpoint accuracy. Stereotactic body radiation therapy is used to treat certain types of lung tumors that cannot be removed safely with surgery. It is also highly effective on tumors in the liver and spine.
High dose rate (HDR) brachytherapy can deliver high doses of radiation in a short time (approximately ten minutes) with minimal risk to nearby organs. In our state-of-the-art HDR brachytherapy suite and full operating room, a computer-controlled tiny radioactive source is placed inside the body near the site of the cancer. CT scanning is used to plan a safe and accurate treatment. This technique is most commonly used for cancers of the head and neck, breast, uterus, thyroid, cervix, and prostate.
Robotic transrectal ultrasound (TRUS) guided radiation therapy treats prostate cancer using tiny radioactive seeds inserted directly into the prostate gland through small needles. The radiation oncologist uses an ultrasound video image to see the prostate during treatment, and to make sure that the seeds are implanted correctly. Robotic guidance is used to assist with needle navigation and accurate placement of the seeds.
Radiation oncologists are the doctors who oversee your radiation treatment. They work with other specialists, such as medical oncologists and surgeons, to coordinate your cancer care.
You will meet with your radiation oncologist the first time you visit the Department of Radiation Oncology and during the planning phase of your treatment.
Your radiation oncologist will prescribe the exact radiation dosage as well as the number of treatments you will need.
Once your daily radiation treatment sessions begin, you will have scheduled appointments with your radiation oncologist at least once every week.
Ayal Aizer, MD, MHSMichele Albert, MDBrian Alexander, MD, MPHTracy Balboni, MD, MPHElizabeth Baldini, MD, MPHClair Beard, MDJennifer Bellon, MDBruce Borgelt, MD, PhD, MPHAileen Chen, MD, MPP Anthony D'Amico, MD, PhDPhillip Devlin, MDRay Dugal, MDDaphne Haas-Kogan, MDJay Harris, MDMonica S. Krishnan, MDBenjamin L. King, MDMartin T. King, MD, PhDDavid Kozono, MD, PhDMiranda Lam, MD, MBALarissa Lee, MDJason Lee, MDTatiana Lingos, MDStephanie MacAusland, MDRaymond H. Mak, MDHarvey Mamon, MD, PhDJoseph Mancias, MD, PhDKaren Marcus, MDDanielle N. Margalit, MD, MPHNeil Martin, MD, MPHPeter Mauch, MDKent W. Mouw, MD, PhDAndrea Ng, MD, MPHPaul L. Nguyen, MDPeter F. Orio, III, DOMichael E. Pacold, MD, PhDItai M. Pashtan, MDJohn Phillips, MD, MPHWilliam D. Powlis, MDJennifer Pretz, MDRinaa Punglia, MD, MPHJonathan D. Schoenfeld, MD, MPhil, MPHRon Y. Shiloh, MDJacqueline Tan, MDRoy B. Tishler, MD, PhDJulia Wong, MD
Our experienced oncology nurses have backgrounds in medicine, medical oncology, surgical oncology, bone marrow transplantation, infectious diseases, and critical care. Nurses are paired with physicians in disease-specific practices and work closely with them to care for patients.
Medical physicists are responsible for the overall safety and accuracy of the treatment equipment as well as for the computers used to optimize your treatment. They work directly with radiation oncologists during treatment planning and delivery.
In addition, medical physicists oversee the work of dosimetrists to ensure that complex treatments are individually tailored for each patient. Both medical physicists and dosimetrists monitor your treatment weekly to ensure accuracy and quality.
Dosimetrists assist radiation oncologists in planning your treatment through the use of computers, CT scans, special x-ray films, and body measurements.
The radiation oncologist gives the dosimetrist guidelines for the dose to be delivered, and then the dosimetrist calculates the size, shape, and arrangement of the area that will receive the dose of radiation.
The goal of the dosimetrist is to design a combination of fields that adequately treats the area of disease while avoiding areas of sensitive normal tissues. A senior medical physicist and your radiation oncologist will oversee your plan before treatment to ensure you are getting the best, and safest, care.
Radiation therapists are responsible for administering the radiation treatments that your radiation oncologist prescribes. They participate in the planning and simulation process, work with you during treatment sessions, and maintain treatment records.
Our residents have completed four years of medical school and one year of internship, and are specializing in the field of radiation oncology. Residents are integral members of our treatment team. Under supervision, they are involved in all aspects of patient care. These include the initial consultation; discussion with treating physicians from other specialties to develop a strategy; simulation; development of a treatment plan in collaboration with the dosimetry department; and the daily management of patients receiving treatment.
The Department of Radiation Oncology has an active research program that includes both basic (laboratory) and clinical research. Our research often involves collaboration with other departments as we strive to better identify and treat cancer, and to develop ways to deliver higher doses of radiation to the tumor area while reducing the effects to the surrounding healthy tissue.
Areas of concentration include:
The group's participation in national and local cancer trials makes it possible for patients to receive cutting-edge therapies. Our principal research interest is the use of radiation therapy in breast cancer treatment. In particular, we are involved in improving breast-conserving therapy for patients with invasive breast cancer and ductal carcinoma in situ.
This work has involved a series of collaborative studies with radiation oncologists, surgeons, pathologists, radiologists, medical oncologists and medical geneticists to define the optimal use of a variety of modalities, including radiation therapy. Studies have also included evaluations of radiation therapy after mastectomy to improve survival, and collaborative work with investigators in medical physics to ensure the safest and most effective techniques.
Our research focuses on improvements in radiotherapy for cancers of the central nervous system, using combination therapy with targeted radiosensitizing agents. In order to increase the control of malignant primary tumors and brain metastases, we design and participate in a variety of protocols that use targeted biological drugs or chemotherapy to sensitize tumors to radiation.
As part of the Harvard Gastrointestinal Cancer Center, we participate in a large number of clinical trials with the goal of improving outcomes for patients with cancers of the gastrointestinal tract. Many of these trials combine new types of chemotherapy and/or biological therapy with radiation. Available technologies include intensity-modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT). Currently active protocols involve a variety of innovative approaches, including improved cancer imaging, identifying new ways to predict and minimize the risk of long-term radiation complications, shorter courses of treatment for selected patients with rectal and pancreatic cancer, and novel treatments for liver cancer.
Our research focus is on improving curability and quality of life for patients with cancers of the urinary tract and male genital tract. Current treatment protocols include a randomized trial evaluating the role of chemotherapy (Taxotere) with radiation and androgen ablation in patients with high-risk prostate cancer; a study of MR/TRUS image-guided brachytherapy for patients with newly diagnosed prostate cancer; brachytherapy for men who have had a cancer recurrence after prior radiation; investigating a new form of radiation therapy (RapidArc™) in men with prostate cancer; determining the cardiovascular side effects of androgen deprivation therapy; and defining genetic-based markers of prostate-cancer progression.
In the area of translational science, we are working to develop molecular signatures of prostate tumors that can be used to design more individual therapies for men diagnosed with prostate cancer.
We have a strong interest in the care and medical management of men with testicular cancer. We are investigating new strategies that decrease their exposure to potentially unnecessary computerized axial tomography (CAT) scans as well as potentially unnecessary radiation and chemotherapy. We are working with the Adult Survivorship Program to create a treatment summary for all testicular cancer patients which will include the patient’s diagnosis, prognosis and potential for late effects of therapy. This document will be sent to primary care doctors with recommendations for future testing, such as early testing of cholesterol or more rigorous evaluation for hypertension. We are interested in the genetic predictors of treatment-related morbidity and in the quality of life for men with testicular cancer following diagnosis and treatment.
Current treatment protocols examine the use of MR-guidance and other 3D imaging approaches during brachytherapy, in order to improve imaging and reduce the risk of radiation damage to adjacent normal tissues. Other research studies focus on the epidemiology of endometrial cancer, the effects of radiation therapy on gynecologic malignancies, and quality-of-life improvements through novel techniques in gynecologic radiation oncology.
In collaboration with our colleagues in medical and surgical oncology, we are investigating the use of systemic therapy in combination with radiation for patients with advanced disease. Systemic therapy includes standard chemotherapy agents as well as targeted agents and investigational treatments. All of our studies use state-of-the-art, intensity-modulated radiation therapy (IMRT).
Our group maintains one of the largest databases in the country on more than 2,000 patients treated for Hodgkin lymphoma in the last 40 years. The database provides valuable information on the efficacy of different treatment approaches and the various late effects of treatment. In addition, we are dedicated to optimizing treatment for patients with newly diagnosed disease and the follow-up care of survivors of lymphoma. Studies included examination of the role of radiation therapy for specific lymphoma types, optimal radiation dose and fields, novel techniques such as 4-dimensional treatment planning that may improve treatment outcome, and prospective screening trials for second malignancies and cardiac disease in lymphoma survivors
The Sarcoma Program is internationally recognized for research in sarcoma in terms of basic science, laboratory investigation, and clinical trials, offering many new drugs and approaches to patients. We work closely with our colleagues in surgical and medical oncology to define the optimal role of radiation therapy as part of patient management (pre-operative vs. post-operative radiotherapy, intra-operative radiotherapy implants, or no radiotherapy). The unique expertise in our department positions us to offer innovative treatment techniques such as IMRT (intensity modulated radiation therapy), RapidArc™ therapy, brachytherapy, surface applicator therapy, and stereotactic body radiotherapy in addition to 3D-conformal therapy. Projects in development include the optimization of radiation techniques and doses for the treatment of retroperitoneal sarcoma, the development of strategies to minimize the risk of wound complications, definition of clinical characteristics and patterns of failure for specific histologic sub-types of sarcoma, and optimal integration of radiation therapy and systemic sarcoma treatment.
Our primary research goal is to improve radiation treatment and outcomes for patients with thoracic cancers. Current clinical studies involve new treatment techniques, such as stereotactic body radiotherapy, for delivering high radiation doses to tumors in the lung while sparing normal tissues. In addition, we are investigating advanced imaging technologies to improve the precision of radiation therapy planning and delivery to tumors with motion. Other ongoing research includes laboratory-based and translational studies to identify targeted drug treatments that may improve the effectiveness of radiation therapy for lung cancer, as well as population-based studies to study variations in the use of radiation therapy and outcomes among lung cancer patients.
Patients with a new diagnosis should call 877-442-3324 to make an appointment.
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Dana-Farber Cancer InstituteDepartment of Radiation Oncology450 Brookline AvenueBoston, MA 02215
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