Our Approach to Radiation Oncology

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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 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.

MRI-Guided Linear Accelerator (MRI-LINAC) uses magnetic resonance imaging, or MRI, together with radiotherapy to treat cancers throughout the body, with specific advantages for soft-tissue tumors. The radiation delivery on the MRI-LINAC is fully integrated with the MRI. This means the system can deliver treatment radiation beams and monitor the target area at the same time. The unique combination of technologies gives our physicians greater control over the delivery of radiation because they can see the internal anatomy and tumor.

MRI-Guided Advanced Procedure and Simulations (MAPS) uses MRI imaging to perform an external beam radiation therapy “simulation” (or planning procedure) for a variety of tumors for improved targeting.

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.

Low dose rate (LDR) brachytherapy: Radioactive seeds are permanently implanted into an organ harboring cancer, most commonly the prostate. These seeds emit low levels of radiation directly to the cancer for several weeks. After the prescribed dose of radiation is deposited to treat the cancer the seeds no longer emit radiation and remain harmlessly behind. This technique ensures the maximum radiation dose is given to cancerous tissues, while minimizing exposure to the surrounding healthy tissue.

Retreatment: Retreatment represents one of the biggest challenges in radiation therapy. When cancer recurs at or near the original site, radiating the site a second time can cause very serious toxicities and should only be offered in select cases. Our doctors have years of experience in selecting appropriate patients and treating previously radiated areas while minimizing side effects. Our head and neck group has extensive experience using intensity-modulated radiation (IMRT) in this setting and is also investigating the use of stereotactic body radiotherapy (SBRT) in specific situations.

Deep inspiration breath hold: Pioneered at the Dana-Farber Brigham Cancer Center, this technique helps avoid inadvertent radiation to the heart during treatment for breast cancer. By taking and holding a deep breath before and during radiation therapy, the patient’s lungs inflate and the heart moves away from the radiation field. Technicians use sophisticated monitoring devices to ensure breath holds are consistent during each treatment.

Specialization treating rare cancers: Our doctors are internationally-renowned experts in treating rare cancers, such as various forms of hematologic malignancies, sarcomas and Merkel cell carcinoma. We provide unparalleled knowledge and skill in the diagnosis, treatment and management of these and other uncommon diseases. We also frequently lead the development of treatment guidelines and collaborate with scientists and physicists around the world to conduct clinical trials that explore cutting-edge therapies.

4D-CT and motion management: This technology is used to treat tumors in organs that move when you breathe, like the lung or liver. This enables the radiation oncologist to monitor the exact tumor location and adjust for changes during treatment, minimizing radiation exposure to healthy tissues.

Supportive and palliative radiation oncology (SPRO): The first of its kind in the US, the SPRO service provides a dedicated clinical team available 24/7 to address the complex and urgent clinical care needs of patients with advanced cancers. The service provides a comprehensive evaluation of the patient, assesses the potential role of radiotherapy and other potential palliative modalities, and communicates with patients and families regarding radiotherapy recommendations and other care considerations.

Spinal Tumor Program: Cancers involving the spine are a complex problem requiring specialized multi-disciplinary care to optimize assessment and management. Our specialized team of physicians and nurse practitioners from radiation oncology, neurosurgery, orthopedic surgery, interventional neuroradiology, and psychosocial oncology and palliative care, work as a team to provide dedicated, coordinated assessment and management for patients with spinal tumors of all types.