The Radiotherapy Unit of San Rossore Medical Center is dedicated to treat cancer as well as benign non-tumorous diseases. Radiotherapy represents one of the most relevant oncological treatments which, taking advantage of high-energy ionizing radiations by means of special equipments (such as the linear accelerator), aims at destroying the tumorous cells ensuring in the meanwhile the highest attention to protect healthy tissues. Radiotherapy Unit is composed by highly professional doctors, physicists, technicians and nurses.
Respiratory Gating Techinique: nella to treat thoracic and abdominal areas (e.g. for treatment on breast lungs etc…)
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Types of Radiotherapy
- As exclusive therapy:
-conventional fractionation treatment-hypofractionation treatment, that is the possibility of supplying high doses with equal or superior therapeutic efficacy, thus reducing the total duration of the treatment in comparison with more traditional schemes.
- As combined radiotherapy: it is integrated in different ways with surgery (preoperative, intraoperative, postoperative) or in association with chemotherapy (neoadjuvant, concomitant, sequential) or with hormone therapy or immunotherapy.
In order to reduce and/or eliminate symptoms due to neoplastic diseases such as pain, compression syndrome (e.g. mediastinal syndrome, marrow compression, etc..) or, rarely, hemmorhages otherwise not controllable, and/or combined with other therapies.
RADIOTHERAPY OF BENIGN LESIONS:
For example hypophysis adenomas, meningiomas, arteriovenous malformations (AVM), Basedow disease, keloids, aneurysmatic cysts, pathologies affecting cranial nerves (e.g. the trigeminal nerve), vascular diseases..
DOCTORS, MEDICAL PHYSICISTS AND TECHNICIANS
Our Team is made of high professionals with long-standing experience coming from the best Institutions in Italy: Radiotherapy of University Hospitals of Ferrara, Bologna, Florence, Aviano (IRCSS-Institute for Treatment and Research), Pisa and IEO (European Institute of Oncology in Milan).
- 64-multislice Computed Tomography (TC Open Sensation Siemens): completely dedicated to radiotherapy
- Linear accelerator TrueBeam STx (see the photogallery above), by Varian Medical System, with integrated Cone-beam CT: it allows radiological analysis before the treatment, in order to monitor the real position of the tumorous target and critical organs, to correct possible location mistakes and evaluate possible movements (even millimetric) of the cancer cells due to unavoidable organ motion, and thus to irradiate with higher accuracy.
TrueBeam STx takes also advantage of a micro multileaf/multilamellar system which allows to perform very accurate stereotactic treatments in cranial and extracranial areas and reduce the duration of the treatment thanks to the capacity of the machine to supply X radiations even in FFF (Flattening Filter Free) modality.
Treatment Planning Systems (TPS) in close collaboration with Medical Physicists
- Imaging Fusion Systems by means of MiM for CT, MRI and PET
- Physical-dosimetric instruments to perform the periodical check of the equipment
- Immobilisers personalized on the basis of the body area to be treated
It also takes advantage of the following equipment/technologies to obtain images to be used in order to carry out the treatment plan:
- Internal: MRI 1.5 Tesla of our Radiology Unit
- External: PET and PET/CT in collaboration with Nuclear Medicine of CNR in Pisa and Nuclear Medicine of University Hospital S. Chiara in Pisa.
- Volumetric Modulated Arc Therapy (VMAT)
- Intensity-Modulated Radiation Therapy (IMRT)
- Image-Guided Radiation Therapy (IGRT)
- Conformational Radiation Therapy 3D-CRT
- Stereotactic Intracranial and Extracranial Radiotherapy (SRT and SBRT)
- Adaptive Radiotherapy (ART)
- Respiratory Gating Treatments, widely used for mammary neoplasias, lungs, etc.
Two are the ways to perform Respiratory Gating:
- Free Breath: the irradiation takes place while the patient breathes freely and normally, because of the reduced mobility of the cancer during this stage; the breathing is continuously monitored so to be sure the irradiation is performed in the most suitable moment.
- Deep Inspiration Breath Hold (DIBH): the irradiation takes place during apnoea, for which the patients are provided, both during the centering and the treatment, with a LED display which gives them a visual feedback of the thoracic expansion caused by the breathing, in order to help them to immediately find a suitable position ( and to maximumly limit error occurrence due to respiratory movements).
The first step is the “Radiotherapic Oncological Consultation”, during which the Radiation Oncologist collects all the necessary information concerning the patient’s past and current health conditions, in order to evaluate the nature and extension of the cancer and to be able to proceed with the multidisciplinary consultations.
Once the clinical situation has been defined, the Radiation Oncologist analyzes the chance to perform the irradiation treatment, choosing the most suitable way for the patient as mutually agreed with Medical Physicists.
The Radiation Oncologist, together with the Radiology Technician (TSRM), performs a Contouring CT in order to define the position and way to immobilize the patient which is most suitable for the kind of treatment chosen.
Afterwards, the Radiation Oncologist pinpoints the areas to mark on the CT, also taking advantage of the information obtained from other diagnostic investigations like MRI and PET. Thanks to innovative softwares, the Radiation Oncologist is able to combine all of the patient’s images so to locate the area to be irradiated, with millimetric accuracy.
Radiation treatment plan:
The Medical Physicist prepares a personilized treatment plan for the patient by optimizing the dose on the target, in order to mostly avoid the irradiation on healthy organs; then, the Treatmnent Plan will be analyzed, possibly modified and accepted by the Radiation Oncologist.
Before it is performed on the patient, the Treatment Plan is tested on ArcCheck (used to test rotational treatments), evaluating the right dose supply (part of the Quality Control).
For the treatment session the patient is accompanied inside the room (Bunker) where stands the linear accelerator and he/she is made lie down on the therapy table; another CT is done to be compared with the Contouring one. Con questa procedure è possibile posizionare il paziente con precisione millimetrica
The Health Technician continuously monitors the patient by means of a closed circuit video system, and is able to communicate with him/her thanks to an intercom.
During the whole period of treatment and after its conclusion, visits will be carried out on the patient with possible prescription of support therapies.
The treatment can be performed on outpatients as well as inpatients in particular clinical circumstances, in case of combined therapies (such as chemotherapy, nutrition, medical support therapies) or for logistical reasons. (Click on here to see the possibilities).
Our Radiotherapy Center works together with both Multidisciplinary Groups inside San Rossore Medical Center and different specialists from other National Centers; that in order to ensure each patient the correct integration and personalization of the treatment according to international protocols and internal guidelines.
Safety and quality for patients during the Radiotherapy
evaluate and verify the treatment plan and any previous and current radiological image, also by means of ConeBeam, to ensure maximum accuracy; they also carry out intertreatment visits.
are in charge of checking the equipment to ensure optimal treatments; they also guarantee the care path: from the creation of the treatment plan and its approval by the doctor, through its transmission to the machine by means of Record and Verify System (ARIA) which allows the identification of the patient and his/her treatment plan and the recording of the supplied dose, to the test of the right irradiation before the treatment start and the supervision during respiratory gating treatments along with other technicians and doctors.
Radiology Technicians (TSRM):
follow the Radiation Oncologist along the whole treatment: testing with the Physicists the right irradiation of the machine; preparing the patient, possibly using positioning and immobilizing techniques; capturing the images required for the creation of the treatment plan; preparing the treatment tools and performing the treatment itself of whose accuracy they are responsible; assisting the Radiation Oncologist in the on-line check.
(Thanks to Varian and Tecnologie Avanzate for images and videos)