Radiation and Chemotherapy and Alternative Approaches

Our neurosurgical team, neuro-oncology team, and radiation oncology team work closely to develop a plan for radiation and chemotherapy when it is recommended as part of a patient’s treatment plan. All of these treatments are available at Capital Health Medical Center – Hopewell, which provides convenience and a continuity of care for patients.

Radiation Therapy

Radiation therapy is a critical part of the treatment for brain tumors. At the National Brain Tumor Center our neuro-oncology experts work closely with radiation oncologists, nurses, and other staff in our Center for Oncology to provide the specific radiation therapy option best suited for each patient’s tumor. Various radiation therapy techniques such as IMRT, stereotactic radiosurgery and brachytherapy are available at the National Brain Tumor Center.

External Beam Radiation

The National Brain Tumor Center offers expertise in non- invasive radiation therapy treatment options including 3D conformal radiation therapy, intensity modulated radiation therapy (IMRT), RapidArc® radiotherapy, and stereotactic radiosurgery.

Capital Health uses both the CyberKnife® Robotic Radiosurgery System and the TrueBeam™ linear accelerator. Our experienced team will determine which treatment is right for you based on a number of factors including the size of the tumor, the type of tumor, whether the area where the tumor is located has been radiated previously, and whether it is a primary tumor or metastasis.

The National Brain Tumor Center offers CyberKnife and TrueBeam at Capital Health Medical Center – Hopewell in the Center for Oncology which is important to the continuity of care. Patients can have their imaging, consultation and treatment all in one location. It’s the same location where our multidisciplinary appointments take place.|

CyberKnife Radiosurgery is a non-invasive treatment used to treat brain tumors. At our CyberKnife Center our experienced team utilizes the image-guided radiosurgery system to deliver radiation to tumors in the brain and spine with pinpoint accuracy while avoiding damage to surrounding healthy tissue. CyberKnife can be used over a period of days to treat some tumors, whereas other options can only be used in a single administration. Unlike with Gamma Knife, patients being treated with CyberKnife do not require a stereotactic frame to be fixed to the skull.

TruBeam Linear Accelerator TrueBeam rotates around the patient to deliver a prescribed radiation dose from nearly any angle. It can perform traditional 3D conformal radiation therapy, intensity modulated radiation therapy (IMRT), RapidArc® radiotherapy, and stereotactic radiosurgery. TruBeam offers on-board imaging, or Image Guided Radiotherapy, allowing physicians to evaluate the tumor while the patient is having treatment.


Brachytherapy

GliaSite Radiation Therapy System (RTS) is a form of brachytherapy. Following surgical resection of the tumor, a neurosurgeon places the balloon catheter in the cavity where the tumor was located. The other end of the tube extends through the skull to lie under the patient’s scalp where an injection port allows for introduction of liquid radioisotope. Post-surgery, the balloon is filled with a contrast solution and after recovery from surgery the patient has the contrast solution removed and a liquid radiation source is injected to replace it. Following treatment the radiation solution and the catheter is removed. This novel treatment method delivers radiation from inside the tumor cavity where the tumor was located. This is different from traditional radiation where radiation is delivered from the outside in.

Chemotherapy

Chemotherapy is used in the treatment of cancer to: destroy cancer cells that remain following surgery (adjuvant therapy); slow the growth of a tumor or shrink a tumor before surgery (neoadjuvant therapy); or lessen symptoms (palliative chemotherapy).

Unfortunately, chemotherapy can be less effective in patients with brain tumors due to the presence of the blood-brain barrier, which prevents many of the drugs from reaching the brain and the tumor site. However, there are several chemotherapy agents that do cross the blood-brain barrier and demonstate effectiveness against malignant brain tumors.

The specific type of tumor and its molecular characteristics as well as itsits location will help our team determine if chemotherapy isan appropriate part of the treatment plan we design for our patients. These factors will also help determine the delivery method (intravenously (through IV),orally (with pills) or Intra-arterially (via a catheter into the tumor) or directly into the brain (placed at surgery); how long it will be delivered; and whether it will be administered before or after surgical options are used.

Other Approaches

Optune

This is a new type of treatment for malignant gliomas using low level electric fields designed to kill dividing cancer cells. Optune is delivered through 4 transducer arrays placed directly on the scalp. Optune is a noninvasive regional therapy that targets dividing cancer cells in the brain. Optune creates alternating, “wave-like” electric fields called Tumor Treating Fields (TTFields). These TTFields travel through the e brain in different directions and work by killing brain cancer cells when they start to divide. It is used in both newly diagnosed and recurrent GBM. Recent randomized trials have demonstrated the effectiveness of Optune in extending the lives of patients with malignant brain tumors.

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