Comprehensive Cancer Care Services

Types of Radiation Therapy

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External Beam Radiation Therapy (EBRT)
EBRT is given via machines called linear accelerators, which produce high-energy external radiation beams that penetrate the tissues and deliver the radiation dose deep in the areas where the cancer resides. These modern machines and other state-of-the-art techniques have enabled radiation oncologists to significantly reduce side effects while improving the ability to deliver radiation. Highlands Oncology employs state-of-the art linear accelerators manufactured by Varian Medical Systems, the proven leader in the industry.

EBRT is typically delivered on an outpatient basis for approximately 6 to 8 weeks. EBRT begins with a planning session, or simulation, during which the radiation oncologist places marks on the body and takes measurements in order to line up the radiation beam in the correct position for each treatment. During treatment, the patient lies on a table and may be treated with radiation from multiple directions. The actual area receiving radiation treatment may be large or small, depending on the features of the cancer. Radiation can be delivered specifically to an organ or encompass the surrounding area, including the lymph nodes.

Three-Dimensional Conformal Radiation Therapy (3D-CRT)
EBRT can be delivered more precisely by using a special computed tomography (CT) scan and a targeting computer. This capability is known as Three-Dimensional Conformal Radiation Therapy, or 3D-CRT. The use of 3D-CRT appears to reduce the chance of injury to nearby body structures. Since 3D-CRT can better target the area of cancer, radiation oncologists are evaluating whether higher doses of radiation can be given safely and with greater cancer cures. Highlands Oncology utilizes the latest in multi-slice high speed spiral CT scanners. Images from this sophisticated imaging system are directly linked to a highly advanced 3-dimensional treatment planning system.

Intensity Modulated Radiation Therapy (IMRT)

IMRT is an advanced form of 3D conformal radiation therapy that is able to shape or conform radiation beams to the size, shape and location of a tumor while minimizing the impact on surrounding normal tissue or organs. IMRT delivers varying intensities of radiation within each treatment field. The intensity is varied by the placement of “leaves”, which either block or allow the passage of radiation. Typically 5 to 10 beams from multiple directions are delivered. By combining these non-uniform beams it may be possible to deliver dose distributions that more closely match the shape and volume of the tumor. The physician along with a team of dosimetrists and physicists utilize a powerful computer program that optimizes a treatment plan based on the physician’s dose instructions, and information about tumor size, shape and location in the body. A medical linear accelerator, equipped with a special device called a multileaf collimator that shapes the radiation beam, delivers the radiation in accordance with the treatment plan. The most common sites treated with IMRT include prostate, mouth and throat.


Internal radiation is known by a number of names: “HDR treatment”, “High Dose Rate brachytherapy”, “interstitial brachytherapy”, “seeds”, “implant”, “MammoSite®”, or “balloon therapy”. These terms refer to treatment in which radioactive material is placed directly into or near the cancer.

Prostate Brachytherapy
A common method for the treatment of prostate cancer is interstitial brachytherapy also referred to as a “prostate seed implant”. This procedure is performed in the surgery department of our local hospitals and can typically be done on an outpatient basis. The procedure consists of permanent implantation of radioactive seeds into the prostate gland through the perineum. The perineum is the area of skin between the scrotum and the anus. The implantation procedure is performed in the operating room while the patient is asleep or numb from the waist down. An imaging device known as an ultrasound probe is inserted into the rectum to visualize and guide placement of the seeds into the prostate. After the procedure, the patient will temporarily contain a small amount of radiation from the seeds. Although this amount is not generally dangerous to most other people, some physicians may advise patients to avoid close contact with young children or pregnant women for several weeks. Because implant radiation focuses the radiation closely around the prostate, this method of radiation delivery is best suited for patients with early stage cancers and is an option for adding additional dose to the prostate in higher-risk patients after they have completed radiation to the pelvic lymph nodes.

Prostate Cancer Options


Breast brachytherapy or MammoSite is an alternative to traditional EBRT for women who choose breast conservation rather than a mastectomy. Breast conservation therapy involves removing the tumor in a procedure called a lumpectomy, and is followed by radiation therapy to reduce the likelihood of recurrence. Traditional EBRT following a lumpectomy consists of five to six
weeks of radiation treatment, five days per week. With breast brachytherapy, a site-specific, prescribed dose of radiation is administered during a five-day course of therapy. Because of the relatively short duration of the treatment course, breast brachytherapy is an attractive option for women who choose lumpectomy over mastectomy, but do not wish to undergo 6 weeks of EBRT.

The MammoSite procedure for breast brachytherapy involves inserting a deflated balloon into the cavity where the tumor was removed. The balloon is connected to a catheter which is outside of the breast. The balloon is filled with saline, and both the balloon and the catheter remain in place during the time the woman is undergoing treatment. The radiation therapy is performed on an outpatient basis in a five-day, twice-per-day sequence of treatments. During each treatment, a radioactive source or “seed” is inserted into the catheter. The source is precisely positioned within the catheter delivering an exact dose while minimizing radiation exposure to the rest of the breast, skin, ribs, lungs, and heart. No source of radiation remains in the patient’s body between treatments or after the final procedure. The catheter and balloon are removed after the final procedure. Conventional brachytherapy for breast conservation requires the insertion of 14 to 20 catheters per procedure and is much more complex than the breast brachytherapy procedure described here. This treatment technique was pioneered right here in northwest Arkansas utilizing the latest treatment planning and delivery systems from Nucletron, the world leader in high dose rate brachytherapy.

Gynecological Brachytherapy
Gynecological Brachytherapy or “GYN implant” is a common method of treatment for vaginal and cervical cancers. This treatment technique utilizes equipment called “applicators” that are inserted into the vagina or cervix to position the radiation source in close proximity to the disease. These applicators are then connected to a highly-sophisticated remote controlled delivery device called a High Dose Rate (HDR) Remote After-loader. This device contains the radioactive source connected to a thin cable which can be precisely positioned anywhere within the applicators. The radiation is performed on an outpatient basis and usually consists of 3 to 5 treatments spread out over 2 to 3 weeks but can vary significantly based on disease type. The applicators are removed after each treatment and no source of radiation remains in the patient’s body between treatments or after the final procedure.

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