The MMC Cancer Institute
The MMC Cancer Institute
Radiation Oncology
Overview
Radiation oncology - also called radiation therapy - uses high-energy x-rays to destroy cancer cells while sparing the surrounding normal tissue. Radiation therapy may be used alone, or combined with other cancer treatments such as chemotherapy and/or surgery. It may be used for curative as well as palliative care. Approximately 67% of patients with cancer will be treated with radiation therapy at some point in the course of their illness (Source: American Society for Therapeutic Radiology and Oncology, Fact Sheet www.astro.org).
The MMC Cancer Institutes Radiation Oncology Department meets stringent national standards for quality, safety and technical excellence - earning it accreditation from the American College of Radiology (ACR). In fact, its the only radiation oncology program of its kind in Maine to achieve and maintain this distinction.
Whats more, no other facility in the state offers such a comprehensive array of the most advanced radiation therapy modalities. This means that here patients have access to the latest, most effective treatment options proven to deliver the best possible outcomes.
What also sets MMC apart is the expertise of our team of six board-certified radiation oncologists - so patients benefit from a remarkable depth of specialized knowledge and experience from physicians with a regional reputation for excellence.
This expertise is brought to bear in weekly multidisciplinary tumor board conferences that we hold for lung, breast, prostate and other site-specific cancers. At these conferences, all the specialists involved in evaluating and treating that type of cancer - including medical oncologists, surgeons, pathologists, radiologists and radiation oncologists - review appropriate cases and apply their combined expertise to each patients plan of care.
MMCCIs Radiation Oncology facilities are also a primary clinical site for Southern Maine Community Colleges Radiation Therapist program. Staff at MMCCI Radiation Oncology provide radiation therapy students with clinical oversight and direction, as well as teach courses in Radiation Physics, Treatment Planning and Dosimetry, and Radiographic Anatomy. This collaborative effort between MMCCI and SMCC has been in existence for over 25 years, and has contributed to an overall placement rate of 95% for new graduates.
Another distinguishing aspect of radiation oncology at MMCCI is our team of physicists. These behind-the-scenes professionals are the ones responsible for maintaining and calibrating the radiation therapy equipment to ensure that it consistently delivers the accurate dose of radiation. Radiation oncology physicists are in high demand for their expertise, and we have recruited and retained a high-performing team that plays a critical role in the quality of radiation therapy provided at the MMC Cancer Institute.
Further, the majority of the registered nurses (RNs) involved with the MMCCI Radiation Oncology Department at the Scarborough campus are oncology-certified nurses. These nurses have met or exceeded requirements for practice in cancer care, completed education in oncology nursing and possess a tested knowledge of the specialty. Certification in oncology nursing is based on current professional practice, so it validates a nurse's knowledge is up-to-date.
In addition, MMCCI is actively involved in radiation oncology research, looking at ways to enhance patients quality of life and alleviate the side effects related to cancer treatment. MMCCIs radiation oncology team is the only one in Maine that is a member of the Radiation Therapy Oncology Group (RTOG).
The RTOG is the primary research arm of the American College of Radiology. Its made up of physicians and other researchers from over 300 of the leading academic and community medical facilities around the world - including the MMC Cancer Institute. Since its inception in 1968, the RTOG has activated 460 protocols, accrued a total of approximately 90,000 patients to cooperative group studies, and published more than 800 papers reporting the results of its findings. The RTOG maintains a roster of 40 active studies devoted to the group's primary disease sites: central nervous system, head and neck, lung, gastrointestinal (esophagus, stomach, pancreas, anal canal and rectum), genitourinary (bladder and prostate), breast and cervix. Access to these investigational protocols is available to appropriate patients.
In addition to opening Radiation Therapy Oncology Group (RTOG) trials, radiation oncology is an integral part of other clinical trials such as surgical oncology, neuro oncology, medical oncology and Childrens Oncology Group (COG).
The MMCCI Radiation Oncology Department provides treatment at four centers located in Scarborough, Portland, Bath and Sanford (see listing at the end of this section). This multi-center approach gives patients the convenience of remaining closer to home while undergoing their course of radiation therapy.
Types of cancer treated
Many common cancer types in children and adults can be effectively treated with radiation therapy, including, but not limited to:
Malignancies of the central nervous system (brain and spinal cord)
Head and neck malignancies including cancer of the oral cavity, pharynx and larynx
Thoracic malignancies including lung and esophageal cancer
Breast cancer, following lumpectomy or mastectomy
Gastrointestinal malignancies including gastric, pancreatic, rectal and anal cancer
Genitourinary malignancies including bladder and prostate cancer
Gynecologic malignancies including uterine and cervical cancer
Non-Hodgkins and Hodgkins lymphomas
Skin cancers, including melanoma
Soft tissue and bone sarcomas
Cancer metastasis to any anatomic location
Comprehensive radiation therapy options
The following is an overview of the range of advanced radiation oncology treatment techniques available at the MMC Cancer Institute:
Three-dimensional conformal external beam radiation therapy (EBRT)
Three-dimensional conformal radiation therapy makes it possible to deliver a higher dose of radiation to a tumor with less damage to the surrounding normal tissue. The patient undergoes an initial CT scan to determine the position of the tumor. Next, the data from the CT scan is fed into a treatment-planning computer to precisely define and shape the radiation beam to conform to the tumor mass. The actual treatment consists of multiple radiation beams from different directions.
Intensity-modulated radiation therapy (IMRT)
IMRT is a new type of conformal external beam radiation therapy that enables the radiation oncologist to not only more precisely shape the beam to the tumor, but also vary the intensity of the beam as it passes near or through non-cancerous tissues. As a result, a uniform dose of radiation can be delivered to the tumor while sparing toxic doses to nearby critical structures.
Image-guided radiation therapy (IGRT)
IGRT is the most advanced form of radiation therapy. Research demonstrates that IGRT provides the best treatment outcomes with fewer, less severe side effects. One of the challenges of delivering radiation to a tumor is that the tumor can move based on the patient's day-to-day position on the treatment table (as well as from breathing). IGRT is IMRT guided by imaging (such as CT, ultrasound or stereoscopic X-rays) performed in the treatment room just before the patient is given the radiation treatment. Its used to assess the position of a tumor and anatomic structures within the body versus relying on external landmarks. Incorporating IGRT during radiation treatment couples image-guided accuracy with intensity-modulated precision. The result is improved targeting of cancerous tissue, while sparing nearby healthy tissue.
Stereotactic radiosurgery (SRS)
Stereotactic radiosurgery is a non-invasive method of treating brain tumors without the risks of surgery or a long hospital stay. Despite its name, radiosurgery is not actual surgery; it is a radiation therapy technique that uses highly precise equipment and three-dimensional computer planning to focus a beam of high-dose x-rays on a brain mass. The treatment-planning process is complex and requires a multidisciplinary approach led by the radiation oncologist and neurosurgeon. The actual treatment can last from 30 minutes up to two hours and, after the procedure, patients are able to return home.
Low-dose rate (LDR) brachytherapy
Brachytherapy refers to the placement of radioactive implants - either on a temporary or permanent basis - inside the body to deliver a radiation dose to cancerous tissue. With LDR brachytherapy, cancer patients have an applicator placed into or near the tumor while in an operating room or other controlled setting. Radiation pellets or seeds are loaded into the applicator to treat a targeted area. In most cases, the applicator and pellets remain in place for hours up to several days. During treatment, patients stay in the hospital and often are confined to bed, and visitors are restricted to avoid radiation exposure. This type of treatment is called low-dose rate because the radiation is delivered slowly over an extended period.
LDR brachytherapy is most frequently used for treating low- to moderate-risk prostate cancer. In this treatment, the radioactive seeds permanently remain in the prostate where they slowly deliver radiation that kills tumor cells.
High-dose rate (HDR) brachytherapy
MMC was the first hospital in Maine to offer HDR brachytherapy, a newer technique that delivers a higher dose of radiation in a shorter period of time. This focused approach limits the size of the treatment volume which, in turn, permits the radiation dose to be intensified. This therapy can be used alone or as a boost to standard EBRT in appropriately selected patients.
As in LDR brachytherapy, the applicator is placed into or near the tumor while the patient is in the operating room or similar setting. The treatment itself, however, is delivered over the span of a few minutes due to the increased strength of the high-dose rate seed. Once treatment is completed, the radiation source automatically returns to the protective storage of the HDR machine and the applicator is removed.
HDR brachytherapy is used in treating more aggressive prostate cancer as well as lung, gynecological and breast cancers (see partial breast irradiation, below). The number of treatments required varies depending on the tumor site and treatment goal. Candidates for HDR brachytherapy are carefully selected to ensure that the treatment meets their individual needs.
Accelerated Partial Breast Irradiation (APBI)
APBI is a form of HDR brachytherapy that offers more convenience for appropriate early-stage breast cancer patients by shortening radiation therapy from the standard six to seven weeks of treatment to just one week.
This technique uses a type of high-dose rate radiation therapy implant. A balloon catheter is placed into the cavity where the breast cancer was surgically removed, and inflated to hold the catheter in place. Once the correct position is verified and other specific criteria are met, the catheter is connected to the HDR machine and the radioactive pellet is placed in the balloon to deliver focused radiation. The treatment lasts just a few minutes, then the catheter is disconnected.
The APBI regimen involves twice-daily outpatient treatments over a five-day period (compared to daily visits over a six-week period for conventional, whole-breast external beam radiation therapy).
Why MMC is the regions hospital of choice for radiation therapy
The states largest, most experienced team of board-certified radiation oncologists, with a depth and breadth of expertise that is unparalleled in Maine and has earned a regional reputation for excellence
Maines only American College of Radiology-accredited radiation oncology program, proof that it has met rigorous standards of quality, safety and technical excellence
State-of-the-art technology, giving patients access to the latest, most effective radiation therapy modalities
A multidisciplinary approach to care, ensuring that patients benefit from the combined expertise of cancer specialists in medical and surgical oncology as well a radiation oncology
A track record of excellent outcomes that meet or exceed national quality benchmarks
Access to innovative treatment regimens through MMCs participation in clinical trials
Four treatment centers located from mid-coast to southern Maine, for optimal patient convenience
Contact information
MMCCI Radiation Oncology
98 Campus Drive
Scarborough, ME 04074
207.396.7500
MMC also offers radiation therapy at the following centers:
Coastal Cancer Treatment Center
175 Congress Avenue
Bath, ME
207.443.5866
Southern Maine Radiation Therapy Institute at Maine Medical Center
22 Bramhall Street
Portland, ME 04102
207.662.2276
Cancer Care Center of York County
27 Industrial Avenue
Sanford, ME
207.459.1600