A True Beam

Advanced technology precisely targets radiation to destroy cancer cells.

Cancer can be complicated. In many cases, the cause of a cancer’s development is unknown or complex and poorly understood. On the other hand, the fundamentals of cancer are straightforward and well recognized. That knowledge is the inspiration behind radiation therapy as a cancer treatment.

Dr. Rahul Chopra of Cancer Care Centers of Brevard in Melbourne discusses the services, capabilities and equipment, including the TrueBeam® radiotherapy system, used at the centers to treat cancer patients.

Todd V. Panarese, MD, (left) and Rahul Chopra, MD, use the Varian TrueBeam linear accelerator to treat cancer patients.

“The definition of cancer is uncontrolled cellular division,” informs Rahul Chopra, MD, board-certified radiation oncologist at Cancer Care Centers of Brevard. “When cells are dividing, they use their DNA, which is essentially the instruction manual on how to divide.

“With cancer, the cells continue to divide and use their DNA twenty-four seven. When this happens, especially with cells that don’t typically actively divide, such as those in the brain, they eventually form a mass, a tumor.”

Radiation therapy works as a cancer treatment by interrupting the cancer cells’ dividing process, notes Dr. Chopra.

“Radiation is basically packets of high energy that work at the molecular level,” he explains. “During radiation therapy, this energy is directed into the tumor where the DNA architecture of the cancer cells is disrupted.

“The cancer cells no longer have their instruction manual for dividing and building new cells. Therefore, the cancer cells die off because they are not able to perform their normal functions.

“Imagine contractors building a house. When those contractors do not have a blueprint to follow, they cannot complete the structure properly to spec.”

Radiation therapy is generally used instead of or in addition to surgery to remove cancerous tumors. It is typically the treatment of choice when a patient’s tumor is not reachable through surgery, not completely removed during surgery or when patients are not candidates for surgery.

“To render patients cancer free, surgeons must have a complete resection, or removal, of the tumor and surrounding cancer cells,” Dr. Chopra educates. “If a surgeon cannot do that or if we know from oncology testing that there is still some cancer left after surgery, radiation therapy is often used to kill the remaining cancer cells.

“When deciding to use radiation therapy, we evaluate the type of cancer, the stage of the cancer and the patient’s medical status. It is not used just in patients with late-stage disease when surgery has failed to remove all the cancer.

“Even a patient with stage one lung cancer, but who was a heavy smoker all their life, is on oxygen and doesn’t have adequate lung reserves is not a candidate for surgery. Radiation therapy would be the treatment of choice for this patient.”

Some people consider radiation therapy and chemotherapy, the use of drugs to kill cancer cells, as competing treatments. In many cases, however, chemotherapy is used in addition to radiation therapy.

“Radiation therapy and chemotherapy are more like complementary therapies, rather than competing therapies, in the treatment of most solid tumor cancers,” Dr. Chopra elaborates. “Chemotherapy is not a curative treatment in these cancers, so it is used as an adjunctive, or helper, treatment.

“Radiation oncology is my specialty. After a medical or surgical internship, we undergo four years of dedicated oncology training in the use of therapeutic external beam, brachytherapy and unsealed sources of radiation in the treatment of cancer and some benign disease.

“At Cancer Care Centers of Brevard, there are also hematologists-oncologists, or medical oncologists, on staff who use chemotherapy to treat cancer patients. We offer both treatments at our centers. Patients do not have to go to a separate center for their chemotherapy.”

Focused Techniques

Radiation therapy is not a new idea, but the past decade or so has seen the development of many advanced techniques for using radiation to kill cancer cells. These include intensity-modulated radiation therapy (IMRT) and image-guided radiation therapy (IGRT). These techniques allow radiation oncologists to better reach tumors with the radiation beam during treatment.

The machine used to deliver these types of radiation therapy is called a linear accelerator. Cancer Care Centers of Brevard use the latest technology linear accelerator to provide these advanced techniques of radiation therapy. It’s called the TrueBeam® radiotherapy system.

“The TrueBeam allows us to perform the full gamut of radiation oncology,” Dr. Chopra confirms. “With it, we can provide IMRT and IGRT as well as stereotactic body radiation therapy, another technique for aiming the radiation. The TrueBeam enables us to deliver very focused volumes of radiation therapy to destroy tumors throughout the body.

“On the day of treatment, patients lie on a table. The TrueBeam has built-in arms that take CT scans. These scans give us three-dimensional maps of the body, so we can see where the tumors are in relation to the rest of the patients’ organs and tissues. We then target the tumors and deliver the dose of radiation exactly where the cancer is located.”

According to Varian Medical Systems, manufacturer of TrueBeam, the technology is designed from the ground up to treat tumor targets with enhanced speed and accuracy. It can be used wherever radiation therapy is recommended, including the lung, breast, prostate, and head and neck. It enables radiation oncologists to treat patients quickly, while delivering precise doses of radiation to the target areas.

One technique that can be performed with the TrueBeam is volumetric-modulated arc therapy, or VMAT. VMAT is a more comprehensive form of IMRT. With VMAT, radiation oncologists can shape the radiation dose around the tumor in a three-dimensional volume.

“During VMAT, we can sculpt the radiation around critical structures in the body,” Dr. Chopra relates. “With it, we are able to give a high dose of very conformed radiation right around the tumor and stay away from areas such as the spinal cord, esophagus, heart and other organs.

“We often use VMAT on metastatic brain tumors that develop from cancers that commonly spread to the brain, such as lung, breast and kidney cancer. We have fairly good rates of controlling tumors in the brain with this technology, eighty-five to ninety percent in some cases.”

VMAT may also be the type of radiation therapy used in those patients with early-stage lung cancer who are not candidates for surgery. With VMAT using the TrueBeam, the radiation oncologist is able to deliver a high dose of radiation to destroy the lung tumor without surgery.

Independent and Accredited

Cancer Care Centers of Brevard is an independent, accredited, comprehensive oncology practice that offers a complete range of cancer treatment services, both medical and radiation oncology.

In addition to IMRT, IGRT and VMAT on the TrueBeam radiotherapy system, the centers provide other advanced radiation services. These include CT scanning and simulation, electron beam radiation therapy, high-dose-rate brachytherapy and prostate seed implantation.

“We are the largest independent, comprehensive oncology practice in Brevard County,” Dr. Chopra states. “In addition to full radiation services, we also provide leading-edge oncology and chemotherapy. We also have a genetic counseling program, and we perform CT and PET scans on site to help in the staging and management of cancer.

“The centers are accredited by the American College of Radiology, the oldest accrediting body for both radiology and radiation oncology. Accreditation means we meet a standard of quality set by the ACR. Our medical oncologists are accredited by the American Society of Clinical Oncology through its Quality Oncology Practice Initiative.

“Cancer Care Centers of Brevard are independent, not hospital-owned or affiliated. As we are independent, we are able to work with all of the hospitals and cancer centers in the region and state of Florida to best assist patients in easily and appropriately accessing their care.”

The centers participate in Medicare, Medicaid and all major medical insurance plans.

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    • Cancer Care Centers of Brevard

      For over 25 years, their mission has been to provide a compassionate setting for patients and their families. They believe in the dignity of all patients living with cancer and respect their physical, emotional and spiritual needs. At Cance... Read More

    • Rahul Chopra, MD

      Rahul Chopra, MD, is board certified in radiation oncology by the American Board of Radiology. He received his medical degree from the University of Florida College of Medicine, Gainesville, where he earned honors in research. He then co... Read More