Special Treatment Modalities

The Department of Radiation Oncology at Stanford is nationally and internationally recognized as a premier Department of Radiation Oncology. As an academic department, the faculty are well known, well published, and considered experts in their fields. There are a number of unique treatment programs and treatment modalities for cancer therapy for which it holds particular prominence.

Pediatric Radiation Therapy

Comprehensive daily consultative services and radiation therapy are available for children. The clinical services include external beam radiation therapy with both photons (3-D conformal therapy) and electrons, intracavitary radiation therapy with Cesium-137 sources, and interstitial radiation therapy with Iridium-192 and Iodine-125. Total body irradiation for bone marrow transplantation, intraoperative radiation therapy, and stereotactic radiosurgery programs are integrated into multi-disciplinary approaches for children. A combined modality approach is used for all children, with weekly general tumor boards, and monthly neuro-oncology tumor board meetings. Full pediatric anesthesia services are available when needed.

Clinical research programs include pediatric Hodgkin's disease protocols, and collaboration in the Pediatric Oncology Group, National Wilms' Tumor Study, the Intergroup Rhabdomyosarcoma Study, and the Childhood Cancer Survivors Study.

Sarah S. Donaldson, M.D., Department of Radiation Oncology, Stanford Medical Center
Phone: (650) 723-6195; Fax: (650) 725-3865.
Patient appointments may be made by calling 650-723-6171 or 650-498-6339.

Radioimmunotherapy (Radiolabeled Antibodies)

Radioimmunotherapy (RIT) is a promising new therapeutic modality for the treatment of a wide variety of malignancies. RIT utilizes antibodies to carry radioactivity to disease sites. Antibodies are immunoglobulin molecules that bind to specific targeted antigens. Monoclonal antibodies (MAB) are produced by a single clone of antibody producing cells, and are highly specific for a given antigen. Radionuclides can be chemically linked to MAB, resulting in stable radioimmunoconjugates for therapy.

Susan J. Knox, M.D., Department of Radiation Oncology, Stanford Medical Center
For more information, call 650-498-4073.

Stereotactic Radiosurgery

Stereotactic Radiosurgery is an important new treatment option for many patients with abnormal blood vessels in the brain (arteriovenous malformations), brain tumors, or other special tumors of the head and neck regions, such as nasopharynx tumors or acoustic schwannomas. This technique uses sophisticated computerized imaging to precisely target a narrow X-ray beam. Using this method, it is possible to effectively destroy small tumors or close down abnormal blood vessels. This technique, which is accurate to one millimeter or less, does not require surgery and can be done on an outpatient basis.

Radiosurgery is limited to lesions that are well-defined and no larger than three to four centimeters. The location of the lesion is also important. For example, lesions too close to radiosensitive structures, such as the optic nerve, are not good targets for radiosurgery.

Stereotactic Radiosurgery includes the participation of both the neurosurgical and radiation oncology team. Members of both teams participate together to evaluate and treat each patient.

Contact Iris Gibbs, M.D. (650) 725-1723

Total Skin Electron Beam Therapy

The Stanford Department of Radiation Oncology was responsible for development of contemporary techniques of total skin electron beam therapy. This technique permits delivery of high doses of radiation to the skin without treatment to the underlying tissues and organs. It is especially useful in the treatment of mycosis fungoides (cutaneous T-cell lymphoma) and other rare lymphomas of the skin.

Contact Richard T. Hoppe, M.D. (650) 723-6171 or (650) 723-5510

Three-Dimensional Treatment Planning

Successful treatment outcome in radiation oncology is based on two broad principles:

irradiation of tumor-bearing tissues to adequate, or curative, doses; and
sparing of normal, or uninvolved, tissues from unnecessary radiation.

Optimal treatment planning procedures play a key role in achieving these goals. Recent improvements in computer systems and treatment planning software allow physicians to visualize a patient's anatomy in three dimensions relative to the radiotherapy treatment machines. This information enables us to "conform" radiation dose more closely to the shape of an individual's tumor by creating specially tailored blocking devices and/or optimizing the directions from which radiation is administered. On average, such three-dimensional treatment planning, by improving the accuracy of planning, creates both better coverage of tumors and reduced treatment of normal tissues. Studies of patients treated with conformal therapy indicate that acute side effects of radiation are reduced and that higher doses of radiation may be delivered to some tumors without increasing the risk of side effects of treatment. Multi-institutional trials are underway to determine the optimum application of this technology for tumors of the brain, lung, and prostate, and already appear quite promising.

The Department of Radiation Oncology at Stanford uses a state-of-the-art three-dimensional treatment planning system, including the incorporation of a specially designed CT scanner in the radiotherapy department that will allow us to obtain even more detailed and accurate 3D anatomical information for planning purposes. In addition, the Physics Division is working on the development of a highly sophisticated treatment approach, called "intensity-modulation", which may ultimately allow complete computer-optimization and automated delivery of treatment plans.

Contact Steven Hancock, M.D. (650) 725-4796 or Christopher King, Ph.D., M.D. (650) 723-5055

High Dose Rate Remote After-Loader Brachytherapy

In addition to our standard low dose rate (LDR) isotope implants and intracavitary placements, we also have available a high dose rate (HDR) remote after loading treatment system.

This provides for high localized doses of radiation to be delivered to the tumor quickly and without radiation exposure to hospital staff. HDR brachytherapy treatments can often be performed on an outpatient basis. They have been shown to be as effective as traditional LDR brachytherapy, and tumors in almost any body site can be treated with the HDR system.

Our HDR remote after loading treatment planning system permits optimization of dose to tumor, limiting the dose to adjacent vital organs. We currently have active programs in the use of HDR treatment in head and neck, pulmonary, and gynecological cancers. Patients with other local regional tumors can be considered for HDR treatments on an individualized basis.

Contact Christopher King, Ph.D., M.D. (650) 723-5055

Prostate Brachytherapy

Today, the treatment of localized prostate cancer involves selecting which patients are best suited for surgery, external-beam radiotherapy or brachytherapy (ie. the radioactive seed implantation within the prostate gland). Often, patients are eligible for all three options, each of which offer an equal likelihood of cure but differ significantly in terms of potential side-effects.

Brachytherapy exists in two forms: permanent low dose-rate (LDR) and temporary high dose-rate (HDR). HDR is usually performed as a boost in conjunction with a shortened course of external beam. HDR alone as a single form of treatment is considered investigational at this time. At Stanford we offer only LDR prostate brachytherapy, either as a single treatment for eligible patients or in combination with external-beam radiotherapy.

Permanent LDR brachytherapy can be used alone for the treatment of localized prostate cancer. This procedure consists of the implantation within the prostate gland of small radioactive sources (either Iodine-125 or Palladium-103) that deliver their dose of radiation over a period of several months. These are left within the gland and do not cause any harm once they become inert. Prior to the procedure a trans-rectal ultrasound (TRUS) Volume Study of the prostate is done in order to map out the precise location of all the 'seeds'. During the procedure these seeds are placed into the prostate via needles under the guidance of a TRUS. The brachytherapy procedure takes about an hour in the OR and is usually done under spinal anesthesia. The patient generally may go home that same day.

The side-effects of brachytherapy include mild urinary symptoms (frequency and urgency) as well as mild rectal irritation (urgency and frequency). These usually last a few months and are managed with mild medications. Potency sparing of brachytherapy is probably better than either surgery or external-beam radiotherapy. There is virtually no risk of urinary incontinence. The great majority of patients suffer only mild side-effects and for this reason prostate brachytherapy has gained its reputation as a convenient treatment with an excellent quality-of-life profile while offering durable cure rates equivalent to surgery.