Innovative Treatment and Technology
Our Cutting-Edge Radiation Oncology Technology
We are committed to incorporating the latest evidence-based radiation treatment technologies into your care. Many of our doctors are international leaders on the advancement of these technologies to improve your treatment outcomes. Our specially trained board-certified radiation oncologists are skilled in a wide range of standard and emerging treatments including:
3D Conformal Radiotherapy
The goal of three-dimensional conformal radiotherapy (3D-CRT) is to deliver a dose that conforms to the shape of the tumors, while sparing surrounding healthy tissue. This approach uses 3D images in the treatment planning process and is (often more precise) than conventional radiotherapy. With this approach, CT and/or MRI images are used to define the areas of treatment and to distinguish the tumor from normal structures. With this data, the physician can develop a complex treatment plans that delivers most concentrated dose of radiation within the confines of the tumor. 3D-CRT is used to treat tumors that in the past might have been considered too close to vital organs and structures for radiation therapy.
4D CT Treatment Planning and Delivery
The explicit inclusion of the temporal changes in anatomy during imaging, planning and delivery of radiotherapy. Completing 4D CT Imaging is the acquisition of a sequence of cat scan imaging over consecutive phases of a breathing cycle, i.e. inspiration, expiration, normal breathing. This imaging technique allows for the physics team to complete a 4D Treatment plan designing treatment on CT image sets obtained for each phase of the breathing cycle. Utilizing the 4D Treatment plan allows the therapy team to deliver the radiation dose throughout the breathing cycle.
Adaptive Radiation Therapy (ART) and Advanced Imaging
Adaptive Radiation Therapy (ART) allows physicians to continually modify a patient’s treatment plan based on new measurements of tumor size or the tumor cavity, and any relevant changes in the patient’s own anatomy. Because adaptive radiation therapy systematically monitors these and other important variables, our experts can make significant adjustments in the field of treatment, and in dosage of radiation given, early on. This approach allows us to customize the therapy to the individual patient, and target radiation therapy with greater accuracy and precision.
Brachytherapy is a radiation therapy modality that allows the escalation of radiation dose while sparing normal tissues. Increased radiation dose has been shown in many situations to provide improved results by improving local tumor control. Brachytherapy involves the placement of radioactive sources ("seeds" or wires) either in tumors (interstitial implants) or near tumors (intracavitary therapy and mold therapy). The radiation is emitted outward, unlike external beam radiotherapy, where radiation must transverse normal tissue in order to reach the tumor. The word "brachytherapy" means "short therapy", appropriately implying that the radiation is limited to short distances. This results in decreased toxicity and/or allows the escalation of radiation dose. Brachytherapy can be used intraoperatively in situations where surgery is not possible or not optimal or in situations where prior dose-limiting external radiotherapy has already been given. Combined approaches of surgery and brachytherapy can often improve the results of surgery alone in a variety of malignancies.
At Columbia University Irving Medical Center, brachytherapy has successfully been used to treat a variety of tumors, including tumors of the cervix, esophagus, biliary tract, pancreas, head and neck, soft tissue sarcomas, and prostate cancer. Efforts are currently under way to optimize the use of brachytherapy by altering dose rate and fractionation. High dose rate, low dose rate, and pulsed dose rate techniques are being explored. Novel approaches combining chemotherapy with external beam radiotherapy and brachytherapy may improve the results in treatment of a variety of tumors.
Endobronchial brachytherapy is an innovative form of radiation therapy that uses high-dose rate (HDR) brachytherapy to destroy tumors in the lungs or throat, via the bronchial tubes.
Radiation can also be delivered with lose dose rate (LDR) or high dose rate (HDR ulitizing a vaginal cylinder applicator or with the tandem and ovoids applicator. You and your doctor will determine which type of radiation and applicator are right for you.
Radioactive seed implantation is when tiny radioactive particles no larger than a grain of rice are implanted directly into the treatment cavity. These seeds are implanted directly into, or in very close proxcimity, to the tumor which allows them to deliver high doses of radiation to the tumor without affecting the normal healthy tissues around it.
Intraoperative Radiation Therapy (IORT) delivers a single highly target dose of radiation directly to the lumpectomy cavity during breast surgery---immediately after a tumor is removed. Focusing the radiation in that cavity rather than applying radiation to the whole breast is as effective as whole breast radiation, according to research comparing the two methods. Watch NBC and ABC news reports on this innovative therapy here and here.
Plaque brachytherapy is the most widely used treatment for choroidal melanoma and delivers a highly concentrated radiation dose to the tumor (with relatively less radiation to surrounding healthy tissues). The radioactive plaque can also be called a “radiation implant” or “radioactive source.”
Working with the Interventional Radiologist Y-90 utilizes thousands of radioactive beads injected directly safely into the arteries that supply blood to the tumor. These radioactive beads are made of either plastic or glass known as either Theraspheres or SIR-Spheres.
CT Simulation and Treatment Planning
The majority of Radiation Oncology patients have at least one simulation procedure prior to initiating a course of radiation therapy. At NewYork-Presbyterian we use a specialized type of Computerized Tomography (CT) scanner called a CT Simulator. This piece of equipment produces 3-D images of each patient's internal anatomy which helps our doctors to precisely locate the region of interest as well as the surrounding critical structures. Highly accurate measuring devices are then employed to record the treatment site in relation to external markers. This critical first step is important in defining the area to be treated, as well as the fashioning of any necessary immobilization devices to assure that the patient is in the same position each day throughout the entire course of treatment.
A novel imaging technology called CTVision helps to reduce radiation to critical body structures. The CT scanner pivots around the patient, taking a series of pictures that pinpoint the exact location to receive radiation therapy. This technique is also called “CT on Rails.” This approach results in more precise positioning of the patient and the ability for more precise targeting of the tumor. This is one of many new techniques that allow physicians to reduce the amount of radiation delivered during therapy.
Deep Breath Hold Radiation
Deep breath hold radiation is used to minimize breast radiation exposure to the heart and lungs.
Ethos™ Adaptive Radiation Linear Accelerator
Ethos™ Adaptive Radiation Linear Accelerator leverages artificial intelligence to provide adaptive radiation treatments in less than 30 minutes per treatment for cancers of the anus, bladder, cervix, head and neck, endometrium, esophagus, pancreas, prostate and rectum. NewYork-Presbyterian/Columbia is the only site in New York City to offer this therapy and has the second busiest program in the country.
External Beam Radiation Therapy
External Beam Radiation Therapy involves a series of daily outpatient treatments to accurately deliver radiation to the breast. Painless radiation treatments are delivered in a series of daily sessions. Each treatment will last less than 30 minutes, Monday through Friday, for five to seven weeks. The usual course of radiation treats only the breast, although treatment of the lymph nodes around the collarbone or the underarm area is sometimes needed.
Focused Ultrasound Trials
Columbia University Irving Medical Center offers focused ultrasound trials for pediatric and adult brain cancers.
Gamma Knife® Icon™ Stereotactic Radiosurgery
The Gamma Knife is a safe, non-invasive device for treating deep–seated brain tumors and Arteriovenous Malformations (AVM's). With this emerging technology, many conditions, including those that were once considered inoperable, can now be treated without the need for an incision and with little or no pain. The Gamma Knife targets multiple areas of the brain simultaneously without the need for a head frame. This treatment was first available at NewYork-Presbyterian/Columbia and is now offered at both cancer centers.
The Gamma Knife is not a knife as its name implies. It is a highly sophisticated system that delivers up to 201 beams of gamma radiation, with pinpoint accuracy, to an abnormality within the brain. When concentrated, the rays provide enough radiation to treat the diseased area effectively. Yet the low intensity of each single beam ensures the safety of the surrounding healthy brain tissue.
On the day of treatment, the patient is fitted into a metal frame, called a stereotactic headframe. Open on all sides, it allows physicians to precisely target the abnormality throughout the several procedures. First patient’s brain is screened with images taken with by MRI (Magnetic Resonance Imaging), a CT scan or angiogram. This determines the size and position of the tumor or AVM.
Once the imaging studies are completed, physicians use a computer program to help plan the course of treatment.
The target area of the brain and the appropriate radiation dosage are quickly established. Now ready for the Gamma Knife, the patient lies down. The head frame is now positioned inside a large metal helmet, called a collimator. Next, the patient slides into the Gamma Knife's sphere, which contains the source of radiation. The collimator then directs radiation to the pre-determined points in the patient's brain.
Treatment usually consists of a series of exposures, each lasting approximately 10 minutes. Patients experience little or no discomfort, and most are able to to home the day of the procedure.
Gamma Knife Benefits
With the Gamma Knife, post-treatment complications are greatly reduced when compared to open surgery (or other types of radiation?). Further, areas of the brain for which other therapies are ineffective can be successfully treated. The Gamma Knife's precision and safety make it a highly appropriate choice for both pediatric and adult patients.
The range of diseases effectively treated by the Gamma Knife includes:
Vascular lesions such as arteriovenous malformations (AVMs)
Glial and astrocytic tumors
Skull base tumors
Other benign and malignant tumors
The use of the Gamma Knife continues to expand, as a result of ongoing research and development.
Hypofractionated Radiation Therapy
Hypofractionated radiation therapy is a revolutionary breakthrough. This technique reduces treatment time, delivering faster, shorter courses of therapy and is available for many cancers such as breast, prostate and rectal.
Image Guided Radiation Therapy (IGRT)
Image Guided Radiation Therapy (IGRT) allows physicians to take a series of images during radiation treatment. These images can help improve the accuracy of radiation therapy in selected patients.
Tumors that move during the breathing cycle, such as those within the lung or liver, can present a challenge for conventional radiation treatment–as moving targets, they are harder to "hit" with a focused beam of radiation. In order to properly treat these tumors, a wider field must be targeted.
Respiratory gating is a technology that allows the radiation oncologist to monitor the patient's breathing pattern during the treatment. The radiation bean can then be turned on only during a specific segment of the breathing cycle. With this approach, the effects of respiratory motion can be significantly reduced, or even eliminated. This allows for more accurate targeting of the tumor, and may also reduce the amount of radiation received by the surrounding healthy tissue.
IGRT combines traditional radiation treatment with a simultaneous CT scan to allow for greater precision and accuracy when targeting and treating tumors. IGRT is the process of frequent two and three-dimensional imaging, during a course of radiation treatment, to ensure that the treatment volume is being accurately targeted. Three-dimensional IGRT fuses a cone-beam computed tomography (CBCT) dataset with the computed tomography (CT) dataset from planning. Two-dimensional IGRT matches planar kilovoltage (kV) radiographs fluoroscopy or megavoltage (MV) images with digital reconstructed radiographs (DRRs) from the planning CT. The images are taken after the patient is set up for treatment. Once the image is acquired it automatically fuses with the planning CT (for 3D IGRT) or the DRRs obtained from the planning CT (for 2D IGRT). Upon fusion of the two images the therapist is able to visualize whether or not the treatment volume is off target from the planned target and make the necessary adjustments to ensure accurate treatment.
Intensity-Modulated Radiation Therapy (IMRT)
Intensity-modulated radiation therapy (IMRT) is an advanced form of three-dimensional conformal radiotherapy (3DCRT). In addition to using multiple shaped portals from which the radiation beams emanate, the intensity of the beams within each portal is spatially modulated using sophisticated software and hardware. This enables an optimized dose distribution to be delivered to the three-dimensional tumor volume while maintaining constraints of avoiding close or overlapping normal structures. IMRT is often used for the treatment of tumors that are in close proximity to normal organs that are more sensitive to radiation. For example, IMRT is often used in the treatment of prostate cancer to achieve high tumor control with significantly reduced rectal toxicity.
IMRT is an advanced mode of high-precision radiotherapy that allows for the radiation dose to conform more precisely to the three-dimensional (3-D) shape of the tumor by controlling the intensity of the radiation beam in multiple small volumes. IMRT also allows higher radiation doses to be focused to regions within the tumor while minimizing the dose to surrounding normal critical structures.
IMRT uses the same linear accelerator as conventional therapy but involves dynamic multi-leaf collimators that use movable "leaves" to conform the radiation beam to the shape of the tumor from multiple directions. IMRT greatly enhances the ability of our doctors to tailor the radiation dose to each patient's individual anatomy.
Intraoperative Radiation Therapy (IORT)
Intraoperative Radiation Therapy (IORT) is radiation therapy that is administered during surgery directly in the operating room. It delivers a single highly target dose of radiation immediately after a tumor is removed. This procedure is performed at NewYork-Presbyterian/Columbia for cancers of the eye, breast, abdomen and pelvis.
Linear Accelerator-Based Stereotactic Radiosurgery
Provides radiation in the form of a single highly focused beam applied in multiple sweeps around the brain lesion, and is suitable for larger tumors. This method also permits multiple smaller-dose, or fractionated radiotherapy, which offers advantages for some patients.
MRI-Guided External Beam and Brachytherapy
MRI-guided external bean and brachytherapy is used to treat gynecologic and other types of cancers.
MRI-LINAC (Magnetic Resonance Imaging-Guided Linear Accelerator)
MRI-LINAC (Magnetic Resonance Imaging-Guided Linear Accelerator) uses MRI and radiotherapy to provide more targeted radiation over five treatments or less. NewYork-Presbyterian/Weill Cornell was the first in the Northeast and the fourth in the world to offer this therapy and has the second busiest MRI-LINAC program in the country.
Multiple Radiation Immunotherapy Trials
Partial Breast Irradiation
Doctors are studying ways to deliver radiation to only the affected portion the breast. Available in a few clinics for a very select group of patients, these techniques are used after a lumpectomy to deliver radiation to the tumor site rather than the entire breast.
Breast brachytherapy involves placing flexible plastic tubes called catheters or a balloon into the breast. Over one to five days, the catheters or the balloon are connected to a brachytherapy machine so high doses of radiation can treat the nearby breast tissue.
Other partial breast treatments include 3-D conformal Irradiation and Intra-operative Radiation Therapy (IORT) delivered in the course of surgery (lumpectomy).
Mammosite-Accelerated Partial Breast Irradiation (APBI) using Brachytherapy
Partial breast brachtherapy is a breast conserving therapy that has become a major treatment modality for stage I and II breast carcinoma for patients who have undergone a lumpectomy. The Department of Radiation Oncology offers a partial breast treatment technique sometimes referred to as MammoSite Breast Brachytherapy. Treatment of breast cancer with Mammosite usually involves a five-day treatment course (2 times a day) with each treatment taking about 15 minutes each. After the breast cancer is removed, a small, soft balloon attached to a thin catheter is placed inside the lumpectomy cavity. The balloon is filled with saline solution and remains in place during the five-day treatment. During the twice-per-day treatments, the catheter is attached to a computer-controlled HDR Brachytherapy unit which inserts the radioactive sources according to the treatment plan. APBI is delivered directly to the cavity from which the breast cancer was removed rather than to the entire breast, which allows for a much higher daily dose compared to that used during the standard whole breast radiation therapy and often yields excellent cosmetic results. At the end of the five days, the treatment is complete and the catheter is removed.
Contura Balloon for Brachytherapy
A new procedure with regards to breast conservatory therapy is the Contura system. The Contura system differs from a typical MammoSite treatment in that the balloon contains five separate tubes within. The addition of these tubes helps your doctor shape the dose away from the skin or chest wall. The balloon also uses a vacuum to remove excess fluid and adhere closely to the lumpectomy cavity. Due to the conformity of the balloon within the lumpectomy site, the radiation is administered only where it is needed, sparing exposure to normal breast tissue. The Contura balloon is usually used in conjunction with a lumpectomy but not all lumpectomy patients are candidates for this system. Alternately, patients who do not fit the criteria for traditional MammoSite balloon therapy may be given the option to receive treatment using the Contura system.
Prone Radiation Therapy
Prone radiation therapy is used to minimize breast radiation exposure to the heart and lungs.
Prostate Seed Implants
Radioactive seeds are sometimes placed in diseased tissue on an outpatient basis or during an operation. They may be used to keep the radiation dose focused on a specific organ or they may be placed in areas where it is difficult or impossible to assure complete surgical removal of all the diseased tissue during an operation. One type of low dose rate brachytherapy is a prostate seed implant or PSI. During this intraoperative procedure, radioactive seeds are placed within the prostate gland to treat prostate cancer. This is one of the most effective options for many men whose cancer is in an early stage. Seeds are placed using ultrasound guided implantation techniques and deliver a dose of radiation to the prostate gland, with real time dose optimization, while sparing the normal surrounding tissues. These tiny seeds contain a radioactive material, such as Iodine-125, Palladium-103 or Cesium-131 and are permanently implanted in the prostate gland where they give off low-level radiation for weeks or months and then become inert.
Radioactive eyeplaques are an innovative treatment for melanoma.
Stereotactic Body Radiotherapy (SBRT)
Precise delivery of radiation to a tumor while sparing normal surrounding tissues. This technique achieves a higher dose than what could be given with conventional techniques.
Both SRS and SBRT can be used to treat pediatric cancers, as well as those that occur in adults.
Stereotactic Radiosurgery (SRS)
Stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT). Stereotactic radiosurgery are new procedures that allow physicians to deliver high doses of radiation to the tumor site while sparing healthy issues.
SRS is not an actual surgery—it is the ability to deliver radiation to the target site from a variety of different angles, based on 3D imaging. In some cases,image-guided radiation therapy (IGRT) may be used to pinpoint the location of the tumor before and/or during the radiation treatment.
The advantages over conventional radiation therapy are as follows. SRS can nr used to treat extremely small tumors or those located in hard-to-reach places. The treatment time is significantly shorter. And while the therapy can often be completed in a single day, radiation oncologist may recommend multiple treatments, depending upon the size of the tumor.
Stereotactic radiosurgery is generally used to treat brain and spinal cancers.
Stereotactic body radiation therapy (SBRT) offers the same benefits as stereotactic radiosurgery and is used to treat a wide variety of cancers.
Total Body Electrons (TBE)
Total Body Electrons (TBE) are used to treat mycosis fungoides, a type of skin lymphoma.
Total Body Irradiation (TBI)
Total body irradiation (TBI) is used at Columbia University Medical Center as part of the conditioning regimen prior to allogeneic (from a matched donor) bone marrow transplantation for leukemias and lymphomas.
Often allogeneic stem cells (ie.) are used for the reconstitution of the immune system after high-dose therapy. Allogeneic cells (from a brother/sister or from an unrelated HLA-matched donor) provide a therapeutic benefit since their immune function plays a role in fighting the patient’s cancer. Total body irradiation aids in the acceptance, of these foreign immune cells.
Better supportive care, refinements and improvements in total body irradiation technique and chemotherapy regimens, and new insights into immune cell therapeutics, all contribute to the more effective management of these patients.
Total Lymphnoid (Nodal) Irradition (TLI)
Total Lymphnoid (Nodal) Irradition (TLI) is a treatment for transplant rejection.
Volumetric Arc Therapy (VMAT) - RapidArc
Volumetric Arc Therapy (VMAT) or RapidArc is the most advanced form of Intensity modulated radiotherapy (IMRT) which allows for precise delivery of the radiation beam in a 360-degree rotation of the grantry. VMAT allows for treatment times from 2 minutes up to 10 minutes; much better than conventional IMRT treatment plans that allow for multiple treatment fields in which the gantry stops multiple times delivering separate radiation beams. VMAT utilizes special software and an advanced linear accelerator to deliver these treatments daily. This treatment is more comfortable for patients because they spend less time in their designed treatment positions. This allows patients to be able to have access to daily radiation treatment and be back to their normal routine in a quick amount of time.