Cancers Treated at Southwest Oncology Centers

Prostate Cancer

Prostate cancer is one of the more-common cancers in men. By identifying a rising PSA level, an abnormal growth of prostate-cancer cells may be detected at an early stage, when the disease is still limited to the prostate gland. When not detected early, however, the disease can invade nearby tissues or spread to other parts of the body. At an early stage, prostate cancer can be curable by implanted brachytherapy treatment alone (as detailed elsewhere in this website). Both early stage and more-advanced prostate cancers can also be treated successfully by using our Tomotherapy equipment. This is a refined system of intensity modulated radiation therapy (IMRT), designed to deliver radiation precisely to the target volume while sparing the adjacent normal tissues.

Breast Cancer

Breast cancer is a common cancer in women, and rarely occurs in men. Early breast cancer can be treated with “breast conservation therapy,” involving limited removal of the tumor, sampling of the sentinel lymph nodes, and irradiation of the whole breast (with or without chemotherapy, depending upon other factors). Tomotherapy produces a very uniform radiation dose throughout the breast, minimizing “hot spots” which may be associated with bothersome skin reactions.

“Partial breast irradiation” appears to be as effective as whole-breast irradiation in lower-risk women, requiring only one week of treatment rather than the more-typical 6 weeks. More advanced or recurrent breast cancers may also be suitable for Tomotherapy, since treatment with its single continuous field avoids the “hot spots” that may result from adjacent fields overlapping — as may occur with conventional irradiation. Tomotherapy is also very efficient at minimizing the dose and damage to adjacent heart and lung tissue.

Colorectal Cancer

Cancer of the colon and rectum is very common. Although early-stage tumors can often be treated with surgical removal, larger tumors or cancers in the lower rectum require other treatments to achieve a successful outcome or to prevent the need for a permanent colostomy.  Pre-operative irradiation for 5 to 6 weeks (with or without chemotherapy, depending on other factors) is often required to prepare larger tumors for adequate surgery. Concurrent chemo-irradiation has now become the standard curative approach for cancers in the lower rectum or anal canal, with that approach often preventing the need to proceed with colostomy placement. Tomotherapy permits reduction of dose to the small intestines, while delivering treatment to the colorectal tumor and its draining lymph nodes — thereby reducing the risks of long-term bowel problems and of post-surgical complications.

Colorectal cancer can metastasize to the liver, sometimes as the only site of distant spread. As the liver tissue is quite sensitive to irradiation, in the past it has been difficult to irradiate liver metastases without causing severe side effects. Tomotherapy, however, now provides the chance to treat limited portions of the liver with high accuracy, while sparing the rest of this vital organ.

Lung Cancer

Lung cancer is the most common fatal cancer in the U.S. When possible, lung cancers are removed by surgery, often to be followed by 6 to 7 weeks of irradiation and/or chemotherapy, depending upon the findings at surgery. However, some lung cancers present with a size and degree of anatomical spread to lymph nodes, as seen by PET (positron emission tomography) scanning, that makes surgical resection impossible. And some patients have medical issues, such as cardio-pulmonary disease or diabetes, which may make thoracic surgery too dangerous to consider. Tomotherapy is an excellent technique for treating such tumors to high dose, while minimizing damage to adjacent lung or heart tissues.

For earlier-stage lung cancers in medically inoperable patients, tightly localized irradiation with Tomotherapy appears to be almost as effective as surgical resection. Such therapy is much gentler for medically frail patients, requiring only one week of treatment rather than the more-typical 6 to 7 weeks.

Some lung cancer patients have a type of tumor called Small Cell Lung Cancer (SCLC). When this cancer is detected at an early stage with a smaller size, it may be preferable to give radiation treatments twice daily (separated by 6 hours) to deliver 30 fractions of radiation over 15 treatment days. When the tumor volume is larger or intertwined with more sensitive structures, it may be safer to treat just once daily over a period of 6 weeks. Oftentimes, chemotherapy is recommended to be given in conjunction with the irradiation, given the propensity of SCLC to spread to other parts of the body. Metastasis to the brain is so common with SCLC, however, that 10 fractions of prophylactic brain irradiation is typically recommended to follow the conclusion of the chest treatment, even when the patient’s brain MRI scan does not show visible evidence of lesions.

Head and Neck Cancer

While some cancers of the throat, mouth, voice box, nose and sinuses can be treated with limited surgery, irradiation treatment typically is the primary treatment (with or without chemotherapy, depending on other factors). Traditional irradiation courses, and even standard IMRT techniques, however, often cause severe side effects. These include significant loss of weight, and worsening of salivary production, taste, dental integrity, appetite and vocal quality. As the spatial accuracy of Tomotherapy dose delivery can often better protect the salivary glands, vocal apparatus and dentition even better than standard IMRT, we believe that both acute and long-term side effects will be reduced with this technique, without lessening the degree of treatment success.

Brain Tumours

Brain tumors can be benign, or they may have various degrees of aggressive malignancy. Complete surgical removal of these tumors is often unsafe, due to their being adjacent to or intertwined with critical brain structures. In such cases, a total resection with curative intent may cause permanent disability.

As radiation treatment is less injurious than surgery to the normal brain tissues, irradiation is commonly used to treat brain tumors. In accordance with the specific tumor type, and as to whether the tumor had originated within the brain or had spread there from a cancer elsewhere in the body, the recommended radiation treatment course will differ. Primary malignant brain tumors will generally receive 6 to 7 weeks of treatment. Benign or less aggressive tumors will receive somewhat briefer courses. When metastatic tumors have spread to the brain, a 2 to 3 week course is often recommended. Sometimes, a single high-dose session (stereotactic radiosurgery) may be advised for treatment of a single or limited number of small metastases. Because of its precise CT-image guidance system, Tomotherapy equipment can be used with great accuracy to treat this entire range of brain tumors.

Upper Gastrointestinal Cancer

Cancers arising in the upper gastrointestinal tract are quite serious. Tumors of the esophagus, stomach, gall bladder and pancreas may be fairly advanced at the time of detection, making curative surgery difficult or impossible. These cancers frequently require 5 to 6 weeks of radiation (with or without chemotherapy, depending on other factors), usually delivered after an attempt at surgery.

Radiation-sensitive organs are closely adjacent to these cancer sites. For the esophagus, the lungs and heart are in close proximity. For upper abdominal tumors, attention must be paid to the liver, kidneys and small intestine. And dose to the spinal cord must be kept within tolerance limits throughout its entire length. The high precision of Tomotherapy, however, can make possible the delivery of an optimal irradiation dose to these very challenging cancers, while keeping the dose exposure of sensitive, adjacent organs within their tolerance levels.

These cancers sometimes metastasize to the liver and/or lung. Although the liver and lung are both radiation-sensitive, it may be possible to use Tomotherapy to direct the tightly delivered irradiation to solitary metastatic lesions, while sparing the rest of these organs.

Gynecological Cancer

Women may develop cancers in any of their reproductive organs, including the vagina, ovary and uterus (cervix or endometrium). Early-stage cervical and endometrial cancers are usually highly curative. More advanced cancers of the uterus and vagina have a greater tendency to spread to lymph nodes in the pelvis and sometimes paraspinal region. Ovarian cancer can spread over a wider region of the pelvis.

These malignancies require 5 to 6 weeks of radiation treatment to encompass the primary disease site and the lymph nodes at risk, while sparing the small intestines as much as possible. Radioactive sources may be temporarily placed (brachytherapy technique) into the vagina, cervix, uterus or adjacent tissues, either during or following the external beam irradiation with Tomotherapy, to increase the total dose to the primary tumor site.

Ovarian cancer is often advanced at diagnosis, requiring radiation treatment in addition to surgery and chemotherapy. Broader-field irradiation can be used to treat diffusely scattered tumor sites in the abdomen and pelvis, with Tomotherapy technique able to boost the dose safely to sites of bulky disease.

Genitourinary Cancer

Cancers of the bladder, ureters and kidneys may require treatment with surgery, chemotherapy and/or irradiation. Tumors involving the inner surface of the bladder can often be cured by trans-urethral resection and instillation of chemotherapy within the bladder. However, tumors that have invaded into the bladder muscle are much more difficult to control. These more invasive cancers may require surgical removal of the entire bladder (radical cystectomy). Certain patients may also be treated with localized, high-dose irradiation (often, with chemotherapy) – where Tomotherapy treatment can be helpful in minimizing bowel dose and side effects.

Treatment of cancers of the ureter and kidney often require surgical resections and chemotherapy, with irradiation often playing a lesser role due to the sensitivity of the kidneys and the small bowels.

Besides prostate cancer (detailed elsewhere), another cancer unique to men is testicular cancer. Seminoma, the most common variety, is very sensitive to irradiation, with 95% success after about 3 weeks of irradiation to the pelvic and para-aortic lymph nodes on the side of the resected testicle. Given the length of the lymph node chain requiring irradiation, Tomotherapy is an excellent technique for minimizing the common side effects of nausea and diarrhea that may be caused by irritation of the gastrointestinal tract.

Connective-Tissues Cancer

Cancers of the bladder, ureters and kidneys may require treatment with surgery, chemotherapy and/or irradiation. Tumors involving the inner surface of the bladder can often be cured by trans-urethral resection and instillation of chemotherapy within the bladder. However, tumors that have invaded into the bladder muscle are much more difficult to control. These more invasive cancers may require surgical removal of the entire bladder (radical cystectomy). Certain patients may also be treated with localized, high-dose irradiation (often, with chemotherapy) – where Tomotherapy treatment can be helpful in minimizing bowel dose and side effects.

Treatment of cancers of the ureter and kidney often require surgical resections and chemotherapy, with irradiation often playing a lesser role due to the sensitivity of the kidneys and the small bowels.

Besides prostate cancer (detailed elsewhere), another cancer unique to men is testicular cancer. Seminoma, the most common variety, is very sensitive to irradiation, with 95% success after about 3 weeks of irradiation to the pelvic and para-aortic lymph nodes on the side of the resected testicle. Given the length of the lymph node chain requiring irradiation, Tomotherapy is an excellent technique for minimizing the common side effects of nausea and diarrhea that may be caused by irritation of the gastrointestinal tract.

Lymphoma

Cancers of the lymph nodes, such as Hodgkin’s Disease or non-Hodgkin’s Lymphoma can involve single or multiple lymph node regions, and occasionally other (extra-nodal) sites. For treatment of localized lymphomas, 3 to 4 weeks of irradiation alone often suffices for local control. When multiple anatomical sites are involved, irradiation is often used as supplementary treatment for bulky sites or to persistent disease following systemic chemotherapy. Tomotherapy can help limit radiation side effects to adjacent tissues, especially when treating lymphoma sites near vital structures or in the head and neck region or for extranodal sites such as the stomach.

Childhood Malignancies

Fortunately, cancer is rare in children. However, solid tumors (not leukemia) can often grow rapidly and to a large size before initial detection. Surgical removal is recommended, unless prohibited by excessive dangers or risk of disability. Many childhood cancers respond well to chemotherapy, though some will also require radiation treatment. However, radiation delivery is especially challenging in children, due to the radiation sensitivity of growing tissues.



Since Tomotherapy can precisely target such tumors, while sparing adjacent structures, it is possible to limit dosage to growing tissues while treating inoperable cancers to effective doses. It is even possible to treat the entire brain and spinal cord to effective doses – as is sometimes required for certain tumors – while sufficiently sparing the bones of the spine and head to permit relatively normal growth, and markedly sparing dose to the more-anterior regions of the chest, abdomen and pelvis. As the Tomotherapy beam rotates around the child like a CT scanner, all children can be treated comfortably lying on their backs, rather than lying face down with conventional irradiation or even with many IMRT techniques.

Skin Cancers

Skin cancer is the most common type of cancer in the United States. Basal cell and squamous cell skin carcinomas (and Bowen’s carcinoma in situ) are overwhelmingly the most common forms of skin cancer. If detected at an early stage, various treatment options are available with high likelihood of cure. While the great majority of skin cancers can be treated with surgical excision (Mohs procedures), a minority are of a more-advanced nature or may pose challenges for achieving an optimal medical or cosmetic outcome from surgery.

Tightly localized radiation treatment is an invaluable option for those skin cancers in surgically awkward locations, such as eyelids, nose, ears or lips, or which may be adjacent to tendons or other sensitive structures, and in sites of thin skin, such as the scalp or pretibial region. Irradiation treatment may also be recommended for those patients at greater risk for surgical excision, such as those with diabetes or requiring anti-coagulation therapy for cardiovascular conditions.

A small fraction of skin cancers are melanomas and far more dangerous. Treatment for melanoma typically requires surgical excision. Post-operative irradiation delivery is recommended for more-invasive tumors, using Tomotherapy delivery aimed at a larger tissue volume that often includes regional lymph nodes.

At Southwest Oncology Medical Centers, our dedicated physicians have worked closely with many dermatologists. We have long-term experience with electronic brachytherapy and with electron-beam and X-ray techniques for skin-cancer treatment This type of irradiation can also be offered as effective prophylaxis against the post-operative formation of bulky scar tissue in the skin of keloid-forming patients.

Skin Cancer Treatment with Irradiation

Our clinical facilities at Southwest Oncology Centers are fully dedicated to the personalized treatment of patients with non-melanoma skin cancers. We use superficially penetrating, low-energy irradiation to treat challenging lesions of the skin and the underlying subcutaneous tissues. We have achieved great success with these challenging cases (see Image Panels below).