A National Cancer Institute-designated Comprehensive Cancer Center

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Radiation Oncology

Department of Radiation Oncology
Radiation oncology is one of the three main oncology specialties involved in the successful treatment of cancer. This specialty provides expert opinion on whether radiation therapy will be useful for your cancer and how best to safely and effectively deliver it. Radiation therapy has been used to treat cancer for nearly 100 years, and today it is an important part of every cancer patients care. Patients with cancers of the prostate, breast, lung, brain, skin, cervix, head and neck, and many other sites have been successfully treated with radiation therapy alone or in combination with surgery or chemotherapy.
 
Whether radiation therapy is right for you can only be determined by a radiation oncologist. A radiation oncologist is a doctor who has gone through specialized education and training on the appropriate and safe use of radiation therapy.
 
Cancer care is complex. To insure the highest chance of success, every appropriate form of therapy needs to be considered. Your cancer care is not complete unless you ask your doctor for an opinion from a radiation oncologist.
 

Letter from Department Chair

Welcome to City of Hope's Department of Radiation Oncology. Our highly experienced treatment team is dedicated to providing state-of-the-art therapy in a setting that is supportive and compassionate. Treatment is provided in a caring and professional environment by staff who are dedicated to making your visit as informative and stress-free as possible.
 
Using leading edge technology, we offer specialized services in external beam radiation therapy,radioactive seed implantationfor prostate cancer, stereotactic radiosurger yand image guided intensity modulated radiation therapy. We also offer novel approaches to cancer therapy, such as radioimmunotherapy and helical tomotherapy. Through innovative laboratory and clinical research programs, we continue to investigate ways to further advance the efficacy and safety of radiation therapy. In addition to our clinical research efforts, we offer aResidency Program in Radiation Oncologyas well as anEducational Program in Radiation Therapy Technology.
 
As with the entire staff at City of Hope, our mission is to provide you with a setting that is therapeutic to your entire person - "Body, Mind, and Spirit". I would like to invite you to learn more about us and what we have to offer. Thank you for visiting us.
 
Sincerely,
 
Jeffrey Wong, M.D.

 

 

 

Specialty Treatment Programs

Helical TomoTherapy
In October 2004, City of Hope became the first facility in the Western U.S. to offer radiation therapy treatment using the TomoTherapy HI-ART SystemÆ. The system combines the advances in Intensity Modulated Radiation Therapy (IMRT), 3D medical imaging, and computer control that have been instrumental in improving cancer treatment.
 
Current treatment requires two separate apparatus - one images the target, the other delivers the radiation. With helical TomoTherapy, the computed tomography (CT) scanner is married to the radiation source, all in one system, thereby increasing the precision of the treatment. As the patient lies on a treatment couch, the device rotates continuously around him or her. Its radiation beam turns on and off rapidly, splitting into hundreds of tiny beamlets that deliver precise amounts of energy to the tumor.
 
Helical tomotherapy improves the treatment of tumors adjacent to sensitive organs such as the lungs, where it is difficult to target tumors without affecting the healthy tissue around them. It is also useful in treating prostate cancer, where limiting radiation to the adjacent rectum and bladder is critical.
 
Importantly for patients who will be treated with a bone marrow transplantation, physicians will evaluate the potential of helical tomotherapy to specifically irradiate just the bone marrow, while sparing normal tissues.
 
Downloadable TomoTherapy fact sheets (.pdf):
 
Image Guided Radiation Therapy
The latest radiation therapy techniques, such as intensity modulated radiation therapy (IMRT), are based on sparing the maximum healthy tissue from inadvertent irradiation. In order for this to be accomplished, treatment margins around the tumor are minimized, thus precision and accuracy of targeting are critical to success.
 
However, due to the uncontrolled movement of internal organs or structures and the uncertainties remaining in repeating and maintaining the set-up of the patient, delivering the planned treatment accurately to the target is a significant challenge. This could result in a geographical miss of the target organ, or over-treatment of critical structures.
 
Image Guided Radiation Therapy (IGRT) provides radiation oncologists with the tools to see the tumor better, track its movement and stay on target. TomoTherapy, as the next generation of IMRT treatment, which incorporates advance sparing of normal structures, with image based targeting, has virtually replaced standard IMRT at City of Hope.
 
Three Dimensional Conformal Therapy
3-D conformal therapy is based on the three dimensional treatment planning from reconstructed CT or MRI data. This data provides the treatment planning system with the necessary information regarding the tumor volume, as well as normal structures. The major advantage of conformal radiation therapy is the ability to precisely shape high dose regions of radiation to the tumor or target volume, while at the same time sparing the normal tissue.
 
Total Body Irradiation
City of Hope was a pioneer in the development of bone marrow transplantation (BMT) and was one of the first medical centers in the nation to perform this procedure. City of Hope physicians continue to be on the cutting edge of this revolutionary technique used to treat leukemia, lymphoma, Hodgkin's disease and other types of cancers that have not responded to traditional therapies. An important part of bone marrow transplantation is Total Body Irradiation Therapy, a procedure that is used to irradiate the entire body of the patient. This form of radiation - done in conjunction with high dose chemotherapy - purges the patient's bone marrow, which subsequently is replaced with new donated bone marrow that no longer contains cancer cells. The donated marrow may be from a matched donor (allogeneic) or marrow from the patient (autologous).
 
Total Marrow Irradiation
In June  2005, City of Hope performed the first total marrow irradiation procedure in the world using TomoTherapy technology. Since then, the total marrow irradiation program has been expanded and has become available in a number of clinical trials.
 
For years, radiation oncologists have treated blood and bone marrow cancers with total body irradiation, and solid tumors with broad radiation beams. During this process, it is difficult to keep radiation from damaging organs in surrounding areas. TomoTherapy technology, with its tiny radiation beamlets, targets tumors more precisely. City of Hope can now deliver radiation to the entire marrow compartment where the cancer cells reside, in a precisely focused manner. This total marrow irradiation potentially improves treatment while reducing recovery time and side effects.
 
Stereotactic Radiosurgery and Stereotactic Radiotherapy
Stereotactic Radiosurgery and Stereotactic Radiotherapy are forms of highly focused external beam radiation therapy used to treat small tumors such as those in the head and brain. These treatment procedures demand the participation of a multi-disciplinary oncology treatment team, consisting of the radiation oncologist, neurosurgeon, neuro-oncologist, medical physicist and radiation therapist.
 
Some of the clinical indications for this therapy include:
  • Brain metastases
  • Gliomas
  • Acoustic neuromas
  • Meningiomas
  • Pituitary adenomas
  • Pediatric brain tumors
  • Low grade astrocytomas
 
Stereotactic Radiosurgery is a procedure that gives a focused single dose of radiation to a small target area with pin-point accuracy. Stereotactic Radiotherapy refers to similarly precise therapy given with smaller doses over a period of time. Patient treatments are generally completed in less than an hour. Patient comfort and stabilization is achieved with the use of either a frameless or rigid frame immobilization technique, which provide millimeter accuracy.
 

Arcadia Radiation Oncology

 
To make an appointment or for more information, please contact us at 626-574-3657.
 
City of Hope Radiation Oncology – Arcadia
301 W. Huntington Drive, Arcadia
 
City of Hope is now providing radiation oncology services in Arcadia (at the previous Arcadia Methodist Hospital site).   
 
Working closely with Arcadia Methodist, one of Southern California’s premier hospitals, City of Hope expands its ability to provide care to patients in the community.  City of Hope Radiation Oncology is committed to providing quality radiation therapy services.
 

Equipment

The Radiation Oncology Department has state-of-the-art equipment to perform the most advanced forms of radiotherapy. Our present equipment includes two TomoTherapy units, two linear accelerators, radiographic simulator, CT simulator, computerized treatment management system, and two treatment planning systems.With thisequipment, City of Hope can offer patients the therapy that is right forthem.
 
Helical TomoTherapy
In early 2004, City of Hope became the first in Southern California to offer radiation therapy treatment using the TomoTherapy HI-ARTÆ System. The system combines the advances in Intensity Modulated Radiation Therapy (IMRT), 3D medical imaging, and computer control that have been instrumental in improving cancer treatment.
 
Previously, treatment required two separate apparatusone visualizes the target, the other delivers the radiation. With helical tomotherapy, one unit houses both the computed tomography (CT) scanner and radiation source. The advanced, single helical tomotherapy unit thus systematically simplifies the radiation process, while providing more advanced, precise treatment technology.
 
CT Simulator- 3 Dimensional scanning
A CT simulator uses a CT scanner to localize the treatment fields on the basis of the patient's CT scan. A computer program automatically positions the patient couch and the laser cross hairs to define the tumor, normal organs and the treatment fields. This same program provides automatic outlining of external contours and critical structures, with interactive treatment field display and placement, display of dose distribution, and review of multiple treatment plans.
 
 
With the complexity of advanced treatment, computerized monitoring is required to provide the additional verification and documentation of all treatment deliveries. This computerized verification provides agreater level of treatment accuracy on a daily basis, while managing and documenting all aspects of radiation therapy care.
 
Treatment Planning System
This system offers 3-dimensional treatment planning for extrememly complex TomoTherapy-IGRT and Intensity Modulated Radiation Thearpy (IMRT).
 
Three Dimensional Treatment Planning System 
Treatment planning software has been commercially developed to meet the planning needs of the most complex radiotherapy arrangement. Currently, the most advanced diagnostic imaging studies, such as MRI and PET/CT can be incorporated into the treatment planning process. The fusion of these imaging studies provides radiation physicians and physicist with enhanced views of both cancerous and normal structures, for even greater targeting or sparing.
 
 

Radioimmunotherapy

The Department of Radiation Oncology is investigating a new type of radiation therapy that targets radiation to the tumor using monoclonal antibodies (MAbs). This form of therapy is called radioimmunotherapy (RIT).
 
The nationally-recognized, multidisciplinary RIT program began at City of Hope 16 years ago. Currently funded by a number of grants from the National Cancer Institute, researchers are investigating the use of MAbs -- genetically engineered molecules specifically designed to hone in on cancer cells. Active research efforts within theDepartment of Radiation Oncology focus on the use of radiolabeled MAbs as a method to target therapeutic amounts of radioisotope through the blood stream directly to the cancer cell.
 
RIT uses the radioactive metal to Yttrium-90, which delivers higher levels of local radiation to the tumor. The radiolabeled MAb is administered through a vein and then circulates through the body to the surface of tumor cells. The tumor cells are destroyed by the radiation given off from the localized radiolabeled MAbs.
 
Three different antibodies are being used in our current radiation oncology clinical trials. One binds carcinoembryonic antigen (CEA), a tumor antigen found in certain patients with breast, colon, lung, thyroid and ovarian cancers. The second antibody binds to CD20, an antigen found on the surface of certain lymphomas. The third antibody binds to HER2 (human epidermal growth factor receptor 2) which is overexpressed in approximately 25% of breast cancer patients.
 
Currently, ongoing clinical trials are investigating the potential utility of genetically engineered, high affinity, radiolabeled monoclonal antibodies to detect and treat disease in patients with colon, lung, breast, and thyroid,as well as leukemias and lymphomas. These trials are evaluating strategies to further improve the therapeutic index of this treatment modality through the addition of chemotherapy agents or through stem cell transplantation.
 
Radioimmunotherapy for Leukemias and Lymphomas
There has been significant progress made in the treatment of lymphomas and leukemias with radioimmunotherapy. These malignancies are sensitive to radiation and therefore are ideal targets for this form of therapy. Within the next few years, radioimmunotherapy will soon become part of the standard therapies offered to these patients. Investigators are actively evaluating the use of radioimmunotherapy in patients undergoing bone marrow transplantation, to determine whether this form of radiation can complement and/or replace traditional forms of radiation in these patients.
 
Radioimmunotherapy for Colon, Breast, Prostate Cancers and Other Malignancies
Finally, clinical trials are evaluating the ability of smaller molecular weight, faster clearing antibodies to detect and eventually treat colon, breast, and prostate cancer and other malignancies. These novel faster clearing antibodies are also being evaluated in the laboratory and in the clinic as tools to detect small deposits of tumors using PET imaging. PET is a powerful tool for cancer detection, often detecting tumors that are not detected by other imaging modalities. These agents will help physicians better diagnose and treat disease. In addition, the radiation oncologist using IMRT, CT treatment planning and image fusion technology, will be better able to focus the high dose region to areas of active disease within the tumor.
 
Multidisciplinary Approach
The Radioimmunotherapy Program is a multidisciplinary effort involving basic and clinical scientists. In addition to Radiation Oncology, other collaborating specialties at City of Hope include:
 
 
This collaborative effort is made possible by the unique research environment that City of Hope provides.
 

Helical TomoTherapy

The TomoTherapy HI-ART System® represents the next generation of cutting edge radiation therapy technology and provides City of Hope oncologists with unprecedented ability to deliver radiation therapy with surgical precision. This means more effective treatment to the tumor, with reduced dose to normal organs, resulting in significantly reduced side effects. The TomoTherapy system has broad applicability to many forms of cancer, including cancers of the prostate, lung, brain, head and neck, bone and soft tissue, as well as lymphomas, multiple myeloma and some leukemias.

How It Works

TomoTherapy essentially is a marriage of two types of technology:
 

  • Spiral CT Scanning
  • Intensity Modulated Radiation Therapy
     

As with a CT scanner, the patient moves through the unit, but instead of a regular x-ray a special therapy x-ray spirally rotates around the patient.


Video: TomoTherapy rotates around the patient

Older methods of radiation therapy attempt to treat a tumor by focusing relatively large beams of radiation from two to six different directions. The TomoTherapy system instead uses hundreds of pencil beams of radiation spirally rotating around the tumor, focusing in from all directions. This video (right) shows the pencil beam patterns produced by TomoTherapy.

 

Using these dynamically rotating beamlets, each varying in intensity, oncologists can now deliver radiation with unprecedented precision. The high dose region of radiation can now be shaped or sculpted to fit the exact shape of each patient's tumor. This means a more effective and potentially curative dose to the cancer, with reduced damage to normal tissues and fewer complications. Like an artist, the oncologist is now "painting" radiation with a finer brush, rather than with a wide brush used just a few years ago. He/she is able to paint the tumor with greater precision and keep that paint within the borders of the tumor.


 

 

 

 

 

 

 

 

 

 

 

 

 

 

The illustration at left demonstrates the ability of TomoTherapy to deliver a high dose of radiation to a patient with prostate cancer. The high dose region outlined in red, wraps tightly around the prostate gland with very little radiation hitting the rectum or bladder. In contrast, with previous conventional technology the high dose region would usually include portions of the rectum and bladder.


For some tumor sites, such as cancers of the prostate gland, there can be movement of the gland from day to day due to differences in patient position, and rectum or bladder filling. TomoTherapy is one of the first radiation therapy systems of its kind to incorporate not only radiation therapy, but also tumor imaging capabilities comparable to a diagnostic CT scan. As shown in the accompanying video, TomoTherapy can therefore adjust for day to day changes of the patient's position and internal motion of the target, essentially giving it the ability to remain "locked" on the tumor, to further improve the precision of treatment delivery.

 


 

With the ability to see and treat each patient’s cancer with greater precision, the TomoTherapy system offers new hope for patients with many forms of cancer. As the first cancer center in the Western U.S. to offer TomoTherapy and the world’s first facility to perform total marrow irradiation using TomoTherapy, City of Hope oncologists can use this new technology to treat patients with prostate and lung cancer, as well as medulloblastoma, multiple myeloma and lymphomas.

 

 

 

 



 

Radiation Oncology Team

Support This Program

It takes the help of a lot of caring people to make hope a reality for our patients. City of Hope was founded by individuals' philanthropic efforts 100 years ago. Their efforts − and those of our supporters today − have built the foundation for the care we provide and the research we conduct. It enables us to strive for new breakthroughs and better therapies − helping more people enjoy longer, better lives.

For more information on supporting this specific program, please contact us below.

Joe Komsky
Senior Director
Phone: 213-241-7293
Email: jkomsky@coh.org

 
 
Radiation Oncology Treatments
 
Watch:   Jeffrey Wong, M.D., chair of the Department of Radiation Oncology describes the innovative treatment and technology options for cancer patients.
City of Hope provides academic instruction for physicians in our Radiation Oncology Residency Program - a four-year Accreditation Council for Graduate Medical Education accredited. The overall goal of the program is to train physicians to be outstanding radiation oncologists and to provide graduates with a solid foundation in translational and clinical research.
 
This program is designed to offer a full curriculum that incorporates both didactic and clinical elements that are reflective of contemporary practice in radiation therapy today.
 
City of Hope is committed to making the process of becoming a patient here as easy as possible. Call 800-826-HOPE (4673) or complete the Schedule a Callback form.
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