Types of Cancer Treated

Radiation Oncology Treatment for Bladder Cancer

This is a treatment that uses high-energy rays (such as X-rays) to kill cancer cells. It is usually delivered from the outside of the body (external beam radiotherapy), and it is routinely performed as an outpatient treatment. External beam radiotherapy is usually given daily (each session lasting for approximately 20-25 minutes) daily for up to five to seven weeks.

External beam radiotherapy can also be given with weekly chemotherapy (low-dose) with the goal of enhancing the killing effects of the radiation. For selected patients with bladder cancer, radiation therapy can be used instead of surgery; however, it's much less effective than surgery. You need to discuss with your physician whether you are a candidate for external beam radiotherapy and its potential side effects.

Treatment Types

• Image Guided Radiation Therapy (IGRT)
• Intensity Modulated Radiation Therapy (IMRT)

Bladder Cancer Specialists

The following physicians at the Taussig Cancer Institute specialize in Bladder cancer.

• Kevin Stephans, MD
• Rahul Tendulkar, MD

Radiation Oncology Treatment for Brain Tumors

The Department of Radiation Oncology is one of the few departments in the region to offer true three-dimensional treatment planning capabilities. This advanced computer-based planning system uses CT and /or MRI images to help define optimal distribution of radiation dose within critical normal tissues like the brain. A major goal of the brain tumor radiotherapy program is to develop a system that can "fuse" all available diagnostic imaging information thereby establishing the most precise definition of the areas to be included in the treated volume. This process will allow the design of more specific radiation dose deposition strategies, thereby decreasing the risk of late neuropsychiatric complications and brain necrosis.

Within the actual target area, several recent clinical studies have clarified the radiation dose requirements necessary for long term brain tumor control. Based on these studies, it appears that many tumor types (especially high-grade gliomas) will require significantly higher central target doses than conventional radiotherapy techniques allow. One method of providing this sort of localized dose escalation involves a computer-assisted stereotactic brain "implant" using high activity Iodine-125. Cleveland Clinic is currently investigating a number of these newer stereotactic radiotherapy implant approaches in an attempt to define optimal methods of boosting sites of residual brain tumor after conventional external beam irradiation.

Cleveland Clinic's Stereotactic Radiosurgery ("Gamma Knife") program was the first operational radiosurgery unit in Ohio. In this approach, a conventional linear accelerator is retrofitted with a number of special targeting and patient immobilization aids to allow high-precision (in some cases, sub-millimeter) focus of radiation beams generated via a series of converging treatment arcs. This approach is especially useful in the treatment of single or multiple brain metastases. For patients with metastases measuring less than 3 cubic centimeters, up to 90% long-term control rates are expected after a single treatment. Thus, radiosurgery offers a convenient, highly effective alternative to inpatient surgical procedures for brain metastases.

The use of radiosurgery in the treatment of many types of primary brain tumors and various "functional" diseases (such as trigeminal neuralgia) is also being investigated at the Clinic.

Treatment Types

• Image Guided Radiation Therapy (IGRT)
• Intensity Modulated Radiation Therapy (IMRT)
• Novalis Radiosurgery
• Stereotactic Radiosurgery (Gamma Knife)

Brain Tumor Specialists

The following are Cleveland Clinic Radiation Oncologists with a special interest in the treatment of brain tumors using stereotactic radiotherapy and radiosurgery:

• Samuel Chao, MD
• Erin Murphy, MD
• John Suh, MD

Radiation Oncology Treatment for Breast Cancer

Breast Cancer is one of the true specialties of the Department of Radiation Oncology, and several hundred breast cancer patients are treated each year. The central focus of our breast radiotherapy programs for breast cancer involve the development of beam alignment and shielding techniques that minimize radiation dose to nearby lung and heart tissue that is received during breast radiation therapy. Specialized breast radiotherapy treatment protocols and computer software allow optimized patient set-up and radiation beam alignment. All breast radiotherapy patients undergo computerized treatment planning to allow minimization of radiation "hot spots" and "cold spots," thus decreasing the risk of radiation complications and tumor recurrence in the irregularly contoured breast tissue.

Treatment Types

• Active Breathing Coordinator
• Brachytherapy
• Clarity Breast System
• Hyperthermia Therapy
• Image Guided Radiation Therapy (IGRT)
• Intensity Modulated Radiation Therapy (IMRT)
• Intraoperative Radiation Therapy (IORT)
• Mobetron Intraoperative Electron Radiotherapy
• Prone Breast Irradiation

Breast Radiation Therapy Cancer Specialists

The following are Cleveland Clinic Radiation Oncologists with a special interest in the treatment of breast cancer using breast radiotherapy and other techniques:

• Roger M. Macklis, MD
• Rahul Tendulkar, MD

Other Cleveland Clinic links related to the treatment of breast tumors:

• The Breast Center

Radiation Oncology Treatment for Gynecological Cancer

Cleveland Clinic Department of Radiation Oncology maintains one of the most active radiation implant ("brachytherapy") programs in the country, and gynecologic malignancies represent a major clinical focus for this program. Over one hundred brachytherapy applications are performed each year for gynecologic tumors of various stages. Members of Radiation Oncology's clinical staff have special expertise in gynecologic oncology using brachytherapy, and are fully board-certified in both gynecology and in radiation therapy.

Cleveland Clinic is one of the few departments in the region to offer mechanized high dose-rate ("HDR") brachytherapy. This brachytherapy system involves a computer-assisted gear-driven piston assembly that can march a high-activity radioactive source through a series of carefully planned treatment positions via catheters implanted within and around a tumor target. This automated sequence is performed under physician and physicist guidance in the specially shielded suite within the department. This suite is currently being outfitted for intra-operative HDR brachytherapy, adding an additional dimension to the department's brachytherapy programs in this area.

A full range of megavoltage external beam treatment machines and conventional low dose-rate brachytherapy equipment completes the therapeutic armamentarium used by the Gynecologic Oncology section of the department.

Treatment Types & Devices

• Brachytherapy
• Hyperthermia Therapy
• Image Guided Radiation Therapy (IGRT)
• Intensity Modulated Radiation Therapy (IMRT)

Gynecological Cancer Specialists

The following physicians at the Taussig Cancer Institute specialize in Gynecological Cancer.

• Betty Obi, MD - Hillcrest Hospital
• Jerrold Saxton, MD - Main Campus
• Rahul Tendulkar, MD - Main Campus

Radiation Oncology Treatment for Head and Neck Cancer

Cancers of the head and neck are highly treatable using radiation therapy. For early stage tumors of many sites, radiotherapy offers an equally efficacious and generally less toxic alternative to radical surgery. For more advanced tumors, pre-operative or post-operative radiotherapy is often combined with conservative surgery by our cancer specialists to allow effective tumor control without severely disfiguring or dysfunctional treatment consequences.

Cleveland Clinic is currently investigating the use of combined chemo-radiotherapy for many upper aerodigestive tract tumors. This multimodality approach taken by our cancer specialists may allow organ preservation even in cases where critical structures near the larynx are densely invaded by the tumor. Close clinical coordination among the specialists--the medical oncologist, the radiation oncologist, and the surgeon--is essential to the successful implementation of this program. Direct extramural referrals from Cleveland area medical oncologists and ENT surgeons are welcome.

Our department of Radiation Oncology and our cancer specialists are constantly evaluating the clinical outcomes of its treatment programs in order to optimize patient care. The departmental data for the control of early stage vocal cord cancers was recently presented at a professional meeting, and the data confirmed a 3-year local control rate of over 90% for the entire group. For those patients with highly localized tumors, the control rate was 100%. Additionally, the highly individualized treatment plans employed by our cancer specialists for these lateralized tumors result in significantly less soft-tissue edema and skin necrosis compared with patients treated using other radiotherapy techniques.

Advanced technologies are now available for optimizing management, such as the incorporation of IMRT and other means of limiting side-effects of treatment and increasing cure rates.

Treatment Types

• Hyperthermia Therapy
• Image Guided Radiation Therapy (IGRT)
• Intensity Modulated Radiation Therapy (IMRT)
• Intraoperative Radiation Therapy (IORT)
• Mobetron Intraoperative Electron Radiotherapy
• Prone Breast Irradiation

Head and Neck Cancer Specialists

The following physicians at the Taussig Cancer Institute specialize in Head and Neck Cancer.

• Jerrold Saxton, MD

Radiation Oncology Treatment for Lung Cancer

Radiotherapy is an integral, foundational component in managing lung cancer. The role of lung radiotherapy for an individual patient, whether for potential cure or symptom relief in advanced disease, is determined after consultation with a Cleveland Clinic Radiation Oncologist. This consultation often is in the context of a multidisciplinary thoracic oncology lung cancer review involving other pulmonary specialties, including medical and surgical thoracic oncologists and Pulmonary Medicine.

The Radiation Oncology Lung Program also actively offers patients an opportunity to participate in appropriate lung radiotherapy clinical trials and is the leading service within the Department of Radiation Oncology in that regard. For each lung cancer patient, the approach is to offer optimal, individual medical care in the context of high-level, technological expertise, including lung radiotherapy. Computerized tomography (CT-scan)-based, three-dimensional treatment planning; intensity modulated radiotherapy (IMRT); and stereotactic body radiotherapy are among the options available at Cleveland Clinic. With these approaches, individualized treatment plans can be developed with the goals of minimizing the amount of normal body tissue receiving high-dose radiotherapy while maximizing cancer destruction.

Refractory or metastatic lung tumors pose a serious oncological problem, with many patients suffering from airway obstruction, bleeding, and pain syndromes. These syndromes often are in the context of previous treatments, and, therefore, there are few options. For these patients, the Department of Radiation Oncology has developed a series of novel palliative techniques aimed at relieving obstruction and reducing mass effects from these tumors. Bronchoscopically directed, high-dose-rate (HDR), endobronchial brachytherapy can be quite effective in relieving local obstructive symptoms. Stereotactic body radiotherapy may be appropriate for retreatment in the chest or for dealing with complex metastatic cases. Same-day consultations with expedited treatment schedules are available for urgent cases.

Doctors also use lung radiotherapy, often combined with chemotherapy, as primary treatment instead of surgery. Lung radiotherapy may also be used to relieve symptoms such as shortness of breath. Radiation for the treatment of lung cancer most often comes from a machine (external radiation). The radiation can also come from an implant (a small container of radioactive material) placed directly into or near the tumor (internal radiation or brachytherapy)

Lung radiotherapy affects normal as well as cancerous cells. Side effects of radiation therapy depend mainly on the part of the body that is treated and the treatment dose. Common side effects of lung radiotherapy are a dry, sore throat; difficulty swallowing; fatigue; skin changes at the site of treatment; and loss of appetite. Patients receiving radiation to the brain may have headaches, skin changes, fatigue, nausea and vomiting, hair loss, or problems with memory and thought processes.

Lung radiosurgery is a form of delivering higher dose of radiation to a small tumor. It could be used sometimes to replace surgery especially in those patients who may not be suitable for surgery.

Treatment Types

• Active Breathing Coordinator
• Image Guided Radiation Therapy (IGRT)
• Intensity Modulated Radiation Therapy (IMRT)
• Novalis Radiosurgery

Lung Cancer Specialists

Cleveland Clinic Radiation Oncologists with a special interest in the treatment of thoracic tumors using radiotherapy and lung radiosurgery:

• John Greskovich, Jr., MD
• Kevin Stephans, MD
• Gregory Videtic, MD

Additional Information:

Multidisciplinary Lung Cancer Clinic

Radiation Oncology Treatment for Lymphoma

Lymphocyte-derived neoplasms have long been considered highly sensitive to the effects of ionizing radiation and our department of Radiation Oncology is very experienced in the implementation of exacting technical set-ups such as "Mantle" radiotherapy fields and "Total Nodal Irradiation" plans for selected malignant lymphoma patients.

Cleveland Clinic Radiation Oncology is deeply involved in the investigation of both conventional radiotherapy and specialized new technologies that may be applicable to the treatment of malignant lymphomas. Conventional external beam radiotherapy has long been a mainstay in the treatment of both Hodgkin's and non-Hodgkin's lymphoma. For Hodgkin's disease, selected early-stage cases may be treated with definitive radiotherapy, yielding long-term survival rates in excess of 90%. The combination of chemotherapy and lower dose "involved field" radiotherapy also provide excellent long-term survival and can often limit the toxicity of treatment compared to radiotherapy alone. This combination of chemotherapy and local field radiotherapy also plays a major role in more advanced stage cases of Hodgkin's disease.

In a similar way, many cases of Non-Hodgkin's Lymphoma (NHL) show substantial improvements in the relapse-free survival when local field radiotherapy is added to systemic radiotherapy treatment, such as chemotherapy or immunotherapy. Data from several large randomized multicenter trials show that intermediate doses of radiation (30 - 45 Gy) can provide long term NHL control when accompanied by intermediate dose chemotherapy. In some cases of indolent NHL, the use of radio-immunotherapy allows the combination of specifically targeted radiopharmaceutical therapy and antibody-based immunologic targeting to optimize tumor control with minimal toxicity.

When we combine chemotherapy with radiotherapy, we usually start with chemotherapy and reserve radiotherapy for the point at which chemotherapy has demonstrated its maximal response. Side effects and total numbers of chemotherapy and radiotherapy treatments will depend on the type of lymphoma, the area under treatment, and the specifics of the patient's medical history. The radiation oncologists at the Cleveland Clinic who specialize in lymphoma are accustomed to working closely with medical oncologists both at the Cleveland Clinic and elsewhere in the medical community. This "team approach" assures a seamless collaboration between the medical disciplines.

Treatment Types

• Radiolabeled Antibody Therapy and Total Irradiation
• Total Body Irradiation

Lymphoma Specialists

The following are Cleveland Clinic Radiation Oncologists with a special interest in the treatment of malignant lymphoma using radiotherapy:

• Roger M. Macklis, MD

Radiation Oncology Treatment for Ocular Melanoma

Ocular melanoma is a rare tumor of the eye which requires special expertise and interdisciplinary cooperation to treat if vision is to be preserved. This treatment often includes radiotherapy. Cleveland Clinic participates in national protocols sponsored by the Collaborative Ocular Melanoma Study. Radiotherapy treatments are frequently delivered in the form of custom-made radioactive plaques temporarily positioned behind the eye to aid in the delivery of radiotherapy. Plaques are formed using radioactive seeds on a gold shield shaped to the eye. The gold base effectively prevents irradiation and prevents the radiotherapy from reaching deeper structures such as the brain.

The following are Cleveland Clinic Radiation Oncologists and radiotherapy specialists with a special interest in the treatment of ocular melanoma using radiotherapy:

Types of Treatment

• Radioactive Plaque Therapy

Ocular Melanoma Specialists:

• Roger Macklis, MD

Radiation Oncology Treatment for Pediatric Cancer

The care of the pediatric cancer patient requires special clinical coordination and interpersonal skills, and often requires a radiotherapy or brachytherapy treatment program. The Department of Radiation Oncology is well equipped to handle all such cases of pediatric cancer, including those requiring daily anesthesia during the period of treatment. Cleveland Clinic has a rapidly expanding pediatric practice, and the ongoing expansion and renovations taking place within the Cleveland Clinic Children's Hospital division ensure that a full range of ancillary pediatric specialists and pediatric cancer support programs are available to supplement the brachytherapy and radiotherapy treatments.

Types of Treatment

• Total Body Irradiation

Pediatric Cancer Specialists

The following are Cleveland Clinic Radiation Oncologists with a special interest in brachytherapy treatments, pediatric oncology, and the use of radiotherapy and brachytherapy to treat pediatric cancer:

• Samuel Chao, MD
• Roger M. Macklis, MD
• Erin Murphy, MD
• John Suh, MD

Other Cleveland Clinic Links related to the treatment of Pediatric Malignancies:

• Pediatric Neurosurgery

Radiation Oncology Treatment for Prostate Cancer

After a diagnosis of prostate cancer has been established with a biopsy, the patient should discuss the treatment options, like prostate brachytherapy or prostate seed implants, with their health care provider.

Some unique features of our program include:

• The first group to publish the improvements gained by treating patients with one session in which the treatment planning and treatment occurs on the same day. This also results in greater convenience for the patient since one less visit is necessary.
• The first prostate brachytherapy program in the country to use the Memokath prostate stent to help reduce side effects after prostate brachytherapy.
• The lowest rectal side effect profile of any published series. Our rectal bleeding rate is 1% and we have not had any rectal perforations or fistulas.

Treatment Types

• Brachytherapy
• Calypso 4D - Prostate Cancer Treatment
• Clarity System
• Hyperthermia Therapy
• Image Guided Radiation Therapy (IGRT)
• Intensity Modulated Radiation Therapy (IMRT)
• Intraoperative Radiation Therapy (IORT)

Prostate Cancer Specialists

The following are Cleveland Clinic Radiation Oncologists with a special interest in the treatment of prostate cancer:

• Jay Ciezki, MD
• Rahul Tendulkar, MD

What is the treatment for sarcoma?

Depending the location, grade, type, and size of the tumor there are several treatments available for a person diagnosed with sarcoma, including sarcoma radiation therapy. You should consult your cancer doctor to discuss the appropriate treatment. These treatments include the following:

• Surgery
• Sarcoma Radiation Therapy
• Chemotherapy
• Sarcoma Brachytherapy

Surgery:

The goal of surgery is the removal of the tumor. Usually a small extra margin of nearby tissue is also taken out. Amputation was often used in the past for most patients with sarcoma found in the extremity. However, when combined with radiation, amputation can be avoided in almost all patients with sarcomas of the extremity. This type of limb-sparing surgery is what is performed most often today. Abdominal or retroperitoneal sarcomas are a little more difficult to surgically remove due to the vital organs that may be next to the mass.

Chemotherapy:

Chemotherapy uses drugs to kill cancer cells. Chemotherapy can be taken orally (by a pill) or through a needle in the vein or muscle. The medication enters the blood stream, travels through the body, and kills cancer cells throughout the body; this is sometimes called systemic therapy. Chemotherapy that is given after surgery when no cancer cells can be seen is called adjuvant chemotherapy.

The most commonly used drugs are ifosfamide and doxorubicin. Sometimes other drugs such as dacarbazine, methotrexate, vincristine, cisplatin, paclitaxel, and others are added in combination. When several drugs are used together, the combination is given a shortened name such as: MAID (combined mesna, doxorubicin [Adriamycin], ifosfamide, and dacarbazine) or AIM (doxorubicin [Adriamycin], ifosfamide, and mesna). Mesna is a drug used to protect the bladder from the severe irritation often caused by ifosfamide.

Radiation Oncology Sarcoma Treatment

Sarcoma radiation therapy (sometimes in conjunction with chemotherapy) may be given before surgery to shrink the tumor and allow complete resection. After surgery, additional (adjuvant) sarcoma radiation therapy is sometimes used to kill any cancer cells that remained after surgery and to reduce the chances of the tumor returning in the area of its origin.

Radiation Therapy:

Sarcoma radiation therapy is a form of cancer treatment that uses x-rays or other high-energy rays to kill cancer cells.

There are two ways of delivering radiation to the cancer:

• External Radiation: External beam radiation therapy (EBRT) is the most common form of radiation therapy. The treatment machine (linear accelerator) directs beams of high-energy radiation at the tumor. The machine can change position so that the beams can enter the body from any angle. External radiation therapy is usually given in daily treatments of few minutes each over several weeks, typically 5 days a week for 5 to 6 weeks.
• Internal Radiation: Internal sarcoma radiation therapy (brachytherapy) delivers a high dose of radiation to a small area by using one or more implants (radioactive sources) placed in or around the tumor. These implants can be temporary or permanent.

The radiation oncologist will select the type of therapy that is most suitable for a particular type of cancer. Radiation therapy can also be used to palliate (ease) symptoms of sarcoma when it has spread to other body organs.

The medical oncologist will select the type of therapy treatment that is most suitable for a particular type of cancer.

Sarcoma Clinic

Cleveland Clinic Sarcoma Interdisciplinary Clinic (CCSIC) is located at the Taussig Cancer Institute at Cleveland Clinic.

The mission of the CCSIC is to provide a multidisciplinary, comprehensive & compassionate approach to patients with typical or atypical malignancies in an effort to provide excellent care and to make treatment more convenient for patients.

The purpose of this clinic is to provide a setting where medical providers from different specialties can come together to create the most favorable treatment regimen for a given patient. In addition, the patient and their family can obtain expert opinions from the various specialties with just one visit to the clinic. The team includes surgeons, radiation and medical oncologists, radiologists, pathologists, social workers, nurse practitioners, physical therapists and physiatrists and other support personnel.

The vision of the CCSIC is to be the premier clinical site that provides exemplary patient care, fosters the development of new diagnostic criteria & treatments, and promotes a unified multidisciplinary approach to patients with soft tissue and bone tumors.

Types of Treatment

• Brachytherapy
• Clarity Breast System
• Hyperthermia Therapy
• Image Guided Radiation Therapy (IGRT)
• Intensity Modulated Radiation Therapy (IMRT)
• Intraoperative Radiation Therapy (IORT)
• Mobetron Intraoperative Electron Radiotherapy

Sarcoma Specialists

The following are Cleveland Clinic Radiation Oncologists with a special interest in the treatment of Sarcoma:

• Samuel Chao, MD
• John Greskovich, Jr., MD
• Erin Murphy, MD
• Kevin Stephans, MD

Radiation Oncology Treatment for Skin Cancer

Radiotherapy has traditionally played an important role in the treatment of a wide range of benign and malignant skin tumors. Both electron beam therapy and a modern orthovoltage treatment machine with a penetration depth that is optimized for dermatologic lesions are available at Cleveland Clinic. For small squamous cell or basal cell carcinomas, often just a few high-dose radiotherapy treatments to small target areas will suffice to cure the lesion. Conversely, the department is also experienced in the design of very complex clinical treatment plans, such as total skin electron therapy for patients with mycosis fungoides.

Types of Treatment

• Hyperthermia Therapy

Skin Cancer Specialists

The following are Cleveland Clinic Radiation Oncologists with a special interest in the treatment of skin tumors using radiotherapy:

• John Greskovich, Jr., MD
• Jerrold Saxton, MD