At SFRO, our physicians and their team of specialists work together to provide comprehensive radiation therapy plans specially tailored to meet each patient's needs. The advanced technology and equipment in use at our cancer centers supports new treatment techniques and has helped make SFRO one of the leading radiation oncology treatment centers in Florida.
SFRO Treatment Planning includes the following:
An initial consultation with one of our Radiation Oncologists
A Computed Tomography Simulation (CT Scan) for localization and treatment planning purposes
A CT image reconstruction, provided by computer technology, a process that allows our physicians to view normal anatomical structures, bone and tissues in 3-D planes
A Comprehensive Radiation Therapy Plan (CRTP), established by one of our physicians, that aims a radiation beam directly at the tumor, encompassing microscopic disease, and "conforms" to the target while avoiding normal structures
High-energy linear accelerators, along with 3-D conformal radiotherapy cancer treatment planning, enable us to precisely deliver aggressive, high doses of precise radiation, thus increasing cure rates and decreasing unwanted side effects and complications
Treatment Options Linear Accelerators High-energy linear accelerators enable us to execute complex radiation treatment plans in
a timely and effective manner. At SFRO, we employ Varian's Trilogy™ and iX Systems, Siemens PRIMUS™ Linear Accelerator, BrainLAB and CyberKnife®, some of the most advanced linear accelerators in the radiation field. These state-of-the-art accelerators allow our team to deliver higher and more conformal doses of radiation to target tumors while minimizing the effects on healthy tissues and organs. What's more, a computerized tomography (CT) simulator and 3-D cancer treatment planning enable us to direct higher doses of radiation to the tumor safely. This results in fewer side effects and greater accuracy.
Prostate Seed Implant with Low-Dose Rate (LDR) Brachytherapy Radioactive seed implantation or Low-Dose Rate (LDR) Brachytherapy is ultrasound-directed allowing for the precise placement of Iodine-125 seeds (or palladium for more aggressive tumors) without an operation or an incision. LDR Brachytherapy allows our physicians to deliver radiation directly to the prostate without affecting the bladder or rectum. This procedure, which takes approximately one hour and is performed under local anesthesia, is generally tolerated on an outpatient basis.
High-Dose rate (HDR) Brachytherapy The High-Dose Rate (HDR) Brachytherapy program at SFRO is large and varied in the range and complexity of implants performed. Our centers presently use the Nucletron Micro-Selectron HDR unit along with a computer-aided treatment design system. Major advances in computerization now allow brachytherapy to be used by our physicians to deposit high doses of radiation directly into cancerous tumors, minimizing the risk of damage to surrounding healthy tissue. With HDR brachytherapy, the implant is removed from the body after each treatment. Patients often prefer the HDR treatments because they typically require fewer repeat outpatient visits.Most types of cancer respond well to HDR brachytherapy. These include cancers of the prostate, breast, throat, thyroid and cervix. In fact, some cancers that were considered to be incurable only a few years ago can now be effectively controlled with this new highly targeted radiation treatment.
Conformal Planning One of our most essential weapons in the battle against cancer is our precise treatment planning. Using automated 3-D image analysis, sophisticated software, and accurate dosimetric calculations; we are able to plan an extremely accurate and effective treatment plan. Using the latest diagnostic imaging, we can fuse the CT simulation with the aforementioned studies and be able to localize and identify the tumor boundaries with extreme accuracy. This allows improved dose delivery and safely excludes normal tissue from receiving high doses of radiation therapy.
Three Dimensional (3-D) Conformal Therapy Three Dimensional (3-D) Conformal Radiotherapy is a highly precise technique based on a 3-D view. The goal of 3-D conformal radiotherapy is to deliver a conformal dose distribution to tumors, while sparing surrounding normal structures. The use of patient specific 3-D images in the treatment planning process distinguishes 3D-CRT from conventional radiotherapy. This advanced innovative technique permits our Radiation Oncologists to shape and precisely deliver a high-energy X-ray beam to the cancerous disease site while protecting
normal tissues.
Multileaf Collimation Targeting cancer cells with radiation using Multileaf Collimation (MLC) can greatly increase the success of treatment for a wide variety of cancers. This computer-controlled device contains 120 mechanical "leaves" that move and shape a beam of radiation to match the three-dimensional (3-D) shape of a patient's tumor. This technology is particularly effective for small, irregularly shaped tumors in locations that otherwise would difficult to reach.
Intensity Modulated Radiation Therapy (IMRT) The goal of all radiation therapy is to irradiate the tumor with a lethal dose while limiting the radiation received by the normal tissue that surrounds the tumor. IMRT uses a sophisticated dose calculation to design and deliver precisely targeted radiation. This is accomplished by using computer-controlled small radiation shields in a linear accelerator. Dozens of uniquely shaped radiation fields are delivered to the patient using various angles and approaches. The difference between 3-D Conformal Radiation and IMRT is that IMRT can create high dose volumes that are concave in shape, sparing surrounding critical normal tissues that are extremely close to the tumor. During each field of treatment, the dose delivered is being modulated or adjusted by the multi-leaf collimator (a device that consists of a number of "fingers" or "leaves" which project into the primary beam to create the required shape). However, in order to spare some areas, other areas will receive more radiation. It is the job of our Radiation Oncologists and our Radiation Physicists to critically evaluate the trade-offs between avoiding normal tissues and adjusting radiation doses to the tumor.IMRT is extremely useful in treating targets surrounded by a large volume of normal tissue and/or critical structures that are especially close to the targeted tumor. Types of tumors that may be treated with IMRT include brain, head and neck cancer, prostate, spinal cord, and tumors very close to radiosensitive normal tissues like the optic nerve (e.g. pituitary or nasopharyngeal cancer).
Image-Guided Radiation Therapy (IGRT) Image-Guided Radiation Therapy is conformal radiation treatment guided by imaging equipment, such as CT, ultrasound or stereoscopic X-rays. IGRT allows radiation to be delivered to tumors with more precision than was traditionally possible. Since tumors often move based on the patient's day-to-day position on the treatment table (as well as from breathing), IGRT allows the physician to better deliver the radiation dose directly to the cancer by using a variety of automated and tracking systems. By imaging tumors daily, the physician can precisely locate the tumor while the patient is in the treatment position. This minimizes the volume of healthy tissue exposed to radiation during treatment, yet allows the delivery of higher doses of radiation to the tumor volume.
Advanced Treatment Accelerated Partial Breast Irradiation A new alternative for some women, who have opted for breast-conserving surgery, is accelerated partial-breast irradiation (APBI). It works by delivering radiation directly to the lumpectomy cavity (the space left after the tumor is removed) directly to the tissue surrounding the cavity where the cancer most likely may recur. APBI treatment is given under the direction of a Radiation Oncologist and Breast Surgeon. It is delivered two times daily for five days on an outpatient basis. APBI treatment is a two-stage process:
1) device/catheter placement and 2) radiation delivery. After the surgeon performs the lumpectomy, a device/catheter, is placed inside the lumpectomy cavity. A portion of the catheter remains exposed. After the device is in place, a CT scan is performed to assess the shaping and placement of the device. The device may be adjusted, if necessary, to be optimal.
During radiation therapy, the portion of the catheter that remains exposed will be connected to a computer-controlled High Dose Radiation (HDR) machine. A tiny radioactive seed travels from the machine, through the catheter and into the device inside the patient's breast. The seed will remain in the device and deliver radiation for about 10 minutes. The seed is then withdrawn back into the machine and the procedure is complete. No radiation remains in the breast. After the last treatment (on the fifth day), the device is easily removed. We use treatment systems from MammoSite®, SAVI™, and Contoura® to perform Accelerated Partial Breast Irradiation.
Trilogy™ The Trilogy accelerator is the world's first image-guided radiation therapy system optimized for both conventional and stereotactic approaches to treating cancer. The versatile Trilogy™ system delivers IGRT as standard, and can be used to deliver 3D conformal radiotherapy, IMRT, stereotactic radiosurgery, fractionated stereotactic radiation therapy, and intensity-modulated radiosurgery to both benign and malignant tumors. The Trilogy is designed to deliver a high dose rate for fast treatment times and to help ensure effective hypofractionation. As a result, patients can be treated accurately while treatment times are minimized. Trilogy provides a flexible and efficient treatment delivery system with state-of-the-art treatment capabilities, and streamlined clinical environment with an integrated approach. This results in a safe treatment environment where more patients can be treated reliably and effectively.
CyberKnife® Robotic Radiosurgery System The CyberKnife® is the world's only robotic radiosurgery system designed to treat tumors anywhere in the body non-invasively and with sub-millimeter accuracy. Using image guidance technology and computer-controlled robotics, the CyberKnife® System is designed to continuously track the tumor, detect its location and correct for tumor and patient movement in real-time throughout the treatment. Because of its extreme precision, the CyberKnife® System does not require invasive head or body frames to stabilize patient movement.
Stereotactic Radiotherapy with Novalis Stereotactic Radiosurgery (SRS) is a high precision non-invasive procedure that uses high energy, highly-focused x-rays to treat certain types of tumors. Although SRS was originally developed to treat brain lesions, we are now able to use SRS in select sites throughout the body due to recent technological advances. It may also be used to treat inoperable tumors, and as a post-operative treatment to eliminate any leftover tumor tissue. Novalis BrainLAB is highly precise and accurate in delivering required tumoricidal radiation doses to the target while sparing normal structures. Because Novalis delivers radiation in a high dose rate mode, it shortens treatment time considerably. On average, Novalis is optimized to deliver radiosurgery in 15 minute treatments. This prevents errors due to movements during longer treatments. Treatment is non-invasive with no surgical incisions or associated complications. Novalis is also equipped with state-of-the-art image-guided radiation therapy tools and a sophisticated robotic patient-positioning system. These allow for sub-millimeter accuracy and precision in patient setup. In many cases, treatment is completed in one to five days.
A brief overview of these treatments includes: 
Linear Accelerators
Radioactive seed implantation or Low-Dose Rate (LDR) Brachytherapy is ultrasound-directed allowing for the precise placement of Iodine-125 seeds (or palladium for more aggressive tumors) without an operation or an incision. LDR Brachytherapy allows our physicians to deliver radiation directly to the prostate without affecting the bladder or rectum. This procedure, which takes approximately one hour and is performed under local anesthesia, is generally tolerated on an outpatient basis.
High-Dose rate (HDR) Brachytherapy
Conformal Planning
Multileaf Collimation
Intensity Modulated Radiation Therapy (IMRT)
Accelerated Partial Breast Irradiation
Stereotactic Radiotherapy with Novalis
