Three dimentional conformal radiotherapy technical was firstly began to apply in 1988 in our clinic. After our experiment in conformal radiotherapy technique, we are the first who started intensity modulated radiotherapy technical (YART) in 2005 in our country.
We feel proud of giving treatment with technical of YART to the patients with greatest number with and having the largest experiment. Since 2010, we have started to apply volumetric intensity modulated radiotherapy with RapidArc device. With this method, treatment time is reduced and the patient stays in treatment device for a shorter time. Reducing of time minimizes potential changes related to lengthening of duration of hospital stay and it gives opportunity for increasing of set-up accuracy.
Real-time Position Management™ (RPM) System
Breath Phase synchronization in imaging and treatment
Real-time Position Management™ (RPM) is a system that is not invasive and is a video basic imaging. With this system we can obtain qualified imaging from lungs, breast, and upper abdominal region. RPM system is reliable, easy to use and quick. Application comfort for the patient is high and provides opportunity to operate with breath holding and breathing protocol.
Changing tumor movement in patient’s breathing phase can be followed with RPM system. Breathing phases graph is followed by computer through watching a cubic plastic box including reflecting signs located on chest cage or abdominal wall with infrared camera. Treatment device is arranged as to give ray in selected breathing phase. In left side mammary treatment, lung swells and removes the hearth from chest wall during deep breath holding. Thus, dosage taken by hearth and left descending coronary artery decreases. In our clinic, left side mammary treatment is made in control of RPM during deep breath holding.
RPM system can be used during the treatments of lung, liver, and pancreas.
Radiotherapy in guide of imaging with Prostate golden marker: Prostate IGRT
Prostate is an organ placed between the rectum, last part of large intestine, and bladder. Place of the prostate changes continuously from posterior to anterior due to the fact that fullness of rectum and bladder changes continuously. Because targeted organ is the prostate to be beamed In prostate cancer, the place of it should be determined for certainty in all treatment fractions. During the beaming it is not desirable to make treatment by giving big margin; if the dosages taken by rectum and bladder increase, early or late side effect ratio in these organs belonging to radiation increases. There 24 carat golden with millimeter sizes are located in prostate in transrectal way in order to give high dosage radiotherapy effective with narrow and small margins truly. This operation is an application that takes shorter time and is easier than biopsy. Our patients tolerate this operation very well (1). Before this operation it is necessary to empty the rectum with lavement and there is no need for anesthesia.
Place of the prostate is determined truly for each day by watching these golden markers placed in prostate with the support of front and side electronic portal films taken during the treatment.
1) Implantation of fiducial markers for image guidance in prostate radiotherapy: patient-reported toxicity. Igdem S, Akpinar H, Alço G, Agaçayak F, Turkan S, Okkan S. Br J Radiol. 2009 Nov;82(983):941-5. doi: 10.1259/bjr/14201041.
IMRT in Head-Neck Tumors
In most early stage head-neck tumors, the treatment choice is surgery. Post-operative radiotherapy is applied in the existence of high risk factors such as tumors remaining in surgical limit, spreading to regional lymph nodes. While in some case the radiotherapy can be applied alone, in our days it is applied with chemotherapy. In some early stage tumors, for example in early stage vocal cord tumors, the fact that it is preferred to surgery give opportunity to provide better voice quality. In local progressed head-neck tumors, chemotherapy given simultaneously with radiotherapy is the most proper treatment choice.
Even if the disease is in early stage, nasopharynx cancer is the disease for which surgery is not a choice. Nasopharynx cancer is treated with radiotherapy along with a curative aim in all stages, in local progressed diseases, spontaneous chemotherapy is also given.
It is aimed to prevent the permanent dryness of the mouth by saving salivary glands with intensity modulated radiotherapy in head-neck cancer.
Simultaneous Integral Boost:
While radiation dosage is shaped to target volume with IMRT, the dosage taken by normal tissues is reduced. It is possible in the same time to give different dosage to different treatment volumes and this approach is named as Simultaneous Integral Boost (SIB). SIB and dosage painting technical can be used in many fields such as gynecologic and gastro intestinal tumors except from head-neck tumors.
IMRT in Brain Tumors
In recent years, intensity modulated radiotherapy which is an advanced form of three dimensional conformal radiotherapy is started to be used more frequently in phenomena beamed due to the brain tumors. According to the interview made among the American radiation oncologists, central nervous system is the region where intensity modulated radiotherapy is applied in third order frequency. Intensity modulated radiotherapy can be also used in benign meningioma phenomena whose structure is very irregular shaped.