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Radiation Oncology

At Ruby Hall Clinic we have always strived to provide Cancer care par excellence with world class technology.

In January 2006 we installed Siemens ONCOR Impression,the first Linear Accelerator with IGRT technology. With our expertise in Steriotactic Radiosurgery,this put us in the forefront amongst all radiation Centres in India.

With growing reputation and turnover, we installed a second Linear Accelerator, mainly to provide Stereotactic Body Radiotherapy, with its high dose radiation and UNFLAT beam facility. From patient’s point of view, with continous upgrade of technology, we have been able to target cancerous tissues in a better way , without affecting the normal tissues and in a fewer sessions.

We make special effort to make sure that the patient is comfortable -physically and psychologically -during the entire course of the treatment.

The patient is encouraged to avail of help provided by various support groups which are active in the Centre.

Dr. Ashok Bhanage
Chairman, Cancer Centre



Brachytherapy

Bractherapy is a delivery of radiation therapy by means of Radioactive isotope kept in a very close vicinity of tumour. In this technique Radiation therapy is delivered by Ir192 (Radioactive high dose rate source). That means very low dose of radiation is given to surruonding normal structures . Brachytherapy is mainly useful in gynecological malignancies. These procedures are done under a short general anaesthesia followed by CT scan based planning and treatment and patient goes home the same day. Besides this, we have expertise of interstitial implant brachytherapy for perineum, breast and extremities. In this technique special tubes are kept in the tumourbed after surgical removal of tumour and through those tubes high dose of radiation can be given in short duration of time.

2D Complex Radiation Therapy

It is a conventional treatment offered using linear acceleartor. Although the service is named as conventional, at Ruby Hall Clinic, patients undergo CT scan based planning and port film verification wilh this technique. Ruby Hall Clinic has the latest high resolution amorphous silicon portal imager for this purpose.

Intensity Modulated Radiation Therapy (IMRT)

IMRT is an advanced mode of high precision radiation. In IMRT, MLCs are used to subdivide (modulate) radiation beams into many beamlets aimed at the tumor, from various directions. Also, intensity of each of these beamlets can be adjusted individually. Thus, it is a specialized form of 3D-CRT that allows radiation to be shaped exactly to the fit the’ tumor. Using IMRT, it is possible to further limit the amount of radiation that is received by healthy tissues near thr tumor as compared to 3D-CRT. In many situations,this may alsoallow a relatively higher dose of radiation to be delivered to the tumor, increasing the chance of cure. As this method of treatment delivery is very accurate, proper positioning of the patient becomes crucial. The planning of IMRT procedure takes 2-4 days after immobilization and the imaging procedure.

Total Body Irradiation (TBI)

It is a special procedure which is used as conditioning regimen for bone marrow transplant or haematopoetic stem cell transplantation. This is to eradicate any residual Cancer cell in the body and it also helps in achieving immunosupperssion so that the host does not reject the donor cell. This procedure helps in improving the success rates of bonr marrow transplants. Procedure involves giving radiation to the whole body. The patient is made to stand on a customised instrument. Lens and lungs are shielded under aspectic conditions. The patient receives radiation twice a day for maximum of 3 consecutive days.

We are the only institute to have this facility in Pune.

3 Dimensional Conformal Radiation Therapy(3D-CRT)

Tumors are not regular, they come in different shapes and sizes. Three-dimensional conformal radiation therapy or 3D-CRt, uses computers and high defination software with special imaging techniques to map the size, shape and location of the tumor. Computer Assisted Tomography (CT scans), Magnetic Resonance Imaging (MRI scans) and/or Positron Emission Tomography (PET scans) are used, individually or by fusion, to create detailed, three dimensional representations of the tumor and the surrounding organs. This therapy uses a multileaf collimator (MLC) to frame precise radiation beam to a targetd area. The MLC is device with a series of computer-controlled leaf-like plates. As the radiation beams are very precisely directed, adjacent normal tissues receive less radiation and are able to heal quickly. Hence, this treatment is superior to the conventional treatment. Time taken for 3D-CRT planning is between 1 and 3 days.

Stereotactic Body Radiotherapy (SBRT)

Stereotactic Body Radiotherapy (SBRT) is an emerging image-guided radiation method. SBRT is directed to extremely well-defined targets within the body. SBRT delivers very high doses of radiation precisely to tumor sites within the body with the purpose of improving local control and limiting side effects. SBRT is appropriately used for small lung Cancer or metastasis, small liver tumors or bony tumors in other sites that may not be apprpriate for surgical resection or in patients who would not be candidates for surgery. SBRT is generally completed in 3-5 treatment fractions.

At times, small gold fiducial markers are implanted with minimally invasive techniques to provide stereotactic image guidance during radiation therapy. 3D imaging (CT,CT/PET,CT/MR) is used to construct very precise plans minimizing radiation dose to normal structures.

SRS/SRT

Strereotactic Radiosurgery (SRS) is a proven alternative to conventional surgery for a treatment of many lesions in the brain like pituitary adenomas, meningiomas,arterivenous malformation etc. In SRS, a pre-planned radiation dose will be delivered in a ” single session”. When multiple sesions of treatment are delivered, it’s called SRT(Stereotactic Radiotherapy)

In Frameless SRS/SRT , a totally noninvasive immobilization procedure is adopted to deliver SRS and SRT treatments while maintaining the same accuracy as used in frame based conventional SRS/Srt treatments. With SRS/SRT , it is possible to produce the effect of surgery while efficently avoiding the normal tissue complications that usually result during surgery.

With addition to high dose rate on the linac, the time taken for SRS/SRT will be 40% less and therefore the treatment will be faster. Along with cone beam C.T.Scan imaging during treatment, the accuracy is much better. We are the only Centre in Pune to have this facility.

Image Guided Radiation Therapy (IGRT)

Image-Guided Radiation Therapy, or IGRT, helps to improve the delivery of radiation. IGRT involves conformal radiation treatment guided by a CT scan (called Cone BEAm CT), done in the treatment room just before the patient is given radiation treatment. The imaging information from the planning CT scan done earlier is overlapped on this Cone Beam Ct. With this technique, movements of the tumor due to differences in organ filling or breathing or reduction in size can be tracked. Also,even the variation in millimeters in daily positining of the patient is detected and corrected instantly.

With the addition of carbon target cone beanm C. T. imaging, the quality of imaging is much better.

Hence IGRT is one of the most advanced form of radiotherapy today and Ruby Hall Clinic is first to install and use it in India. Treatment with “respiratory gating” is used for tumors that move during respiration such as lung and liver.