Radiation therapy or Radiotherapy is a type of curative cancer treatment (HDR - high-dose-rate ionizing irradiation) or palliative treatment (LDR - low-dose-rate ionizing irradiation). Its painless and therapeutical use aims at killing cancer cells by preventing their growth and reproduction, while reducing damage to healthy tissues that surround the tumour. This local treatment is normally complemented by surgery and chemotherapy and is currently one of the most effective treatments against cancer thanks to the technological improvements occurred in this field in the last decades.
Upon arrival to the radiotherapy unit, patients are examined by a radiation therapy oncologist (responsible for supervising the entire treatment and the diseaseís evolution), a radiation therapy technician (responsible for the implementation of the treatment) and healthcare assistants. Pursuant to the protocol, the process goes through three stages: 1. planning or virtual simulation using a scanner, CT-scan, PET, RVM to accurately determine irradiation volume, 2. physical dosimetry to demarcate the affected area and sensitive organs subject to irradiation and 3. testing of the treatment before it starts.
Grupo IMO has been pioneer in the implementation of cutting-edge treatments in radiation therapy for cancer patients in Spain in the last 20 years. We run strict quality controls and deliver excellent care in every proceeding.
External radiotherapy technique that uses 3D anatomical images, usually provided by a CT-scan, in order to clearly define the areas that will receive radiation with the aim of using all information available in order to calculate the dose in 3D. To focus radiation dose on tumour site the machine normally rotates around the body and radiation enters into different parts and converges in the predefined site for irradiation beams to adapt to the irregularly-shaped tumour, hence the name conformal radiation therapy. Each session lasts between 10 to 15 minutes.
Grupo IMO applies this technique since 1996.
This treatment is stronger compared with three-dimensional conformal radiation therapy (3D-CRT) as the dose is precisely and homogeneously directed at the tumour site with minimum impact to the surrounding areas. This improvement is possible thanks to Intensity-Modulated Radiation Therapy (IMRT) which modulates radiation intensity based on the different areas previously predefined. This technique often uses a linear accelerator or device guided by a complex IT system that calculates the dosage and controls the irradiation beams. The technique is indicated for tumours in the ENT region, prostate cancer, children’s tumours, re-irradiations, breast tumours, and abdominal tumours. Sessions last between 20 to 30 minutes.
This cutting-edge technique has an additional advantage: while patients receive radiation, it takes images similar to those of the CT-scan. As the couch enters into the machine in order to obtain CT-scan images, technicians adjust the position aligned with the new CT-scan (comparing it with the actual planning CT-scan). Subsequently, the machine irradiates using a linear accelerator rotating 360 degrees around the patient. The system avoids inaccuracies produced by internal organs' movements and changes in volume, as it can be adjusted in every session thanks to a CT-scan taken during the treatment. Its combination of thousands of radiation beams allows it to cover wide regions. It is the recommended treatment for all kinds of tumoral pathologies, namely those located in the head, neck, brain, breast and prostate, spine tumours, liver and lung metastasis, re-radiations and paediatric tumours. Sessions last 30 minutes.
Grupo IMO is the pioneer in the use of this technique in Spain since the setting up of the first machine in 2006 with the opening of the Tomoetherapy Unit of La Milagrosa. The Group will become the first Spanish group using two Tomotherapy machines since 2010.
Radio-surgery is a one-session bloodless treatment used for brain tumours. It is extremely accurate with efficiency rates around 85-95%. After placing a stereotactic guide to locate the treated site in 3D, it directs thin radiation beams from multiple external points positioned with pinpoint accuracy for low-energy radiation beams to be sufficiently high in the treated site. In order to guarantee such accuracy, the guide shall be firmly fixed to the patient and to therapy table or a platform attached to the room floor. Several machines are available: Gammaknife®, using conventional linear accelerator with the adequate tools; with Tomotherapy (Tomo-Radiosurgery) or with a special type of accelerator mounted in a robotic arm called Cyberknife®, that will be described bellow. Stereotactic-radiosurgery locates intracranial lesions with utmost accuracy, emitting high doses of radiation at the tumours, thus decreasing doses over non-affected areas and surrounding tissues. It is recommended for primary and metastatic tumours, and for benign tumours (meningiomas, neurinomas) and vascular malformations that may be dangerous due to their location and may complicate surgery. This single-session lasts about one hour.
In Spain, Grupo IMO was the pioneer in implementing radio-surgery with linear accelerators. Its definitive boost came in 1991 with the implementation of the Radiosurgery Unit San Francisco de Asís in Madrid.
Radiosurgery is currently applied to other parts of the body other than the Central Nervous System. Stereotactic body radiation therapy (SBRT) is normally a multi-session radiation therapy. Other techniques include stereotactic localization and sub-milimeter accuracy. The oncologist must pinpoint the tumour’s movements due to the patient’s respiratory and involuntary movements, as well as normal movements of internal organs, such as heart and lungs, which may lead to the movement of tumours. To that aim, powerful 4D software is used in order to pinpoint radiation with utmost accuracy despite potential oscillations due to involuntary movements. In the second half of the 1990s Cyberknife® was born: a machine capable of providing accurate radiosurgery treatments while controlling the movement of internal organs. Cyberknife® is indicated for cranial, extracranial or spine injuries and tumours easily accessible given their size (lung, liver, prostate) applying hypofractionated treatments (with larger doses of radiation in fewer treatment sessions. Each session lasts approximately one hour.
Grupo IMO uses this technique since 2006 in Tomotherapy treatments and since 2010 with the new Cyberknife VSI: the path-breaking Cyberknife treatment.
This radiotherapy equipment provides pinpoint accuracy for the treatment of tumours that are next to or wrapped around critical organs. It includes a lean and compact linear accelerator (normally used to provide external beam radiotherapy to cancer patients), attached to a robotic arm, controlled by a computer. This technique provides unsurpassed maneuverability in targeting tumours as it rotates around the patient in virtually any direction. Besides, it literally breathes along with the patient, continuously keeping submilimetric accuracy over the treated area. Movement synchronization is achieved by previously placing small markers visible under X-rays, placed in the tumour or its surrounding areas. The treatment room is equipped with X-rays that are continuously taking images of these marks whereas a powerful computer creates a correlation between previous anatomic information and the movements of the external sensors mounted onto the patient’s skin. The robotic arm receives orders to modify its movements and offset the tumour’s changes in position while the patient breathes. This type of radiosurgery can be applied in any part of the body, without the need for stereotactic guidance in order to achieve pinpoint accuracy. The patient’s breathing is no limitation for tumours that are next to or wrapped around the lungs. Given its special features, it is mainly indicated for the treatment of brain, lung and liver tumours and tumours next to the spinal chord (primary and metastatic).
Grupo IMO has a Cyberknife unit since 2010.
Brachytherapy or internal radiation therapy allows doctors to use a higher total dose to treat a smaller part of the body in less time than with external radiation. A specific dose is applied directly into the tumour by targeting radiation into the sites that are located nearby or next to the tumour. This entails a positive advantage as it can apply high doses that are biologically very efficient to treat the tumour or the area at risk. However this also poses a constraint as the treated tumours are relatively small. Accessibility to the tumour has improved recently. In a few minutes, HDR has the ability to place miniaturized radiation sources via narrow plastic tubes as they can be coloured in almost every part of the body. The therapy comprises 1 to 10 sessions (depending on the tumour, dose and location). While the radioactive sources -implants- are placed in the patients' body, the patient shall remain isolated and confined in a radiation-proof room. Upon completion of the treatment, the patient no longer bears radioactive material. Recently a new applicator (AccuBoost®) has been developed for a different treatment of the surgical site after breast cancer surgery, which is directly placed onto the skin, and radiation directly targets the site using a mammography. Therefore needles are no longer introduced in the breast. Tumours that are more suitable for this specific brachytherapy technique are skin, breast, prostate and gynecological tumours, as well as certain ORL tumours, pulmonary and bronchial carcinoma. Although the treatment only lasts a few minutes, the entire procedure (including placing the delivery device) may last a few hours. Before removing the delivery device and discharging the patient, the procedure may be repeated several times in one day. Patients may receive up to 10 separate HDR brachytherapy treatments in one or several weeks.
Grupo IMO applies this HDR Brachytherapy and High-dose-rate intra-operative brachytherapy (IOHDR) since 1998.
LDR Prostate Brachytherapy or seed implantation has proven to be extremely useful for the treatment of limited-extension tumours with a positive prognosis. It places hundreds of radioactive seeds in the prostate gland in pre-fixed positions. As the seeds are permanently placed, they are continuously radiating until their activity decreases. As the radiation dose sharply falls in a very short distance, it is not a problem for those living with the patient provided that the first days appropriate precautions are observed. The treatment lasts approximately two hours. Patients are admitted to hospital the night before. Although seed implantation has existed for a few decades now, recent improvements in image technology have made it even more efficient. Doctors can properly see the prostate by means of ultra-sound and therefore they can carefully place the seeds and control the effect on surrounding tissues. With 10 to 15 years of experience, some institutions already have long-term results proving that radioactive seed implants are extremely useful to control prostate cancer, essentially achieving the same outcome than with surgery or radiation therapy with external beam in prostate cancer patients that have been properly selected.
In 1991 Grupo IMO was the first centre in Madrid and second in Spain implementing prostate brachytherapy with Iodine-125 seeds. Since 2010 we carry out real-time prostate brachytherapy.
In IORT, a single high-intensity radiation dose is applied during surgery upon extraction of the tumoral tissue directly treating the affected tissues and therefore being extremely efficient. It requires specific technology and strong coordination between specialists such as radiation therapy oncologists, surgeons and anaesthetists. Sometimes patients, doctors and anaesthetists go directly to the treatment room equipped with the linear accelerator. However there are also mobile radiation therapy devices, such as compact linear accelerators or kilovoltage treatment units (Intrabeam®) which can be moved to the OR to provide the treatment. Brachytherapy techniques can also be used, placing plastic tubes to administer radiation into the affected site. IORT is specially indicated to treat areas at risk around the tumour once it has been removed. It has also been used as palliative therapy in tumours that cannot be fully removed.
Grupo IMO uses this technique since 1991.
