When using percutaneous ("through the skin") radiation therapy, the desired area is irradiated from the outside. Special positioning devices or masks (see image) are used for the head and neck area to hit the target volume as precisely as possible in every irradiation session and to protect the surrounding healthy tissue. Markings are made on the body of the patient or on the mask to ensure the exact positioning every time.
In most cases, the target is irradiated from several directions. The gantry moves around the patient and irradiates part of the overall dose from the respective directions which are determined in the radiation plan. The daily treatment takes only a few minutes. The overall dose needs to be applied in smaller individual doses to avoid side effects. Therefore, an irradiation series usually lasts a few weeks with one, or possibly two, irradiations per day.
Rapid-Arc-irradiation of an ENT tumour
Using IMRT, i.e. Intensity-Modulated Radiation Therapy, or VMAT, i.e. Volumetric-Modulated-Arc-Therapy (Rapid Arc) allows us to adapt the radiation dose even more precisely to the target and to offer optimal protection to sensitive organs such as salivary glands.
In VMAT, i.e. Volumetric Modulated Arc-Therapy or Rapid-Arc technique, the gantry moves around the target volume respective the patient.
Stereotactic Radiotherapy (SBRT)
Stereotactic radiotherapy is a specific method in which a small target is irradiated with high precision. The safety margin is only 1-3 mm, which allows for a very high radiation dose in very few or even just one session. As a result, the tumour cells are destroyed. This is comparable to a surgical tumour removal, which is why this procedure - in case of a one-time irradiation session - is also referred to as "radiosurgery". The side effects are usually low. Stereotactic irradiation is often used for metastases (e.g. in the brain, lungs, liver or bones) and also allows to reliably remove minor (lung) tumours.
With some diseases, e.g. rectum, anal, oesophagus, lung and ENT carcinoma, it is sensible to combine radiation with chemotherapy. The latter is applied alongside the irradiation (usually as an infusion) to improve the effect of the radiation therapy by simultaneously damaging the tumour by means of different influences. Depending on the therapy concept, chemotherapy is either applied during the entire duration of the treatment or only in sections, for instance in the 1st and 5th week or once per week.
Chemotherapy can be applied as an out-patient procedure or in-patient procedure, which means that the patient will remain in the hospital during this time. Chemotherapy is carried out by specialist oncologists. To provide this service, we closely cooperate with many oncologists as well as the clinic for haematology and oncology at Klinikum Schwabing. We offer out-patient chemotherapy via the day clinic for oncology and haematology of the hospital. If an in-patient stay is required, our patients can be admitted to the oncology ward of the hospital.
Whole-body irradiation combined with chemotherapy is an integral part of the preparation of an allogenic peripheral stem cell transplantation or an allogenic bone marrow transplantation to treat hematological tumour diseases, particularly acute myeloleukemia (AML). The objective here is to deactivate the body's immune system and the tumour cells, so that the stem cells of a foreign donor can be accepted by the patient's body.
With the exception of the university hospitals and large centres, our practice is one of the few radiation therapy practices in Germany who have the technical equipment and expertise to carry out whole-body-irradiation. Here, we regularly use 3-D-planning and in many cases also IMRT/IGRT. The irradiation is carried out in close cooperation with the clinic for haematology and oncology at Klinikum Schwabing and the paediatric oncology department of the paediatric clinic of the Technical University Munich.
Afterloading or brachytherapy is a procedure in which a radiation source is brought in a hollow organ of the body in direct proximity to a tumour or the region that is to be irradiated. First, an applicator is entered into the concerned organ. Then, the tube is automatically moved within the applicator, which is also called "afterloading". After the irradiation, the radiation source is pulled back and the applicator is removed. The dose fall-off around the target volume is quite steep, so that the effect on the surrounding healthy tissue is minor. Our afterloading device is equipped with an Iridium-192-source. This radionuclide has a high dose-rate, which reduces the irradiation time to just a few minutes.
In our practice we irradiate gynaecological tumours of the uterus, the cervix and
the vagina. Here, afterloading-therapy is used for limited dose saturation
following percutaneous irradiation or as an adjuvant irradiation after a
hysterectomy to reduce the risk of a tumour-recurrence.
The treatment is carried out in cooperation with the physicians of the women's clinic at Klinikum Schwabing.
We also use this treatment for local dose saturation with oesophageal tumours with the support of our colleagues of the clinic of visceral medicine of Klinikum Schwabing.