Acıbadem Healthcare Group has invested a total of 46 million dollars on cancer treatment. More recently, the Cancer Center has been equipped with state-of-the-art technology devices, requiring an investment of up to 7,5 million dollars. Intended to serve not merely to the patients coming from the neighbouring provinces, but also patients from abroad, Acıbadem Cancer Center has been equipped with 3 important technological treatment methods in the field of cancer, termed 'three-in-one technology'.

Acıbadem Healthcare Group is determined to offer its patients the state-of-the-art cancer treatment methods. With this objective in mind, Acıbadem Healthcare Group has brought together the latest technologies in cancer with its highly experienced and knowledgeable specialists. The Cancer Center located in Acıbadem Healthcare Group Hospital has been equipped with a highly specialised treatment device which can single-handedly perform the functions of three important therapeutic applications such as image-guided radiotherapy (IGRT), intensity-modulated radiotherapy (IMRT) and stereo-tactic radiotherapy (STRT):

IMRT: Intensity-modulated radiotherapy
IGRT: Image-guided radiotherapy
STRT: Stereo-tactic radiotherapy

Acıbadem Healthcare Group Radiation Oncology Specialist Professor Enis Özyar talked about the latest innovations in the treatment of cancer and answered our questions about the cancer treatment applied in Acıbadem Cancer Center.

1- What kind of benefits does the three-in-one technology allow for in the treatment of cancer?

CUSTOMISED TECHNOLOGY FOR SENSITIVE ORGANS

IMRT technology is used in the case of those tumours which are located very close to or envelope a radiation-sensitive organ in the body which needs to be protected.

For instance, in some cases of head and neck cancers, if there is a tumour around the spinal cord or if it is at all possible to spare the salivary glands, this method gains importance. It has been in widespread use in prostate cancers in order to protect the neighbouring normal tissues. Furthermore, we use this method whenever we need to radiate the same area in the patient's body for a second time. Having been used only in such cases at the outset, the IMRT technology has gained popularity over other techniques and come into more widespread use once it has been observed that it provides better protection for the healthy tissues. The difference between intensity-modulated radiotherapy and classical radiotherapy could be likened to watering the flowers with special irrigation devices instead of using the fire hose.

WE PUT SPECIAL MARKS ON THE TUMOUR

In IGRT technology, we would draw the classical radiotherapy areas on the patient at the beginning of the treatment. We would treat the patient for a period of one month or one month and a half by merely following the same lines. From time to time, we would take x-ray images of the patients to check for the effects of treatment; we would check the bones and the treatment areas. While this method caused more normal tissues to be exposed to radiation, the potential movements of the tumour risked an error in the amount of the dosage it was exposed to. In IGRT, we take daily cross-sectional images of the treated area of the patient and correct any errors arising from the neighbouring organs or the movements of the tumour. In this way, it is possible to provide sensitive radiation for the tumour every day. Whereas previously we would have two-dimensional monitoring of the golden marks inserted in the tumour, the new system allows for three-dimensional cross-sectional imaging of the tumour during treatment. These are images similar to those obtained with a CAT scan and provide for safer treatment. Some marks inserted in the tumour with IGRT or close monitoring of the bone structures allow for daily radiation of the tumour as per planned dosage.

PENCIL-THIN DISCRETE RADIATION

In STRT (Stereo-tactic Radiotherapy) technology, we provide discrete radiation. The radiation clusters employed in this kind of treatment are as thin as a pencil and target the tiniest of tumours. It is applied to a very tiny area; consequently, the number of healthy tissues exposed to radiation is a lot less. As such, instead of treatments which may last up to 5-7 weeks, in some tumours it is possible to have high dosage STRT applications which require one single session or short treatment periods.

2- The new devices allow for real time position management. What exactly is the benefit for the patient?

We are in a position to be able to perform all Real Time Position Management (RPM) treatments on the same machine. In this technique, as the patient gets prepared for treatment, a special device is put on the patient's chest area to record the respiration patterns. The movement of the tumours is monitored as they get displaced and radiation is given in certain positions based on respiration patterns as the patient breathes in and out. Patient compliance is of utmost importance here.

3- What other devices are used in Acıbadem Cancer Center?

At Acıbadem Hospital we use two high technology linear accelerators, a digital imaging system which shows the accuracy of the radiotherapy areas and provides instant images and one conventional simulator.
Simulator is a system which checks for the accuracy of treatment areas prior to treatment. This is a procedure whereby a mark is drawn on the patient or on his/her masks. The dosage of radiation one gets exposed to during one single session of treatment is much higher than the amount of radiation one gets exposed to through natural means throughout one's life. As such, it is of utmost importance that the treatment be delivered correctly in each and every session. Therefore, pre-treatment simulation is very important.

4- What is the benefit for the patient when the images obtained from different devices can be integrated?

We benefit from the advantages of the high technology available in our Cancer Center. The advanced computerised radiotherapy planning system in our Center allows for planning based on fusing the images obtained from the CAT scan, the MRG and the PET-CAT. The CAT scan images used in patient treatment provide us with information about the patient to a certain extent. On the other hand, depending on the CAT scan, it is possible to obtain different information on MRG and PET-CAT. It is possible to acquire more information about the patients by superimposing the images obtained through these three methods with the images obtained from the treatment position of the patient. It is thus possible to determine the tumour more accurately, allowing for more appropriate treatment.

WE HAVE ESTABLISHED A SYSTEM WHEREBY ALL DEVICES MAY COMMUNICATE WITH ONE ANOTHER

5- Is there a system which allows for the integration of all the data that is obtained from these devices? Could the presence of so many devices cause confusion?

There is a computer network which makes it possible for all of these devices to communicate with one another. This network is called the ARIA system. There are a considerable number of medical devices used in the preparation and the treatment of radiotherapy. If information transfer among these devices were done manually, there would be a lot of room for errors and loss of information, and it would be very time consuming. This necessitates a system which ensures that all of these systems communicate with one another and that all patient information is stored appropriately. The utilisation of this system makes it possible for the patient to start error-proof therapy as soon as possible.

6- What is the superiority of high technology in the treatment of cancer?

The particular therapeutic benefit of these devices is that they radiate the tumour with a high degree of accuracy while ensuring maximum possible protection for the normal and healthy tissues.

7- What is the most recent state-of-the-art technology and medical practise in radiation oncology worldwide?

The latest technology in radiotherapy is to minimise damage to the healthy tissues and increase the dosage of radiation emitted to the tumours. While this increases the chances that tumours are brought under better control, it also improves life expectancy and quality of life on the part of the patients. For instance, in cancers of the head and neck region, patients receiving classical radiotherapy treatment experience severe dryness of the mouth in their future lives and this has a negative impact on quality of life. This new technology allows for the minimisation of these side effects.

8-What is the importance of multidisciplinary treatment in cancer and what are the benefits for the patient?

Different scientific branches play a role in the treatment of cancer patients. These are generally the surgeons of the relevant branches, radiation and medical oncologists, paediatric oncologists, chest disease specialists, pathologists, radiologists and nuclear medicine specialists.
Discussing the patient in what is called the tumour council meetings plays an important role in the identification of the ideal approach to the patient. Here, the doctors discuss the ideal method for the patients and make sure that the planned treatment is delivered to the patient in the most appropriate manner. While discussing the patients at the joint council contributes to their receiving the most ideal treatment, these meetings also play a significant role in the treatment team having access to updated information, improve communication and learning among the members.

For more information:

ALO ACIBADEM 444 55 44
www.acibadem.com.tr