2016-17 Cancer Network Annual Report

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Precision Radiation

Targeting the cancer, preserving the tissue

Our Sentara Cancer Network specializes in outpatient and inpatient targeted therapies that zone in on a patient’s cancer cells while sparing his or her surrounding tissue from excessive radiation. The doctor’s ability to target cancer precisely means the patient keeps healthy tissue while eradicating cancerous areas. When radiologists precisely target tumors and other lesions, they often completely eliminate the need for surgery. Other therapies use radiation to reach tumors not accessible in open surgery. In some cases, doctors implant radioactive particles in patients to deliver radiation directly to the tumor.

Pinpointing the tumor: External beam radiation therapy

Sentara Albemarle Medical Center, Sentara CarePlex Hospital, Sentara Martha Jefferson Hospital, Sentara Norfolk General Hospital, Sentara Northern Virginia Medical Center, Sentara Obici Hospital, Sentara RMH Medical Center, Sentara Virginia Beach General Hospital

External beam radiation therapy is a method for delivering a beam of high- energy X-rays to a patient’s tumor. This strategy exposes the cancerous tumor to a much larger dose than the surrounding healthy tissue. Ionizing radiation works by damaging the DNA of exposed tissue. To prevent non-cancerous tissue from being damaged, the radiation beams are shaped and aimed from several angles to intersect at the patient’s tumor.

Reaching the once inaccessible: Stereotactic radiosurgery (SRS)

Sentara Martha Jefferson Hospital, Sentara Norfolk General Hospital, Sentara Obici Hospital

SRS is a minimally invasive form of surgical intervention that uses a three- dimensional coordinates system to locate small targets inside the body. Using highly focused beams of ionizing radiation with high precision is a way to target tumors and other lesions that could be otherwise inaccessible for open surgery.

Targeting cancer: Edwin Crandley, M.D., Radiation Oncology, Sentara Norfolk General Hospital

No surgery, no pain: CyberKnife®

Sentara Norfolk General Hospital

At the Sentara Cancer Network, we understand that being a leader in treating tumors means investing in promising new technologies. Our CyberKnife® robotic radiosurgery system, available at the Sentara Advanced Radiosurgery Center, is the most advanced system of its kind in Hampton Roads. CyberKnife is a non-invasive alternative to surgery for the treatment of both cancerous and non-cancerous tumors anywhere in the body, including the prostate, lung, brain, spine, liver, pancreas and kidney. The treatment delivers beams of high-dose radiation to tumors with extreme accuracy and offers new hope to patients. Though its name may conjure images of scalpels and surgery, the CyberKnife treatment involves no cutting. In fact, the CyberKnife system is the world’s first and only robotic radiosurgery system designed to treat tumors throughout the body non-invasively. It provides a pain-free, non-surgical option for patients who have inoperable or surgically complex tumors, or who may be looking for an alternative to surgery.

Treating and marking tumors: Brachytherapy/radioactive seed implant therapy

Available at numerous sites throughout the network

Brachytherapy is a form of radiotherapy where a radioactive source is placed inside or next to the area in a patient’s body requiring treatment. It’s commonly used for gynecologic cancers, urological cancers and early breast cancers. For breast cancer, the radioactive seeds are used to mark a tumor so that the surgeon can be as precise as possible during surgery.

Therapy for a curved or irregular surface: High-dose rate (HDR) for skin cancer

Sentara CarePlex Hospital, Sentara Norfolk General Hospital, Sentara Obici Hospital, Sentara RMH Medical Center, Sentara Virginia Beach General Hospital

A mobile radiation option for certain types of skin cancers gives patients a more convenient and targeted treatment. A high-dose rate iridium device, called an HDR unit, uses specially designed applicators with the high-dose rate treatments applied directly to the skin. It allows more precise treatment, especially for curved or irregular surfaces including those on the face, arms and legs, while sparing the patient’s surrounding healthy tissue.

Improving convenience for our patients: Accelerated partial breast irradiation (APBI)

Sentara CarePlex Hospital, Sentara Martha Jefferson Hospital, Sentara Norfolk General Hospital, Sentara RMH Medical Center

APBI is a form of brachytherapy (internal breast radiation) in which radioactive substances are placed directly into a patient’s breast via a specialized catheter after a lumpectomy. APBI delivers the entire course of radiation within 5 to 7 days, reducing the time and travel required for the patient. It also radiates the area in the breast that is most likely to have recurrence and reduces the side effects of radiation by sparing normal tissues.

From clinical trial to care option: Intraoperative radiation therapy (IORT)

Sentara CarePlex Hospital, Sentara Northern Virginia Medical Center

IORT delivers a concentrated, high-dose beam of radiation to cancerous tumors. The tumor is irradiated while it is exposed in an operative suite. Sentara CarePlex Hospital introduced IORT to our network during a clinical trial with IntraBeam® in 2007. The Xoft electronic brachytherapy system, available at Sentara Northern Virginia Medical Center, takes the treatment to the next level by offering the patient mobility and shielding during the process.

Delivering the power of precision: Anthony Crimaldi, M.D., and Sylvia Hendrix, M.D., Radiation Oncology, Sentara Martha Jefferson Hospital

Taking a team approach: Chukwuemeka Obiora, M.D., General Surgery, and Carlos Velasco, Ph.D., Radiation Oncology, Sentara CarePlex Hospital