The Departments of Radiation Oncology work together with medical oncologists and surgeons to provide patients with the most comprehensive multidisciplinary management of head and neck cancer available. The most current and effective treatment approaches are provided in ultramodern settings where patient privacy and comfort are foremost.
There are two main types of radiation treatments, external and internal, that can be used based on the needs of the patient. External beam radiation is delivered using a linear accelerator that produces high energy x-ray or electron beams. Internal radiation or brachytherapy uses either radioactive seeds or catheters positioned to guide a highly active source to the area to be treated.
Nutritional counseling is especially important for our head and neck patients since they sometimes experience difficulty eating. At NewYork-Presbyterian, we offer free nutritional counseling services to assure that all aspects of our patient's needs are met.
Many head and neck cancer patients benefit from external beam treatments that are given 5 days a week for up to 7 weeks. Each treatment lasts a few minutes and there is no discomfort during the actual radiation treatment. Radiotherapy hardware, software, treatment planning and delivery methods have advanced dramatically in recent years. These advances allow us to more accurately target head and neck cancers with higher doses of radiation, while minimizing the damage to adjacent healthy tissue. NewYork-Presbyterian utilizes the following state-of-the-art techniques during treatments.
IMRT treatment techniques are used for most of our head and neck patients. This sophisticated, computer controlled method allows the intensity of the treatment beam to be varied or modulated to closely conform the dose to the area to be treated. IMRT allows the dose to be concentrated in the diseased tissue and minimized in the healthy tissue.
At NewYork-Presbyterian, we often use technology that combines or "fuses together" magnetic resonance images (MRI), positron emission tomography (PET), and CAT Scan images to help us determine the geometric and metabolic characteristics of each tumor. This process allows for better treatment planning and maximizing the benefit of IMRT.
During stereotactic radiotherapy the treatment beam is reduced to approximately the thickness of a pencil. This narrow beam is aimed at the target in continuous arcs. The patient's head and neck is gently immobilized with a special frame to eliminate any movement. This sophisticated system allows the dose to be precisely tailored to the individual anatomy of each patient and assures that the entire tumor is treated in all dimensions. The system also limits the dose to the surrounding normal tissues.
Treating the floor of the mouth and the oral cavity presents many challenges. For patients who require this care, NewYork-Presbyterian Radiation Oncology offers treatments using a special adapter for the linear accelerator called an intra-oral cone. This device often provides the best treatment option for oral cavity cancers because it greatly minimizes the radiation dose to the surrounding normal tissues.
Brachytherapy treatments can be effective for various head and neck cancers. One type of brachytherapy called low-dose-rate (LDR) brachytherapy is performed by permanently or temporarily implanting radioactive seeds in the cancerous tissue so they can give off their radiation dose for days or months. Another type, called high dose rate (HDR) brachytherapy, uses a highly radioactive source that is temporarily placed near the target area to quickly give a high dose and then removed.
We continue to offer LDR permanent seed implants using the isotope Iodine-125 (I-125) to deliver the therapeutic radiation dose. However, recently NewYork-Presbyterian Radiation Oncology became the first in the nation to use a new isotope called Cesium-131 (Cs-131) for one type of head and neck cancer. Cs-131 delivers the therapeutic dose much more quickly then I-125 — weeks instead of months — and has other characteristics that may give superior outcomes depending on the needs of the patient.
More commonly, temporary implants using LDR Iridium-192 (Ir-192) are used as appropriate.
We also offer highly specialized HDR treatments for certain head and neck cancers including cancers of the tongue. Because of the specialized nature of these treatments, they are only available at a few other centers in the nation.