The primary tool of any Medical Oncologist is the use of either a single antineoplastic drug or the combination of such drugs into a standardized treatment regimen that kills cancer cells by stopping them from growing and dividing. Most chemotherapy is delivered intravenously, though some can be delivered orally. Our Oncologists determine how often you'll receive chemotherapy treatments based on what drugs you'll receive, the characteristics of your cancer and how well your body recovers after each treatment. Chemotherapy treatment schedules vary. Chemotherapy treatment can be continuous or it may alternate between periods of treatment and periods of rest to let you recover. The total number of treatments you receive depends on numerous factors. Chemotherapy treatments are given as outpatient treatments and involve a relatively small amount of time each day of treatment. Consultation visits may last for as much as an hour or more. It is important that you not miss treatments as this could affect treatment results. Chemotherapies work by killing cells that divide rapidly. As they kill fast-growing cancer cells, though, they can also damage or kill healthy cells as well. Damage to blood cells, for example, leads to side effects such as anemia, fatigue, and infections. Chemotherapy can also damage the cells that line the mucous membranes found throughout the body, including those inside the mouth, throat, and stomach. This leads to mouth sores, diarrhea, or other problems with the digestive system. And damage to cells at hair roots, or hair follicles, leads to hair loss. Each person with cancer reacts differently to chemotherapy and its various side effects. Fortunately, Landmark doctors now have many ways to reduce and even prevent these side effects. We will help with managing side effects so that your treatment goes as smoothly as possible.

In intensity modulated radiation therapy (IMRT), very small beams are aimed at a tumor from many angles. During treatment, the radiation intensity of each beam is controlled, and the beam shape changes hundreds of times during each treatment. As a result, the radiation dose bends around important healthy tissues in a way that is impossible with other techniques. Because of the complexity of these motions, Verity Radiation uses special high-speed computers, treatment-planning software, diagnostic imaging and patient-positioning devices to plan treatments and control the radiation dose during therapy. For IMRT to be effective, the anatomical position of the tumor and surrounding healthy tissues must be accurately defined. CT, PET scans and MRIs provide the necessary three-dimensional anatomical information, while advanced imaging devices provide daily information about the location of internal organs. A device called a multileaf collimator adjusts the size and shape of the computer-determined radiation beams. The collimator, a computer-controlled mechanical device, consists of dozens of individually adjusted metal leaves. These leaves move across the irradiated tissue while the beam is on, blocking out some areas and filtering others to vary the beam intensity and precisely distribute the radiation dosage.

Tumors can move, both during a radiation treatment session and from one treatment session to another. This commonly occurs as a result of normal internal organ action (digestion, elimination, and breathing). If these changes in position move the tumor out of the planned treatment range, the tumor may either not receive the full amount of radiation that it should, or normal tissues may receive more radiation than they can tolerate. By use of new image-guided techniques (IGRT), it is now possible to verify tumor locations each day. One of the most effective methods, used by Verity Radiation daily, involves producing a computed tomography (CT) image of the patient using the “cone beam” technique. By using a linear accelerator’s larger conical beam, the entire 3-D volume of the treatment area can be imaged with just one rotation of the device. Image-guided Radiation Therapy is an important key in achieving both unparalleled tumor control and normal tissue sparing. At Verity, we have the integrated tools that work toward successful image-guided motion management in the radiation oncology process to provide efficient and effective treatment.

Each patient’s CT scan is imported directly into the treatment planning computer and the physician uses this 3-dimensional information to define the treatment area. In some cases, MRI and PET scans are merged with the CT to help define the tumor. The dosimetrist and physicist work with your physician to design radiation beams that conform to the shape of the tumor and avoid healthy tissue to the greatest extent possible. This allows us to deliver high doses of radiation to the tumor while minimizing the radiation to nearby normal tissues.

One of the major features available through use of the Trilogy system is Stereotactic Radiosurgery (SRS). In SRS, a number of precisely directed beams of ionizing radiation are aimed from diverse directions and meet at a specific point within the body, delivering very high doses of radiation to that point. As with other treatment techniques available at Verity, a CT scan is used to provide a 3-dimensional view of the tumor. This data is used to develop complex plans designed to deliver highly focused radiation while sparing normal adjacent tissues. In some cases an entire course of treatment is given in a single treatment.

Diagnostic imaging is the process of producing detailed pictures of organs and various body structures. These pictures are used to detect various abnormalities such as tumors, to determine the extent of a disease, and to evaluate the effectiveness of a treatment. Diagnostic imaging may sometimes be used when performing biopsies or other surgical procedures. All Landmark imaging departments are American College of Radiology accredited and staffed by trained, certified professionals.

Mammography is specialized medical imaging that uses a low-dose x-ray system to see inside the breasts. A mammography exam, called a mammogram, aids in the early detection and diagnosis of breast diseases in women. Landmark uses state of the art 3D Mammography equipment from Hologic, the leader in 3D Mammography imaging.

3D / 4D Ultrasound imaging (sonography) uses high-frequency sound waves to view inside the body. Because ultrasound images are captured in real-time, they can also show movement of the body's internal organs as well as blood flowing through the blood vessels. Unlike X-ray imaging, there is no ionizing radiation exposure associated with ultrasound imaging.