Advanced technology at Avera McKennan also allows select patients to benefit from a radiation boost at the time of surgery, directly to the surgical site, without impact to skin, tissues or organs. Intraoperative electron radiation therapy (IOeRT) has a proven track record in the treatment of colorectal cancer, and this technology has been available at Avera McKennan since 2011. Dr. Kathleen Schneekloth, board-certified Radiation Oncologist, said that when physicians believe that a selected patient could be a candidate for IOeRT, his or her case is scheduled in the surgical suite that is equipped with the Mobetron unit. Yet the surgeon and radiation oncologist do not make a final decision to use IOeRT until surgery is underway, and the tumor bed is visible. IOeRT is indicated for locally advanced disease that is varied in resectability. Indicators include gross residual disease at the resection bed, gross positive margins or positive microscopic margins, based on pathology review. IOeRT is intended to give a supplemental dose, in addition to any pre- or postsurgical radiation and chemotherapy prescribed for the patient, in order to prevent recurrence in a high-risk area. In addition to sparing nearby organs, it spares nerves, and the ureters. “The data shows the treatment is well tolerated, and in appropriately selected patients, provides a higher tumor control rate with normal morbidity to other organs,” Dr. Schneekloth said. A typical dose, through collimators ranging in size from 4 mm to 9 mm, is 10 to 20 gray. Actual treatment is a minute to a minute and a half, when all care staff step out of the room and the patient is monitored remotely by the anesthesiologist. After the treatment, the patient is not radioactive, and there is no residual radioactivity in the room.
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At Avera McKennan, IOeRT is used primarily in the treatment of breast cancer through participation in an international research trial, and it has also been used incidentally for gynecologic cancers, soft tissue sarcoma and pancreatic cancer in addition to colorectal cancer.
Known as “radiosurgery,” the treatment is non-invasive, through the skin. Radiation beams converge on a small spot, making this technology applicable for small fields, including metastases to the liver, brain or spine.
Avera McKennan also has the technology to offer intraoperative high-dose rate brachytherapy for similar indications. At the time of surgery, straw-like hollow catheters are inserted close to the tumor bed. After surgery, in the Avera Cancer Institute’s dedicated brachytherapy suite, a radioactive source is delivered through the channels directly to the tumor site, delivering a very precise dose to high-risk areas while sparing other structures. Brachytherapy may be helpful when working around a curve in the body, as opposed to IOeRT which is delivered in a straight path. For patients who are not candidates for surgery, the Avera Cancer Institute offers stereotactic radiosurgery/stereotactic body radiation therapy (SRS/SBRT) using the Elekta Versa HD. This linear accelerator delivers a high dose of radiation with extremely high precision.
“Surgical and radiation techniques are considered on a case-by-case basis through a multidisciplinary approach as part of an appropriate treatment plan, designed for the best possible outcome.” – Dr. Kathleen Schneekloth, board-certified Radiation Oncologist
Advanced Surgical and Radiation Therapy Techniques • Robotics • Single-incision laparoscopy • Intraoperative electron radiation therapy (IOeRT) • Intraoperative HDR brachytherapy • S tereotactic radiosurgery/stereotactic body radiation therapy (SRS/SBRT)