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What is radiation?

Radiation is a form of energy that can be delivered externally with X-rays or internally with radioactive sources. The goal of radiation is to damage cancer cells so that they cannot reproduce and they die.

Does Moffitt have a Cyberknife? If not, why not?

Moffitt does not have a Cyberknife. Cyberknife is one type of machine that delivers Stereotactic Ablative Radiotherapy (SABR). This is the type of radiation that is "pinpoint" and delivers a high dose of radiation to the tumor in one to five treatments. There are other machines that deliver SABR, and we prefer the Trilogy and Truebeam units. Our patients often have difficulty lying on the table for an extended period of time, so we prefer the shorter treatment times with our machines. We used SABR to treat more than 200 patients with lung cancer and more than 100 patients with abdominal cancers. Our team has extensive expertise in stereotactic delivery and collaborates closely with our Moffitt radiology and surgical colleagues.

Does Moffitt have protons? If not, why not?

Proton therapy is a different type of radiation and has been available for the past 30 years. Moffitt does not have a proton unit. The unique advantage of the proton machine is that it has what is called a Bragg peak, which means the amount of radiation delivered to the healthy tissue beyond the tumor shows a steep decline. Our faculty selected the choice of treatment units we have to be able to personalize the treatment to the individual patient. We did not feel we needed a proton unit to be able to offer our patients the latest technology to minimize their side effects. Men with prostate cancer can relate to this since recent studies showed that proton therapy did not offer an advantage over IMRT (Intensity Modulated Radiation Therapy).

What is brachytherapy?

This is internal radiation. This means that the radioactive source is placed either in or near the tumor. It can be delivered with permanent seeds that decay over time (LDR or low dose rate), or it can be delivered with a source that can be removed after 10 to 15 minutes (HDR or high dose rate).

How is Moffitt different from other radiation treatment centers?

At Moffitt , we like to remind our patients that it is about the team, not the machine. With all of the media in our modern society, patients can hear about radiation treatment machines and focus on the machine. We believe, though, that selecting the treatment team is most important.

The biggest difference is that Moffitt has doctors who specialize in a particular type of cancer all under one roof. This means that, for example, when a patient is referred for esophageal treatment, a surgeon, medical oncologist, gastroenterologist and radiation oncologist might all see the patient to determine the best option for treatment. Since many patients will receive radiation before or after surgery, the radiation oncologist can collaborate closely with the team. The radiation oncologist at Moffitt is an expert in the treatment of that particular type of cancer and practices what is called "academic" medicine. This means that the doctor is always trying to improve treatment for this disease, which may involve teaching younger doctors, publishing papers, teaching national courses, giving lectures or inventing new treatments that get patented. Our doctors are involved with clinical trials as well to try to find the next best treatment.

How does Moffitt decide what technology to offer patients?

Our faculty are experts in their field. If there is new technology available, they first want to know if it is safe. If so, they want to know what the evidence is that the new technology is better than existing techniques. This rigorous process of evaluation is done on a continual basis to ensure that we offer our patients state of the art treatment.

How should I deal with side effects?

At Moffitt, your radiation doctor will see you every week. In addition to the physician, we also have a dietitian, social worker, and nurse available. Our goal is to complete the treatment and manage the side effects effectively to offer the best quality of life that is possible.

How does the doctor figure out where my tumor is?

Our doctors have access to extensive technology to improve knowledge of where the tumor is. First, sometimes markers that show up on X-rays are implanted in or near the tumor. For example, this can be done for prostate cancer as well as gynecologic, pancreatic, rectal, esophageal, and liver tumors to guide radiation delivery. Second, our doctors have access to CT, MRI, PET and 4D PET/CT to help determine the location of the tumor. If the radiation doctor has a question about the scan, the site specific radiologist can be called to help. Sometimes, our surgeons call our doctors into the operating room to show them where a patient’s tumor is. The radiation specialist thus can review the X-rays of the tumor location with the whole team. Every week, Moffitt Cancer Center has tumor boards where a group of physicians review the patient’s X-rays and discuss the best way to treat that particular patient.

What does the radiation therapist do?

Radiation therapists are very important. They are experts in setting the patient up every day for treatment. At Moffitt, we have built-in quality checks to make sure that the treatment is delivered safely and appropriately. We have weekly peer review conferences where each new patient is reviewed. Our physics staff does weekly chart checks to make sure the treatment is delivered as the doctor planned. Safety is of the utmost priority to our faculty and staff.

How busy is your cancer center?

Moffitt is a high-volume cancer center. Our doctors thus have significant experience in treating many different types of cancer.

Do the radiation doctors at Moffitt contribute to national guidelines on cancer treatment?

Yes. Our doctors are involved in many ways. They sit on expert review panels that update guidelines for treatment. They contribute research articles, give lectures, and are involved with national teaching courses.