Brain
Tumors of the brain and spinal cord; brain metastases
Dan Garwood, MD and Robert Timmerman, MD

Many types of tumors can involve the brain, from benign, slow-growing tumors, to aggressive rapidly growing cancers.  Malignancies can be primary brain tumors, that is, tumors which started in the brain, or metastatic, meaning cancers which spread to the brain from some other organ or site in the body.  The most common adult primary brain tumors are called Gliomas, such as Glioblastoma Multiforme.  Metastatic cancers come to the brain from other sites, such as cancers of the lung or breast, or indeed almost any part of the body where malignancies start. Radiation therapy is commonly used in the treatment of tumors involving the brain, either as the primary mode of therapy, or in conjunction with surgery, to treat any cancer cells left behind.

Radiation can be used in two ways against brain tumors; either focused, to treat a small volume in hopes of eradicating a specific lesion, or directed more broadly, to encompass a wider volume of the brain where tumor cells might have spread.  Focused, or stereotactic, radiation uses multiple beams of radiation tightly targeted to the tumor, which allows for very high doses of radiation in the target, but relative sparing of the surrounding normal tissue.  Intensity Modulated Radiation Therapy (IMRT) is often used in the treatment of brain tumors.

Breast Cancer
Tumors of the breast
Dan Garwood, MD and Ann Spangler, MD

The Moncrief Radiation Oncology Center provides state-of-the-art treatment for all stages of breast cancer including post-mastectomy irradiation, and breast conservation treatment with whole-breast irradiation and accelerated partial breast irradiation.  Disease specific indications considered for treatment include intraductal carcinoma (also known as ductal carcinoma in-situ, DCIS), lobular carcinoma in-situ (LCIS), infiltrating (or invasive) ductal carcinoma, infiltrating (or invasive) lobular carcinoma, medullary carcinoma, and sarcomas of the breast and chest wall.

For patients undergoing post-operative or whole breast treatment, radiation therapy is delivered with one of our three linear accelerators, and intensity modulated radiation therapy (IMRT) is used to optimize coverage of the breast while decreasing the radiation delivered to the adjacent normal structures (including the heart and opposite breast).  Accelerated partial breast irradiation using the MammoSite RTS® implant system is available for carefully selected patients with early stage disease.

Moncrief Radiation Oncology Center is affiliated with the University of Texas Southwestern's Simmons Comprehensive Cancer Center and interacts in multi-disciplinary consultation and management with medical oncologists and surgeons.  We actively participate in clinical research when appropriate and offer patients the option of participation in trials offered through national collaborative groups such as the NSABP, RTOG and CALG-B as well as investigator-initiated and industry-sponsored trials.

Gastrointestinal
Cancer of the gastrointestinal tract

Patients treated at the Moncrief Radiation Oncology Center for tumors related to the gastrointestinal tract enjoy the consultation treatment tactics of a multi-disciplinary team.  Actual radiation therapy treatments are carried out with the most modern approaches including 3-D conformal radiotherapy, intensity modulated radiation therapy (IMRT), and brachytherapy implants.  Multimodality programs have been developed for comprehensive treatment of esophageal cancer, stomach cancer (including gastric cancer and gastrointestinal stromal tumors), pancreatic cancer, cancer of the liver and bile ducts (hepatocellular carcinoma or hepatoma, cholangiocarcinoma including Klatskin's tumor, and gall bladder cancer), small bowel carcinoma, colon cancer, rectal cancer, and anal cancer.  In addition, the center has experience with more rare cancers occurring in the abdomen including sarcomas and appendiceal cancers.  Finally, the department has extensive and growing experience with ablation of liver metastases in selected patients.  This includes the use of stereotactic body radiation therapy for ablation of liver metastases using specialized linear accelerators or the Cyberknife.

Genitourinary
Cancers of the urinary tract and male genital organs; prostate
David Pistenmaa, MD, PhD and Robert Timmerman, MD

Patients with genitourinary (GU) cancers are seen at the Moncrief Radiation Oncology Center by direct referral or in conjunction with the multi-disciplinary urological oncology program at UTSW.  Special programs exist for treatment of both common and uncommon GU malignancies.  The most common, prostate cancer, is coordinated through a multi-disciplinary team comparing the options of observation, surgery, and a variety of radiation therapy strategies.  The center has a large experience in 3-D conformal radiotherapy, intensity modulated radiation therapy (IMRT), prostate seed brachytherapy implants, and combinations of these therapies.  A similar approach is used for other GU cancers including bladder cancer, urethral cancer, ureteral cancer and kidney cancer (hypernephroma).  A special GU cancer problem, testicular or testis cancer, affects a much younger population and with proper treatment has a high chance of cure even with extensive metastases.  The approach at UTSW is comprehensive for testis cancer drawing on our large experience to find a cure and avoid long term side effects.

Ongoing research is helping our department develop new treatments for GU cancers. Basic science research at UTSW in animal models has shown that large dose per fraction radiation delivery may be both feasible and more effective.  With this information we are embarking on new strategies to use highly focused stereotactic body radiation therapy for treating organ confined prostate cancer.  In addition, we are designing trials to address problems with recurrence after prostatectomy as well as investigation into making treatments less toxic and more convenient.  We also participate in cooperative group trials such as the RTOG and CALG-B to offer patients the most modern therapies.

 Gynecology
Cancers of the female genital tract and urethra
William Hittson, MD and Eleysia Outlaw, MD

Patients with gynecological (GYN) cancers are seen at the Moncrief Radiation Oncology Center by direct referral or in conjunction with the multi-disciplinary oncology program at UTSW.  Special programs exist for treatment of both common and uncommon GYN malignancies.  The most common, endometrial cancer, is coordinated through a multi-disciplinary team comparing the options of post surgical observation, surgery alone, and a variety of radiation therapy strategies.  The facilities include the use of a high dose rate (HDR) remote afterloading irradiatoin delivery device.  This system, coupled with the physician's expertise, allows highly conformal high dose brachytherapy implanation of areas involved or at risk for cancer infiltration.  All of this is done with the comfort and convenience of an outpatient treatment.  The center has a large experience in 3-D conformal radiotherapy, intensity modulated radiation therapy (IMRT) and combinations of these therapies.  A similar approach is used for other GYN cancers including cervical cancer, vaginal cancer, vulvar cancer, ovarian cancer, and uterine sarcomas.

Ongoing research is helping our department develop new treatments for GYN cancers.  In addition to the use of the most modern radiotherapy, we have implemented prudent use of the chemotherapy concurrent with radiation and are designing trials to address making treatments less toxic.  We also participate in cooperative group trials such as RTOG,  GOG and CALG-B to offer patients the most modern therapies.

Head & Neck
Cancers of the head and neck, including thyroid and skin
William Hittson, MD, Robert Timmerman, MD and Eleysia Outlaw, MD

A number of special problems face individuals diagnosed with head and neck cancer.  The significance of the upper aerodigestive tract in eating, drinking, speaking, and breathing demands special care in avoiding dysfunction to such basic processes.  Patients with head and neck cancers are seen at the Moncrief Radiation Oncology Center by direct referral or in conjunction with the multi-disciplinary oncology program at UTSW.  A multi-disciplinary strategy combining surgery, chemotherapy and radiotherapy is used for most advanced head and neck cancers.  The most comon cancer sites treated include paranasal sinus, nasopharynx, tonsil, palate, base of tongue, pharyngeal wall, oral tongue, floor of mouth, retromolar trigone, alveolus, larynx (including vocal cord), hypopharyngeal, and tracheal.

The Moncrief Radiation Oncology Center has in-depth experience in 3-D conformal radiotherapy, intensity modulated radiation therapy (IMRT), brachytherapy and combinations of these therapies. Ongoing research is helping our department develop new treatments for head & neck cancers. 

Lymphoma/ Melanoma/ Sarcoma

Lymphoma, multiple myeloma, Kaposi's sarcoma; Cancerous growth appearing on the upper back, lower legs, and head and neck; soft tissue sarcoma

Pediatrics
Tumors and hematologic malignancies in children

Significant progress has been made in the treatment of cancer in children over the past decades. Many types of pediatric malignancies considered fatal 50 years ago have become highly curable today. This remarkable progress has been achieved through multi-institutional trials made possible by the participation of the overwhelming majority of patients at university hospitals. Dedicated academic physicians, such as those at UT Southwestern and Children's Medical Center, have served as the catalysts in completing these trials, investigating new treatments and supporting patients along with their families throughout. Cancer in children often is quite distinct from adult cancer, just as are the patients' needs. Children's Medical Center is equally unique in its ability to offer comprehensive services tailored to children.

As cancer can strike virtually any site in the body, radiation may be used anywhere. It can be especially useful when a tumor affects surgically inaccessible sites or when surgery might be disfiguring. Ground breaking technology available at UT Southwestern called Cyberknife is capable of delivering high precision radiation therapy to the tumor. Cyberknife offers patients the potential of increasing the radiation dose to the tumor while simultaneously reducing collateral high dose radiation to surrounding normal tissue. The reduction in dose to adjacent normal tissues should lead in turn to fewer side effects. Intensity modulated radiation therapy (IMRT) is available as another route to deposit radiation more selectively. IMRT has emerged throughout the country as a means of selectively irradiating tumors and decreasing high dose radiation to adjacent normal structures. In selected cases, applying radioactive sources near the tumor, brachytherapy, is used as well to increase the tumor dose.

The physicians at Children's Medical Center and UT Southwestern are at the forefront of pioneering the study of new agents to combat cancer, monitoring late effects of treatment, and improving our understanding of the molecular mechanisms cancer. Understanding the biology of the development of cancer moves discoveries from the lab bench to the bedside. At UT Southwestern and Children's Medical Center, research is translated to helping patients and making cancer history.

Thoracic
Cancers of the lung, thymus, and esophagus
Hak Choy, MD and Robert Timmerman, MD