The previous standard procedure, computed tomography-assisted three-dimensional conformal radiation therapy, is being increasingly replaced by intensity-modulated radiation therapy (IMRT). 3-D conformal methods are often used for target areas that are not at body depth.

DynamicArc therapy is another form of high-precision radiation therapy. During the treatment, the radiation device rotates around the patient so that the tumor region is continuously targeted from different directions. There is a higher concentration of beam on the tumor area and further protection of the surrounding tissue. This allows higher radiation doses to be brought into the tumor (target volume).

Intensity-modulated radiation therapy, abbreviated IMRT, is a further development of 3D-conformal radiation therapy and is always carried out on the basis of computed tomography-based radiation planning.
 

The technique can be performed with a step-by-step rotating gantry (instrument housing with movable multi-leaf collimator - MLC) as a static IMRT or with a device that rotates continuously around the patient as a dynamic IMRT (RapidArc). The intensity, direction and shape of the therapy beam changes dynamically and continuously.
For these intensity-modulated and dynamic radiation techniques, special technical equipment of the radiation device with image guidance systems (X-ray system, therapy beam system, cone-beam CT) as well as a special radiation planning system are required. Intensity-modulated radiation therapy also achieves significantly better protection of the surrounding organs and structures. 

In our practice, we mainly work with dynamic IMRT (RapidArc).

Stereotactic radiation therapy is a technique for radiation therapy tumors with high single doses in one ("radiosurgery") or a few sessions. A requirement for the application of very high doses per session is a spatial (stereotactic) aiming device of the highest precision. The highly-concentrated dose can be applied in the tumor, while the surrounding tissue is very well protected.

Depending on the location and environment of the tumor, the size is limiting the use of this technique. 

Stereotactic radiation therapy is used for the treatment of brain tumors, spinal cord and spinal tumors, lung and liver tumors. With advancing scientific knowledge, the areas of applications are currently becoming broader and wider. 

High-precision radiation therapy is particular important for benign brain and spinal cord tumors (e.g. meningioma, acoustic neuroma).

For this form of radiation, positioning and fixation systems (masks) are often used, since this very complex radiation technique requires a particularly image guidance safe application of the radiation dose. Especially in the brain and spinal cord. A special, device-independent and control system (Brainlab ExacTrac) allows accuracy in the submillimeter range.

Breath-controlled radiation therapy is used for cancer diseases of the chest or upper abdomen. During a minute-long radiation therapy, the organs that are close to the diaphragm or lungs move with each inhalation and exhalation. For this reason, the radiation area for cancer diseases in the chest cavity or upper abdomen, must be larger in order to detect the complete tumor in every breathing position. 4D - CT (recording of a CT scan during all respiratory phases) is used to accurately measure the respiratory motion of the tumor, to keep the radiation area as small as possible in order to protect the surrounding tissue as much as possible. Breath-controlled radiation therapy is also used, for example, in patients with left-sided breast cancer ("deep inspiration breathhold", DIBH). Radiation therapy is performed when the heart is close to the chest wall in deep inhalation. This means it is possible to protect the heart better. Radiation therapy only takes place in deep inhalation, for which the patient must hold her breath for at least 20-30 seconds.

With the help of special applicators, a radioactive source is introduced into the tumor tissue, tumor bed or body cavities of the affected organ - a gentle but extremely effective radiation therapy treatment. The radiation only works on the tumor and in the immediate surroundings. This technique is mainly used for tumors of the uterus and cervix. Tumors of the respiratory system and esophagus can also be treated. Brachytherapy in the afterloading process is carried out in our practice in Harlaching. Here, we cooperate with the Gynecological Cancer Center of the Clinic for Gynecology and Obstetrics at the Klinikum Harlaching and with other clinic doctors. With the installation of the new Aquilion Lightning computed tomograph in the brachytherapy room, we have the opportunity to perform the endocavitary afterloading procedure on the CT table without repositioning the patient between CT planning and application with very high precision, without the risk of geometric deviations.
The described techniques are often used in combinations. Rapid technical and scientific developments in radiation therapy bring different techniques closer together. The team of your radiation therapists is responsible for the indication, dose determination and the use of the respective target-oriented optimal technique. For planning and carrying out your treatment process, our entire team will be happy to help you.