ONCOLOGY DEPARTMENT

URO ONCOLOGY SERVICES

We at SRC & Super specialty lay stress not only on curative but also on preventive aspect of
cancer diseases as early detection and timely intervention can change outcome of these
diseases significantly.

Cancer is a major health hazard in the world. Number of cancer patients is increasing all over
due to various known and unknown factors. India is not unaffected by this change.

Urinary tract cancers form an important part of urinary tract diseases. With the increasing trend
of smoking and alcohol and increased awareness among patients we have more number of
patients under the operable category. In the modern era of health care the onus is on us not just
to treat the disease but to improve the quality of life of patients. Taking a step forward in this
direction we have set international standards as the goal and continue to strive towards it.

Today, at SRC & Super specialty we strive not just to make the patient disease free but to have a
life wherein the patient is free of the social stigma that they undergo post-surgery. Our specialists
at SRC & Super specialty are working day in and day out to achieve the goals we have set for
ourselves.

Post prostatectomy urinary incontinence is most dreaded complication of robot assisted radical
prostatectomy. Our center is using “Retzius sparing technique” which provides early urinary
continence after prostatectomy resulting in better quality of life after prostatectomy. Similarly,
with use of robot assisted technique our center provides advantage of minimal invasive
technique in inguinal node dissection and retroperitoneal lymph node dissection in carcinoma
penis and testicular tumor patients respectively.

This, in addition to our team of medical and radiation oncologist make sure that they leave no
stone unturned to see that the patient receives complete protocol based treatment. We have
state of the art diagnostic and therapeutic services and provide complete cancer care making
sure that we are nowhere behind with the international standards of healthcare.

Diagnostic Facilities

 TRUS guided Prostate Biopsy

 MRI-TRUS Fusion Guided Prostate Biopsy
 Flexible Cystoscopy
 Flexible Ureteroscopy
Intervention

 Hyperthermic intravesical chemotherapy (HIVEC) for Urinary Bladder Cancer

 High intensity focused ultrasound (HIFU) for Prostate Cancer
 Open/ Robot-Assisted Laparoscopic Prostatectomy for Prostate Cancer
 Open/ Robot-Assisted Cystoprostatectomy with intracorporeal/extracorporeal ilial conduit/
orthotopic neobladder for Urinary Bladder Cancer
 Open/ Laparoscopic/ Robot assisted radical nephrectomy/ Nephron sparing surgery for
Renal malignancies
 Open/ Laparoscopic/ Robot assisted nephroureterectomy with bladder cuff excision for
Ureter Malignancy
 Robot assisted retroperitoneal lymph node dissection for Testicular tumor
 Open/ Laparoscopic/ Robot assisted Adrenelectomy for Adrenal tumor
Medical Oncology

 Cancer is considered a systemic disease and thus most patients registered at SRC &
Super specialty are seen by the department of Medical Oncology, which deals with
systemic therapies in the form of chemotherapy targeted therapies, hormonal
therapies, immune therapies (monoclonal antibodies, check-point inhibitors) and
hematopoietic stem cell transplantation. The department is committed to offering
efficient and compassionate care to both adult and pediatric patients with cancer.
Unlike surgery and radiation therapy, which is usually done only once or very rarely
twice, cancer patients needing systemic therapy not only get multiple cycles (4 to 6
cycles and up to 3 years of therapy in Acute Lymphoblastic Leukemia) of therapy
upfront, but they can also receive multiple (up to 6 or even 8) lines of treatment in
presence of resistant / progressive or relapsed disease. Systemic therapies are not only
given before local therapies (neo-adjuvant setting); along with surgery/ radiation
therapy; after local therapies (adjuvant setting) and as maintenance therapies in
curative settings, but also as palliative therapies in advanced cancers to improve the
quality of life.
 Evidence based, internationally approved Chemotherapy guidelines are followed for
treatment of various solid and hematological malignancies.
 Medical oncology department extends their support and services to the patients who
are beyond the scope of active chemotherapy treatment by offering optimum
palliation. Medical oncology OPD services are available from Monday to Saturday
between 9:00 AM to 5.30 PM while emergency services are available 24×7.
 The hospital’s medical oncology department includes specially trained nursing and
peripheral staff that assists in the administration of Chemotherapy in Day Care as well
as in indoor. Chemotherapy Drug mixing is done at a separately designated Cytotoxic
Admixture lab, under laminar airflow with prescribed quality controls.
 In order to make administration of chemotherapy safe and more patient friendly, use
of central catheters or ports is instituted routinely in the department. The medical
oncology department at the hospital is also backed by a modern and highly efficient
blood bank offering facility round the clock for blood & blood components.

Radiation Oncology:

 The current facilities offer modern sophisticated, state-of-the-art treatments

like 3-D conformal radiotherapy (3-D CRT), intensity-modulated radiotherapy
with image guidance & radiosurgery (IMRT & IMRS, with IGRT),
Stereotactic radiotherapy/ radiosurgery (SRS, SRT) with appropriate motion
management, in addition to conventional radiotherapy. Intra-cranial
Stereotactic Radiotherapy and Radiosurgery are delivered using the "Brain-
 Lab" system comprising of micro-multileaf collimator (mMLC) and a dedicated
planning system.
 The expertise and experience of the motivated faculty renders us with the
ability to deliver high precision, conformal radiotherapy with state of the art
facilities. We have the experience to deliver complex radiotherapy procedures
like TSET (Total Skin Electron Therapy), TBI and Adaptive radiotherapy.
In addition, the physicians are specialized by disease site in the body and
form an integral part of the disease management groups (DMGs).
 The department can boast of being an active brachytherapy facility with
experience in practically all sites of the body. The efforts are aided by modern
treatment planning systems.
 A stringent quality assurance (QA) program and features like the "Online
Portal Imaging and online CT imaging (both KVCT AND MVCT)" ensure
efficient and accurate radiotherapy treatment delivery and verification. With
the newer Linear Accelerators, this is possible.

The objective of the department of Radiation Oncology is directed towards

delivering optimal radiotherapy and comprehensive patient care.

Intensity Modulated Radiotherapy (IMRT)

 Intensity-modulated radiation therapy (IMRT) is an advanced form of three-dimensional
conformal radiotherapy (3DCRT). It uses sophisticated software and hardware to vary
the shape and intensity of radiation delivered to different parts of the treatment area. It
is one of the most precise forms of external beam radiation therapy available. Currently,
IMRT is used to treat select patients with prostate cancer, head and neck cancer,
gynecologic cancers, some brain tumors, pediatric and bone & soft tissue tumors. In
IMRT, the physician designates specific doses of radiation (constraints) that the tumor
and normal surrounding tissues should receive. The physics team then uses a
sophisticated computer program to develop an individualized plan to meet the
constraints. This process is termed "inverse treatment planning". The treatment plan is
then evaluated and finalized before the precise implementation and delivery of the
planned radiation using sophisticated linear accelerators under strict quality assurance.
Optimal delivery of IMRT is a team effort that includes the radiation oncologist, medical
radiation physicist and radiation therapy technologist.
Stereotactic Radiosurgery (SRS)
 It is a highly precise technique used to treat brain tumors and other intracranial cancers.
Stereotactic radiosurgery involves a single, high-dose application of radiation to the
tumor, instead of the many smaller doses given in standard radiation treatment. This
technique, which is accurate to one millimeter or less, does not require surgery.
Stereotactic radiosurgery includes the participation of the radiation oncology, radiology
and surgical team who work together to evaluate and treat each patient. Radiosurgery is
limited to lesions that are well defined and no larger than three to four centimeters. The
 location of the lesion is also important. For example, lesions too close to radiosensitive
structures, such as the optic nerve, are not good targets for radiosurgery. Through the
use of three-dimensional computer-aided planning and the high degree of
immobilization, the treatment can minimize the amount of radiation to healthy brain
tissue. Stereotactic radiosurgery is routinely used for brain tumors and lesions. It may be
the primary treatment; utilized where a tumor is inaccessible by surgical means; or as a
boost or adjunct to other treatments. Stereotactic radiosurgery is an important treatment
option for many patients with abnormal blood vessels in the brain (for example, arterio-
venous malformations), solitary metastatic brain tumors, meningioma’s and other special
tumors of the head and neck regions, such as acoustic schwannomas. Radiation is
delivered using a framed system. Several radiation beams are precisely aimed to
converge upon a small tumor. The patient lies on a couch that rotates 180 degrees for
maximum targeting, without harming surrounding tissues.
Stereotactic Radiotherapy (SRT)
 SRT accurately delivers lower doses of radiation over a series of treatment sessions. The
overall total dose is higher than with an SRS treatment. Each treatment is called a
"fraction" therefore this type of therapy is sometimes called "fractionated" therapy. SRT
combines the advanced precision of radiosurgery with fractionated radiation and hence
improves delivery compared to standard radiation therapy. Fractionated therapy can be
particularly important when the tumor is adjacent to or involving vital neurological
structures such as the optic nerve. It can be used in situations where single dose
radiosurgery cannot be applied safely. Patients who have larger lesions that are not
appropriate for radiosurgery may benefit from the advanced precision and focal radiation
applied with SRT. SRT also has ideal application for pediatric patients because compared
to conventional radiation it treats a much smaller area of a normal brain. Children are
more sensitive to many of the side effects from radiation. SRT utilizes a frame system
with a mouth bite, which is a painless dental impression that fixes to the upper teeth.
This allows the patient to be precisely positioned on a repeat basis.
Stereotactic Body Frame (SBF) Radiotherapy
 Stereotactic body radiotherapy is also called as extra-cranial stereotaxic. This specialized
technique of radiotherapy allows very precise delivery of radiation doses to relatively
small target volumes situated at sites outside the cranium. Owing to the high degree of
precision in radiation delivery and the small volumes of tissue generally treated, it is
possible to deliver higher doses of radiation per sitting and thus resulting in shorter
duration of total treatment time. For accurate delivery and reproducibility of patients'
treatment position, a special device called the stereotactic body frame is used for
positioning and immobilizing the patient. The treatment is completely non-invasive
requiring no needle sticks or anesthesia for treatment. It is an outpatient procedure
requiring no hospitalization. It is also convenient in that it is usually delivered in one to
five treatments sessions.
Total Body Irradiation (TBI)
 Conventionally radiation therapy is considered to be a form of localized treatment with
the radiation beam directed to the diseased area sparing the surrounding normal tissues
as far as possible. In certain conditions like low grade lymphomas radiation can also be
delivered to the entire body in low doses either used alone or in combination with
chemotherapy to achieve disease control. Low and high dose total body irradiation is also
used as a part of the conditioning regimen for bone marrow transplant.
Total Skin Electron Beam Therapy (TSET)
 Disease conditions like Mycosis Fungicides primarily involve the skin all over the body. As
mycosis fungicides respond very well to radiation, radiotherapy remains the mainstay of
 treatment of this disease. Total skin electron beam therapy is a specialized technique of
radiotherapy, which allows the delivery of a relatively uniform dose of radiation
(electrons) to the skin all over the body while sparing the underlying structures.
Electron Arc Therapy
 This specialized technique of radiation therapy allows delivery of the radiation to flat or
curved superficial surface structures like skin, chest wall, abdominal wall, and scalp/ skull
while minimizing radiation doses to the underlying structures.
Tomotherapy
 TomoTherapy, or Helical TomoTherapy, is a new way to deliver radiation treatment for
cancer, and is the latest in radiation therapy delivery systems. TomoTherapy literally
means "slice therapy," and gets its name from tomography, or cross-sectional imaging.
The TomoTherapy System delivers a very sophisticated form of intensity-modulated
radiotherapy (IMRT), and combines treatment planning, CT image-guided patient
positioning, and treatment delivery into one integrated system. The equipment used for
TomoTherapy looks much like a CT scanner. The patient lies on a couch that moves
continuously through a rotating ring gantry. The gantry houses a small megavoltage
linear accelerator, which delivers radiation in the shape of a fan beam as the ring is
turning. With the couch moving at the same time the gantry is rotating, the radiation
beam make a spiral (or helical) pattern around the patient, targeting tumors with optimal
levels of radiation while minimizing the dose to healthy normal organs and tissues in the
region.
 The advantage of TomoTherapy is having a radiation treatment beam projected into the
tumor continuously as it rotates, rather than having a limited number of fixed beams,
each providing only a fraction of the dose necessary to irradiate the tumor. With the
TomoTherapy System, it is now possible to adjust the size, shape, and intensity of the
radiation beam to target the radiation to the size, shape, and location of the patient's
tumor.
 Additionally, this unit provides the opportunity to obtain CT images of the body in the
treatment setup position, and is hence one of the first devices capable of providing
modern image-guided radiation therapy (IGRT). These CT scan images also can be used
to precisely place the radiation beam and allow the operator to modify the treatment
should the patient’s anatomy change due to weight loss or tumor shrinkage (adaptive
radiotherapy).
Image Guided Radiation Therapy
 IGRT, or Image Guided Radiation Therapy, is currently one of the most sophisticated
methods of radiation therapy delivery in the world. IGRT is the process of frequent two
and three-dimensional imaging, during a course of radiation treatment, used to direct
radiation therapy utilizing the imaging coordinates of the actual radiation treatment plan.
An example of Three-dimensional (3D) IGRT would include localization of a cone-beam
computed tomography (CBCT) dataset with the planning computed tomography (CT)
dataset from planning. Similarly Two-dimensional (2D) IGRT would include matching
planar kilo voltage (kV) radiographs fluoroscopy or megavoltage (MV) images with digital
reconstructed radiographs (DRRs) from the planning CT.
 This linear accelerator has an on-board kv imager that obtains cone beam CT (CBCT)
images of the patient daily, at the time of treatment set-up and positioning. This
integrated imaging system allows the radiation technologists to verify the position of the
tumor before each treatment session, so adjustments can be made online and on the
spot to make sure that radiation is delivered exactly where it should be. CBCT based
IGRT can result in sub-millimeter accuracy in treatment delivery, and this allows doctors
to safely reduce the treatment margins thus increasing dose to the tumor and at the
same time significantly reducing radiation dose to critical normal organs near the tumor.
Pediatric malignancies, Lung cancer, head and neck tumors, breast cancer, prostate
cancer, stereotactic radiosurgery and stereotactic body radiotherapy are just some
examples of the treatments commonly performed using IGRT.