Rapid Access Palliative Radiotherapy Service (RAPRS)
The Royal Adelaide Hospital provides rapid access palliative radiotherapy for patients with advanced cancer. The RAPRS clinic is run weekly with an initial consultation, planning and treatment all performed in one single visit of less than 2 hours. The service is delivered by a team of highly qualified radiation oncologists, radiation therapists, medical physicists and nurses. We accept GP and specialist referrals to this service.
All referrals are triaged to the service according to clinical urgency. To refer your patient, complete and send your referral to Outpatients by fax to (08) 7074 6105.
For more information please email Peter.Gorayski@sa.gov.au
Stereotactic Radiosurgery
Stereotactic radiosurgery (SRS) is the use of highly focussed radiation to treat benign (non-cancerous) or malignant (cancerous) brain tumours very precisely using a 3-D reference system (‘stereotactic’) and accurate positioning and immobilization of the head. It is a non-invasive alternative to neurosurgery for certain brain tumours. Despite the name, radiosurgery does not involve an operation and it is typically delivered as an outpatient procedure. Although usually administered in one large radiation dose (fraction) on one day, several or many smaller doses can sometimes instead be delivered over a few days or weeks. If more than 5 fractions are used, the procedure is called stereotactic radiotherapy (SRT).
In South Australia, linac SRS and SRT have been available solely at the RAH since 1993, with well over 300 treatments delivered by the end of 2014. The most common tumours treated are; acoustic neuromas (benign tumours of the nerve of balance and hearing), arterio-venous malformations (benign collections of abnormal blood vessels), brain metastases (secondary cancers that have spread to the brain from a primary cancer elsewhere in the body) and meningioma’s (benign tumours arising from the coverings of the brain). Note that there is no cost to the patient, unlike Gamma Knife treatment in Sydney, which involves a co-payment.
Delivery of SRS and SRT requires collaboration between many disciplines (neurosurgery, radiation oncology, radiation therapy, medical physics and radiation oncology nursing), with the Royal Adelaide Hospital possessing an innovative and experience specialist group. Patients are assessed initially and followed-up after treatment, in a weekly outpatient Radiosurgery Clinic.
Stereotactic Ablative Body Radiotherapy
Stereotactic Ablative Body Radiotherapy (SABR), otherwise known as Stereotactic Body Radiotherapy (SBRT), is the delivery of one or a few very high doses of radiation to small, well defined tumours involving the body. SABR can potentially offer a safe, non-invasive alternative to surgery (in many cases with equivalent outcomes to surgery) and is indicated in various types of primary and secondary cancer.
The Royal Adelaide Hospital was one of the first centres offering SABR in Australia, and draws upon the expertise of a multidisciplinary team of clinicians, radiation therapists, physicists and nurses.
SABR is not suitable for all cancers and will depend on factors such as overall condition of the patient, stage of disease and type of cancer. Patients are assessed in clinic and if appropriate will proceed to a meticulous planning phase followed by image guided treatment in either one session or a limited number of sessions over a few days. Your radiation oncologist will discuss with you the appropriateness of SABR and the possible side effects of treatment.
Indications for SABR can include primary cancers of the lung, liver and kidney, whilst oligometastases to the lung, liver, bone and lymph nodes may also be treated. Other areas are currently being tested also.
Brachytherapy
Brachytherapy is the use of radioactive sources which are either implanted within or positioned adjacent to the tumour. The treatment maybe invasive and require an anaesthetic. Brachytherapy sometimes requires that the source be placed permanently (low dose rate) or temporarily (high dose rate) depending on the situation and can be delivered with or without conventional external beam radiotherapy. This technique is used to treat a range of cancers including those involving the prostate, cervix, uterus, lung, oesophagus, gallbladder, anal canal and skin.
Radiotherapy for children
Childhood cancers are rare. The malignancies affecting children are often of different types and involve different organs from those diagnosed in adults. Radiation therapy plays an important part in the treatment of many childhood cancers, and is often combined with surgery, chemotherapy and/or newer targeted drug therapies.
These factors, along with the potential long-term effects of radiation therapy in children, require specialised understanding and care.
The Royal Adelaide Hospital is the only facility in South Australia to accept children and adolescents of all ages for radiation therapy, according to their specific treatment needs.
We work closely with staff at the Women’s and Children’s Hospital to provide a multidisciplinary approach to diagnosis, treatment and supportive care. We strive to deliver streamlined and individualised care for children undergoing radiation therapy as part of their cancer treatment.
The Royal Adelaide Hospital is the only radiation therapy facility in South Australia fully accredited to treat children on Children’s Oncology Group (COG) trial protocols. Our staff collaborates with other Children’s Oncology centres Australia-wide and overseas to ensure a high standard of care for children undergoing radiation therapy in South Australia.
A dedicated group of paediatric radiation oncologists, radiation therapists, nurses and allied health professionals aim to meet the specific needs of children in an adult hospital environment, and regularly seek ways to improve the care provided.
We are also the only centre in Australia to provide comparative planning services for Proton beam therapy [link to new Proton page], and have a proven track record in aiding applications for the Medical Treatment Overseas Program (MTOP). Proton treatment is currently unavailable in Australia, but we are able to provide guidance in your decision making through our collaboration with Proton Therapy centres in Europe and the US.
Intensity Modulated Radiotherapy and Volumetric Modulated Arc Therapy
Modern Radiation Therapy is a cancer treatment that uses state-of-the-art technology to deliver the best possible outcomes for patients, both for cancer control and the reduction of side effects. An example of this is the use of Intensity Modulated Radiation Therapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT), both of which are available at the Royal Adelaide Hospital.
Every patient’s anatomy and tumour location is unique, through using high-quality CT and other diagnostic scans (such as PET scans and MRI scans) we are able to accurately locate both tumour and areas of normal tissue, where the radiation dose needs to be concentrated or minimised. In many cases the tumours can be close to sensitive normal tissues, that require dose avoidance. IMRT and VMAT use the vastly increased computer power we now have to produce optimised plans to more effectively cover the tumour and reduce potential side effects to these normal tissue structures.
Before these techniques were available, a radiation beam had a uniform intensity across its entire area. Regions were within the beam or not, in effect making things “black or white”. Now we can vary the intensity of the dose within each treatment beam, essentially giving us “shades of grey”. This allows far greater control over where the dose is distributed, and completely individualized plans for patients receiving this form of therapy.
Total Body Irradiation
Total body irradiation (TBI) is used to treat blood related cancers, such as some types of leukaemia. This treatment is often given in conjunction with chemotherapy as part of the preparation for a blood stem cell or bone marrow transplant.
Typically, a course of TBI is delivered twice per day over 2-3 days, with each treatment being at least 6 hours apart. The purpose of TBI is to eradicate remaining cancer cells, suppress the immune system (to facilitate transplantation) and to treat areas of the body where chemotherapy is less penetrable.
Total Skin Electron Therapy
Total skin electron therapy (TSET) is used to treat mycosis fungoides, the most common type of cutaneous T-cell lymphoma. This involves treating the entire skin surface with low energy electron beams. Due to the physical properties of electrons, the radiation penetrates only the skin, thus sparing deeper tissues and organs. TSET is most often used in patients who are not responding to other treatments and is occasionally used in conjunction with other therapies.
