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Types of Treatments

patient and doctor
Brain tumor expert Dr. Larry Kleinberg with patient.

The experienced radiation oncology team specializes in treating a variety of cancers with a number of radiation therapy options, including proton therapy. All these therapies use high energy, penetrating waves or particles to destroy cancer cells or keep them from reproducing. Your medical team will determine the most effective options for you.

Our treatments fall in several types:

Proton therapy

Proton therapy is a form of targeted radiation treatment that uses energy from positively charged particles called protons. Protons very precisely zero in on tumors, delivering most of their cancer-fighting energy directly to cancer cells while minimizing radiation exposure and damage to neighboring healthy tissue and organs. The therapy reduces the risk of late effects after treatment.

Because of its precision, proton therapy makes it possible to treat cancers near delicate organs, such as the spinal cord and heart, and offers a new treatment approach for recurrent cancers. It also provides a safe and effective way to treat cancers that present a challenge because of their location in the body, such as brain cancer and cancers in the eye or base of the skull and neck.

Learn more about Johns Hopkins National Proton Center.

Brachytherapy

Brachytherapy is a targeted, high-dose radiation treatment delivered via radioactive “seeds” that are placed directly in or near the tumor or via an applicator device placed at the tumor site using a special needle or catheter. The seeds may be inserted just for several minutes or hours and then removed, or left inside the body to release radiation over time. Brachytherapy cannot be used for every type of cancer but may reduce side effects and allow for shorter treatment times, providing patients with a better quality of life.

Specific types of brachytherapy offered by Johns Hopkins include:

  • Endorectal Brachytherapy for Rectal Cancer – This uses a cylinder-shaped applicator to deliver focused radiation to the surface of rectal tumors. After the probe is placed in the rectum, a wire with a radiation source at the tip is slowly inserted into the applicator. Normal tissue such as the bladder, small intestines, and sexual organs farther away from the probe. The treatment takes about 15 minutes.
    Benefits include having less damage to normal tissue around the tumor site, a decreased risk of bowel complications and secondary cancers, less time between diagnosis and surgery, no chemotherapy during radiation therapy and a faster recovery from surgery.
  • High-Dose Rate Intra-Operative Radiation Therapy (HDR-IORT) – This therapy provides an intensive, targeted dose of radiation to a tumor site during surgery, after the tumor is removed, to sterilize the area where the tumor was located. It is often given after standard radiation therapy and has been shown to decrease the chance of the cancer coming back.
    HDR-IORT is particularly effective at treating recurrent tumors as well as large tumors that adhere to normal tissues, and it may cause fewer side effects than traditional external beam radiation treatment.

​​External beam radiation

External beam radiation delivers a beam of high energy X-rays to a patient’s tumor site to destroy cancer cells. The technique gets its name from the fact that the beams come from an external source (a machine called a linear accelerator) and are aimed at the site of the tumor.

There are several types of external beam radiation used at Johns Hopkins. They include:

  • Image-guided radiotherapy (IGRT) – This technique uses frequent imaging to display the cancer site, allowing experts to provide highly precise and accurate delivery of the radiation. The radiation oncologist can create and view images of the tumor site before and during the time radiation is delivered. IGRT is particularly helpful for cancer sites in parts of the body that move (such as the lungs) or sites near major organs and tissues that should not receive radiation (such as the heart or kidneys).
  • Intensity-modulated radiation therapy (IMRT) -- This radiation technology uses computer-controlled radiation beams in conjunction with three-dimensional computed tomography images of the tumor site and surrounding areas. IMRT delivers targeted radiation doses to the tumor site, patterned to match the shape of the tumor through modulating the intensity of the radiation beams. This means the tumor site receives the high doses needed to destroy cancer cells while sparing surrounding organs and tissue.
  • 3D Conformal Radiation Therapy – For this technique, imaging scans are used to create a three-dimensional model of the exact shape and size of the tumor. Then multiple radiation beams are aimed at the tumor shape, sparing nearby healthy tissue.
  • TomoTherapy – This combines IMRT with computed tomography scans. Detailed, three-dimensional maps of a tumor’s size and location are created, then the machine delivers small beamlets of radiation from various angles, providing exceptional accuracy when targeting tumors.
  • Volumetric Modulated Arc Therapy (VMAT) – Single or multiple radiation beams sweep around the patient, greatly reducing treatment time. Three-dimensional imaging technology aids in the precision of radiation delivery, giving doctors the ability to visualize the tumor at the time of treatment.

Radio Embolization

This cancer treatment uses tiny glass or resin beads called microspheres to deliver radiation to a tumor through the bloodstream. These particles are placed inside blood vessels, where they travel to the tumor and deliver a high dose of radiation.

One type of radio embolization used at Johns Hopkins is TheraSphere, a treatment for liver cancers. Doctors infuse millions of particles into the arteries that feed liver tumors. Then, the particles lodge themselves by the tumors, emitting radiation.

Dr. Redmond with patient
Dr. Kristin Redmond with CyberKnife patient.

Stereotactic Radiosurgery 

Despite the name, this treatment is a nonsurgical radiation therapy that can be used as an alternative to invasive surgery. The technology delivers multiple radiation beams from different angles and planes. Three-dimensional  images are used to determine the exact location of the tumor. This treatment can treat very small tumors or those located in hard-to-reach places.

  • Fractionated Radiosurgery (FRS) uses the same technologies but treatments may be spread out over several days using lower doses of radiation.

Stereotactic Body Radiation Therapy (SBRT)

This treatment administers very high doses of radiation using several beams of different intensities, and aimed at different angles to target the tumor. The therapy can be given as a single dose or up to several doses.

  • CyberKnife, a type of SBRT, uses a robotic arm to deliver radiation in different ways and at different angles.
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