Radiation Oncology

The Centre of Excellence in Radiation Oncology is located at Lower Ground Floor at Amrita Hospital and Research Center, Faridabad. Our multidisciplinary clinics and tumor boards enable us to provide a comprehensive care plan to each patient entrusted in us with his care. We work in close collaboration with Surgical Oncologists, Medical Oncologists, Pediatric Oncologists, Neurosurgeons, Pathologists, Nuclear medicine physicians, and Radiologists to ensure that every patient gets an individualized treatment plan for his ailment.

We are committed to a high degree of clinical expertise and are equipped with latest technologies for the same. Each member of the team including Radiation Oncologists, Medical physicists, Radiation Technologists and Oncology nurses are involved in providing highest standard of patient care and safety. We take extra care to treat cancer cells while sparing normal tissues wherever possible and ensure patient comfort with thorough pre-treatment planning and counselling before treatment. Multiple safety checks at every step including patient positioning, motion management, radiation planning and quality assurance ensure accurate and effective treatment delivery.

About the Department of Radiation Oncology

The Department of Radiation Oncology at Amrita Hospital Faridabad, combines clinical expertise, compassionate care, and advanced radiation therapies to deliver the safest, most effective treatments for cancer and benign tumors. 

Mission statement 

The Department of Radiation Oncology at Amrita Hospital Faridabad's aim is to provide excellence in patient care by administering the highest level of quality in a safe and caring environment. We aspire to inspire, educate, motivate, teach, and mentor a diverse team of physicians, physicists, and radiation therapists to become exceptional care takers, create techniques to improve community outcomes, and become future leaders in academic medicine and/or healthcare delivery. We are active players, not bystanders, in the life science revolution that will mark the first half of this century as a period of reduced human suffering.

Our mission is

• To establish the best quality, personalized, evidence based and compassionate radiation treatment using latest state- of the-art radiotherapy technologies.
• To generate new knowledge concerning causes, prevention and treatment of cancer; to transmit new knowledge from our clinical and laboratory research

Vision

We envision the Department becoming a globally preeminent academic radiation oncology department; recognized for exceptional clinical care, quality radiation delivery, the conduct and reporting of important research and the practice of effective teaching and healing.

Core Values

• Excellence in patient care 
• Quality assurance
• Improved  clinical outcomes
• Innovation 
• Integrity

Tumor Board- MDT

A Tumor Board is a multidisciplinary team of specialists who collaboratively review and discuss cancer cases to develop an optimal treatment plan for each patient. Members typically include medical, surgical, and radiation oncologists, pathologists, Nuclear medicine physicians, radiologists, geneticists, nurse practitioners, social workers, and other medical specialists relevant to the patient's care.

All patients undergoing Cancer treatment at our hospital are discussed in the tumor board and an individualized treatment plan is generated before the first cancer treatment.
This is done to ensure that the first cancer treatment received by you is the best cancer treatment you can get.
During tumor board meetings, each case is thoroughly discussed, examining diagnostic information, medical history, pathology reports, imaging studies, previous treatments and other pertinent information. The team deliberates on the most suitable treatment options, considering factors such as the type and stage of cancer, patient's overall health, and their personal preferences. This collective decision-making approach ensures comprehensive, individualized care, enhancing treatment outcomes and patient satisfaction. 

High Precision Radiation Oncology

High Precision Radiation Oncology represents the cutting-edge of cancer treatment, utilizing precise targeting and high-dose radiation to eradicate cancer cells while minimizing damage to healthy tissues. This approach often integrates advanced imaging techniques such as CT, MRI, and PET, to create a comprehensive treatment plan. With the advent of technology like stereotactic radiosurgery and intensity-modulated radiation therapy, this field has revolutionized non-invasive cancer treatment, improving patient outcomes and reducing side effects. High Precision Radiation Oncology is a significant advancement towards personalized cancer care.

Individualized and Personalised radiotherapy

Individualized and Personalized Radiotherapy is a transformative approach in cancer care, tailoring treatment to each patient's unique tumor characteristics and genetic makeup. This method allows for a more efficient and effective treatment strategy, increasing therapeutic ratio by maximizing the dose to the tumor while sparing surrounding normal tissues. It employs advanced imaging, molecular profiling, and big data analytics to provide precise radiation delivery. This customized approach can lead to improved patient outcomes, lower toxicity, and better quality of life during and after treatment. As such, Individualized and Personalized Radiotherapy embodies the future of cancer care.

Image-guided brachytherapy and Interventional radiotherapy

Image-Guided Brachytherapy (IGBT) and Interventional Radiotherapy are advanced methods in the field of oncology. IGBT is a high-precision form of radiotherapy where radioactive implants are placed directly into or near the tumor, providing a high dose of radiation while sparing surrounding tissues. Advanced imaging techniques, such as ultrasound, CT, or MRI, guide the precise placement of these implants, enhancing treatment accuracy.

Interventional Radiotherapy, also known as brachytherapy, involves the direct placement of radioactive sources into the tumor or body cavities. This method allows for an intense radiation dose delivery to the tumor while minimizing exposure to surrounding healthy tissues. Both techniques represent significant advancements in targeted cancer treatment.

Personalized Quality assurance and Medical Physics

Personalized Quality Assurance (QA) in Medical Physics is a pivotal aspect of patient safety and treatment effectiveness in radiation oncology. It ensures the precise and accurate delivery of radiation doses, tailored to each individual's specific treatment plan. This involves rigorous testing and calibration of radiotherapy equipment, meticulous verification of treatment plans, and ongoing monitoring during treatment sessions.

Medical Physics plays a crucial role in this process, applying principles of physics to medicine, particularly in diagnostic imaging and radiotherapy. This interdisciplinary field is integral in developing and implementing QA protocols, conducting research to improve treatment efficacy, and ensuring optimal performance of medical devices. Personalized QA in Medical Physics thus enhances the safety and effectiveness of individualized radiotherapy

Processes for Quality Assurance

There is a thorough QA and chart review procedure before each patient begins therapy to verify the patient's treatment plan is ready for treatment. Furthermore, once therapy begins, there is a continuous sequence of inspections and double checks to ensure that treatment is provided safely and accurately. Our physicians and representatives from each functional area meet weekly for a peer review to discuss and enhance treatment strategies. Our therapists perform daily inspections on all equipment, and our physicists perform monthly and annual tests to verify its safety and accuracy.

Technology and Treatment Procedures

Our department uses technology in the most effective way possible that delivers the maximum dose to the tumor and the least possible dose to the organs at risk so that you can resume your daily activities with the least toxicity possible.

Radixact with Synchrony: The helical design of the Radixact System (non-invasive) is a treatment option that is designed to target the tumors accurately and results in a sharp dose fall off as it conforms radiation dose precisely to the tumor and spares the healthy tissues maximally.  As the patient table moves there is continuous 360-degree radiation dose delivery. This system features a fully integrated MVCT which helps us in daily imaging. This imaging technology seamlessly can see the shape and location of your tumor anywhere in the body and in real-time before each treatment session. It is integrated with new features of Accuray’s unique Synchrony® real-time motion synchronization technology. It helps to correct the tumor's movement because of respiration and digestion without discomfort to the patient. Synchrony uses image guidance during radiation delivery to automatically adapt the movement of the radiation beam in synchronization with the movement of the tumor.

 Complex IGRT for all cancer sites

• SBRT with adaptation 
• Complex hippocampal sparing
• Total body Irradiation
• Total marrow irradiation
• Synchrony based SBRT
• Fiducial Tracking
• Adaptive Treatment- Precise ART
• Artificial intelligence for segmentation
• SRS for Ventricular Tachycardia

 PreciseART® Online Adaptive Solution

Adequate dose coverage to the target area and dose sparing of organs at risk (OAR) can be compromised due to interfraction variations during an individual patient’s radiation therapy regimen. These variations include translational shifts (e.g., x, y, and z), rotations, and anatomic changes (e.g., yaw, pitch, and roll; organ deformation, weight loss). Adaptive radiation therapy (ART) is introduced to fully address any interfraction variations which are not possible in conventional treatment. ART is a state-of-the-art approach that uses a feedback process to account for patient-specific anatomic or biological changes during the treatment, thus delivering highly individualized radiation therapy for cancer patients.

TrueBeam with HyperArc and Virtual Cone

Only Third Centre in the world to commission the Virtual Cone for Trubeam LINAC for Stereotactic Radiosurgery 
This machine is flexible enough to meet all clinical needs. It provides a variety of advanced treatment techniques such as HyperArc and RapidArc. 

HyperArc high-definition radiotherapy (HDRT) is a solution for frameless, MLC-based, non-coplanar stereotactic radiosurgery (SRS). A defined workflow, including simulation guidelines, patient immobilization for imaging and treatment delivery, treatment setup, intra-fraction imaging, and a pre-determined delivery sequence, enables a one-click delivery of non-coplanar SRS. Truebeam has advanced imaging techniques like Respiration-synchronized MV/kV radiographs, 4D CBCT, Iterative CBCT, Triggered Imaging, and more. Trubeam is equipped with 4D Delivery, Gating, and Deep Inspiratory Breath Hold(DIBH).

• SRS With Virtual Cone
• SRS with HD MLC and hyperarc
• SBRT
• IGRT for all cancer sites
• Rapidarc(VMAT)
• IMRT
• Gating
• DIBH
• TSET
• Electron therapy
• 3DCRT
• Artificial intelligence for segmentation
• Multi-Criteria optimization 

 Brachytherapy and other operative procedures 

• 40 Channel Flexitron by Elekta
• MR guided Brachytherapy
• Advanced applicators like Venezia Gynecological malignancies
• Ultrasound-guided insertions
• Advanced Martinez template with stepper for Prostate Cancer
• Stereotactic Brachytherapy for Brain tumors
• Stereotactic Brachytherapy for Lung, Liver, Node, Kidney, and Pancreatic Cancers
• Complex Intracavitary and Interstitial brachytherapy
• Complex Interstitial Brachytherapy for Gynecological, Breast, Head, and Neck, and Soft tissue malignancies
• Fiducial insertion in Liver and Prostate
• Brachytherapy in the palliative setting 

 Imaging for Radiation Simulation

• 64-slice PET CT Simulator
• 4DCT – RGSC Varian
• 4DPET CT – RGSC Varian
•  CT simulation force CT
• 3T MR Simulator- In the Radiation Department (coming soon)

Treatment Planning System and OIS

• Precsion for tomotherapy planning
• Precise ART
• Precise RTX
• Varian Eclipse
• Varian Aria
• Elekta Oncentra 
• Syngovia Workstation equipped with AI based segmentation 

 Intraop MRI and RT Suite- Coming Soon

The Radiation Oncology Department at Amrita Faridabad will house India's first dedicated 3T MRI. The Intra op MRI RT suite will be capable of intraoperative MRI that guides tumor resection in Neurosurgery. It is capable of MR thermography, which is required to monitor the heating of the tissues during HIFU or hyperthermia. The same suite is also utilized for Intra op MR Brachytherapy and MR RT simulations for MR Assisted radiotherapy. 

• Intraoperative MRI
• Intraoperative MR Brachytherapy
• MR RT Simulations 
• MRI Assisted Radiotherapy
• PET MRI
• Diagnostic Services
• 4D MRI

Choosing us for your radiation therapy means entrusting your care to a team of experts dedicated to providing state-of-the-art, personalized treatments. Our team of certifiedand experienced Radiation oncologists, medical physicists, and radiation therapists use advanced technology to deliver precise radiation doses, minimizing side effects and maximizing treatment effectiveness.

We embrace a multidisciplinary approach, with each patient's case reviewed in detail by our tumor board, ensuring comprehensive, individualized care. Our commitment to personalized quality assurance ensures every treatment is meticulously planned and accurately delivered.

Our focus on patient-centered care goes beyond clinical expertise. We offer a supportive environment, with a dedicated team to help navigate the treatment journey, providing emotional support, and addressing any concerns. We are committed to not just treating your cancer, but supporting you throughout your journey.

External Beam Radiation Therapy (EBRT) is delivered with the following techniques: -

• Conventional Radiation Therapy: EBRT is given via machines called linear accelerators. EBRT is typically delivered on an outpatient basis for approximately 6-8 weeks. EBRT begins with a planning session, or simulation, during which the radiation oncologist and medical physicist does a planning CT scan and delineates the tumor and takes measurements in order to line up the radiation beam in the correct position for each treatment. During treatment, the patient lies on the treatment couch of the linear accelerator and treated with radiation beams from multiple directions by the radiation therapy technologist.
• 3D Conformal Radiation Therapy: It is an advanced form of radiation treatment planning and delivery as compared to conventional treatment. In this CT- Scans is acquired in the treatment position of the body part to be treated and the tumor and organs at risk (OAR) are outlined / contoured. Treatment planning system is used for treatment planning with the intended tumor dose and less dose to surrounding normal structures and OAR. This technique uses computers to create a three dimensional picture of the tumor and radiation treatment planning. Linear accelerator having multileaf collimators is used for radiation treatment. The multi leaf collimators (MLC) are carefully adjusted according to the shape, size, and location of the tumor. As a result, more radiation can be delivered to the tumor cells while less is directed at the normal cells that are nearby using high definition software.
• Intensity Modulated Radiation Therapy (IMRT): IMRT is an advanced form of 3-D conformal radiation treatment planning and delivery that allows to customize the radiation dose by modulating, or varying, the amount of radiation given to different parts of the area being treated. The radiation intensity is adjusted/ modulated with the use of computer- controlled, moveable “leaves” which allow the passage of radiation from many beams that are aimed at the treatment area. As a result, more conformal radiation can be delivered to the tumor cells while less is directed at the normal cells that are nearby.
• Image Guided Radiotherapy (IGRT): Day to day patient’s set up position on the treatment couch may change, resulting in misadministration of radiation. To account for positional variations on board imaging system is used. Wherein image is acquired before the execution of radiation and fused with the planning CT- scan. Any variation in position is corrected and radiation is delivered. It is called as Image Guided Radiation Treatment (IGRT). On board imaging facilities available are: 3D Cone beam CT (CBCT), 2D KV- KV x-ray, MV- MV portal image, KvCT, 6D patient positioning system. Depending upon the site, a suitable IGRT technology will be used
• Treatment of Moving Tumors with 4d Gating Device: Due to natural breathing, some of the tumor motion with in body is observed more than 1cm. To account for tumor motion, especially in Lung and Liver, we need to cover large area of treatment resulting in large volume of normal tissue in the radiation field. To account for tumor motion 4D gating technology or tumor tracking techniques are used to deliver high doses of radiation to tumor while maintaining doses to normal surrounding tissues and OAR.
• RAPID ARC: It is an advanced form of radiation treatment planning and delivery on high technology linear accelerator having capability of radiation delivery called volumetric modulated arc treatment (VMAT or Rapid Arc). It utilizes the dynamic motion of MLC, variable gantry speed and dose rate for optimization of dose to target and OAR. Delivers IMRT/IGRT in only 3-5 minutes using 2-3 arcs as compared to 20-25 minutes with 7-9 field 3DCRT/ IMRT techniques. It has following advantages:
  • Convenience
  • More Accurate
  • High dose Conformity
  • Better Target Coverage
  • Superior sparing of adjacent critical organs / structures
• SRS-SRT – Stereotactic Radiosurgery Stereotactic Radiosurgery (SRS) allows non-invasive treatment of brain tumors, metastatic lesions, arteriovenous malformation (AVM, and other selected conditions. It is an outpatient treatment that delivers a high dose of radiation to a highly defined target. Treatments can be prescribed to deliver the total dose of radiation in a single treatment (SRS), hypo fractionated (FSRS) 3-5 fraction with high fractional dose.
• Stereotactic Radiotherapy (SRT): A specialized type of external beam radiation therapy called stereotactic radiation uses focused radiation beams targeting a well-defined tumor, relying on detailed imaging, computerized three-dimensional treatment planning and precise treatment set-up to deliver the radiation dose with extreme accuracy (i.e stereo tactically).
• Brachytherapy: Brachytherapy, also called internal radiation therapy, allows conformal higher total dose of radiation to treat a smaller area with sharp fall in dose gradient away from the tumor, and in a shorter time than is possible with external radiation treatment. It is of 3 types:
  • Intracavitary/ Intraluminal Brachytherapy: Intracavitary brachytherapy is a method for delivering very localized radiation to small tumors, which have not spread, or to deliver an additional dose of radiation to a small volume at high risk for recurrence. It is achieved by placing radioactive sources directly into a naturally occurring body cavity. Intracavitary brachytherapy is used in patients with cancers of the cervix after external radiation therapy has been completed. It is also used for patients with cancer of the uterus who have had surgery and have a high risk of recurrence at the top of the vagina. Intraluminal radiation is also used as an adjunct to external beam radiotherapy in some cases of esophageal cancer and lung cancer.
  • Interstitial Implant: In this the radioactive sources are placed within the tumor, which are easily accessible and small in size. Hollow nylon plastic catheters are implanted in the tumors under general anesthesia as per the standard implant rules. Thereafter, CT scan is done to reconstruct the implanted catheters and source positions are selected for optimization and dose calculation with the help of dedicated treatment planning system (TPS). After plan evaluation by radiation oncologist and medical physicist the treatment is delivered with Micro-selectron HDR system housed with Iridium-192 radioactive source. Common tumors which are treated with this technique are: Ca Base of tongue, Buccal mucosa, lip, breast, soft tissue sarcoma.
  • Intraoperative Brachytherapy: Tumors attached or adjacent to critical structures can often not be completely resected or resected with adequate surgical margins. Sites involving major blood vessels, the paravertebral spaces, or critical abdominal structures often present technical difficulties for standard brachytherapy procedures using 1-125 or Ir-192 implants. These techniques allow for a high-dose delivery to the tumor bed with minimal normal tissue toxicity. These intraoperative implant procedures effectively treat small residual tumors or suspicious margins where standard brachytherapy techniques may be unsatisfactory and technically difficult to perform.

 Radiation Services are offered for Both Benign and Malignant cases. Each case and management decision is concurred upon in a multidisciplinary setting, Following which high-end radiation services are offered. The Radiation Oncology Department has the expertise and technology to treat all possible clinical sites with quality and precision. 

• Outpatient Department 
• Radiation Therapy 
• External Beam Radiation Therapy 
• Brachytherapy  
• Intensity Modulated Radiation Therapy (IMRT) 
• Treatment of Moving Tumors with 4d Gating Device
• Stereotactic Radiotherapy (SRT) 

Our philosophy at the radiation oncology center is rooted in providing compassionate, comprehensive, and cutting-edge care for our patients regardless of religion, caste, and socioeconomic status. We believe that every patient is unique, and as such, we are committed to delivering personalized treatment plans tailored to each individual's specific needs.

We believe in the power of multidisciplinary collaboration, with our dedicated team of specialists working together to ensure the best possible outcome for every patient. Our approach is not just about treating the disease; it's about treating the whole person. This means providing support, education, and resources to address the emotional and psychological aspects of a cancer diagnosis, alongside the physical dimensions.

We are dedicated to continual learning and innovation. Our team actively participates in research and strives to stay abreast of the latest developments in radiation oncology to offer our patients the most advanced treatment options. We are unwavering in our commitment to delivering the highest standard of care, and we consider it a privilege to journey alongside our patients in their fight against cancer.

• 10 bunkers, 2 for Brachytherapy, and 8 for external beam
• Bunker for 3 CT simulators and 1 MR simulator
• 3 OTs for brachytherapy
• PG lounge Seminar room, tumor board rooms, and dedicated faculty rooms
• 6-bedded recovery room 
• Inpatient services 

The current standard of care in Oncology is always envisioned 10 years in the past. We go by this statement and take Research very seriously in our department. 

Our Department and the entire Oncology department come under the Hospital-based cancer registry that is funded by the NCDIR, IMCR. All Patients are registered in this prospective cancer registry and all our OPD documents are stored in a structured format, which allows ease of research and allows us to analyse our data more quickly and  effectively

Many clinical trials are underway, feel free to reach out to our co-ordinators for more information on the same. 

Providing consultations to cancer patients on an outpatient basis, after thorough physical examination and diagnostic tests and advising them on the modality, dosage and duration of radiation therapy as per the international and institutional standard protocol. The patients are also referred to surgical and medical oncologists, if so required.

Radiation Oncology, also called radiation therapy or therapeutic radiology, is a specialty of medicine that uses various forms of ionizing radiation to treat disease, especially various cancers. The aim is to kill the cancer cells with as little risk as possible to the normal cells adjoining the cancer cells in the body. The Radiation Oncology department has the facility of providing both, the external as well as internal radiation therapy.

• Radiation Therapy: The department of Radiation Oncology is equipped with the latest state of the art equipment to deliver highly precise radiation therapy to achieve better tumour control and also to reduce radiation dose to surrounding normal organs. There are two main forms of Radiation therapy:
• External Beam Radiation Therapy: Delivery of high energy x- rays or electron beam directly to the tumor with the radiation generating unit called linear accelerator outside the body.
• Brachytherapy: Internal Radiation or implantation of radioactive sources directly into the tumor and/or around the tumor.

MoU Page for amrita Vishwavidyapeetham

Welcome to Our Comprehensive Virtual Guide for Radiation Therapy

Step 1: Outpatient Department (OPD) Consultation

Your journey begins with a consultation with a radiation oncologist, who will review your medical history, conduct a physical examination, and discuss potential treatment options. You're encouraged to ask questions and express any concerns you may have.

Step 2: Additional Tests and Imaging

You might need further tests such as blood work, CT scans, MRI scans, or PET scans. These tests help your care team understand more about your cancer.

Step 3: Simulation

During the simulation process, you'll be positioned in the same way you will be for actual treatment. A CT scan is usually done to identify the precise area to be treated. Marks may be placed on your skin to ensure accurate targeting of radiation.

Step 4: Treatment Planning

Once the simulation is complete, your care team will develop a personalized treatment plan. Using special software, they determine the exact area to be treated, the appropriate radiation dose, and the number of treatments needed.

Step 5: Treatment

Radiation treatments are typically given five days a week for several weeks. Each session lasts about 15 to 30 minutes. The treatment itself is painless and does not make you radioactive.

Step 6: Regular Check-ins

Your health will be closely monitored throughout the treatment process. Regular check-ins with your radiation oncologist will occur to assess the effectiveness of the treatment and manage any side effects.

Step 7: Last Day of Treatment

On your last day of treatment, your care team will discuss the next steps with you, which usually include a follow-up schedule and any necessary supportive care.

Step 8: Follow-Up Appointments

After treatment, you will have follow-up appointments to monitor your recovery and manage any long-term side effects. These visits are also essential for early detection of any cancer recurrence.

We understand that undergoing radiation therapy can be a challenging journey, but our dedicated team is here to provide the highest quality care and support for you every step of the way.