Information for Providers about Hollings

MUSC Hollings Cancer Center received one of the first three Elekta Esprit stereotactic radiosurgery (SRS) systems in the country. The Elekta Esprit system means better precision, less toxicity and a more comfortable experience for patients.

SRS uses gamma radiation to perform noninvasive “surgery” in the brain without the need for cutting instruments. It can be used for any type of cancer that has metastasized to the brain; most often this is lung, breast, melanoma, or kidney cancer. It is also used for non-cancerous tumors (for example, meningiomas) and neurological conditions, such as trigeminal neuralgia, a chronic pain condition.

The Elekta Esprit uses 192 beams of radiation, each as small as 4 millimeters, to target precise locations in the brain within 0.3 millimeters, sparing healthy brain tissue nearby.

The system can be used with a frame or mask, depending on the individual treatment plan. The mask system means that some patients will be eligible for fractionated treatment, or a treatment plan that is broken up into three or five sessions rather than one. This means shorter, more comfortable sessions and less toxicity, as well as improved treatment of larger tumors. The increased flexibility of the Esprit system means that more patients will find they are eligible for this treatment option.

Our team of radiation oncology physicians and physicists helped bring radiosurgery to South Carolina more than 20 years ago. As a joint partnership between the departments of Radiation Medicine and Neurosurgery, our Gamma Knife Center performs approximately 300 radiosurgeries per year and is one of the largest Gamma Knife facilities in the country.

Our extensive experience results in better outcomes for our patients and our team approach streamlines the process of evaluating each patient’s options, so that the most appropriate course of treatment can be developed and initiated without unnecessary delay, confusion or anxiety. This system represents our continuing commitment to offer patients the latest options in radiosurgery.

Our department currently boasts three Varian TrueBeam linear accelerators equipped with OBI, advanced imaging packages, RapidArc, Optical surface monitoring systems (OSMS), RPM, PerfectPitch 6DOF couch tops and HDMLC.

The TrueBeam system is an advanced technology providing enhanced imaging capabilities and many forms of external beam radiation therapy used to treat various types of cancerous and noncancerous tumors in the head, neck and throughout the body. These include image-guided radiation therapy (IGRT) and intensity-modulated radiation therapy (IMRT). With similar features and capabilities as TrueBeam, the TrueBeam STx also offers stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT). This is a specialized type of treatment in which high-dose radiation is delivered to targeted locations in a patient’s body in five or fewer treatments.

Both technologies have advanced imaging features that allow physicians to pinpoint a patient’s tumor and shape the system’s radiation beams to match the size and shape of the tumor. This precision and accuracy allows physicians to tailor treatments to each patient’s particular cancer and may result in fewer overall side effects.

Key advantages of TrueBeam:

• Treatment is an outpatient procedure, painless and noninvasive.
• Extreme precision minimizes radiation damage to normal tissue.
• Beam shaping offers highly accurate and uniform treatment.
• Short treatment times – about 15 minutes – eliminate errors from minor patient movements during longer treatments.
• Patients return immediately to normal routines with minimal side effects.
• No overnight hospital stay required.

This is the newest development in helical tomotherapy systems. Most conventional radiation therapy machines use five to nine beam angles, and were developed for 2D and 3D conformal therapy. The Radixact Treatment System delivers radiation continuously from all angles around the patient, and features patented beam-shaping technology created specifically for intensity-modulated radiation therapy (IMRT). More beam angles, plus more precise beam modulation, creates dose distributions that conform to complex tumor shapes.

Helical delivery is an excellent treatment option for exceptionally long treatment volumes, such as extended field pelvic radiation and craniospinal irradiation. It is capable of treating these volumes with straight forward single-setups that would usually require patient-repositioning and repeat setup-imaging for a standard linear accelerator. It also serves as an excellent treatment alternative for re-irradiation of head and neck lesions as it allows for treatment of targets that are in close proximity to an organ of risk, while sparing much of the dose to the at-risk structure. The Radixact system has faster treatment delivery and imaging, vastly increased planning and evaluation capabilities, and increased couch stability compared to the older tomotherapy units.

These allow for quantitative iodine and virtual non-contrast imaging, metal artifact reduction for improved contouring and much more. DECT is a rapidly evolving technology with the potential for many new applications in the near future.

MUSC is a high-volume center for both MR-guided HDR gynecologic brachytherapy and LDR prostate brachytherapy. Our knowledgeable team of dedicated radiation oncologists, physicists, therapists and nurses, coupled with our extensive experience with challenging cases has earned us a place as the referral center for brachytherapy in the state of South Carolina. As a result, we continue to see yearly growth in this area.

Our prostate program has pioneered a technique for building custom linked seeds in the operating room and has recently adapted the technique to the use of Cs-131 seeds. Our gynecologic brachytherapy program utilizes an Elekta Flexitron brachytherapy delivery system and can perform a variety of implants utilizing various applicators including the Venezia advanced gynecological applicator, the Utrecht interstitial CT/MR applicator, the interstitial ring CT/MR applicator, Syed templates, dual tandem implants and the vaginal CT/MR multi-channel applicators.

We also perform HDR brachytherapy for a variety of rarer applications including soft tissue sarcomas, endobronchial lesions, esophageal cancer and benign and malignant skin conditions. In addition, MUSC has a thriving LDR eye plaque brachytherapy program.

For more than 30 years, MUSC Hollings Cancer Center has been South Carolina's leader in blood and marrow transplantation. We are the only combined adult and pediatric FACT (Foundation for Accreditation of Cellular Therapy) accredited Blood and Marrow Transplant (BMT) Program in the state.

According to the CIBMTR/NMDP Report published in 2023, which averaged and compared the combined years of 2019-2021, our BMT program achieved an actual one-year survival rate of 77.6% for patients receiving first allogeneic transplants. This rate is above the national average of 76.2%.

We offer Total Body Irradiation as part of conditioning regimens for bone marrow transplants at MUSC. TBI is currently performed on our Varian 600C unit.

Hollings is the only cancer center in South Carolina to offer total skin electron beam therapy to treat cutaneous T-cell lymphoma. Total skin electron beam therapy covers the entire skin surface with low-dose electron beam radiation to reduce the skin patches and plaques caused by cutaneous T-cell lymphoma. The radiation penetrates only 1-2 millimeters below the skin, so organs are not affected, but the cancer cells will die off.

• IBA
  
  • Blue Phantom 2
  • Blue Phantom Helix
• Sun Nuclear
  
  • MapCheck 2
  • Daily QA3
  • Tomodose
  • 1D Scanner with PC electrometer
  • ArcCheck
• Landauer MicroStar OSL system 2
• Mobius DOSELAB, Mobius3D, MobiusFX
• Various ion chambers, diodes, electrometers
• MUCheck

• Varian Eclipse with RapidPlan
• Varian ARIA
• RayStation Treatment Planning for RadiXact
• Elekta GammaPlan
• Velocity Al
• Elekta Oncentra brachytherapy
• Varian Variseed

Surgeons at MUSC Health in Charleston have access to the da Vinci SP, a single-port robotic system.

The da Vinci SP enables surgeons to perform minimally invasive robotic surgery in locations that would otherwise be anatomically challenging. Head and neck cancer surgeons utilize the system to perform transoral robotic surgery. Urologic cancer surgeons can utilize the system for extraperitoneal or transvesical surgery.

The hepato-pancreato-biliary surgical team has established an accelerated access pathway for people diagnosed with non-metastatic HPB cancers. This program enables patients to meet with our surgical team quickly to begin planning treatment.

The program is available for people with non-metastatic gastric cancer, liver cancer, pancreatic cancer, small intestine cancer and gallbladder cancer.