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Radiation detail

Total Body Irradiation

Total body irradiation (TBI) is utilised at the Royal Perth Hospital campus of Perth Radiation Oncology as an integral part of the treatment for bone marrow transplants performed for adults in this state, at Royal Perth Hospital.

This treatment is predominantly utilised in patients who have Leukaemia's and Lymphomas and have a matched unrelated donor for their bone marrow transplant.

The current technique used has been utilised since 1997, when one of our treatment rooms was specifically designed to enable us to perform this specific treatment. Patients are positioned in a custom made stand (as per original article from Raymond Meribel, Geneva) and are given, in general, six treatments over three days with a boost to their lung block areas on day two.

The technique has been specifically adapted over the last few years, due to the increase in the number of Lymphomas that are being treated with total body irradiation and bone marrow transplant, by utilising a TBI and TNI. Total lymph node irradiation (TNI) is a boost for macroscopic areas of lymph nodes that require more dose than the standard total body irradiation technique.

The first patient treated with the combination of TBI and TNI was treated in 1998 and is alive today, well and working with very limited side effects from the actual treatment. Our figures for this treatment have been recently assessed and are comparable to international figures of survival for this technique.

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Radiotherapy Treatment for Cardiac Rejection

Cardiac rejection in transplant patients can cause very significant morbidity in a small group of the increasing number of patients who undergo cardiac transplantation.

The drugs that are used to control this rejection can have significant side effects, which are not always tolerated well by the patient.

Radiotherapy has been used historically to successfully manage rejection for other transplanted organs as well as the heart and we have instituted a short course total nodal irradiation (TNI) protocol, which has been in use for the last six years.

This protocol was initially developed in response to the need for an urgent and immediate short course treatment for acute severe rejection in the initial patient. This technique has since been adapted and utilised with excellent results in decreasing the level of rejection significantly and allowing the patients to have significantly reduced doses of anti-rejection medication in the long term.

Patients have TNI with daily treatment which is given over four treatment days. Morbidity from this treatment is low, patient tolerance is excellent and compliance to treatment is also excellent.

Patient selection and management is effected in collaboration with the Royal Perth Hospital cardiac transplant team.

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Skin malignancy of the nose and Tin Foil Irradiation technique

The three dimensional shape of the human nose provides a significant challenge for the delivery of high quality, effective radiotherapy.

In response to the large number of skin cancers seen in Western Australia and the propensity for skin cancers over the nose area to be multiple, we have formulated a new technique which we believe is superior to other commonly used radiation therapy techniques for this site.

The technique uses tin foil bolus material with 4, 6 or 8 MEV electrons and CT guided beam matching and dosimetry to deliver a homogeneous dose to the entire treatment region of skin of the nose. It can control and potentially deliver the dose to deeper than usual mucosal structures if required. This protocol has been in practice for five and a half years and we have treated over seventy patients with this technique.

The results are excellent, with better than 90% local control with median follow up of three years. The cosmesis is excellent in the long term and acute side effects of treatment settle within the first month of completing radiotherapy.

This technique offers an excellent cosmetic alternative to surgery for appropriate squamous cell carcinomas and basal cell carcinomas.