Radiation Oncology Department

At Sheba, we use the revolutionary Novalis system developed by BrainLab, a state-of-the-art accelerator that is equipped with a smart robotic system. The advanced real-time tracking system is located both on the floor and ceiling of the accelerator room and can monitor slight variations in the patient’s anatomy. It then uses this data to rotate the accelerator, allowing the aim to be corrected with the aid of a robotic bed. This system enables perfect targeting that delivers radiation with an accuracy of about half a millimeter, making the Novalis a premier method of radiation therapy.

The Novalis system is considered to be a superior system for performing spinal radiosurgery, which demands sophisticated equipment and expert skill. Treatments that were previously considered high-risk can now be done by experienced specialists, with a greater freedom and intensity.

The Novalis has also been used at Sheba to perform radiosurgery on the lungs and liver, and the implementation of this system at Sheba to treat prostate cancer is being planned.

At Sheba, we custom design each treatment program for prostate cancer by performing a comprehensive evaluation that takes into account the location and stage of the tumor, the level of risk with regard to cancer biology, and the patient’s overall health and quality of life.

Advanced imaging techniques have led to significant improvements in prostate cancer treatments, most notably MRI and PET with PSMA. By using these techniques, we are able to better pinpoint the location of a prostate tumor and identify small metastases that are still curable. Additionally, the use of new and unique technologies at Sheba enables more precise, safer and shorter radiation therapy sessions, such as:

• Ablative stereotactic radiation (SBRT), which involves a particularly high dose of radiation, is administered in order to lower the number of required treatments. For example, instead of about 50 sessions, only five radiotherapy sessions are needed.
• Brachytherapy uses internal radiation to eradicate cancer, generally in the form of implanted radioactive pellets or beads. Maximum therapy can be delivered without the need to penetrate healthy tissue. Sheba is one of only a handful of medical institutions that offer this progressive therapy.
• A gel is inserted into a thin membrane that separates the prostate from the rectum, thereby allowing radiation to be delivered without exposing the intestine to a high dose of damaging radiation.
• Gold grains are implanted in the prostate, helping to properly focus radiation beams. Targeted repeat radiation therapy is offered, when necessary, with enhanced protection for nearby organs.

This innovative technology involves delivering radiation during surgery, instead of delivered radiation before or after surgery. The goal is to attack the tumor with full force and maximum accuracy, in order to prevent recurrence. Presently, several devices are available in Israel to perform intraoperative radiotherapy on small breast tumors.

At Sheba, a more advanced powerful accelerator technology is used, which propels electrons (not X-rays) deeper into body tissue, where it can irradiate large tumors in the abdomen, pelvis and other organs – with minimal exposure to surrounding healthy tissue and organs. The accelerator is mounted on a mobile platform with a robotic arm, which helps direct the radiation to the depth of the surgical incision. From July 2019 to February 2020, more than 50 surgeries were performed at Sheba using this portable accelerator.

SBRT – stereotactic body radiation therapy – is a highly precise, focused radiation technique administered in high doses. The uniqueness of this method is that it compensates for body movements while breathing, thereby promoting extreme accuracy. Healthy tissues around the tumor are protected, and the success of treatment without side effects is improved. In order to custom design each SBRT session, CT scans are used in 4D, which maps out the movement of the tumor as each breath is taken.

Radiation therapy is typically recommended after a diagnosis of breast cancer. However, since the heart can be very close to the chest wall, radiation poses cardiac risks. However, deep breathing during radiotherapy sessions can actually move the heart away from the treatment field by about 1.5 cm, creating a protective buffer zone. The RPM system synchronizes the delivery of radiation with the patient’s respiration. This cutting-edge technology is available at Sheba, where a device made by Varian is used to closely monitor the patient’s breathing.

The technique of partial radiation of the breast (targeted to the tumor bed after surgery) has been increasing in use in recent years. With this method, higher doses of radiation can be administered, and the intense treatment can be done twice a day for five days. Typically, it is most suitable after surgical removal of a 2-3cm tumor.

Partial radiation can be given externally via linear accelerators, or internally via insertion of a catheter into the surgical area. Another option is to use brachytherapy to deliver partial radiation to the breast.

This specialized technology can be used for various cancers, including gynecological tumors, head and neck tumors. IMRT uses computerized control to produce radiation doses that adhere to the tumor with maximum accuracy. When the computer detects that a particular sub-beam poses risk to a vital organ, it can reduce the density of photons in that sub-beam of the radiation field. On the flipside, when a visible target is identified and there is no vital organ in the way, the maximum passage of photons can be allowed. The Rapid Arc method of IMRT shortens the treatment to just a few minutes, enhancing patient comfort.

The conventional method of irradiating brain tumors involved the use of a metal frame to secure the patient’s head. While this frame eliminated patient movement and avoided targeting healthy brain tissue, the setup was generally painful. Nowadays at Sheba, instead of the frame, a comfortable thermoplastic mask is attached to the bed and used along with the Novalis treatment system to target the tumor with high precision.