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Wilson L. Hernandez, M.D.
Dr. Wilson Hernandez is a Board Certified Radiation Oncologist. He received his Radiation Therapy training at the University of Minnesota and also has a background as Internal Medicine Specialist. His area of main interest is IMRT and IGRT. Dr. Hernandez enjoys spending his free time with his wife and 3 children.
Frequently Asked Questions
My
urologist says my prostate biopsies showed prostate cancer. What
do I do now?
Answer: Remain calm. A wide range of good treatment options
exist for prostate cancer. Talk to your urologist about which treatments
are best for you.
Radiation therapy is an option for treatment
of my prostate cancer. How does it work?
Answer: Radiation therapy is a time proven treatment
for cancer. Most
tumors are more sensitive to radiation than the surrounding normal structures
(your bladder and rectum) and thus can be effectively treated. Radiation
can take several forms including radioactive seeds (gamma rays), proton
beam, and man made X-ray treatment.
So what is all the excitement about Image Guided IMRT and what
is it anyway?
Answer: Image guided radiotherapy represents one of the most significant
technical advances in radiotherapy. Image guided radiotherapy shows
significant promise in improving our ability to give sufficient radiation
doses to sterilize tumors while protecting normal structures and thus potentially
decreasing the risk of complications.
You have used the term IMRT. What does it mean?
Answer: Intensity Modulated Radiation Therapy (IMRT) is a relatively
recently developed technique to improve the delivery of radiation therapy
by the linear accelerator. Instead of maintaining a uniform radiation
beam as used in conventional or 3 dimensional radiotherapy, IMRT uses devices
within the machine to divide the radiation beam into multiple smaller beams
called beamlets that can have different intensities (modulated) within
the area being treated. This allows more precise adjustment of radiation
doses to the tissues within the target area allowing increased dose to
the prostate while relatively sparing the surrounding bladder and rectum. This
is important as several recent medical studies have suggested that higher
prostate doses are associated with increased curability.
How do you get set up for IMRT?
Answer: Several steps are required to set up your
therapy. Prior
to beginning your treatment, you will come to our office for imaging. Generally
speaking, a Cat Scan of the pelvis is performed although occasionally additional
scans including a MRI are obtained. At the time of the Cat Scan,
the staff will position you in the treatment position. A small amount
of dye may be introduced into the urethra at this time. The whole
process generally takes about 1 hour. During the next few days, the planning
process takes place using the images from the Cat Scan. You do not
need to be present at this time. Your IMRT treatment plan is prepared
by your physician in conjunction with the medical physics staff.
What happens when my treatment plan is complete?
Answer: When your plan is complete, the staff will arrange for a
final “simulation” appointment. You will be brought to
the actual treatment room for a final run through to double check your
position, measurements, and the feasibility of the computer derived plan. An
X-ray or scan may be taken at this time. Generally, everything
checks out and treatment can begin.
What do you do with the images obtained before
receiving radiation treatment?
Answer: There are two types of images
which can be obtained in the treatment room. The first is similar
to the initial cat scan used to create the treatment plan. The
staff then uses this new image by superimposing it over the original
cat scan (aren’t computers great!). Notation can be made of any internal
organ movement and the treatment position can be adjusted to accommodate and
thus increase the accuracy of the treatment. Increased accuracy over the
seven to eight weeks of treatment can be associated with an increased potential
for cure with a decrease risk of side effects and complications.
The second form of image guided therapy requires your urologist to place several inert marker seeds in the prostatic area. These seeds are then visualized just prior to therapy in the treatment room and compared to the initial seed position. Adjustment can then be made.
This treatment sounds Interesting. But can I afford it?
Answer: The treatment is a medicare reimbursed therapy and is approved
by most private insurance carriers. Coverage is generally good although
your individual plan may be subject to co-pay and/or deductible amounts. Feel
free to contact our staff if you have any questions and we will do our
best to help you.
I think I am interested in image guided radiotherapy. How
do I get started?
Answer: The usual first step is to make an appointment for a consultation
with our physician to be sure that you are a good candidate for Radiation
Treatment. This visit is similar to those in other doctors offices
with a review of your medical history and a physical examination. We
then review with you the procedure as well as its risks. Usually
you receive no radiation exposure at this time although an occasional
patient may receive a Cat Scan to begin the planning process.
Image Guided
Intensity Modulated Radiation
Therapy (IMRT) for Prostate Cancer
How is the IMRT radiation treatment given?
Answer: Your radiation treatments are administrated
by a trained therapist in a dedicated room. The treatment is given by
a linear accelerator (pictured below) while you lie on a couch. The arrangement
is quite “roomy” unlike that of a cat scan or MRI. The
actual treatment is painless. When receiving the treatment, you
are monitored by closed circuit TV and you may converse
with the staff by intercom.
But what about Image Guided Therapy?
Answer: While Intensity Modulated Radiation Therapy (IMRT) is very accurate,
it does have a short coming. The entire plan is based upon your initial
Cat Scan image which fixes the position of the internal organs. However,
the prostate, bladder, rectum and other organs display some movement and
there can be a variation in position of the organs relative to the initial Cat
Scan of several millimeters to as much as a centimeter or two (1 cm ≈ 4/10
inch).
To counter this organ movement, we acquire your image on a frequent basis (often daily). You are placed on the treatment couch in the treatment room in the usual way. However, just prior to beginning your treatment, an image is obtained to determine the relative positions of the internal organs.
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