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BLK Cancer Centre (BLKCC) is the most comprehensive cancer care center in the entire region with a focus on holistic approach to cancer treatment. With more than 100 dedicated beds, ultra-modern equipment’s and organ specific specialist teams, the Centre is a preferred choice for comprehensive cancer care. The Centre uses the latest treatment modalities in management of cancers with chemotherapy, targeted therapies and hormonal therapy. All cases requiring surgery are diagnosed and investigated by surgical teams streamlined into and specializing in organ specific services viz. Head & Neck Oncology, Breast Oncology, Gynae-Oncology, GI Oncology, Uro-Oncology, Thoracic Oncology and Paediatric Oncology etc. BLK Super Speciality Hospital is the proud home to Cyber-knife VSI ® – Asia’s first and world’s seventh installation of its kind. The Cyber-knife VSI is a Whole Body, Robot Guided, Radio Surgery System which offers the miraculously accurate and precise Radiosurgery for even in-operable tumors – such as tumors in the lung, relatively inaccessible areas of the brain, spine and prostrate. The system offers extremely accurate non-invasive and painless treatment to the patients. In addition, the Centre has installed the latest generation PET CT Scan to aid accurate diagnosis and treatment of a multitude of diseases. Besides the Cyber-knife VSI , BLKCC’s Department of Radiotherapy has the latest Trilogy Tx Linear Accelerator, offering state-of-the-art IGRT, IMRT, 3DCRT, Stereotactic RT and High Dose RateBrachytherapy Today, more than half of all patients diagnosed with cancer can be cured, and many others will live long, meaningful lives even with their disease. But getting the correct diagnosis and the most appropriate treatment right from the start is crucial.
What is CyberKnife?
BLK CyberKnife Center
Cyberknife VSI-laitteisto (pdf)
BLK CyberKnife Center
MEDICAL, SURGICAL & GYNAE ONCOLOGY
BLK Cancer Centre offers a combination of Chemotherapy, Immunotherapy, and Targeted therapy to treat cancer in a comprehensive manner. Our medical oncologists have been trained at premier institutions of the world and are adept in handling complex adult and pediatric malignancies. The emphasis is on “personalized cancer therapy” which means that an appropriate tailored therapy is offered to each patient. The department is backed by allied services like professional counseling, physiotherapy and dietetics department which provides a holistic treatment to every individual patient. The decision making for each patient is comprehensively discussed in Tumor Board. Hence, the treatment plans reflect the combined expertise of many doctors – surgeons, medical oncologists, radiation oncologists, radiologists, pathologists, Interventional Radiologists, neurooncologists. This approach ensures that patients who need several different therapies to treat their cancer will receive the ideal combination. An important aspect of safe chemotherapy drug delivery is proper venous access- our oncologists are proficient in the insertion and care of central lines, Chemoport, PICC lines and Hickman catheters. Interventional diagnostic and therapeutic procedures like bone marrow biopsies, lumbar puncture and CSF analysis, ascitic and pleural tappings are routinely performed in the appropriate settings. Novel chemotherapy delivery via the CSF route or via the intraperitoneal route are also offered in select patients. Our nurses work together with doctors and are an essential part of the health care team. Their support, encouragement and deep sense of caring bring tremendous comfort to our patients and their loved ones. Our specially trained oncology nurses care for patients, help administer chemotherapy and care and maintenance of central venous access devices (PICC Line, Port,Hickman’s line etc). Various cancers that are dealtwith in the department are:
Breast cancer is the most common cancer in women in urban centers. We offer
- Effective screening strategies in the form of digital and ultrasound mammography which aids in the early diagnosis of a cancer/benign lump in the breast.
- Surgery (breast conservation surgery/ complete mastectomy with axillary clearance) followed by chemotherapy for early stage Breast Cancer.
- A judicious combination of chemotherapy, hormonal therapy and immunotherapy for Advanced Stage Breast Cancer.
- Every attempt to generate a treatment protocol where a breast conservation surgery with good cosmesis is maintained.
- To perform genetic tests and offer genetic counseling to rule out hereditary breast cancers.
- We are one of the few centres in Delhi which provide sentinel lymph nodes sampling facility in appropriate breast cancer patient.
BREAST CONSERVATIVESURGERY (BCS)
Early Breast Cancer, is today treated with Breast Conservative Surgery (BCS). Only the lump or swelling with good margins is resected and then Radiotherapy is given to rest of the breast tissue which is equivalent to Modified Radical Mastectomy which was practiced. Even in Locally advanced Breast Cancers after NeoadjuvantChemotherapy , tumor size is reduced and BCS can be practiced.
MODIFIED RADICAL MASTECTOMY
Standard treatment for all surgically resectable breast cancers. Whenever patient don’t have access to Radiotherapy facilities or in case patient is not meeting the criteria for Breast Conservative Surgery, Modified Radical Mastectomy is standard of care.
SENTINEL LYMPH NODE BIOPSY
In Early Breast Cancer with nonpalpable lymph node status, Axillary Lymph Node Dissection can be avoided by Lymphoscintigraphy mapping and Sentinel Lymph node biopsy can be done and avoids an extensive axillary lymph node dissection reducing the risk of lymphedema.
All cases require some form of breast reconstruction whether it is Lumpectomy or Modified Radical Mastectomy. All types of reconstruction with LatDorsi Flap, TRAM Flap and Free DIEP Flaps.
This is practiced after lumpectomy , which leads to a volume loss which can be made out of available breast tissue rotation , thereby making the breast look normal.
HEAD AND NECK CANCERS
- Every case is jointly examined by specialised head and neck surgeons, medical and radiation oncologists.
- Radiation therapy alongwith concurrent chemotherapy is one of the standard of care for locally advanced tumors.
- Bulky tumors are offered induction chemotherapy to effectively reduce the tumor size.
- Voice rehabilitation, swallowing exercises and smoking cessastion programs are vital end points of successful treatment of head and neck cancers and are actively pursued in each patient.
Oral cancer is very common in India. Mostly they are in Buccal Mucosa, excision followed by reconstruction in the form of PMMC Flap, Forehead Flap, DP Flap. Most advanced is Free Flap from Radial Forearm Flap, Anterolateral thigh Flap as per availability covers the buccal mucosa defect without deforming the face.
All forms of Laryngeal conservation, including Laser Excision, Chemo Radiotherapy for advanced Cancers, Hemilaryngectomy, TotalLaryngectomy with TEP Prosthesis, SupracricoidLaryngectomy and Near total Latyngectomy are done.
VOICE REHABILITATION SERVICES
BLK Cancer Centre provides Voice Rehabilitation services in all forms to rehabilitate the voice in Laryngoctomy patients.
All forms of Glossectomy are done with reconstruction of the remainder tongue to restore all functions is being done. Associated Neck dissection is done aggressively so as to clear the complete lymph node dissection.
All types of lip cancers are being excised and reconstruction is done as per location of the tumor and microvascular techniques are being used to restore the cosmesis.
All types of Thyroidecomy are done with preservation of Superior Laryngeal Nerve and Recurrent Laryngeal Nerves and Parathyroids.
- The state of the art PET-CT scan (available at our hospital) is now recommended as the imaging modality for staging lung cancers.
- Even though approximately 70% of lung cancer patients present at an advanced stage, multiagent chemotherapy and targeted therapy provide a meaningful extension of life. A host of immunohistochemical and pathologic tests help in delivering a personalized therapy to each patient in our department.
VATS and Complete thoracoscopic surgeries are done for Lung cancers,Metastatectomies and Mediastenaltumours. Pneumonectomy , Lobectomy and segmentectomy are being done by VATS (Videoassistedthoracoscopic surgery).Similarly Mediastenal tumors and lymphadenectomies and Metastatectomies are done by laparoscopy.
GASTROINTESTINAL, LIVER AND PANCREATIC CANCERS
Advanced tumors of the gastrointestinal tract are managed with combination chemotherapy and immunotherapy.
- Portable chemotherapy delivery infusion pump are used with the advantage that the patients spend minimum time at the hospital.
- Liver cancers are treated with highly specialized modalities like transarterialchemoembolization(TACE) and transarterialradioembolisation (TARE).
- Metastatic liver cancers are managed with targeted therapy.
Esophagus is a difficult location to treat because replacing the Food pipe with resection, which is closer to Carina and Bronchus and Rt Atrium. But with Minimally Invasive approach the Esophageal resection is easy without having a tharacotomy thereby reducing the Pulmonary complications. Minimal Invasive Esophagectomy is the gold standard.
Stomach cancers are now assessed by laparoscopy for operability than a decision is taken for Surgery thereby avoiding laparotomy in inoperable cases. Even D2 gastectomy is also being done by laparoscopy. D1 Gasterctomy and Palliative GJ is being done by laparoscopic means.
Laporoscopic colorectal surgery is standard of care at our centre. All cases of Colon Cancers are being done with laparoscopic approach with Medial to Lateral Dissection without handling the tumor as is done in open cases. Especially with NeoadjuvantChemoradiation practice and Laparoscopic approach sphincter preservation rates are higher avoiding a permanent Colostomy.
GALL BLADDER CANCERS AND BILE DUCT CANCERS
Radical Cholecystectomy with Segment IVb and V resection is standard of care and similarly Bide duct cancers are treated with exision and reconstruction with Roux en Y Jejunal Loop.
All forms of Liver resection is carried out including Paediatric patients. CUSA is available which ads to the Surgical Resection easier. Similarly CT volumetry technique is used to assess the residual liver volume.
KIDNEY AND URINARY BLADDER CANCERS
- Kidney tumors are treated with nephrectomy surgery followed by oral targeted therapy.
- Urinary bladder cancers can be offered neo-adjuvant or adjuvant chemotherapy.
- Bladder preservation treatment modalities like chemo-radiation are also practiced in appropriate patients.
- The commonest cancer amongst elderly men, prostate cancer is treated with hormonal therapy, radical prostate excision surgery or radiation therapy.
- The survival in hormone refractory prostate cancers is nowadays extended with chemotherapy and newer hormonal therapy.
- Bone preservation bisphosphonate therapy is given at periodic intervals in metastatic prostate cancers.
Kidney cancers are dealt with Laparoscopically, Lap Radical Nephrectomy is being done with minimum blood loss.and Bladder cancers which are muscle invasive are also resected laparoscopically with only ileal conduit is being done by open method. Similarly Radical Prostatectomy is also done laparoscopically. Penile cancers are dealt as conventionally but Iliac Lymphnode dissection done laparoscopically and Inguinofemoral lymph node dissection done by open method thereby reducing the risk of flap necrosis
Soft tissue Sarcomas are being treated by resection of soft tissue tumors with reconstruction .Resection bed is being treated with Brachytherapy. Bone sarcomas are resected and reconstruction is done by Limb sparing methods using joint replacement techniques in lower end femur , upper end femur, upper end of Tibia and even complete femur replacement. Internal Pelvicectomy is being done in selected cases with same acetabular reconstruction technique.
The leading team of dedicated GynaeOncoSurgeons have expertise in performing radical surgeries for all gynaecological cancers.
Procedure done for the surgical management of the Cervical Cancer this surgery differs from the Simple hysterectomy. The adjoining parametrial tissues of the cervix are also removed with the upper 2cm of vagina. Extent of the radicality depends on the size of the tumor.
Surgical procedure chosen for the small tumors of cervical cancers in young women where fertility preservation is required.
Excision of the cervix for carcinoma In- Situ.
PELVIC NODE DISSECTION
The draining lymph nodes of the cervix in the ileoobturator group of nodes are dissected of the pelvic vessels and is combined with radical hysterectomy in cervical cancer.
PARA-AORTIC NODE DISSECTION
Lymph nodes around the aorta and inferior vena cava are dissected as a part of the surgical management in staging of ovarian cancer and endometrial cancer.
RETROPERITONEAL NODE DISSECTION
Includes the combination of pelvic and para-aortic node dissection and is performed as a part of surgical staging of ovarian and high risk endometrial cancer.
SURGICAL STAGING FOR ENDOMETRIAL AND OVARIAN CANCER
Is important to define the stage of the disease and usually includes the procedure of retroperitoneal node dissection and omentectomy when indicated.
FERTILILTY PRESERVING SURGERY
for ovarian cancer and endometrial cancer in selected patients
MINIMAL INVASIVE SURGERY FOR GYNAECOLOGICAL CANCERS
LAPAROSCOPIC RADICAL HYSTERECTOMY
Radical hysterectomy performed in the cervical and endometrial cancer patients with the use of larproscopy. This offers the similar survival benefit as open radical hysterectomy the procedure has the advantage with the minimal access and faster recovery.
LAPAROSCOPIC PELVIC AND PARA-AORTIC LYMPH NODE DISSECTION
The lymph node dissection as described is done with the help of laparoscopy in selected patients.s
CYTOREDUCTIVE SURGERY FOR ADVANCED STAGE OVARIAN CANCER
The procedure is performed with a aim of excising all the diseased tissues in the abdomen and may include the various following procedures along with excision of ovarian masses and uterus.
ANTERIOR RESECTION AND ANSTOMOSIS
Part of the diseased rectosigmoidcolon is resected and the healthy ends of the rectum and sigmoid colon are anstomosed by using the circular staplers. This procedure is performed as a part of the cytoreductive surgery in either advance stage ovarian cancer, endometrial cancer, recurrent cancer involving rectosigmoid colon.
MODIFIED POSTERIOR EXENTERATION
In this the diseased uterus along with the diseased rectosigmoid colon are removed together and the rectosigmoidanstomosis is done to maintain the function of colon.
Removal of involved urinary bladder and rectum with the cervical/endometrial disease or recurrent cervical or endometrial cancer. This procedure includes the urinary diversion with ilial conduit and colostomy.
RADICAL VULVECTOMY/ WIDE RESECTION OF THE VULVAR LESION
Performed in cancer vulva based on the site and size of the disease.
SENTINEL NODE DISSECTION
Is under taken in smaller lesions of vulvar cancer.
INGUINO FEMORAL NODE DISSECTION
Usually performed as a part of the surgical treatment of vulvar cancer.
EXCISION OF OMENTAL MASSES
RETRO PERITONEAL NODAL DEBULKING
THE FOLLOWING MINOR SURGICAL PROCEDURES:
- LEEP Cervix
- Conization cervix
- Diagnostic laparoscopy
- Trilogy TX Linear Accelerator –
The Trilogy TX system is the first in a new generation of cancer care systems. A versatile system optimized for multiple forms of treatment. The versatile Trilogy TX system delivers 3D conformal radiotherapy, IMRT, fractionated stereotactic radiation therapy, IGRT, and Gated Radiotherapy. The on-board imager on the linear accelerator is an automated system for image-guided radiation therapy that provides high-resolution X-ray images to pinpoint tumor sites. The on-board imager is mounted on the treatment machine via robotically controlled arms that can be positioned for the best possible view of the tumor. The image detector shows exactly how a tumor will move during treatment due to breathing or other patient movements. The power of Trilogy TX yields treatment times that are shorter, making the experience more comfortable for the patient. The precision of Trilogy TX allows you to spare healthy tissues to an extent that was unimaginable only a few years ago. The versatility of Trilogy TX enables treatment of a wide variety of patients using a single machine.
- Choose from a broad range of external beam therapies, including 3D CRT, IMRT, IGRT or DART using the Trilogy TX system.
- 2D and 3D KV image guidance for higher quality imaging at lower doses.
- Full 360° range of treatment delivery angles with positional couch angles.
- Stereotactic frame or frameless immobilization for patient positioning – treat any area of the body.
- Real-time Position Management™ (RPM) system – for gating perfectly timed beam delivery with minimal margins.
- Portal Dosimetry IMRT treatment delivery verification.
- Dynamic high resolution MLC for exquisite beam sculpting.
- Delivery verification and quality assurance in Argus Linac and Argus IMRT quality assurance software.
- Highest dose rate for shorter sessions.
- Tight isocenter alignments on all three axes. Targets the smallest lesions.
- Rapid on-board imaging. Reposition patients quickly and accurately.
- Cone-Beam CT, fine tune patient set ups with ultra-precise CT scans.
- Gammamed ix High Dose Rate brachytherapy unit In brachytherapy, the radiation source is placed within the tumor or in a cavity to deliver very high doses of radiation to the tumor tissue. It conforms the radiation dose to the size and shape of the target and limits side effects by sparing the surrounding healthy anatomy. Brachytherapy delivers high-intensity radiation directly into tumors through fine needles that are deployed from computer-controlled afterloaders that move the radiation source on a wire within the needle according to a prescribed treatment plan. Facility for temporary and permanent implants is available. Used in cancer of the cervix, prostate, breast, esophagus, lung, and soft tissue sarcomas. The total dose is delivered in a series of fractions, or treatment sessions. The treatment can be delivered in a few minutes as the system uses a high dose rate.
- The Cyber-knife VSI is a Whole Body, Robot Guided, Radio Surgery System which offers the miraculously accurate and precise Radiosurgery for even in-operable tumors – such as tumors in the lung, relatively inaccessible areas of the brain, spine and prostrate. The system offers extremely accurate non-invasive and painless treatment to the patients. In addition, the Centre has installed the latest generation PET CT Scan to aid accurate diagnosis and treatment of a multitude of diseases.
AVAILABLE RADIATION THERAPY TECHNIQUES
- 3D Conformal Radiation Therapy (3DCRT)
- Intensity Modulated Radiation Therapy (IMRT)
- Image Guided Radiation Therapy (IGRT)
- Stereotactic Radiation Therapy (SRT)
- Respiratory Gating
- Digital Portal Imaging
- Virtual Simulation of Radiation Therapy with CT Scan/MRI
- High Dose Rate Brachytherapy (HDRBT)
INTENSITY MODULATED RADIATION THERAPY (IMRT)
A type of 3-dimensional conformal radiotherapy that focuses multiple radiation beams directly on the tumor itself. Beam intensities vary, so that the highest possible doses can be used to destroy cancerous tissue keeping the dose to the critical normal tissues to the minimum. This results in very low complication rate following extended radiotherapy treatments. Proper positioning of the patient is crucial to the success of IMRT. Radiation oncologists use special planning software to determine the most accurate treatment
IMAGE GUIDED RADIATION THERAPY (IGRT)
When the radiation oncologists plan highly specialized treatments like 3 dimensional conformal radiotherapy (3DCRT) or intensity modulated radiotherapy (IMRT), they keep the margins around the tumor very tight in order to reduce dose to the surrounding normal tissues. However, there is a possibility of the treatment field to shift on either side by a few millimeters everyday and also the organ in which the tumor arises may not be in the same position daily (most organs move a few millimeters or more in all directions). Therefore the doctor will take into account the above situations and give bigger margins around the tumor, thus including more surrounding normal tissues thereby defeating the purpose of highly precise treatments like IMRT. If IGRT facility is available on treatment machine, doctor can take very tight margins, since the treatment fields and organ position will be verified by image guidance everyday before treatment delivery and adjustments made for field and organ shift on a daily basis before delivery of radiation. Thus IGRT helps in reducing the side effects dramatically in patients and is the ultimate in precision radiation therapy. Stereotactic Radiation Therapy (SRT) Several radiation beams are precisely aimed to converge upon a small tumor. The patient lies on a couch that rotates 180 degrees for maximum targeting, without harming surrounding tissues. This technique is used to treat brain tumors and other intracranial cancers. It can also be used to treat tumors outside the skull.
CT (computed tomography) scanning for simulating radiation treatments for each individual patient is used in all treatment plannings. These simulations are used to test various treatment fields and devices used to immobilize the patient during therapy. Data from the CT simulator ensures that patients get the appropriate dose of radiation before treatment begins. Each patient will undergo a CT scan (CT Simulation) for planning of radiotherapy procedure. Treatment planning based on CT scans is the most accurate method available in the world today. Some patients may require MRI scan along with CT scans, where the CT and MRI images are fused for treatment planning. Facility is also available for fusing data obtained from PET scan for the purposes of treatment planning.
DIGITAL PORTAL IMAGING
Allows for real-time viewing of radiotherapy images, which helps oncologists position the patient by tracking their movements, and to design blocks for protecting healthy tissue. Images can be viewed one at a time, superimposed, or in a movie loop for optimum treatment planning.
HIGH DOSE RATE BRACHYTHERAPY
Used in cancer of the cervix, prostate, breast, esophagus, lung, and soft tissue sarcomas. The total dose is delivered in a series of fractions, or treatment sessions. The treatment can be delivered in a few minutes as the system uses a high dose rate.
A NEW USE FOR BRACHYTHERAPY: BREAST CONSERVATION
HDR brachytherapy is now also used to treat breast cancer. Today, many women with breast cancer are successfully treated with local surgery (lumpectomy), followed by a five-week course of daily external beam radiation to the whole breast. HDR brachytherapy is being used as a way of delivering breast radiation therapy, which involves treating the area around a lumpectomy with a highly localized dose of radiation over a period of about three to five days. This method of treatment as an addition to external beam radiation delivers a very high dose to tumor site resulting into high local control and at the same time gives excellent cosmesis and negligible radiation dose to the underlying lung and heart.
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