Auckland Radiation Oncology

Innovative and advanced radiation therapy with personalised cancer care for patients
The team at Auckland Radiation Oncology are dedicated to taking the time to get to know every patient as an individual, not just as a medical case. This high level of care can alleviate a lot of the anxiety that patients face when confronted with radiation therapy treatment.

Using the latest in targeted radiation therapy technology, we ensure that every patient receives the most effective treatment delivery for their specific case.

Each patient is treated as an individual with a highly customised plan developed with their specialist and our team.
Consistent access to leading radiation oncologists.
Dedicated highly skilled team of caring professionals.
Purpose built facility designed for the best possible care and environment.
Access to a comprehensive range of technologies and techniques for all cancer types.

To see profiles of all of our consultants visit:
aucklandradiationoncology.co.nz/people/

For queries on patient suitability or referral, please see contact info.

Auckland Radiation Oncology has established an international reputation for being at the forefront of radiation therapy cancer treatment, offering patients a choice of leading edge radiation therapy aimed directly at improving cancer treatment outcomes and quality of life. Established in 2008 as the first private radiation therapy treatment centre in New Zealand, we treat 70-100 patients daily requiring radiation therapy, at our treatment centre in Epsom, Auckland.

Our cancer services are based around multidisciplinary teams and partnerships, with each team member offering special skills to support patient care. Our approach to treatment means that each patient's treatment journey is streamlined and simple; making things as easy as possible in what can be a very difficult time.

Our purpose-built facility offers attractive, modern and comfortable surroundings with the convenience of radiation therapy, pre and post treatment care, close proximity to laboratory and radiology providers, a pharmacy and support from Mercy Hospital, all in one central location. ARO also offers free on-site parking, free Wi-Fi for patients, good access to motorways, public transport, accommodation and other services.

Dedicated and compassionate staff at every level ensures that patients are welcomed as individuals and receive highly personalised attention in a comfortable, discreet and compassionate environment.

ARO offers treatments that are funded by health insurers and is a Southern Cross affiliated provider

Areas of Specialisation
The greatest challenge with radiation therapy is to minimise damage to healthy tissue, whilst delivering a sufficient and precise dose to the tumour so that it can be destroyed. Auckland Radiation Oncology utilises the latest advancements in treatment planning, linear accelerator based technology, medical imaging and dosimetry to deliver radiation therapy with the utmost of accuracy to reduce the risk of side-effects to the patient.

Our team is focussed on innovation to ensure the safest and most effective treatment delivery and on providing leading-edge treatments that put the patient at the centre of the treatment process. ARO has a commitment to investment in the latest technology, to ensure that the treatment patients receive is the most appropriate for their condition.

ARO uses imaging and planning methods that enable customisable and easily reproducible plans to deliver the most effective dose possible to different parts of the tumour and surrounding tissue. Intensity modulated radiotherapy (IMRT) and image guided radiotherapy (IGRT) are used concurrently to deliver the planned dose whilst continuously monitoring the position of the actual tumour within the delivered beams.

Imaging
At ARO, using the latest in imaging techniques is essential to delivering safe and effective treatment. Treatment plans are designed and calculated from a dedicated computed tomography (CT) planning scan. This usually involves contouring the organs and tissues within the patient so that the dose received can be accurately calculated and the treatment dose can be delivered precisely to the target volumes. By using 4D-CT scanning the extent of tumour motion can also be determined from the images acquired, enabling the treatment plan to be designed more precisely using adequate margins that will cover the tumour.

In addition to the CT planning scan it may be useful to have additional scans (ideally these scans will be carried out with the patient in the same position as in the CT planning scan):

• Diagnostic CT scans may provide extra information
• Magnetic Resonance Imaging (MRI) scans provide a lot more information and contrast for soft tissues and enable clinicians better accuracy in outlining soft tissue structures such as in the prostate and head & neck regions.

Positron Emission Tomography (PET) imaging

• The use of PET in combination with CT provides accurate information on tumour extent and distribution for many common cancers. PET imaging enables the functional state of tumours and other tissues to be taken into account. Multimodality imaging combining both functional and anatomical or morphological information is now the gold standard for advanced radiation therapy treatment planning. The use of PET results in high accuracy in the detection of many tumour types by detecting only metabolic active tissue which should increase the accuracy of target volume delineation.
• The use of high fractional doses, particularly for Stereotactic Radiation Therapy (SRT), requires precise definition of the target volumes as well as the critical organs.
• Definition of the gross tumour volume is one of the most important steps in treatment planning and all other subsequent steps depend upon.
• PET can be used for staging, prediction of tumour response to therapy, detection of early recurrence and evaluation of changes in organ function following treatment

Volumetric Modulated Arc Therapy (VMAT)

• Elekta VMAT is the next generation arc therapy technique that establishes new standards for radiation therapy treatment speed and dose reduction to the patient. Single or multiple radiation beams sweep in uninterrupted arc(s) around the patient, dramatically speeding treatment delivery. VMAT with complete or partial arc(s) may reduce treatment times from the eight to twelve minutes required for conventional radiation therapy to as few as two minutes.

VMAT provides the radiation oncologist with the greatest freedom of choice regarding how the optimal dose will be delivered. 3-D volume imaging technology integrated into treatment systems at ARO enables our radiation therapists to see the tumour target at the time of treatment and to guide therapy that both maximises the radiation dose to the target and minimises exposure to surrounding healthy tissues.

Intensity Modulated Radiation Therapy (IMRT)
IMRT is an advanced mode of high-precision radiation therapy that allows the precise delivery of radiation doses to a malignant tumour or specific areas within the tumour. IMRT allows for the radiation dose to conform more precisely to the three-dimensional shape of the tumour by modulating the intensity of the radiation beam in multiple small volumes. IMRT also allows higher radiation doses to be focused to regions within the tumour while minimizing the dose to surrounding normal critical structures.

Treatment is carefully planned by using 3-D CT or MRI images of the patient in conjunction with computerised dose calculations to determine the dose intensity pattern that will best conform to the tumour shape. Typically, combinations of multiple intensity-modulated fields coming from different beam directions produce a custom tailored radiation dose that maximises tumour dose while also minimising the dose to adjacent normal tissues.

Because the ratio of normal tissue dose to tumour dose is reduced to a minimum with the IMRT approach, higher and more effective radiation doses can safely be delivered to tumours with fewer side effects compared with conventional radiotherapy techniques. IMRT also has the potential to reduce treatment toxicity, even when doses are not increased. Due to its complexity, IMRT does require slightly longer daily treatment times and additional planning and safety checks before the patient can start the treatment.

Currently, IMRT is being used most extensively to treat cancers of the prostate, head and neck, and central nervous system. IMRT has also been used in limited situations to treat breast, thyroid, lung, as well as in gastrointestinal, gynaecologic malignancies and certain types of sarcomas.

Image Guided Radiation Therapy (IGRT)
IGRT uses a variety of 2-D, 3-D and 4-D imaging techniques throughout the course of radiation therapy to accurately identify, pinpoint and monitor the patients tumour for changes. IGRT increases the probability of tumour control and sparing of normal tissues due to the improved targeting of the tumour.

ARO uses both Elekta XVI and Symmetry™ imaging immediately before or during the time radiation is delivered, while the patient is positioned on the treatment table. These images are then compared to the images taken during simulation. Any necessary adjustments are then made to the patient's position in order to more precisely target radiation at the tumour and avoid healthy surrounding tissue.

• XVI - 2D and 3D kV imaging enables planar and volume imaging to allow soft tissue detail to be seen in any area of the body immediately prior to treatment.
• Symmetry™ - Unique 4D kV imaging provides 4D volume imaging of moving tumour immediately prior to treatment. This volume image is matched to the original 4D-CT image used in the treatment planning phase, and the patient position is then corrected to locate the tumour in the planned position. This allows moving targets to be treated aggressively without compromising the safety of adjacent critical structures.
• IGRT is used to treat tumours in areas of the body that are prone to movement, such as in the lungs, liver, and prostate gland, as well tumours located close to critical organs and tissues.

Stereotactic Radiation Therapy (SRT) and Stereotactic Ablative Radiation Therapy (SBRT/SABR)
Radiation therapy is rapidly evolving, resulting in innovative treatment options, with stereotactic and hypo-fractionated therapies increasingly becoming the standard of care for a variety of cancers such as; acoustic neuromas, pituitary adenomas, haemangioblastomas, secondary brain tumours and tumours in the lung, liver and pancreas. This stereotactic technique is less invasive than surgery and may be more broadly applicable to greater numbers of tumours and patients can conveniently finish their treatment in days instead of several weeks.

These groundbreaking techniques combine advanced tumour targeting under 4D-image guidance and higher doses of radiation than conventional radiation therapy to accurately treat a well-defined tumour.

Any misalignments in patient position are corrected using the robotic patient positioning HexaPOD™ evo couch system which provides six degrees of freedom including translational and rotational corrections. These systems allow sub-millimetre patient positioning accuracy and targeting of the tumour during treatment

ARO has access to New Zealand's only CyberKnife®, providing precision robotic radiotherapy.

Leading-edge treatment planning systems
ARO was the first treatment centre in Australasia to implement RayStation® the most advanced treatment planning system on the market today. The RayStation® optimisation algorithms for VMAT, IMRT and 3D-CRT alongside a comprehensive set of tools for traditional 3D planning form the core of functionality. Fusion capabilities (CT, PET and MRI), contouring, collapsed cone convolution dose computation and 4D data compatibility, as well as unique features such as multi-criteria optimisation, dose tracking, treatment adaptation and deformable registration, are all utilised at ARO to improve patient treatment outcomes.

Key Staff

• Prof Chellaraj Benjamin Clinical Director - ONZM; MBBS; DMRT; MD; FRANZCR
• Dr Ian M Hanson MPhys, Msc, PhD
• Susan Brooks MB ChB 1994 Auckland; FRANZCR 2003
• Dr Anthony Falkov MB BCh 1983 Witwatersrand; FRANZCR 1997
• Dr Maria Pearse MB ChB 1994 Otago; FRANZCR 2003
• A/Professor Giuseppe Sasso MB ChB 1995 Napoli; Spec (Onc Rad) 1998 Napoli
• Dr Louis Lao MB ChB 2001 Otago; FFFRANZCR 2011
• Dr Ramesh Arunachalam MBBS Melbourne; FRANZCR
• Dr John Childs MNZM; MB ChB; FRACP; FRANZCR
• Dr Ruth Angell MB ChB 1992 Otago; FRANZCR 2004
• Dr Roger Huang
• Dr Ramesh Pandey
• Dr Matthew Seel

• Call +64 9 623 6587 to speak with our Specialist Centre bookings team
• Fax through a patient referral letter to +64 9 623 6586
• Email through a patient referral letter to specialistcentre@aro.co.nz or to the specialist directly (email addresses can be found on our website)