Treatments

Cancer treatment

Cancer treatment often requires a multidisciplinary approach that combines the expertise of Medical Oncology, Radiation therapy, and Surgical Oncology.

Specialists in these fields work together to develop a treatment plan that addresses the patient’s unique needs and the specific characteristics of the cancer, to achieve the best possible outcome.

In our medical clinics, we offer a range of treatments, with a bespoke approach, ensuring that each patient receives the best care.

Medical Oncology

Set of treatment techniques that use drugs to kill cancer cells or slow down their growth.

Chemotherapy

Chemotherapy is a cancer treatment where medicine is used to destroy cancer cells. It stops cancer cells from reproducing, which prevents them from growing and spreading in the body
Hormone Therapy

Hormone therapy is used to treat cancers that use hormones to grow, such as some prostate and breast cancers. This treatment prevents cancer cells from feeding on the body’s natural hormones, reducing or blocking the connection between hormone receptors and cancer cells
Targeted Therapies

Targeted therapy is a type of cancer treatment that uses drugs or other substances to precisely identify and attack certain types of cancer cells. A targeted therapy can be used by itself or in combination with other treatments, such as traditional or standard chemotherapy, surgery, or radiation therapy
Immunotherapy

Immunotherapy is a type of cancer treatment that helps the immune system fight cancer. It uses specific medicines to help the immune system identify and destroy cancer cells

Radioncology

Medical specialty that uses radiation to treat malignant and benign tumors, killing cancer cells.

External Beam Radiation Therapy (EBRT)

It is a type of treatment that uses ionizing radiation to treat malignant tumors, and can also be used in benign pathology, where the patient receives radiation from an external source (administered by linear particle accelerator).

In terms of how the treatment planning is carried out, external beam radiotherapy (EBRT) can be divided into three-dimensional (3D) conformal radiotherapy and intensity-modulated radiotherapy (IMRT).

It is also possible to use high doses, in a single administration or in a few fractions, requiring a greater degree of precision, needing more complex techniques, both in immobilization, planning, dosimetry and administration employed, being cranial stereotactic radiotherapy-SRS (also called radiosurgery) or body stereotactic radiotherapy-SBRT (also called stereotactic ablative radiotherapy-SART).
Three Dimensional (3D) Conformal Radiation Therapy

It is the treatment modality that uses ionizing radiation to treat malignant tumors, but can also be used for benign pathology. Treatment planning is performed based on the planning CT images with the aid of a computerized system, resulting in a three-dimensional location and projection of the tumor. This allows the system to calculate the delivery of the radiation beams, with various directions and be able to be shaped or conformed, using hundreds of tiny radiation beam shaping devices, to match the irregular shape of the tumor.
Intensity Modulated Radiotherapy (IMRT)

A treatment that uses ionizing radiation to treat malignant tumors but can also be used for benign pathology. It allows the doctor to deliver higher doses by using multiple small photon beams of varying intensities to precisely irradiate the tumor or target. The radiation intensity of each beam is controlled and the shape of the beam changes throughout the treatment with the use of hundreds of tiny beam-shaping devices. It is one of the most precise forms of external radiotherapy available and yet the most circumscribed to the tumor or target with a homogeneous radiation dose.

In contrast to three-dimensional (3D) conformal radiotherapy, the intensity-modulated radiotherapy (IMRT) uses what is known as 'inverse treatment planning'. In this, the radioncologist defines the radiation doses to be delivered to the tumor and those acceptable to the surrounding tissue, and, with the aid of highly sophisticated computer software, the system chooses the appropriate number and angles of beams, which will safely deliver the specific doses of radiation prescribed by the physician.

The goal of intensity-modulated radiotherapy (IMRT) is to increase the radiation dose to the areas that need it most while reducing the amount of radiation to healthy tissue.
Cranial Stereotactic Radiotherapy - SRS (Radiosurgery)

It uses ionizing radiation to treat malignant tumors, but can also be used in benign pathology, where high doses can be used, usually in a single administration, requiring a higher degree of precision. This treatment requires more complex techniques, both in immobilization and in the planning, dosimetry and administration employed.

The treatment planning is performed based on planning MRI images, sometimes also resorting to cerebral angiography (in the case of AVMs). With the aid of a sophisticated planning software system combined with equipment prepared for this technique in the administration of the treatment, this results in the concentration of many small beams of radiation on the tumor or benign target. Each beam has very little effect on the healthy tissue it passes through, but where all the beams intersect, a high dose of radiation is deposited, causing tumors to shrink and blood vessels to close over time after treatment, robbing the tumor of its blood supply.

With its high precision, it is intended that there is minimal damage to surrounding healthy tissue. In most cases, cranial stereotactic radiotherapy (SRS) has a lower risk of side effects and collateral damage compared to other types of traditional neurosurgery or three-dimensional (3D) conformal radiotherapy.
Cranial Stereotactic Radiotherapy - SRS fractionated (radiosurgery):

It is the treatment modality that uses ionizing radiation in the treatment of malignant tumors, and can also be used in benign pathology. Thus, it’s possible to administer high doses, requiring a higher degree of precision and more complex techniques, both in immobilization and in the planning, dosimetry and administration employed. This treatment is similar to cranial stereotactic radiotherapy-SRS (radiosurgery), with the difference that several administrations (more than five) of treatment are performed, due to the location of the tumor or target, to the nobler organs that may be in close proximity, in order to reduce the risk of side effects and collateral damage.
Modulated Volumetric Arc Therapy SBRT

It is a type of treatment that uses ionizing radiation to treat malignant tumors, where it is possible to use high doses, usually in a single or few administrations (less than five), requiring a higher degree of precision, requiring more complex techniques, both in immobilization, planning, dosimetry and administration employed.

Treatment planning is carried out based on the planning CT images, with the aid of a sophisticated planning software system associated with equipment prepared for this treatment technique. This results in many small beams of radiation being concentrated on the tumor. Each beam has very little effect on the healthy tissue through which it passes, but where all the beams intersect, a high dose of radiation is deposited, causing tumors to shrink and blood vessels to progressively close after treatment, robbing the tumor of its blood supply.

The high precision is intended to minimize damage to surrounding healthy tissue.
Modulated Volumetric Arc Therapy SBRT fractionated

Treatment using ionizing radiation to treat malignant tumors, where high doses can be used, in several administrations (more than five), requiring a higher degree of precision, requiring more complex techniques, both in immobilization, planning, dosimetry and administration employed.

Treatment planning is carried out based on planning CT images, with the aid of a sophisticated planning software system associated with equipment prepared for this treatment technique. This results in the concentration of many small beams of radiation on the tumor. Each beam has very little effect on the healthy tissue it passes through, but where all the beams cross, a high dose of radiation is deposited, causing tumors to shrink and blood vessels to progressively close after treatment, robbing the tumor of its blood supply.

With the high precision, it is intended that there is minimal damage to surrounding healthy tissue.
Image-guided radiotherapy (IGRT)

A procedure that uses ionizing radiation to treat malignant tumors, but can also be used for benign pathology. This method allows the physician to administer higher doses, based on a daily pre-treatment image, where adjustments can be made to the location and administration of the treatment. It is the most adjustable form of external radiotherapy available and requires an imaging system built into the linear particle accelerator.

The treatment planning method used, namely three-dimensional (3D) conformal radiotherapy or intensity modulated radiotherapy (IMRT), is not limiting for the use of this treatment technique.

The use of fiducial markers (gold markers, which are introduced inside the tumor or target), increases the accuracy and assertiveness of the technique and allows the treatment system to adjust the patient's positioning automatically, while being verified by the therapist.
Modulated Volumetric Arc Therapy (VMAT)

It is the treatment modality that uses ionizing radiation to treat malignant tumors, and can also be used in benign pathology. In this way, the physician can administer higher doses, based on intensity modelled radiotherapy (IMRT) planning and by performing a daily pre-treatment image, where it is possible to adjust the location where the treatment is administered in an arc (360° around the desired area). With the use of complex software, it is possible to define the speed of accelerator rotation, the intensity of the beam, a homogeneous radiation dose and more circumscribed to the tumor or target. It is one of the most recent forms of external radiotherapy available and requires an image acquisition system incorporated into the linear particle accelerator. Arc delivery allows for faster daily treatment compared to classical intensity modulated radiotherapy (IMRT).
Radiotherapy controlled by respiratory movements (Gating)

It is the type of treatment that uses ionizing radiation to treat malignant tumors, but can also be used for benign pathology. Gating allows the physician to administer radiation to the tumor or target, taking into account breathing movements and sparing the surrounding healthy tissue, by performing a four-dimensional (4D) planning image acquisition and with the help of a complex software, which allows monitoring of the respiratory rate and definition of which phase of the respiratory cycle the treatment is administered.

The treatment planning method used, namely three-dimensional (3D) conformal radiotherapy or intensity modulated radiotherapy (IMRT) is not limiting for the use of this treatment technique.
Deep inspiration breath hold (DIBH)

A procedure that uses ionizing radiation to treat malignant tumors, which allows the doctor to deliver the radiation to the tumor or target in the deep inspiration phase of the breathing cycle. This allows the tumor to be kept 'still' during treatment and a higher dose can be delivered, sparing surrounding healthy tissue, minimizing toxicity to organs at risk.

A complex computerized, visualized breathing monitoring system (by the patient and therapist) is required, where respiratory rate is measured and teaching of breath-holding in deep inspiration is performed at planning image acquisition, and replicated during treatment administration.

The treatment planning method used, namely three-dimensional (3D) conformal radiotherapy or intensity modulated radiotherapy (IMRT) is not limiting for the use of this treatment technique.
Low-Dose radiation therapy for benign pathologies

This treatment uses ionizing radiation for benign pathology, where the patient receives the radiation on the target or area required. It is common to use stereotactic brain radiotherapy-SRS, usually external beam radiotherapy (EBRT) and electronic brachytherapy.

General indications for radiotherapy are, amongst others, cerebral arterio-venous malformations (AVMs) or meningioma, where stereotactic brain-SRS radiotherapy is applied, acoustic schwannoma or trigeminal neuralgia, where fractionated stereotactic brain-SRS radiotherapy is applied, exophthalmos of graves' disease and other thyroid pathologies, acute/chronic painful degenerative diseases; hypertrophic (hyperproliferative) soft tissue disorders such as early stages of Morbus Dupuytren and Ledderhose or colloids; and bone hypercalcifications such as calcaneal spur where external beam radiotherapy (EBRT) is applied or in small premalignant skin lesions, with electron brachytherapy.
Brachytherapy (BT)

Brachytherapy (BT) is the treatment modality that uses ionizing radiation to treat malignant tumors, where the radioactive source is placed near or inside the tumor (administered through radioactive sources or radioisotopes).

Brachytherapy can be:

- intracavitary or interstitial, depending on where the radioactive sources are placed;

- temporary or permanent, depending on whether or not these sources remain in the body;

- high dose rate (HDR), low dose rate (LDR) or pulsed (PDR), depending on the dose per second.
Intracavitary Brachytherapy

Type of treatment that uses ionizing radiation to treat malignant tumors, where the radioactive source is placed in natural body cavities. For this reason, intracavitary brachytherapy can only be temporary, where the radioactive sources are placed for a calculated period and removed at the end of the treatment.

In intracavitary brachytherapy we can use the dose rate we want to administer for our target. However, ultra-low dose rate and low dose rate are in disuse, given the exposure time to carry out the treatment. Medium dose rate (or pulsed dose) and high dose rate are used on a regular basis.
Interstitial Brachytherapy

It uses ionizing radiation to treat malignant tumors, where the radioactive sources are placed using needles or other devices (called vectors).

In interstitial brachytherapy, we can use the dose rate to administer that we want for our target. However, ultra-low rate and low dose rate (LDR) are commonly used in permanent implants. Medium dose rate (or pulsed dose) and high dose rate (HDR), on the other hand, are used on a regular basis, in temporary treatments, or in organs, which are treated in combination therapy.
Prostate Brachytherapy

It is one of the curative treatments for prostate carcinoma. It can be used on its own (monotherapy) in selected cases of low-risk or intermediate-low-risk tumors, with the permanent implantation of radioactive iodine-125 seeds in the prostate - low-dose-rate (LDR) prostate brachytherapy. It can also be performed in combination (combination therapy) with external beam radiotherapy (EBRT) in high-risk tumors with temporary implantation of cobalt via vectors into the prostate - high-dose-rate (HDR) prostate brachytherapy.
Gynecological Brachytherapy

This treatment is used for tumors of the endometrium (uterus), cervix, of the vagina and tumours of the vulva. It is usually used adjunctly, after radical surgery or chemoradiotherapy treatments, with intensive concomitant intracavitary and temporary implantation with cobalt via vectors - this is called high-dose-rate (HDR) intracavitary brachytherapy - performed in cases of tumors of the endometrium, cervix or vagina. On the other hand, it can be used in an isolated (radical) way, in selected cases of early disease, with interstitial and temporary implantation with cobalt via vectors - the so-called high-dose-rate (HDR) interstitial brachytherapy - in cases of tumors of the vulva.

Intracavitary or interstitial low-dose-rate (LDR) brachytherapy, given the exposure time required to perform the treatment, currently has no indication in gynecological pathology.
Electronic Brachytherapy or Intraoperative Breast Radiotherapy

This is a recent and innovative technique, whereby, using an applicator (vector) developed for the technique, roentgenotherapy (x-rays) is applied to the tumor cell bed. This happens immediately after surgical removal, in the operating room, as the necessary adjuvant radiotherapy treatment, avoiding external radiotherapy (EBRT). It is only used in selected cases of low-risk tumors with established characteristics.

Surgical Oncology

Surgical Oncology is a subspeciality of several surgical specialities, in which various techniques are used to treat cancer. It is involved at all times: diagnosis, staging, treatment and follow-up. It can occur at various stages of treatment and have different objectives: prophylactic, curative or palliative.

Breast Oncological Surgery

At Joaquim Chaves Saúde, we perform breast cancer treatment surgeries and aesthetic reconstruction procedures. The collaboration of Plastic Surgery is instrumental to ensure the latest reconstructive techniques, including grafts from the patient’s own adipose tissue.
Urology Oncological Surgery

Most oncological surgeries in Urology use the latest 3D Laparoscopy technology to reduce the need for open surgeries and allow for less invasive interventions. These include surgeries performed endoscopically (inside the urinary tract), with state-of-the-art resources namely endoscopic instruments with advanced bipolar energy and thulium laser.
Skin Oncological Surgery

At Skin Cancer Center we follow a bespoke approach to each type of skin cancer, guaranteeing the required reconstructive techniques.

At Joaquim Chaves Saúde, we provide a 360º follow-up service, from diagnosis to surgery, for cases of breast, skin and urological cancer. Our patients have access to the latest treatments in a comfortable and safe setting.

See JCS Surgery

operating room of the Carcavelos Surgical Clinic

view from a balcony in a room at Clínica Cirúrgica de Carcavelos

view from a balcony into a room at Clínica Cirúrgica de Carcavelos

State-of-the-art radiology technology

Varian TrueBeam is a linear accelerator used in radiotherapy treatment. This system can be used to treat cancenr in any part of the body. Its precision eliminates radiotherapy side effects, bringing significant improvements in patients’ quality of life.

Faster treatment
Faster radiation doses, less treatment time.
Low Radiation
Minimizes the impact of radiation, increases patient safety and quality of care.

See Truebeam

Treatments

Cancer treatment

Medical Oncology

Chemotherapy

Hormone Therapy

Targeted Therapies

Immunotherapy

Radioncology

External Beam Radiation Therapy (EBRT)

Three Dimensional (3D) Conformal Radiation Therapy

Intensity Modulated Radiotherapy (IMRT)

Cranial Stereotactic Radiotherapy - SRS (Radiosurgery)

Cranial Stereotactic Radiotherapy - SRS fractionated (radiosurgery):

Modulated Volumetric Arc Therapy SBRT

Modulated Volumetric Arc Therapy SBRT fractionated

Image-guided radiotherapy (IGRT)

Modulated Volumetric Arc Therapy (VMAT)

Radiotherapy controlled by respiratory movements (Gating)

Deep inspiration breath hold (DIBH)

Low-Dose radiation therapy for benign pathologies

Brachytherapy (BT)

Intracavitary Brachytherapy

Interstitial Brachytherapy

Prostate Brachytherapy

Gynecological Brachytherapy

Electronic Brachytherapy or Intraoperative Breast Radiotherapy

Surgical Oncology

Breast Oncological Surgery

Urology Oncological Surgery

Skin Oncological Surgery

State-of-the-art radiology technology