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What is four-dimensional radiation therapy (4D radiotherapy)

Four-dimensional radiation therapy (4DRT), also called respiratory gating, is a radiation treatment used to target tumors that move with a patient’s breathing, such as lung, pancreatic, and other gastrointestinal cancers. It allows physicians to track the tumor’s motion so precise radiation can target the tumor and limit damage to surrounding tissue.

When respiratory gating is used, the physicians select the proper segment of the patient’s breathing cycle to deliver treatment. The patient’s breathing cycle is tracked during treatment using specialized cameras and the radiation beams are only turned on during the pre-determined portion of the breathing cycle when tumor motion is as minimal as possible.

Why it's done

4D radiotherapy delivers a targeted distribution of radiation to tumors, while sparing surrounding normal structures. This form of radiation therapy is used to treat tumors that are located too close to vital organs and structures for other types of radiation therapy.

Our approach

At Northwell Health Cancer Institute, 4D radiotherapy is one of many advanced radiation therapies used to destroy cancer cells and slow tumor growth while minimizing damage to healthy tissue. By utilizing 4D radiotherapy, the physicians at Northwell Health can deliver radiation in minimized treatment volumes while decreasing the dose to normal organs. Patients will benefit from a decrease in side effects and the possible improved effectiveness of the treatment.

4D radiotherapy treatment is provided in a caring and professional environment by staff who are dedicated to making each patient visit as informative and stress-free as possible. This begins with an in-depth conversation describing the treatment, including what to expect, possible side effects and goals. The personalized treatment also includes careful consideration of current health, family history, age and patient preferences.

All radiation therapies are administered using evidence-based medicine. A multidisciplinary team of doctors, including radiologists, surgeons, pathologists, medical oncologists and radiology oncologists, collaborates on treatment plans to ensure that every aspect of treatment is precisely coordinated for the best possible outcome. This includes ongoing peer review and chart rounds.

Because convenience is a priority, we offer multiple locations for radiation therapy to enable you to obtain treatment near where you live or work. 

Research at Northwell

Advances in radiation oncology are continuously happening at Northwell Cancer Institute. With innovations in radiation therapy technology and techniques, we continue to improve outcomes. Through our alliance with the leading research organization Cold Spring Harbor, we participate in investigator-initiated trials to offer the most leading-edge therapies to patients. 

Northwell Health Cancer Institute is recognized for its commitment to providing pioneering treatment for cancer patients. The ongoing focus on improving cancer treatments has contributed to significant advancements that are improving the quality of lives and increasing the number of cancer survivors.

Learn more about clinical trials and research happening at Northwell Health Cancer Institute.

What to expect

4D radiotherapy is performed on an X-ray table with each treatment taking approximately 30 minutes. Beams of radiation are precisely matched to the shape of the tumor. During treatment, a linear accelerator moves in a circular fashion to target the tumor.

Your treatment schedule for 4D radiotherapy is determined by your treatment team, based on your specific needs.

Possible side effects

With 4D radiotherapy, some patients have no side effects at all. However, when side effects do occur, they are typically related to the specific area that are being treated. Side effects of 4D radiotherapy include:

  • Eating and digestion problems
  • Diarrhea
  • Nausea and vomiting
  • Headaches
  • Soreness and swelling in the treatment area
  • Urinary and bladder changes
  • Mouth pain and difficulty swallowing

Most side effects usually go away after treatment ends. However, you may feel very tired for six to four weeks after your last treatment. Talk to your doctor about ways to treat potential side effects.

Support groups

Cancer is challenging, but you don’t have to go it alone. At Northwell Health Cancer Institute, a wide range of support groups are available to help you cope with diagnosis, treatment and post-treatment issues.

Learn more about support groups.


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