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Department Spotlight – Austin Center for Radiation Oncology (ACFRO)

Code Horseshoe: All About ACFRO

At the Austin Center for Radiation Oncology, there’s a thrill in the air every time two special words are spoken over the PA system. A “Code Horseshoe” announcement sends every staff member rushing into the halls to be part of something truly special: The graduation of a patient from cancer treatment.

When a Code Horseshoe is called, the happy patient receives not just a diploma commemorating cancer treatment success, but also a real aluminum horseshoe wishing them “happy trails” as they travel into the next phase of life. The patient also gets to ring a bell and receive a salute from every staff member celebrating along with them. 

The horseshoe tradition began years ago, when patients were given a horseshoe to hold to keep their hands occupied during radiation treatment. While COVID restrictions forced the end of items being shared among patients, the ceremony endured. 

“The horseshoe is very Texas; it’s very Austin,” says Dr. Richard Garza, radiation oncologist, who along with Dr. Niraj Pahlajani, radiation oncologist, sees 80 to 100 patients each day at the highly specialized ACFRO clinic.

Because 99% of ACFRO’s caseload are prostate cancer patients, this Urology Austin affiliate practice has been a home away from home for thousands of men seeking high-quality, targeted treatment for prostate cancer. 

“People from all over come into Austin to go to ACFRO,” says Dr. Garza. “We are the only center in Central Texas that focuses on prostate cancer all day long. When you do a lot of cases, you get really good at it. We go deeper into the consult than someone who does a little prostate cancer as well as some breast cancer, some lung cancer, some other cancers.”

ACFRO also has equipment that not many other area providers have, such as our Halcyon and a CT scanner that uses advanced technology called deviceless respiratory gating for better imaging of moving tumors. 

“With this respiratory gating technology, we are offering a new treatment approach using one to five treatments to kidney tumors in patients who are not surgical candidates, and this has been hugely successful among patients needing a knifeless approach,” says Dr. Pahlajani. “Ever since I started offering this approach, patients have been coming to see me in droves to see if they, too, are candidates for the procedure.”

The clinic is especially convenient for working men with prostate cancer, who can arrive for appointments as early as 6 a.m. on weekdays, avoid traffic, and still get to their jobs on time. 

While ACFRO is a high-volume practice, it’s anything but a “factory” where all patients are treated the same. 

“Being a high-volume center means we can invest in the best equipment, so we have multiple tools to use, and we can pick the one that’s best for each patient,” Dr. Garza explains. “We don’t have just one hammer that we use for everything. We have the ability to do an encompassing 45 doses, and localized concentrated 28 and super concentrated five treatments, so each patient gets treatment that is really tailored for them. Many other clinics only offer one type of treatment, like CyberKnife that is limited to five treatments. Here, there’s no pressure to stick with any one type of treatment. Rarely do we have a case we haven’t seen before or a situation we can’t handle.”

Both Dr. Pahlajani and Dr. Garza chose radiation oncology as a specialty because they were intrigued by the advanced technology available to help cancer patients live better lives. With ACFRO as their home base, both physicians feel they have the best of all worlds: The best equipment combined with the best support to give patients the best chance of success.  

“I love working here, because I feel very comfortable managing prostate cancer, and I feel very fortunate to work with Dr. Garza as my colleague and with such a fine team to support me,” says Dr. Pahlajani. “I am also excited to offer cutting-edge treatments to our patients with the wonderful technology that we can offer to our patients.”  

Both physicians say they love what they do and the outstanding team they get to work with at ACFRO.

“Because we specialize in prostate cancer all day long, we do have machines that are not located in other centers, but what’s really different is how our team uses those machines,” says Dr. Garza. “The expertise of the team really sets us apart. And, because we are integrated with Urology Austin, we can access all of a patient’s information quickly and provide seamless care.”

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