DECEMBER 2023 ONCOLOGY CARTOONS

1. DR KANHU CHARAN PATRO
M.D, D.N.B[RT], MBA, FICRO, FAROI, PDCR,
CEPC
www.facebook.com/oncologycartoons/photos_albums
www.slideshare.net/search/slideshow?searchfrom=header&q=oncology+cartoons
DECEMBER 2023 ISSUE/93rd VOLUME

5. Clinic-radiological protocol for the diagnosis and
management of RIBE
MANJUL TRIPATHY/NEUROLOGY INDIA/2019 17th NOV 2023/BRAIN

6. Diagnostic and therapeutic algorithm for brain radio necrosis
Central Nervous System Tumors
Book
18th NOV 2023/BRAIN

7. BillY W LOO/Circ Arrhythm Electrophysiol / 2015
THE FIRST CASE REPORT IN CARDIAC ARRYTHMIA SBRT-
Prof Loo.
19th NOV 2023/STEREOTAXY

8. ONGOING CLINICAL TRIALS ON CARDIAC
ARRYTHMIA SBRT
20th NOV 2023/STEREOTAXY
Melanie Grehn/European Society of
cardiology/2022

9. ONGOING CLINICAL TRIALS ON CARDIAC
ARRYTHMIA SBRT
Melanie Grehn/European Society of
cardiology/2022
21st NOV 2023/STEREOTAXY

10. AHA CARDIAC SEGMENTS IN CARDIAC ARRYTHMIA SBRT
Jeremy/ IJROBP/2021 22nd NOV 2023/STEREOTAXY

11. IMAGING IN CARDIAC ARRYTHMIA SBRT
Jeremy/ IJROBP/2021 23rd NOV 2023/STEREOTAXY

12. SIMULATION TO EXECUTION STEPS IN CARDIAC
ARRYTHMIA SBRT
C. Carbucicchio/JICE/2020 24th NOV 2023/STEREOTAXY

13. SUZANNE LYDIARD/IJROBP/2020
SIMULATION TO EXECUTION STEPS IN CARDIAC
ARRYTHMIA SBRT
25th NOV 2023/STEREOTAXY

14. SUZANNE LYDIARD/IJROBP/2020
SIMULATION TO EXECUTION STEPS IN CARDIAC
ARRYTHMIA SBRT
26th NOV 2023/STEREOTAXY

15. Chen Wei/Electrophysiology and
Ablation/2019
Workflow Schematic for Cardiac Stereotactic Body Radio
ablation
27th NOV 2023/STEREOTAXY

16. Chen Wei/Electrophysiology and
Ablation/2019
PATHOPHYSIOLOGY OF CARDIAC
ARRYTHMIAS
28th NOV 2023/STEREOTAXY
• VT originates from myocardial scar tissue
which is termed as “substrate”. When scar
tissue is interspersed with some normal
myocardial fibres, it is called a border
zone.
• Slow and circuitous electrical conduction
through the border zone, results in a re-
entrant circuit causing a VT.

17. GOOGL
E
CARDIAC SBRT- THE LEARNING CURVE AND PAPERS TO READ
29th NOV 2023/STEREOTAXY

18. DR KANHU CHARAN
PATRO
CARDIAC SBRT A SOLUTION TO ARRHYTHMIA
30th NOV 2023/STEREOTAXY

19. DR KANHU CHARAN
PATRO
TMT AND CYSTECTOMY COMPARISON IN CA URINARY
BLADDER
1st DEC 2023/BLADDER

20. GOOGL
E
SIMPLE WAY OF UNDERSTANDING FOREST
PLOT
2nd DEC 2023/STATISTICS
SEARCH FOR BLACK DIAMOND

21. GOOGL
E
Percentage depth dose
3rd DEC 2023/Physics
Ratio of dose at particular depth
Dose at dmax in central (axis)path
Some factors determine the dose at depth.
It depends upon field size, SSD, energy, and depth.
It follows inverse square law.
Dose decreases at traverses by law.
Depth dose increases as field size increase.
Scattering influences the depth dose increase.
As energy increases penetration increases
As a rule, the depth dose increases.
As inverse square law effects
PDD increases with SDD increases.
When somebody asks PDD of particular energy
Please describe the dose at 10cm of that energy
The PDD of cobalt is sixty percent.
And that of 6 mv is sixty-seven percent.

22. Dr Kanhu Charan Patro
The 7 Rs of Radiobiology
4th DEC 2023/PHYSICS
Radiobiology of seven R due to radiation
Reoxygenation. Repopulation, Redistribution
Repair, Radiosensitivity and Radio immunomodulation
Reinforcement is newly added in this session.
I will talk about cell cycle redistribution.
G2/M-phase are most sensitive to radiation.
Late S is more resistant to radiation.
G2M cells get killed with bout of radiation.
Late S phase cells get G2M conversion.
repetition of this called redistribution.
With a fraction of radiation cells get damage
Either sub lethal or lethal damage
Sublethal damage get repair.
Tumor and normal cells both get repair.
Many mechanisms are there for repair.
Single strand and double strand repair.
Radiation killing needs oxygen.
Euoxic cells get killed by radiation.
After hypoxic cells get oxygen
This repetition is called reoxygenation.
Regrowth of tumor cells in between fraction
It is the effect from surviving clonogen
This phenomenon is known as Repopulation.
Intrinsic radiosensitivity means sensitivity differentiation.
Some get more reaction, and some get less reaction.
With similar dose of radiation and having no explanation.
Radiation also causes immunomodulation.
Either immunosuppression or activation
This happens as antitumor reactivation.
Known as Radio immunomodulation.
“Microscopic ecosystem by cancer cells
Complex crosstalk between cancer and non-cancer cell
Progression, survival, resistant to treatment
Cytokines in the environment are the determinant.
This is known as Reenforcement
This is due to tumor microenvironment [TME].
It means radiation causes changes in cellular biology.
Together they are known as the seven R of radiobiology.
Rodney, Boustani, Farzad and Steel,
Give credit to these with your inner feel.

23. Dr Kanhu Charan Patro
Oxygen Enhancement Ratio
5th DEC 2023/PHYSICS
Radiation to act in cancer sector.
Oxygen presence is the key factor.
Ratio of dose in hypoxic condition
to the dose in euoxic condition
Oxygen presence, type of radiation
Phase of cell cycle are the determination.
Sensitive cells have low OER.
Radioresistant cells have high OER.
S phase having high OER
G2M phase has a low OER.
High OER for low LET radiation.
Low LET for high LET radiation.
Usually, the OER value is one to four.
High in whose LET is lower.
LET of Gamma, beta and X ray are low.
They need more oxygen flow.
OER is high as per law

24. Dr Kanhu Charan Patro
RBE - Relative Biologic Effectiveness
6th DEC 2023/PHYSICS
RBE is known is Relative Biologic Effectiveness
Comparison of two radiations for isoeffect.
It is the ratio of doses of two radiation.
250 Kvp X ray to test radiation.
Filla and Henshaw described this crucial.
It is mostly described in cell survival.
High LET more RBE.
Low LET low RBE.
As LET increases RBE increases.
After some distance RBE decreases
It happens due to over kill effect.
Too much radiation decreases the effect.
For X rays it is one
Mostly five for neutron
Depends upon quality, dose, and fractionation.
Also depends upon dose rate and biological condition

25. Dr Kanhu Charan Patro
LET- linear energy transfer
7th DEC 2023/PHYSICS
It is the action of ionizing radiation on matter.
Energy transfer during traverse in path of matter
LET depends upon radiation nature and matter.
Expressed in kiloelectronvolt per micrometer.
High-LET radiation deposits a large amount of energy in a small distance.
Low -LET radiation deposits a small amount of energy in a long distance.
High LET will slow down the radiation more quickly.
Making shielding more effective generally
High LET radiation hardly allows to repair.
Low LET radiation makes it easy to repair.
Low LET radiation is beta and gamma.
High LET radiation is neutron and alpha.
LET and charge are directly proportional.
LET and energy are inversely proportional.
Low LET radiation causes two hits in different cell.
High LET radiation causes two hits in single cell.

26. GOOGL
E
Constipation in Oncology
8th DEC 2023/BSC
Cancer itself is a problem.
Constipation is an associated problem.
Immobility, decrease intake and Loss of appetite.
Many common drugs also lead to constipate.
Ondansetron and opioids are the common offenders.
You must give laxatives as defenders.
If patient complains of pain abdomen
Do PR to exclude fecal impaction.
If there is a fecal impaction
Not responding to medication
Manual removal is the only option.
Adequate fluid intake is the prevention.
Use regular laxatives if there is no option.
Mild laxatives may be needed.
Strong laxatives if opioids are added.
If a person gets the proper motion
That is the best relaxation

27. DR K C
Patro
Radiation therapy in oncology practice
9th DEC 2023/PHYSICS
We all are exposed to radiation.
Mostly electromagnetic radiation.
There are two types of radiation.
Ionizing and non-ionizing radiation
Nonionizing is not harmful and is cool.
Ionizing radiation damage to cell pool
Radio waves, sunlight etc. are nonionizing radiation.
Gamma rays, X rays, alpha rays etc. are ionizing radiation.
There are two types of Ionizing radiations.
Electromagnetic and particulate radiation.
Particulate radiation is having a mass.
Proton, electrons, and many more in that class
Ionizing radiation causes ion pairs.
Those damage DNA helix pairs
That mechanism is used in radiotherapy.
And it is a most important tool in cancer therapy.

28. Sciencenotes.or
g
Penetrating power of various radiation
10th DEC 2023/PHYSICS

29. Sciencenotes.or
g
Mechanism of radiation damage
11th DEC 2023/PHYSICS
Ionizing radiation causes cell damage.
By interacting with DNA image
Either by direct method
Also, by indirect method
In direct method electron causes double strand damage
In indirect method by single strand breakage
In indirect method water disrupts by electron
Then there is free radical formation
Free radicals having short half-life.
Destroys within 3mm of DNA life.
Free radical causes DNA bond breakage
Also, it brings some chemical change.
Direct method damage by mainly high LET radiation
Indirect method damage by mainly low LET radiation.
Radiation kills only dividing cells.
Also act on few resting cells

30. Hoon Sik
Choi/apjco/2020
SBRT FOR PORTAL VEIN TUMOR THROMBOSIS
12th DEC 2023/STEREOTAXY
HCC may be associated with portal vein thrombosis
Either bland or tumor thrombosis
Portal vein thrombosis causes portal hypertension
Esophageal varices and rectal bleed are the complication
Bland thrombus dose not enhance
In triple phase It looks hypodense
Tumor thrombus usually enhance
In Diagnosis PETCT is the most importance
Evaluate with Japanese classification
According to pre or post bifurcation
Bland thrombus needs stent canalization
Tumor thrombus needs radiation
Portal vein tumor thrombosis is a poor prognosis
Limited options and the situation is crisis
TACE and transplant are contraindicated
Then in this situation SBRT is indicated
SBRT or conventional fractionation
You can plan according to your situation
SBRT in PVTT improves survival
Post SBRT, TACE and transplant adds survival
You can plan SBRT for symptom improvement
You can treat with HCC as radical treatment
For SBRT you must control the breathing motion
Complications are rare due to stereotactic radiation
BED OF seventy-five Gray is desired
Usually, 40-45 Gy in five fraction is delivered
You can plan dose escalation
Please start some form of anticoagulation
Ascites with radiation difficult to manage
You can plan with pig tail drainage
Sequencing of the treatment needs board decision
You may have to Wait six weeks for canalization
•

31. CHING TSO
CHEN/IJMS/2021
PORTAL VEIN TUMOR THROMBOSIS CLASSIFICATION
13th DEC 2023/STEREOTAXY
•
The Japanese VP Staging Classification System and the Eastern Hepatobiliary Classification (also known as
Cheng’s Classification) can stratify HCC with PVTT. Classification of macrovascular invasion of hepatocellular
carcinoma, including portal vein thrombosis and/or tumor invasion. Vp1: the third order branch or portal vein;
Vp2: the second order branch of portal vein; Vp3: the first order branch of portal vein; Vp4: the main trunk of
portal vein. Created with BioRender.com.

32. A
ARORA/EPS/201
9
The indications and contraindications of TACE
14th DEC 2023/HCC

33. Google
Vaccine for hepatitis B induced liver cancer
15th DEC 2023/PUBLIC
The hepatitis B vaccine was named the first “anti-cancer” vaccine by the U.S. Food and Drug
Administration because it prevents chronic hepatitis B infections, thereby preventing liver
cancer caused by the hepatitis B virus.
Did You Know – according to the CDC, 25% of
chronic #HBV infections develop into liver
cancer
Currently, the hepatitis B vaccine price ranges
between ₹45 (from the Serum Institute) and
₹250 per paediatric dose of 10 micrograms in
0.5ml. The hepatitis B vaccine dose for adults,
of 20 micrograms, is nearly double that.