Radiotherapy in paediatrics - late effects and second malignanciesAshutosh Mukherji
1. Childhood cancer survivors face risks of late sequelae from radiation therapy including growth impairment, cognitive deficits, infertility and cardiac issues.
2. The risks are dependent on factors like radiation dose, age at treatment, and volumes of normal tissues irradiated.
3. Second malignancies are a major concern after radiation therapy, with bone tumors, soft tissue sarcomas and breast cancer being common second cancers seen in survivors.
Reirradiation can provide local tumor control for recurrent head and neck cancer when surgery is not possible. Modern radiation techniques like IMRT allow higher radiation doses to be safely delivered to the tumor while minimizing risks of severe toxicity. Outcomes from reirradiation include a median survival of 10-12 months and 2-year local control rates of 40-64%. Patient selection is important to balance potential benefits of local tumor control against risks of treatment-related side effects.
1. Re-irradiation involves delivering a second course of radiation to patients who develop recurrent or new primary tumors in an area previously treated with radiation. It requires careful patient selection and consideration of normal tissue tolerance to minimize toxicity risks.
2. A multidisciplinary evaluation is necessary to determine if re-irradiation provides a survival or palliative benefit over other treatment options like chemotherapy or surgery. Factors like tumor type, initial treatment details, disease control, and patient performance status must be considered.
3. Advanced radiation techniques like IMRT can help spare nearby organs-at-risk and lower toxicity when used for re-irradiation. Close monitoring during treatment is still needed to watch for normal tissue complications.
Radiation therapy can be used to cure or palliate lung cancer depending on the cancer type and stage. For non-small cell lung cancer, conventional radiation therapy is used with surgery and chemotherapy for locally advanced stages, while stereotactic body radiation therapy is used for early stage cancers. For small cell lung cancer, conventional radiation therapy is used for limited stage disease. Palliative radiation therapy provides symptom relief for metastatic lung cancers.
Radiation therapy uses X-rays from a linear accelerator to precisely target tumors while sparing healthy tissue. Multiple low doses are given over several weeks to damage cancer cells' DNA. Daily X-rays and weekly CT scans ensure accurate positioning. Common side effects include skin reddening and swallowing pain, but risks of long-term effects are low. The goal is cure, though some treatments provide symptom relief.
Chemotherapy of head & neck region /certified fixed orthodontic courses by In...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
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0091-9248678078
This document discusses reirradiation in recurrent head and neck cancer. It notes that radiation therapy plays a central role in head and neck cancer treatment but recurrence still occurs in 20-35% of patients. Reirradiation presents challenges due to prior radiation exposure and damage to normal tissues. The document discusses treatment options, appropriate patient selection, techniques like IMRT to minimize dose to organs at risk, optimal timing and dosing of reirradiation, and management of toxicities.
Along with chemotherapy and surgery, radiation therapy is one of the main treatments for many cancers. Here are some things you should know about this therapy, how it works, and its side effects.
Radiotherapy in paediatrics - late effects and second malignanciesAshutosh Mukherji
1. Childhood cancer survivors face risks of late sequelae from radiation therapy including growth impairment, cognitive deficits, infertility and cardiac issues.
2. The risks are dependent on factors like radiation dose, age at treatment, and volumes of normal tissues irradiated.
3. Second malignancies are a major concern after radiation therapy, with bone tumors, soft tissue sarcomas and breast cancer being common second cancers seen in survivors.
Reirradiation can provide local tumor control for recurrent head and neck cancer when surgery is not possible. Modern radiation techniques like IMRT allow higher radiation doses to be safely delivered to the tumor while minimizing risks of severe toxicity. Outcomes from reirradiation include a median survival of 10-12 months and 2-year local control rates of 40-64%. Patient selection is important to balance potential benefits of local tumor control against risks of treatment-related side effects.
1. Re-irradiation involves delivering a second course of radiation to patients who develop recurrent or new primary tumors in an area previously treated with radiation. It requires careful patient selection and consideration of normal tissue tolerance to minimize toxicity risks.
2. A multidisciplinary evaluation is necessary to determine if re-irradiation provides a survival or palliative benefit over other treatment options like chemotherapy or surgery. Factors like tumor type, initial treatment details, disease control, and patient performance status must be considered.
3. Advanced radiation techniques like IMRT can help spare nearby organs-at-risk and lower toxicity when used for re-irradiation. Close monitoring during treatment is still needed to watch for normal tissue complications.
Radiation therapy can be used to cure or palliate lung cancer depending on the cancer type and stage. For non-small cell lung cancer, conventional radiation therapy is used with surgery and chemotherapy for locally advanced stages, while stereotactic body radiation therapy is used for early stage cancers. For small cell lung cancer, conventional radiation therapy is used for limited stage disease. Palliative radiation therapy provides symptom relief for metastatic lung cancers.
Radiation therapy uses X-rays from a linear accelerator to precisely target tumors while sparing healthy tissue. Multiple low doses are given over several weeks to damage cancer cells' DNA. Daily X-rays and weekly CT scans ensure accurate positioning. Common side effects include skin reddening and swallowing pain, but risks of long-term effects are low. The goal is cure, though some treatments provide symptom relief.
Chemotherapy of head & neck region /certified fixed orthodontic courses by In...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
This document discusses reirradiation in recurrent head and neck cancer. It notes that radiation therapy plays a central role in head and neck cancer treatment but recurrence still occurs in 20-35% of patients. Reirradiation presents challenges due to prior radiation exposure and damage to normal tissues. The document discusses treatment options, appropriate patient selection, techniques like IMRT to minimize dose to organs at risk, optimal timing and dosing of reirradiation, and management of toxicities.
Along with chemotherapy and surgery, radiation therapy is one of the main treatments for many cancers. Here are some things you should know about this therapy, how it works, and its side effects.
Learn about the process of radiation therapy to treat soft tissue sarcoma, and how new radiation technology has improved treatment of the disease.
This presentation was given by Elizabeth H. Baldini, MD, MPH, radiation oncology director for the Center for Sarcoma and Bone Oncology at Dana-Farber Cancer Institute. It was originally presented as part of the "15 Years of GIST/Soft Tissue Sarcoma Symposium," held on Sept. 12, 2015 at Dana-Farber in Boston, Mass.
Chemotherapy of head & neck cancer /certified fixed orthodontic courses by In...Indian dental academy
This document discusses chemotherapy for head and neck cancer. It begins by introducing the prevalence and challenges of head and neck cancers. It then outlines various classes of chemotherapeutic agents - alkylating agents, antimetabolites, antitumor antibiotics, alkaloids, and taxanes - and examples of drugs in each class. It discusses the use of chemotherapy in neoadjuvant, concomitant, and adjuvant settings. It also covers targeted agents like EGFR inhibitors and strategies like chemoprevention. Overall, the document provides an overview of chemotherapy options and strategies for head and neck cancers.
This document discusses forward intensity-modulated radiation therapy (IMRT) using the field-in-field (FIF) technique for whole breast irradiation. It begins by introducing the goals of treatment planning to deliver a uniform dose to the target volume while minimizing dose to normal tissues. It then describes how the FIF technique uses multiple subfields in addition to the main tangential fields to improve dose homogeneity. Several studies have shown that improved homogeneity decreases skin toxicities. The document evaluates different methods for generating subfields and finds the alternate subfields method provides the best dose distribution. In summary, the FIF forward planning technique improves dose uniformity in the breast compared to conventional techniques.
- Reirradiation or retreatments after initial radiotherapy is possible for 10% of cancer patients who experience a second cancer. However, if the radiation tolerance of a normal organ or tissue was exceeded in the initial treatment, reirradiation cannot be done safely.
- Early-responding tissues like skin generally recover better than late-responding tissues like fibrosis and can tolerate reirradiation with reduced doses. Spinal cord and lung data from rodent and monkey studies show some reirradiation is possible. Kidney and bladder do not recover from late damage.
- Clinical studies on reirradiation are limited but show it can provide local control and possibly survival for head and neck cancers, though with high risks of toxicity and functional
Hypofractionated radiotherapy regimens are being re-explored for their potential logistical benefits compared to conventionally fractionated radiotherapy. Several studies have evaluated hypofractionation for prostate cancer, finding comparable rates of tumor control and acceptable toxicity profiles. The CHHiP trial directly compared 57Gy in 19 fractions to 74Gy in 37 fractions for prostate cancer, finding no significant differences in patient-reported bowel symptoms up to 2 years post-treatment.
There have been significant advances in the treatment of cervical cancer. The use of Pap smears has allowed for earlier diagnosis and a decrease in late-stage cancers. Recent studies have found improved survival rates in women with locally advanced cervical cancer who received pelvic radiation concurrently with chemotherapy compared to radiation alone. Five-year overall survival was 73% for those who received both radiation and chemotherapy versus 58% for radiation alone. The study provides evidence to recommend radiation with cisplatin and fluorouracil for women with locally advanced cervical cancer confined to the pelvis. Further research is still needed.
Altered fractionation schedules in radiation oncologyAbhishek Soni
Altered fractionation schedules aim to optimize tumor control and normal tissue sparing by manipulating total dose, dose per fraction, time interval between fractions, dose rate, and overall treatment time based on tumor and tissue radiosensitivity and repair characteristics. Hyperfractionation uses a higher total dose with smaller, more frequent fractions to exploit tumor reoxygenation and cell cycle effects while hypofractionation uses fewer, larger fractions which is more effective for tumors with low α/β ratios. Accelerated fractionation decreases treatment time to limit tumor repopulation at the cost of increased acute toxicity. Phase III trials show hyperfractionation and accelerated fractionation improve local control for head and neck cancers with acceptable toxicity.
Discuss the principles guiding the use of radiotherapy in surgeryAbdullahi Sanusi
The document discusses the principles guiding the use of radiotherapy in surgery. It covers topics such as the physical and biological basis of radiotherapy, indications and contraindications, treatment planning, technical aspects, and complications. Radiotherapy is an important clinical discipline for treating cancer and some benign diseases. About 60% of cancer patients require radiotherapy during their treatment course. The principles of radiotherapy are based on understanding the physical and biological effects of ionizing radiation on tumors and normal tissues. [END SUMMARY]
1. The document discusses locally advanced breast cancer and the role of radiotherapy. It outlines the anatomy, target volumes, organs at risk and response assessment using tools like MRI.
2. Postmastectomy radiotherapy can reduce the risk of local recurrence by 72% and increase survival rates. The risk of local recurrence is higher with larger tumor size and more positive lymph nodes.
3. The use of neoadjuvant chemotherapy and radiotherapy after mastectomy further reduces the risk of local-regional recurrence compared to no radiotherapy, especially in patients with more advanced clinical stage.
This document summarizes trials on adjuvant chemotherapy in breast cancer. It discusses the evolution from CMF chemotherapy in the 1970s to newer anthracycline and taxane-based regimens showing improved disease-free and overall survival rates. Key trials established doxorubicin-containing regimens as superior to CMF and showed benefits of adding paclitaxel or docetaxel to anthracycline-based chemotherapy. Dose-dense regimens were found to improve outcomes compared to standard schedules with manageable toxicity.
This document discusses the options and challenges for reirradiating recurrent brain tumors. It may be considered for gliomas or brain metastases if the prior radiation tolerance doses of critical structures like the optic pathways, brainstem and whole brain have not been exceeded. Differentiating tumor recurrence from treatment effects like necrosis or pseudoprogression is important prior to reirradiation. Short interval since prior radiation and large tumor volume predict poor outcomes. With smaller recurrences in favorable locations, reirradiation using techniques like stereotactic radiosurgery may be offered if the radiation interval is over 6 months. A multidisciplinary discussion weighing risks and benefits is needed for each case.
There are many types of cancer treatment that depend on the type and stage of cancer, including surgery, radiation therapy, chemotherapy, immunotherapy, targeted therapy, hormone therapy, stem cell transplants, and precision medicine. Surgery attempts to remove the entire tumor mass and sometimes lymph nodes, while radiation therapy uses radiation to damage cancer cell DNA. Chemotherapy uses cytotoxic drugs to kill rapidly dividing cells, and can be used with other treatments. Targeted therapy and immunotherapy target specific molecular differences in cancer cells. Hormone therapy slows the growth of cancers that use hormones, and stem cell transplants restore blood-forming stem cells after other treatments destroy them. Precision medicine selects individualized treatments based on the genetics of a patient's cancer.
Altered Fractionation Radiotherapy in Head-Neck CancerJyotirup Goswami
Altered fractionation radiotherapy has been shown to improve outcomes for head and neck cancer patients compared to conventional fractionation. Meta-analyses demonstrate significant benefits including improved 5-year locoregional control and overall survival. However, most modern trials do not address fractionation. Hypofractionation shows promise with comparable tumor control and toxicity but reduced treatment time. Ongoing research combines altered fractionation with chemotherapy and radiosensitizers to further improve outcomes while minimizing toxicity.
This document provides an overview of the fourth edition of the textbook "Practical Radiotherapy Planning". The textbook is written by four authors who are professors and consultants in clinical oncology in the UK. It aims to provide guidance on radiotherapy treatment planning based on sound pathological and anatomical principles. The textbook covers topics such as radiobiology, organs at risk, brachytherapy, emergency radiotherapy, and treatment planning for many cancer sites. It emphasizes the underlying principles of treatment planning that can be applied to conventional, conformal and novel radiotherapy techniques. The textbook includes many clinical images to illustrate key planning concepts.
There are many types of cancer treatment. The types of treatment that patient receive will depend on the type of cancer, stage of cancer and how advanced it is.
Some people with cancer will have only one treatment. But most people have a combination of treatments, such as surgery with chemotherapy and/or radiation therapy.
This document discusses the approach towards re-irradiation of common cancers. It begins by noting that local recurrence after radiation therapy and second primary tumors in irradiated areas are challenges, though re-irradiation can provide durable disease control in some cases. It then discusses key considerations for re-irradiation of head and neck cancers, gliomas, gynecological cancers, bone metastases, and brain metastases. Important factors include the initial radiation dose, interval since prior radiation, intent of re-irradiation, cumulative organ doses, and risk versus benefit. Advanced radiation techniques like IMRT can help minimize toxicity risks from re-irradiation. Careful patient selection and multidisciplinary evaluation are emphasized for meaningful survival benefits from re-
Hypofractionation in early breast cancer is no more a research scholars topic. Multiple studies with robust data have proven its utility. It may hold an important role in many countries with constrained resources. This is a short presentation incorporating important completed and ongoing trials. Feel free to use this.
The document discusses the principles of radiation oncology for head and neck cancer treatment. It covers external beam irradiation techniques, brachytherapy, radiobiology concepts like the four R's, and fractionation schedules. Complications of treatment include both acute reactions and late tissue effects like xerostomia, fibrosis, and central nervous system damage. A basic understanding of radiation physics, radiobiology, and treatment approaches is important for counseling patients.
- Young age is a risk factor for local recurrence after breast-conserving therapy, and adding a boost dose reduces the 5-year local recurrence rate from 26% to 8.5% for patients aged 35 or younger, compared to from 3.9% to 2.1% for patients older than 60.
- Post-mastectomy radiotherapy reduces locoregional recurrences by 70% and prevents one breast cancer death within 15 years for every four recurrences prevented at 5 years. PMRT is generally recommended for stage pT3/pN2a or higher.
- While radiotherapy decreases in-field recurrences, significant excess non-breast cancer mortality from heart disease and lung cancer was
1) Esophageal cancer (EC) is the 8th most common cancer worldwide and the 6th leading cause of cancer death, with about 450,000 new cases diagnosed yearly.
2) For patients with unresectable locally advanced or metastatic EC, concurrent chemoradiotherapy provides the best outcomes for controlling symptoms and prolonging survival.
3) Treatment for EC is best managed by a multidisciplinary team to determine the optimal treatment approach, as expert teams were found to achieve better overall survival rates compared to local non-expert teams.
Learn about the process of radiation therapy to treat soft tissue sarcoma, and how new radiation technology has improved treatment of the disease.
This presentation was given by Elizabeth H. Baldini, MD, MPH, radiation oncology director for the Center for Sarcoma and Bone Oncology at Dana-Farber Cancer Institute. It was originally presented as part of the "15 Years of GIST/Soft Tissue Sarcoma Symposium," held on Sept. 12, 2015 at Dana-Farber in Boston, Mass.
Chemotherapy of head & neck cancer /certified fixed orthodontic courses by In...Indian dental academy
This document discusses chemotherapy for head and neck cancer. It begins by introducing the prevalence and challenges of head and neck cancers. It then outlines various classes of chemotherapeutic agents - alkylating agents, antimetabolites, antitumor antibiotics, alkaloids, and taxanes - and examples of drugs in each class. It discusses the use of chemotherapy in neoadjuvant, concomitant, and adjuvant settings. It also covers targeted agents like EGFR inhibitors and strategies like chemoprevention. Overall, the document provides an overview of chemotherapy options and strategies for head and neck cancers.
This document discusses forward intensity-modulated radiation therapy (IMRT) using the field-in-field (FIF) technique for whole breast irradiation. It begins by introducing the goals of treatment planning to deliver a uniform dose to the target volume while minimizing dose to normal tissues. It then describes how the FIF technique uses multiple subfields in addition to the main tangential fields to improve dose homogeneity. Several studies have shown that improved homogeneity decreases skin toxicities. The document evaluates different methods for generating subfields and finds the alternate subfields method provides the best dose distribution. In summary, the FIF forward planning technique improves dose uniformity in the breast compared to conventional techniques.
- Reirradiation or retreatments after initial radiotherapy is possible for 10% of cancer patients who experience a second cancer. However, if the radiation tolerance of a normal organ or tissue was exceeded in the initial treatment, reirradiation cannot be done safely.
- Early-responding tissues like skin generally recover better than late-responding tissues like fibrosis and can tolerate reirradiation with reduced doses. Spinal cord and lung data from rodent and monkey studies show some reirradiation is possible. Kidney and bladder do not recover from late damage.
- Clinical studies on reirradiation are limited but show it can provide local control and possibly survival for head and neck cancers, though with high risks of toxicity and functional
Hypofractionated radiotherapy regimens are being re-explored for their potential logistical benefits compared to conventionally fractionated radiotherapy. Several studies have evaluated hypofractionation for prostate cancer, finding comparable rates of tumor control and acceptable toxicity profiles. The CHHiP trial directly compared 57Gy in 19 fractions to 74Gy in 37 fractions for prostate cancer, finding no significant differences in patient-reported bowel symptoms up to 2 years post-treatment.
There have been significant advances in the treatment of cervical cancer. The use of Pap smears has allowed for earlier diagnosis and a decrease in late-stage cancers. Recent studies have found improved survival rates in women with locally advanced cervical cancer who received pelvic radiation concurrently with chemotherapy compared to radiation alone. Five-year overall survival was 73% for those who received both radiation and chemotherapy versus 58% for radiation alone. The study provides evidence to recommend radiation with cisplatin and fluorouracil for women with locally advanced cervical cancer confined to the pelvis. Further research is still needed.
Altered fractionation schedules in radiation oncologyAbhishek Soni
Altered fractionation schedules aim to optimize tumor control and normal tissue sparing by manipulating total dose, dose per fraction, time interval between fractions, dose rate, and overall treatment time based on tumor and tissue radiosensitivity and repair characteristics. Hyperfractionation uses a higher total dose with smaller, more frequent fractions to exploit tumor reoxygenation and cell cycle effects while hypofractionation uses fewer, larger fractions which is more effective for tumors with low α/β ratios. Accelerated fractionation decreases treatment time to limit tumor repopulation at the cost of increased acute toxicity. Phase III trials show hyperfractionation and accelerated fractionation improve local control for head and neck cancers with acceptable toxicity.
Discuss the principles guiding the use of radiotherapy in surgeryAbdullahi Sanusi
The document discusses the principles guiding the use of radiotherapy in surgery. It covers topics such as the physical and biological basis of radiotherapy, indications and contraindications, treatment planning, technical aspects, and complications. Radiotherapy is an important clinical discipline for treating cancer and some benign diseases. About 60% of cancer patients require radiotherapy during their treatment course. The principles of radiotherapy are based on understanding the physical and biological effects of ionizing radiation on tumors and normal tissues. [END SUMMARY]
1. The document discusses locally advanced breast cancer and the role of radiotherapy. It outlines the anatomy, target volumes, organs at risk and response assessment using tools like MRI.
2. Postmastectomy radiotherapy can reduce the risk of local recurrence by 72% and increase survival rates. The risk of local recurrence is higher with larger tumor size and more positive lymph nodes.
3. The use of neoadjuvant chemotherapy and radiotherapy after mastectomy further reduces the risk of local-regional recurrence compared to no radiotherapy, especially in patients with more advanced clinical stage.
This document summarizes trials on adjuvant chemotherapy in breast cancer. It discusses the evolution from CMF chemotherapy in the 1970s to newer anthracycline and taxane-based regimens showing improved disease-free and overall survival rates. Key trials established doxorubicin-containing regimens as superior to CMF and showed benefits of adding paclitaxel or docetaxel to anthracycline-based chemotherapy. Dose-dense regimens were found to improve outcomes compared to standard schedules with manageable toxicity.
This document discusses the options and challenges for reirradiating recurrent brain tumors. It may be considered for gliomas or brain metastases if the prior radiation tolerance doses of critical structures like the optic pathways, brainstem and whole brain have not been exceeded. Differentiating tumor recurrence from treatment effects like necrosis or pseudoprogression is important prior to reirradiation. Short interval since prior radiation and large tumor volume predict poor outcomes. With smaller recurrences in favorable locations, reirradiation using techniques like stereotactic radiosurgery may be offered if the radiation interval is over 6 months. A multidisciplinary discussion weighing risks and benefits is needed for each case.
There are many types of cancer treatment that depend on the type and stage of cancer, including surgery, radiation therapy, chemotherapy, immunotherapy, targeted therapy, hormone therapy, stem cell transplants, and precision medicine. Surgery attempts to remove the entire tumor mass and sometimes lymph nodes, while radiation therapy uses radiation to damage cancer cell DNA. Chemotherapy uses cytotoxic drugs to kill rapidly dividing cells, and can be used with other treatments. Targeted therapy and immunotherapy target specific molecular differences in cancer cells. Hormone therapy slows the growth of cancers that use hormones, and stem cell transplants restore blood-forming stem cells after other treatments destroy them. Precision medicine selects individualized treatments based on the genetics of a patient's cancer.
Altered Fractionation Radiotherapy in Head-Neck CancerJyotirup Goswami
Altered fractionation radiotherapy has been shown to improve outcomes for head and neck cancer patients compared to conventional fractionation. Meta-analyses demonstrate significant benefits including improved 5-year locoregional control and overall survival. However, most modern trials do not address fractionation. Hypofractionation shows promise with comparable tumor control and toxicity but reduced treatment time. Ongoing research combines altered fractionation with chemotherapy and radiosensitizers to further improve outcomes while minimizing toxicity.
This document provides an overview of the fourth edition of the textbook "Practical Radiotherapy Planning". The textbook is written by four authors who are professors and consultants in clinical oncology in the UK. It aims to provide guidance on radiotherapy treatment planning based on sound pathological and anatomical principles. The textbook covers topics such as radiobiology, organs at risk, brachytherapy, emergency radiotherapy, and treatment planning for many cancer sites. It emphasizes the underlying principles of treatment planning that can be applied to conventional, conformal and novel radiotherapy techniques. The textbook includes many clinical images to illustrate key planning concepts.
There are many types of cancer treatment. The types of treatment that patient receive will depend on the type of cancer, stage of cancer and how advanced it is.
Some people with cancer will have only one treatment. But most people have a combination of treatments, such as surgery with chemotherapy and/or radiation therapy.
This document discusses the approach towards re-irradiation of common cancers. It begins by noting that local recurrence after radiation therapy and second primary tumors in irradiated areas are challenges, though re-irradiation can provide durable disease control in some cases. It then discusses key considerations for re-irradiation of head and neck cancers, gliomas, gynecological cancers, bone metastases, and brain metastases. Important factors include the initial radiation dose, interval since prior radiation, intent of re-irradiation, cumulative organ doses, and risk versus benefit. Advanced radiation techniques like IMRT can help minimize toxicity risks from re-irradiation. Careful patient selection and multidisciplinary evaluation are emphasized for meaningful survival benefits from re-
Hypofractionation in early breast cancer is no more a research scholars topic. Multiple studies with robust data have proven its utility. It may hold an important role in many countries with constrained resources. This is a short presentation incorporating important completed and ongoing trials. Feel free to use this.
The document discusses the principles of radiation oncology for head and neck cancer treatment. It covers external beam irradiation techniques, brachytherapy, radiobiology concepts like the four R's, and fractionation schedules. Complications of treatment include both acute reactions and late tissue effects like xerostomia, fibrosis, and central nervous system damage. A basic understanding of radiation physics, radiobiology, and treatment approaches is important for counseling patients.
- Young age is a risk factor for local recurrence after breast-conserving therapy, and adding a boost dose reduces the 5-year local recurrence rate from 26% to 8.5% for patients aged 35 or younger, compared to from 3.9% to 2.1% for patients older than 60.
- Post-mastectomy radiotherapy reduces locoregional recurrences by 70% and prevents one breast cancer death within 15 years for every four recurrences prevented at 5 years. PMRT is generally recommended for stage pT3/pN2a or higher.
- While radiotherapy decreases in-field recurrences, significant excess non-breast cancer mortality from heart disease and lung cancer was
1) Esophageal cancer (EC) is the 8th most common cancer worldwide and the 6th leading cause of cancer death, with about 450,000 new cases diagnosed yearly.
2) For patients with unresectable locally advanced or metastatic EC, concurrent chemoradiotherapy provides the best outcomes for controlling symptoms and prolonging survival.
3) Treatment for EC is best managed by a multidisciplinary team to determine the optimal treatment approach, as expert teams were found to achieve better overall survival rates compared to local non-expert teams.
This document summarizes recent advances in the management of lung cancer. It covers staging of non-small cell lung cancer (NSCLC) and small cell lung cancer using various imaging techniques like CT, PET, and MRI. It discusses treatment options for early and locally advanced NSCLC including surgery, chemotherapy, and radiation. For metastatic NSCLC, platinum-based chemotherapy is the standard first-line treatment. Second-line options include docetaxel, pemetrexed, erlotinib, and ramucirumab plus docetaxel. Maintenance therapy and anti-angiogenic agents like bevacizumab are also discussed.
- Small cell lung cancer (SCLC) accounts for 10-20% of lung cancers and is strongly linked to smoking. It is an aggressive neuroendocrine tumor that typically recurs after initial treatment.
- SCLC is classified as limited stage (confined to one lung and regional lymph nodes) or extensive stage (has spread widely). Limited stage has a median survival of 16-24 months with chemotherapy and radiation, while extensive stage has a median survival of 6-12 months with chemotherapy alone.
- First-line treatment is platinum-based chemotherapy for both stages. Limited stage also receives chest radiation. Prophylactic cranial irradiation reduces the risk of brain metastases. However, recurrence is common due to S
Small cell lung cancer (SCLC) accounts for 13% of lung cancers. It is strongly associated with smoking and most patients have metastases at diagnosis. SCLC is classified as limited stage, confined to one hemithorax, or extensive stage with distant metastases. Treatment involves platinum-based chemotherapy with radiation for limited stage. Prophylactic cranial irradiation and chemotherapy are recommended after response to lower risk of brain metastases. Outcomes remain poor due to frequent relapse and development of resistance.
The document discusses the leading causes of death worldwide due to illnesses like heart disease, malignant neoplasms, and cerebrovascular disease. It then covers various risk factors for cancer and heart disease, including smoking and diet. The rest of the document details cancer treatment methods such as staging and surgery, as well as principles of chemotherapy, radiation therapy, hormonal therapy, immunotherapy, and molecularly targeted agents. It provides examples of cancers that may be cured through chemotherapy alone or in combination with other treatments.
Principal of Chemotherapy(Pharmacotherapy)Usama151408
Cancer and its treatment were discussed. Chemotherapy aims to kill cancer cells while minimizing harm to healthy cells. It works by interfering with cell division in rapidly growing cancers. Different drug classes target various parts of the cell cycle. Chemotherapy is used curatively, palliatively, as adjuvant therapy after other treatments, and neoadjuvantly to shrink tumors before other therapies. Treatment selection depends on cancer type and stage. Side effects of chemotherapy and radiotherapy were also reviewed.
Small Cell Lung Cancer Management by Dr.Tinku JosephDr.Tinku Joseph
Small cell lung cancer (SCLC) typically presents with widespread metastases. SCLC is classified as limited stage or extensive stage disease. Treatment for limited stage SCLC involves chemotherapy with cisplatin and etoposide plus concurrent thoracic radiation. Prophylactic cranial irradiation is also recommended. Extensive stage SCLC is treated with chemotherapy alone. The standard regimen is cisplatin and etoposide, though carboplatin-based regimens are also used. Local radiation may provide additional benefit for responsive extensive stage patients. Median survival for SCLC depends on stage but typically ranges from 10 to 24 months with treatment.
1) Locally advanced breast cancer (LABC) includes stage IIB-IIIC disease and encompasses operable, inoperable, and inflammatory breast cancer at presentation.
2) Patients with LABC undergo neoadjuvant chemotherapy followed by surgery and radiation therapy. Additional tests are only indicated based on symptoms.
3) The goals of neoadjuvant therapy are tumor response before surgery to enable breast conservation and provide information about response to therapy. Anthracycline and taxane regimens are appropriate, and 15-25% will experience complete pathologic response.
This document discusses treatment options for lung cancer, including surgery, radiation therapy, chemotherapy, targeted therapy, and palliative care. It describes the different types and stages of non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC), and provides details on standard treatment approaches based on cancer stage, including combinations of surgery, chemotherapy, and radiation therapy. Targeted therapies discussed include angiogenesis inhibitors like bevacizumab, and EGFR inhibitors like erlotinib and afatinib that target specific genetic mutations in NSCLC cells.
This document discusses treatment options for lung cancer, including surgery, radiation therapy, chemotherapy, targeted therapy, and palliative care. It focuses on options for non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC), outlining treatments recommended based on cancer stage. For NSCLC, options may include surgery, chemotherapy, radiation therapy, or a combination depending on the stage. Limited and extensive stage SCLC are usually treated with chemotherapy alone or with concurrent chemoradiation for limited stage disease. Targeted therapies that inhibit angiogenesis or target EGFR mutations are also discussed.
Radiotherapy plays an important role in the management of urinary bladder cancers. It can be used as part of bladder-preserving protocols for muscle-invasive bladder cancer or as palliative treatment in elderly patients. Combined modality treatment with transurethral resection and concurrent chemoradiotherapy provides 5-year overall survival of 50-65% and bladder preservation in 38-43% of patients. External beam radiotherapy is typically delivered with a 4-field box technique to the whole pelvis at 45-50 Gy followed by a bladder boost to 60-65 Gy.
Small cell lung cancer (SCLC) accounts for 15-20% of lung cancers. It is an aggressive disease with rapid growth and early metastasis. The median survival is 2-4 months without treatment. Pathology shows dense sheets of small cells with scant cytoplasm and frequent mitoses. Immunohistochemistry markers include CD56, chromogranin, and synaptophysin. SCLC commonly causes paraneoplastic syndromes. Treatment involves chemotherapy with cisplatin and etoposide combined with early, accelerated thoracic radiotherapy to improve survival outcomes. Prognosis remains poor, especially in extensive stage disease.
Nick chen ppt presentation metronomic chemotherapy 2015CNPS, LLC
Metronomic chemotherapy provides several advantages over conventional chemotherapy:
- It is associated with lower toxicity due to more frequent lower doses, allowing better treatment consistency.
- It has enhanced anti-cancer effects through anti-angiogenesis and improved immune response against tumors.
- Targeting both the tumor and tumor microenvironment makes it less likely to encounter chemo-resistance.
1) Adjuvant chemoradiation improves local control for locally advanced rectal cancer compared to surgery alone based on multiple trials from the 1980s and 1990s.
2) Recent European trials have found no clear benefit of adjuvant chemotherapy after neoadjuvant chemoradiation and surgery for rectal cancer, with the exception of the QUASAR trial.
3) Adjuvant chemotherapy may be recommended after preoperative chemoradiation for mid-low rectal cancers with lymph node involvement (ypT3N+) or high rectal cancers with stage ypT2-3 based on trial results and expert guidelines.
Definition: Small cell lung carcinoma (SCLC) is a type of lung cancer that typically starts in the bronchi (large airways) and tends to grow and spread quickly. It accounts for approximately 10-15% of all lung cancers.
Characteristics: SCLC is characterized by small, oat-shaped cancer cells that rapidly divide and form large tumors. It is often associated with a history of smoking and has a strong correlation with tobacco exposure.
Aggressive nature: SCLC is considered highly aggressive, with a tendency to metastasize (spread) early to the lymph nodes and other distant parts of the body, such as the liver, bones, and brain. This rapid spread makes early detection and treatment crucial.
Limited and extensive stage: SCLC is classified into two stages: limited stage and extensive stage. Limited stage means the cancer is confined to one side of the chest and potentially adjacent lymph nodes, whereas extensive stage indicates that the cancer has spread beyond the chest to distant organs.
Treatment approach: The treatment of SCLC typically involves a combination of chemotherapy and radiation therapy. Surgery is generally not recommended for SCLC due to its aggressive nature and tendency to spread early. Chemotherapy, often in combination with immunotherapy, is the mainstay of treatment and can help shrink tumors and control the disease.
Prognosis: The prognosis for SCLC is generally poorer compared to non-small cell lung carcinoma (NSCLC) due to its more aggressive behavior and earlier metastasis. However, treatment advances and research efforts continue to improve outcomes for SCLC patients.
Supportive care: As with any cancer diagnosis, supportive care plays a critical role in managing SCLC. This includes addressing symptoms, managing pain, providing emotional support, and ensuring optimal quality of life for patients.
It's important to consult with healthcare professionals for an accurate diagnosis, personalized treatment plan, and ongoing monitoring for individuals suspected or diagnosed with small cell lung carcinoma.
This document provides an overview of recent advances in lung cancer research. It discusses the types of lung cancer and treatments such as chemotherapy, immunotherapy, and targeted therapies. New discoveries include approval of the first KRAS inhibitor drug and combinations of chemotherapy with drugs that inhibit DNA repair. Ongoing areas of research focus on biomarkers, immunotherapy, liquid biopsies, robotics for surgery, and stereotactic radiation. The future for lung cancer treatment is promising with decreasing mortality rates resulting from new targeted therapies and increased use of screening.
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1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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LUNGevity Core Principles of Managing Stage III NSCLC
1. Core Principles of Managing
Locally Advanced
Non-Small Cell Lung Cancer (NSCLC)
H. Jack West, MD
2. • There is no single “best treatment” for patients
with locally advanced NSCLC. In general, it requires
a combination of treatment for “local disease” that
you can see, as well as potential “distant disease”
that you cannot.
• Higher T (tumor) stage tends to be associated with
greater risk of local disease. Higher N (nodal) stage
and greater number of nodes tends to be
associated with greater risk of distant disease.
Local treatment
(radiation or
surgery)
Systemic treatment
(generally chemo)
Locally Advanced, also known as Stage III
NSCLC, may be treated in any of several ways
3. • Because optimal treatment of
locally advanced NSCLC is
“multimodality” (requires a
combination of chemo with
radiation or surgery or both), it is
ideal to have treatment plans
developed by a team of
specialists in these fields prior to
staring therapy.
Multimodality Therapy: A Team Approach
• Recommendations may vary from patient to patient
based on size of the cancer, its location, T stage, N
stage, health of the patient, and other factors.
4. • Surgery is sometimes recommended for patients with stage IIIA
disease and non-bulky “N2” nodes on the same side as the
main tumor in the mid-chest (mediastinum). This is typically
preceded by “induction” chemo or chemo and radiation.
• Chemo and radiation, without surgery, are considered more
appropriate when there are many areas of nodal involvement,
bulky lymph nodes, or “N3” nodes in the mid-chest opposite
the main tumor.
Not necessarily. Chemo and
radiation combined together
produces comparable survival
to surgery for stage IIIA and
IIIB NSCLC overall and is NOT a
consolation prize.
Hot Light, Cold Steel: Is Surgery the Path
to Cure in Locally Advanced NSCLC?
5. • Originally, only radiation or surgery were
used for locally advanced NSCLC.
Unfortunately, only a small minority of
patients with stage III NSCLC were cured
of their cancer (about 5%).
• Chemo was then added sequentially (preceding radiation),
improving survival at 3-5 years (to about 10%). It can help treat
“invisible”, distant disease in addition to the visible disease
treated with local therapy.
• Administering chemo concurrently with radiation can improve
cure rates (~15-25%). Chemo acts as a “radiosensitizer”,
increasing efficacy of the radiation. The most common chemo
regimens combined with radiation are cisplatin/etoposide or
carboplatin/Taxol (paclitaxel), but others can be used.
Chemo/Radiation without Surgery to
Cure Locally Advanced NSCLC
6. Balancing Efficacy with Safety
• Stage III NSCLC has a high risk of recurrence/progression
through treatment. Combining chemotherapy with radiation
and/or surgery to treat the cancer aggressively has the
potential to improve the cure rate against the cancer, but it
also increases the side effects of treatment.
• These can sometimes be life-threatening, or even fatal. Even
in carefully conducted studies, about 5-7% of patients can die
from treatment, and more or left with significantly
compromised lung function.
• Beyond a certain level (that varies with
the health of the patient), escalating
intensity of treatment may cause more
harm than good and worsen survival.
7. • A key clinical trial compared about 6.5-7 weeks of daily chest
radiation (Mon-Fri) to a longer course and higher dose with
concurrent chemotherapy. This showed that more radiation was
associated with WORSE survival than the standard dose.
• The best studied chemo is about 6-7 weeks, either two courses
of every 3-4 week cisplatin/etoposide or 7 low weekly doses of
carboplatin/Taxol. Giving additional chemo before or after this
has never been shown to be better (though we often give it,
hoping it could be). Taxotere (docetaxel) after chemo/radiation
increased side effects but not survival.
• There is no role established for targeted therapies in locally
advanced NSCLC. Iressa (gefitinib) was significantly harmful,
worsening survival, after chemo/radiation in an unselected
population (most didn’t have an EGFR mutation).
Too much of a good thing?
8. 1. Optimal treatment is individualized to the patient and their
cancer but almost always involves two or three modalities of
therapy (chemo, radiation, surgery).
2. A multimodality plan should be developed by a group of
specialists considering the range of combined therapy options.
3. Surgery may have a role in more limited, less bulky stage III
NSCLC (almost always stage IIIA). A nonsurgical approach with
chemo/radiation can lead to comparable survival.
4. Concurrent chemo and chest radiation (as an alternative to
surgery) leads to improved survival compared with sequential
treatment but isn’t for every patient.
5. Risk from treatment can counterbalance benefit as treatment
becomes more intensive.
Conclusions: 5 Key Points for Managing
Locally Advanced NSCLC