Medical world knows very little of radiation oncology. This presentation will make you updated with latest technology, innovation and principles of radiation oncology. This presentation will clear doubts and misconception of many medical practitioners.

1. Radiation Oncology –
Evolving Modality
Dr. Malhar Patel, DNB
Radiation Oncologist
CIMS Cancer Center

2. Cancer is CURABLE **Terms & conditions apply!!
*If detected EARLY
Cancer is CANCEL???!!!

3. Evolution

4. Evolution of Oncology!!

5. ગરવી ગુજરાત
According to the figures tabled in the Lok Sabha recently by Union health minister
J P Nadda, Gujarat recorded 25,387 cancer deaths and 57,699
cases in 2015. India, which registers around ten lakh cancer cases each
year, has 7.5% of the world's cancer cases. Gujarat accounts for 5%
of India's cancer cases.
Gujarat recorded 23,285, 23,966 and 24,667 cancer-related
mortalities in 2012, 2013 and 2014, respectively . The state recorded
52,920, 54,469 and 56,061 cases of cancer in those three years.

6. Apart from the state, Ahmedabad has also been witnessing an
alarming trend in oral cancer. Ahmedabad is considered the oral cancer capital with
an incidence rate as high as 22 cases per lakh population. This is
alarming, especially when viewed against the country's incidence ratio, which is 9
cancer patients per lakh. According to Gujarat Cancer Registry,
which register the number of cancer cases, around 17,500 men and 12,000 women
fall prey to the deadly disease every year. Cancers of the mouth, lung,
food-pipe, prostate and larynx are most prevalent among men, where as cancers of
the breast, cervix, ovary and food pipe are most common in women.
ગરવી ગુજરાત

7. Chewing tobacco consumption has
increased the risk of head and neck cancer among the
urban and semi urban population of Ahmedabad by
between 13% and 15% in people between of the
35 to 40 years age group, who are at most risk.
ગરવી ગુજરાત

8. Pillars of Oncology

9. Team Work!!!!
• Surgical Oncologist
• Radiation Oncologist
• Medical Oncologist
• Dentist
• Radiologist
• Pathologist
• Physiotherapist
• Dietician
• Nursing & Support Staff
• Psychiatrist

10. RADIATION THERAPY

11. શેકના ડાૅકટર

12. What is Radiation??!!
• Treatment of tumor with Ionizing Radiation
• Cobalt machine  Gamma Rays
• Linear Accelerators  High Energy X – Rays

13. Where Radiation is Commonly
Used

14. Myths About Radiotherapy
• It is Hot
• It is given only in “last stage of cancer”
• It is “ONLY” palliative
• It causes side effects only
• After surgery – No role of adjuvant
radiotherapy
• Loss of body hair
• Cancer spreads after giving radiation

15. Role of Radiotherapy
• Malignant and Benign
• External RT (Teletherapy) and Brachytherapy
• Radical Radiotherapy and Adjuvant Radiotherapy
• Concurrent Chemo-Radiotherapy
• Palliative Radiotherapy

16. General Management Guidelines
• Aim
– Highest Loco-Regional control
– Function preservation
– Minimal morbidity
• Stage I & II – Single Modality ( Surgery / RT )
• Stage III & IV – Combined Modality
» Surgery + RT
» Surgery + RT + CT
» RT + CT

17. Radical
Radiotherapy
• NasopharynX
• OropharynX
(Tonsil, Base Tongue, Soft
Palate)
• HypopharynX
• LarynX
• CerviX
• Prostate
• Oesophagus
• Lung
• Anal Canal
Adjuvant Radiotherapy
• Oral Cavity
• Breast
• Oesophagus
• Rectum
• Cervix
• Endometrium
• Soft Tissue Sarcoma
• Brain Tumors
• Lung
• Pre – Op RT + CT  Rectum,
Oesophagus

18. First Linac and
Basic Collimatoghr
1960
The Evolution of Radiation Therapy
Therapy
Cerrobend Blocking
Electron Blocking
1970s
Computerized 3D Treatment
Planning Multileaf Collimator
1980s
Dynamic MLC
and IMRT
1990s
High-Resolution IMRT & IGRT
2000s
Image Guided Radiotherapy
2006
Cyber Knife
2008
VMAT - IMRT & IGRT
2011
VERSA HD
2014

19. Intensity Modulated Radiotherapy
(IMRT)
• Targeted Radiotherapy
• Precise Treatment
• High dose to target
• Spares Normal Structures
• High Cure Rates
• Less Side Effects

20. Steps in delivering radiation
• Counselling
• Immobilization
• Planning CT Scan/MRI/PET
• Physics Planning
• Image Guidance
• Treatment

21. Counselling

22. Immobilization & Imaging for
planning

23. Imaging Modalities

24. Fusion

26. Dose Planning
Doctor and Physicist

27. IMR

28. Conventional Radiation
IMRT

30. 2D IMR
T

31. IMRT

33. Treatment

34. CBCT

39. SBRT & SRS
• Stereotactic Body Radiotherapy
• Small Lesions in Lung, Brain, Liver, Lymph Nodes
• High dose in 1 – 5 sittings
• Alternate Day treatment
• Accurate & Precise Treatment

40. SBRT SRS
Bone Metastasis – Ca Prostate
24 Gy in 3 Fractions
Acoustic Neuroma
14 Gy Single Fraction

41. Brachytherapy

42. Future of Radiation Oncology
• Radiobiology!!! – Dose Painting
• Radical treatment / Organ preservation
• Newer Techniques like IMRT / IGRT
– Less Late Side Effects
– Higher Cure Rates
• SBRT
– Small Lesions
– Good Results / Less complications

43. SIDE EFFECTS

47. Ye Dosti Hum Nahi Todenge!!

48. Cancer Is NOT Funny
Laughter is the Best Medicine

49. Thank You