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![DR KANHU CHARAN PATRO
M.D,D.N.B[RT],FAROI[USA],MBA,PDCR,CEPC
1
RADIOTHERAPY IN GYNAECOLOGICAL MALIGNANCY](https://image.slidesharecdn.com/fogsi-180916113237/75/RADIOTHERAPY-FOR-ENDOMETRIUM-AND-CERVICAL-CANCERS-1-2048.jpg)
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VISAKHAPATNAM,1/7-MVP[AP]
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![• Very bulky disease
• With paraaortic node
• Satge IV A disease[bladder and rectum inv.]
• 2cycle NACT-f/b radiation
IVB-Neoadjuvant chemotherapy or
concurrent chemoradiotherapy
35](https://image.slidesharecdn.com/fogsi-180916113237/75/RADIOTHERAPY-FOR-ENDOMETRIUM-AND-CERVICAL-CANCERS-35-2048.jpg)
Uploaded byKanhu Charan
RADIOTHERAPY FOR ENDOMETRIUM AND CERVICAL CANCERS
1. The document discusses radiotherapy techniques for treating gynaecological malignancies such as cancer of the cervix, endometrium, vulva, and ovaries. 2. It describes the evolution of radiotherapy from conventional 2D techniques to newer approaches like 3D conformal radiation therapy and intensity-modulated radiation therapy. 3. Key factors in treatment planning and delivery discussed include patient immobilization, imaging techniques for treatment planning like CT and PET scanning, and methods of verifying accurate patient positioning and treatment delivery such as electronic portal imaging.
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RADIOTHERAPY FOR ENDOMETRIUM AND CERVICAL CANCERS
- 1. DR KANHU CHARANPATRO M.D,D.N.B[RT],FAROI[USA],MBA,PDCR,CEPC 1 RADIOTHERAPY IN GYNAECOLOGICAL MALIGNANCY
- 2. O N O L Y O M G C H R I C G R S P E U S PE C I L T Y I VISAKHAPATNAM,1/7-MVP[AP] 2
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- 4. Radiation oncologist 2nd handdoctors 4
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- 15. IN INDIAN SOCIETY BA-BAMEDICINE 15
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- 19. DISCUSSION •CANCER CERVIX •CANCER ENDOMETRIUM •CANCERVULVA •CANCER OVARY 19
- 20. Type of patient: •Multiparous. • Low socioeconomic class. • Poor hygiene. • Prostitutes. • Low incidence in Muslims and Jews. 20
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- 28. BETTER OUTCOME WITHPA NODE 28
- 29. HOW TO ACCESSTHE PA NODE 29
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- 31. The choice oftreatment will depend on • Fitness of the patients • Age of the patients • Stage of disease. • Type of lesion • Experience and the resources avalible. 31
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- 35. • Very bulkydisease • With paraaortic node • Satge IV A disease[bladder and rectum inv.] • 2cycle NACT-f/b radiation IVB-Neoadjuvant chemotherapy or concurrent chemoradiotherapy 35
- 36. HISTOPATHOLOGY-CERVIX • DIMENSION • DEEPSTROMAL INVASION • PARAMETRIUM INVOLVEMENT • CUT MARGIN • LYMPHOVASCULAR INVOLVEMENT • LYMPHNODAL INVOLVEMENT 36
- 37. 37 Indication for postop radiation
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- 40. DDL CRITERIA/SEDLIS CRITERIA DDIMENSION->2cm D DEPTH-DEEP L LVI 40
- 41. AT LEAST TWOPOSITIVE CRITERIA 41
- 42. •Mediacally inoperable •Stage II-IVdisease 42 Definitive radiation
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- 44. Surgery offers severaladvantage • It allows presentation of the ovaries (radiotherapy will destroythem). • There is better chance of preserving sexual function. • (vaginal stonosis occur in up 85% of irradiates. • Psychological feeling of removing the disease from the body . • More accurate staging and prognosis • Glandular tumours (adenocarcinomas) are not detectable by screening are associated with skip lesions and require radical surgery. 44
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- 47. LYMPH NODAL SURGERYIMPORTANCE • Lymph node involvement is a major prognostic factor in cervical carcinoma, lymphatic spread of cervical cancer has been one of the most studied surgical topics in gynecologic oncology • To date, the mainstay of detecting lymph node metastasis is still the histologic evaluation, • Therefore a proper resection of mostly involved lymph nodes remains a crucial surgical step when treating cervical cancer. 47
- 48. COMPLICATIONS OF SURGERY •Haemorrhage: primary or secondary. • Injury to the bladder, uerters. • Bladder dysfunction. • Fistula. • Lymphocele. • Shortening of the vagina. 48
- 49. Radiation toxicity • Bladderrelated • Rectum related • Bowel related • Acute • Late 49
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- 57. WHEN THINGS ARESUSPICIOUS PET CT IS AUSPICIOUS WHEN THINGS ARE UNCLEAR THINK OF NUCLEAR 57
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- 60. HISTOPATHOLOGY-ENDOMETRIUM • DIMENSION • GRADING •MYOMETRIAL INVASION • PARAMETRIUM INVOLVEMENT • CUT MARGIN • CERVIX INVOLVEMENT • OAVRY AND TUBE INVOLVEMENT • LYMPHOVASCULAR INVOLVEMENT • LYMPHNODAL INVOLVEMENT 60
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- 67. GOALS High doseto tumor tissue-Tumor control Normal tissue sparing Minimize long and short term toxicities Better Quality of life 67
- 68. 68 Evolution of TreatmentTechniques CONVENTIONAL RT Collimator shapes Beam Rectangular Treatment Field Shaped Treatment Field 1970s and earlier
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- 71. Dr Santam ChakrabortyDepartment of Radiotherapy, PGIMER Chandigarh OurMethod 71
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- 73. Immobilization: Other methods ElektaBody Frame Body Fix system 73
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- 75. 75 Conventional Radiotherapy 4 FieldBox • Uniform dose to simple shapes • Circa 1930-1960
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- 83. ORGANS EFFECTED BYRADIATION 83
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- 85. CT simulator 70– 85 cm bore Scanning Field of View (SFOV) 48 cm – 60 cm – Allows wider separation to be imaged. Multi slice capacity: Speed up acquistion times Reduce motion and breathing artifacts Allow thinner slices to be taken – better DRR and CT resolution Allows gating capabilities Flat couch top – simulate treatment table 85
- 86. IMRT • Divides eachtreatment field into multiple segments • Modulates beam intensity, giving discrete dose to each segment • Uses multiple, shaped beams (~9) and thousands of segments IMRT Initiated in 1995 Reached the clinic in 2000
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- 91. Dr Santam ChakrabortyDepartment o Bone Marrow Sparing Dosimetric comparision of bone marrow sparing IMRT (Lujan et al): • Found that between a dose level of 18 – 20 Gy a significant reduction in volume of bone marrow irradiated was obtained with IMRT. • Brixey and Colleagues specifically compared hematological toxicity of WP- IMRT vs WPRT in the setting of concurrent CCT f Radiotherapy, PGIMER Chandigarh 91
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- 99. 99 Target Motion in Radiotherapy Cavemanet al Oops! The target moves! IGRT
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- 103. Electronic Portal ImagingDevice (EPID) iView GT- Electa 103
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- 105. 105 Ref image First EPID 2nd EPID OK Set-up verification Using EPID
- 106. DAY-12 1. Treatment procedurebegins 2. EPID 3. Online correction if needed 4. 1st treatment 5. Then treatment continues till completion 6. EPID checking weekly ONLINE CORRECTION LAT DRR LAT EPID 106
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- 109. Conclusions 1. Both 3DCRT and IMRT are proven. 2. However unless dose escalation is done no significant improvement in the control rates should be expected. 3. Chronic and acute toxicity amelioration are the more relevant endpoints. 4. Biologically optimized radiotherapy is an exciting new development 5. Real impact can only be realised with meticulous care in planning and execution. 109
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- 111. DOSE • 85Gy • 50GyEXTERNAL+ BRACHY 35Gy • OVER 6O DAYS 111
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- 123. 123 Uterine Sound Foley’s Bulb Bladder PictureNo. 3 Transabdominal Ultrasonography Picture No. 5 ICA HDR application Picture No. 4 US Guided Brachytherapy
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- 132. MUPIT IMPLANT INCA CERVIX 132
- 133. Stage IV: MetastaticCervix Cancer 133
- 134. 134 METASTASIS -please do notwatch crying
- 135. 10/20/12 01:12 PM135 135
- 136. METASTASIS- give asmiling death 136 136
- 137. Palliative radiation Skeletal X-Ray Bonescan MRI PET-CT 137
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- 148. • I. clinicalExamination – 3monthly for first 2year – 6monthly for after 2year – Annually there after • II. No other investigations in asymptomatic patients for early detection of metastasis, since it is - – Not cost-effective – Does not prolong survival. – Detection and disclosure of spread of disease may be psychologically harmful to an asymptomatic 148 Follow-up
- 149. 149 With in 3month follow up 1. No pap smear/bx 2. Confusion about radiation changes 3. Unnecessary investigation 4. Anxiety 5. Unnecessary treatment
- 150. Vaginal dilator • Oncompletion of treatment all patients are given a vaginal dilator to use until vaginal mucosa healed, this prevents vaginal stenosis. • Premenopausal patients commenced on HRT: 150
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- 166. 10/20/12 01:12 PM166 166
- 167. Just “Doing It”is not good enough ! You must know “what” to do and “where” to do it ! 10/20/12 01:12 PM 167 167
- 168. 10/20/12 01:12 PM168 168
- 169. 10/20/12 01:12 PM169 169
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- 174. MORE FUN ONCANCER EDUCATION 174