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RADIOTHERAPY
SURGICAL
ONCOLOGY
MEDICAL ONCOLOGY
DR BEHGAL K S MD(AIIMS),DNB
DR KANWALJIT CHAHL MS,
MRCS,TMH ,RGCI
RADIOTHERAPY
SURGERY CHEMOTHERAPY
HORMONE-THERAPY
IMMUNOTHERAPYIMMUNOTHERAPY
Cancer Treatment Options
BRACHYTHERAPY
Behgal‘s cancer hospital and
radiation research institute
1.1. Behgal’s RadiationBehgal’s Radiation
Training Institute secTraining Institute sec
91 mohali91 mohali(2012)
2.2. Behgal cancer centreBehgal cancer centre
ph 5 mohaliph 5 mohali((20072007)
3.
 FREE STANDING RADIATIONFREE STANDING RADIATION
ONCOLOGYONCOLOGY
 STAFF:..1 RAD ONCOLOGIST
 ……………2 RSO physicist
 ……………1 dosimetrist
 ……………6 technicians
Behgal‘s cancer hospital and radiation
research institute
1.1. Behgal’s Radiation TrainingBehgal’s Radiation Training
Institute sec 91Institute sec 91
mohalimohali(2012)
2.2. Behgal cancer centre ph 5Behgal cancer centre ph 5
mohalimohali((20072007)
 FREE STANDING RADIATIONFREE STANDING RADIATION
ONCOLOGYONCOLOGY
 STAFF:..1 RAD ONCOLOGIST
 ……………2 RSO physicist
 ……………1 dosimetrist
 ……………6 technicians
ELEKTA SYNERGY
SIEMENS PRIMUS
BRACHYTHERAPY
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Then
computers are
used to help
plan the best
route for each
beam
Sensitive
areas such as
the eyes and
spinal cord
must be
avoided.
brain
eyes
tumour
"isocenter."center of the arc of
rotation of the linear accelerator
"collimators”
The dose plan is developed on the
computer,
Radiotherapy machines are large and expensive
Patients need to travel to a main regional hospital for treatment
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RTPLANNING WITH VMAT ,ONCENTRA ,.....PET -CT-MRI
FUSION ANALYTIC TARGET DESIGNATION..........A
PLEASURE WORKING ON SUCH TECHNOLOGY...WITH OUR
NEW ACQUISITIONS
Overview
3 DCRT3 DCRT
Radiation TherapyRadiation Therapy
TeletherapyTeletherapy
BrachytherapyBrachytherapy
IMRTIMRT
IGRTIGRT DARTDART
Electronic BrachytherapyElectronic Brachytherapy
TomotherapyTomotherapy
Image Assisted BrachytherpyImage Assisted Brachytherpy
Stereotactic radiotherapyStereotactic radiotherapy
Gamma KnifeGamma Knife
LINAC basedLINAC based
CyberknifeCyberknife
HYPERBARIC OXYGEN THERAPY
 Hyperbaric oxygen therapy (HBO) is a form of treatment in which a
patient breathes 100% oxygen while inside a special treatment
chamber. The pressure in this treatment chamber is increased to
higher than normal atmospheric pressure and the patient then
breathes oxygen at this higher pressure. Most treatment is carried
out at twice the atmospheric pressure and no significant side effects
are documented. With continuing growth all over the world
Hyperbaric medicine has found a distinct role in the modern era of
evidence-based medicine
HYPERBARIC OXYGEN THERAPY
Types of Radioisotopes dependingTypes of Radioisotopes depending
upon type of emissionupon type of emission
 γγ emitters :emitters : 226226
Ra,Ra,222222
Rn,Rn,6060
Co,Co,137137
Cs,Cs,192192
Ir,Ir,198198
Au,Au,
125125
I,I,103103
Pd,Pd,169169
Yb,Yb,145145
Sm,Sm,241241
Am.Am.
 ββ emitters :emitters : 3232
P,P,9090
Sr,Sr,9090
Y,Y,106106
Ru,Ru,4949
Va,Va,166166
Ho,Ho,144144
PrPr
External radiotherapy…
 COBALT
 LINEAR ACCELERATOR

Brachytherapy
Radiosurgery
IMRT
IGRT
Xknife srs/sbrt
Therapeutic nuclear medicine
Tumor definition in radiotherapy
Process based on Computed Tomography (CT)
PET-CT-MRI FUSION TECHNOLOGY
ONLY 4 SUCH FACILITIES IN INDIA
Why Brachytherapy?
Brachytherapy
Alternative:
Surgery
End resultCancer
BASAL CELL CARCINOMA
 56Gy------30GY(5,10,22MeV electrons)+26Gy 6mv
Xrays
LONG STANDING
BORDERLINE MALIGNANT
ODONTOGENIC TUMOR
EXCISED ,INTRA OPERATIVE
ELECTRON IRRADIATION
WITH PRIMARY
CLOSURE.......CAME TODAY
20TH DAY POSTOP AND
HAPPY WITH THE COSMESIS
Multileaf Collimators
 The degree of conformity between the
planned field boundary and the boundary
created by the MLC depends upon:
 Projected leaf width.
 Shape of target volume.
 Angle of collimator rotation.
 RCI = Treated Volume (inside 95% isodose
curve) / PTV
 The direction of motion of the leaves should
be parallel with the direction in which the
target volume has the smallest cross-section.
Radiotherapy can destroy small lung tumors while avoiding the
toxicity of thoracotomy
PET-GUIDEDRadiation Therapy in NSCLC
Pre-RT 2 Weeks
Post-RT
6 Months
Post-RT
PET-CT-MRI FUSION TECHNOLOGY
ONLY 4 SUCH FACILITIES IN INDIA
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Infield FailureInfield Failure
All infield failures were located in GTV or CTV.All infield failures were located in GTV or CTV.
Why Brachytherapy?
3-Fields External Beam AP-PA External Beam Brachytherapy
Highly conformal
Treatments by Location
 Intracavitary techniques
(i.e. Vaginal, Rectum)
 Intraluminal techniques
(i.e. Lung)
 Interstitial techniques
(i.e. Breast, Prostate)
 Surface applications
(i.e. Skin)
Pre-radiation 6 months post-
radiation
Radiographic Response
GALL BLADDER CA.
24gy XKNIFE Stereotactic RADIOSURGERY24gy XKNIFE Stereotactic RADIOSURGERY
Prostate HDR Brachytherapy
CLINICAL APPLICATIONS…
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LIMB SALVAGE
LIMB SPARING
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NEVER EVER LOSE HOPE ……..JUST COUNSEL PROPERLY
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DAY 1 DAY6
MOULD BRACHYTHERAPY
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IGRT
IMAGE GUIDED TELE AND
BRACHYTHERAPY IN
GYNAE
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KELOIDS
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GALL BLADDER CA.GALL BLADDER CA.
• OBSTRUCTIVE JAUNDICE
• 60Y F
• MULTIPLE LIVER METS
GALL BLADDER CA.
 24gy XKNIFE Stereotactic
RADIOSURGERY
Lungs HDR Brachytherapy
BRONCHIAL CARCINOMA BRACHYTHERAPY
Esophagus HDR Brachytherapy
BRACHYTHERAPY ALONE WITH
PALLIATIVE INTENT
Cervix HDR Brachytherapy
DOSE EVALUATION
H&N HDR Brachytherapy
H&N HDR Brachytherapy
Rectal Brachytherapy
TRUS Guided Needles Insertion
MammoSite
MammoSite is Inflated to
Position the Tissue to
Receive Radiation Therapy
Design allows the 192
Ir
Source to be Centrally
Positioned within the
Applicator
The192
Ir Source is
Delivered Into the
MammoSite and
Radiation Therapy is
Delivered Per the
Treatment Plan
Palliative
toilet
mammosite
in a widely
metastatic
breast
cancer
MammoSite
Behgal cancer centre”s new IGRT equipment – trubeam
XVI Imager
Multi-leaf collimator
ARTISTE
ARTISTE is the world’s first linear accelerator to feature integrated 3D-volume
imaging. This allows imaging of the tumor site with CT-like quality to be
acquired and reconstructed immediately before treatment, with the patient
already set-up in the treatment position.
Behgal cancer centre”s new IGRT equipment – VARIAN
UNIQUE IGRT &IGRS
RADIATION Techniques
IMRT
Intensity-modulated radiation therapy
structures the dose to spare healthy tissue.
 RapidArc
two minutes or less.
IGRT
Image-guided radiation therapy pinpoints a
moving target.
DARTdynamic adaptive radiation therapy
IGBTImage-guided brachytherapy implants radiation
quickly and precisely.
ORAL CANCERORAL CANCER
 ALL SQUAMOUS CANCERS are irritatingly resistant toALL SQUAMOUS CANCERS are irritatingly resistant to
chemochemo
 Surgery and /or radiation remain the mainstaySurgery and /or radiation remain the mainstay
 With very very good resultsWith very very good results
 At very very low costAt very very low cost
RADIOSURGERY …
AV MALFORMATION
89
Example of treatment
frontal lobe metastasisfrontal lobe metastasis
several months after radiosurgeryseveral months after radiosurgery
PONTINE GLIOMA
Aut omat i c Image
Fusi on f or crani al
Anat omy
PALLIATION
Inoperable to operable
KELOID…….HYPERTHERMIA & ELECTRONS
Superior vena cava obstruction
5gy….single fraction
Nucletron brachytherapy unit
_IRIDIUM 192
Intra operative brachytherapy for renal cell cc
IGRT CA LUNG
FLAP RECURRENCE 2010
THE PATIENT TODAY
GOOD SURGERY NO RT …GIVEN ONLY
BRACHY…AS SALVAGE
BREAST CANCER
Malignant Melanoma of the Uvea
Brachytherapy plaque insertion -1
Brachytherapy plaque insertion-2
Brachytherapy plaque insertion-2
plaque Radiotherapy PLANNING
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RTplanning with VMAT ,ONCENTRA ,.....PET -CT-MRI FUSION ANALYTIC TARGET
DESIGNATION..........a pleasure working on such technology...with our new
acquisitions
CANCER IS CURABLE IF
DETECTED EARLY AND
EVEN IF ADVANCED THE
LATEST TECHNOLOGY
CAN ONLY HELP
Thanks

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Editor's Notes

  1. All Local failures occurred usually occurred within GTV or CTV.