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BASICS IN RADIATION
ONCOLOGY
RADIATION ONCOLOGY
• Radiation oncology is that discipline of human
medicine concerned with the generation,
conservation, ...
• Medical Oncology is that discipline of human
medicine specializes in diagnosing and treating
cancer using chemotherapy, ...
RADIATION THERAPY
• Radiation therapy is the clinical modality dealing
with the use of ionizing radiations in the treatmen...
CELL CYCLE
• G0 – Cell rests and does normal work in the
body
• G1 – RNA and proteins are made for dividing
• S – Synthesis ( DNA is ...
• Radiation kills cells that are actively dividing.
• It also causes damage to the surrounding
tissue.
• Radiation doesn’t...
TYPE OF RADIATION
• IONIZING
– PHOTON THERAPY ( X- RAYS AND GAMMA
RAYS )
– PARTICLE THERAPY ( ELECTRONS,
PROTONS, NEUTRONS...
• RADIOCURABILITY – It refers to the
eradication of tumour at the primary or
regional site and reflects a direct effect of...
Factors affecting Radiosensitivity
• Histologic type
– High sensitivity: Malignant lymphoma, Seminoma, etc.
– Moderate sen...
4 R’s of Radiotherapy
• Repair (few hours)
– Lethal damage
– Sublethal damage
– Potentially lethal damage
• Reassortment (...
RADIOTHERAPY
• PRIMARY
• ADJUVANT
• NEO-ADJUVANT
• CONCURRENT
• PALLIATIVE
Planning and conduct of course of
Radiation Therapy
• Indication for radiotherapy
• Goal of radiation therapy
• Planned tr...
EXTERNAL BEAM RADIATION
• 2D RADIOTHERAPY
• 3D CONFORMAL RADIOTHERAPY
• INTENSITY MODULATED RADIOTHERAPY
• IMAGE GUIDED RA...
BRACHYTHERAPY
• CESIUM, GOLD, IODINE, IRIDIUM,
PALLADIUM
• MAIN TYPES OF INTERNAL RADIATION
– INTERSTITIAL
• PERMANENT BRA...
• Radiation Oncologist - Plans treatment.
• Radiation Physicist – Working of radiation
equipment & delivering the radiatio...
PLANNING
• IMMOBILIZATION
• CT Simulation
• Treatment Planning System
– Target delineation
– Dose prescription
– Beam plac...
IMMOBILIZATION
• GOALS
• DEVICES
– PLASTIC HEADHOLDERS AND SPONGES
– THERMOPLASTS
– PLASTER OF PARIS
– VACUM MOULDED THERM...
THERMOPLAST
IMMOBILIZATION
Video
• TARGET DELINEATION & DOSE
PRESCRIPTION
– Gross tumour volume – 60 – 70 Grays
– Clinical target volume
• High risk – 45 –...
COMBINATION THERAPY
• CONCURRENT CHEMOTHERAPY
– CISPLATIN
• 40mg/m² in 1pint NS IV over 20mins ( Cover bottle with
black p...
TARGETED THERAPY
• Targeted therapy blocks the growth and spread of
cancer by preventing cancer cells from dividing or
des...
SIDE EFFECTS
ORAL MUCOSITIS
• Symptoms include pain, Dysphagia,
Odynophagia, Nausea, Vomiting, Diarrhoea –
GI Toxicity.
• Prevention
– Midline mucosa ...
• Treatment
– Lidocaine, milk of magnesia, chlorhexidine and
diphendhydramine
– Antibiotic lozenges or sucralfate
DERMATITIS
• Erythema, desquamation, oedema, necrosis or ulceration
(dose and duration )
• Sweat glands and hair follicles – damaged
...
• Chronic skin changes
– Oral pentoxifylline (800mg/day)
– Vitamin E (1000IU/day)
• For 6 months
– Prophylactic use of Pen...
XEROSTOMIA
• Subjective experience of dry mouth.
• 50 – 60% decrease – 1st week
• Continues in dose dependent fraction
• S...
• Prevention
– Surgical transplantaion of salivary gland.
• Submandibular gland to submental space.
– Intensity modulated ...
SPINAL CORD
• Transient myelopathy ( 2 – 4 months later ).
• LHERMITTE SIGN or LHERMITTE
SYNDROME.
• Rarely, Permanent par...
THANKYOU
Basics in radiation oncology
Basics in radiation oncology
Basics in radiation oncology
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Basics in radiation oncology

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basics in radiation oncology

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please do refer radiation reference books, Eg Parez

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Basics in radiation oncology

  1. 1. BASICS IN RADIATION ONCOLOGY
  2. 2. RADIATION ONCOLOGY • Radiation oncology is that discipline of human medicine concerned with the generation, conservation, and dissemination of knowledge concerning the causes, prevention, and treatment of cancer and other diseases involving special expertise in the therapeutic application of ionizing radiation.
  3. 3. • Medical Oncology is that discipline of human medicine specializes in diagnosing and treating cancer using chemotherapy, hormonal therapy, biological therapy, and targeted therapy. • Surgical Oncology branch of surgery applied to oncology; it focuses on surgical management of tumours mainly cancerous tumour.
  4. 4. RADIATION THERAPY • Radiation therapy is the clinical modality dealing with the use of ionizing radiations in the treatment of patients’ with malignant neoplasias (and occasionally benign diseases). • The aim of radiation therapy is to deliver precisely measured dose of radiation to a defined tumour volume with as minimal damage as possible to the healthy surrounding tissue, resulting in eradication of the tumour, high quality of survival and prolongation of survival at competitive cost.
  5. 5. CELL CYCLE
  6. 6. • G0 – Cell rests and does normal work in the body • G1 – RNA and proteins are made for dividing • S – Synthesis ( DNA is made for new cell ) • G2 – Apparatus for mitosis is built • M – Mitosis ( The cell divides into 2 cells )
  7. 7. • Radiation kills cells that are actively dividing. • It also causes damage to the surrounding tissue. • Radiation doesn’t kill cells instantly, it may take day to weeks depending on the cell • Skin, bone marrow, lining of intestines affects quickly. • Nerve, breast, brain, and bone tissue show affects later
  8. 8. TYPE OF RADIATION • IONIZING – PHOTON THERAPY ( X- RAYS AND GAMMA RAYS ) – PARTICLE THERAPY ( ELECTRONS, PROTONS, NEUTRONS, CARBON IONS, ALPHA PARTICLES AND BETA PARTICLES ) • NON – IONIZING – RADIO WAVES, MICROWAVES, VISIBLE LIGHT
  9. 9. • RADIOCURABILITY – It refers to the eradication of tumour at the primary or regional site and reflects a direct effect of the irradiation ; but this does not equate with patients cure from cancer. • RADIOSENSITIVITY – is the measure of tumour radiation response, thus describing the degree and speed of regression during and immediately after radiotherapy
  10. 10. Factors affecting Radiosensitivity • Histologic type – High sensitivity: Malignant lymphoma, Seminoma, etc. – Moderate sensitivity: Epithelial tumour (Carcinoma) – Low sensitivity: Osteosarcoma, Malignant melanoma, etc. • Oxygen concentration in tumour tissue: Radiosensitivity is low in the hypoxic state. • Cell cycle: Radiosensitivity is high in M phase and low in S phase. • Cancer-related genes: p53, Bel-2, Fas, VEGF, etc.
  11. 11. 4 R’s of Radiotherapy • Repair (few hours) – Lethal damage – Sublethal damage – Potentially lethal damage • Reassortment (few hours) • Repopulation (5 – 7 weeks) • Reoxygenation (hours to few days)
  12. 12. RADIOTHERAPY • PRIMARY • ADJUVANT • NEO-ADJUVANT • CONCURRENT • PALLIATIVE
  13. 13. Planning and conduct of course of Radiation Therapy • Indication for radiotherapy • Goal of radiation therapy • Planned treatment volume • Planned treatment technique • Planned treatment dose
  14. 14. EXTERNAL BEAM RADIATION • 2D RADIOTHERAPY • 3D CONFORMAL RADIOTHERAPY • INTENSITY MODULATED RADIOTHERAPY • IMAGE GUIDED RADIOTHERAPY • STEREOTACTIC RADIOTHERAPY / SURGERY • INTRAOPERATIVE RADIOTHERAPY • ELECTROMAGNETIC GUIDED RADIATION THERAPY
  15. 15. BRACHYTHERAPY • CESIUM, GOLD, IODINE, IRIDIUM, PALLADIUM • MAIN TYPES OF INTERNAL RADIATION – INTERSTITIAL • PERMANENT BRACHYTHERAPY • TEMPORARY BRACHYTHERAPY – HIGH DOSE RATE BRACHYTHERAPY – LOW DOSE RATE BRACHYTHERAPY – INTRACAVITARY – INTRALUMINAL – SURFACE
  16. 16. • Radiation Oncologist - Plans treatment. • Radiation Physicist – Working of radiation equipment & delivering the radiation dose. • Dosimetrist – Helps the doctor plan and calculate the needed number of treatment. • Radiation therapist – operates the equipment. • Radiation therapy nurse – cares the patient and advice them on radiation treatment & dealing with radiation side efftects.
  17. 17. PLANNING • IMMOBILIZATION • CT Simulation • Treatment Planning System – Target delineation – Dose prescription – Beam placement – Dose calculation – Plan evaluation & Approval – Quality assurance • RADIATION DELIVERY
  18. 18. IMMOBILIZATION • GOALS • DEVICES – PLASTIC HEADHOLDERS AND SPONGES – THERMOPLASTS – PLASTER OF PARIS – VACUM MOULDED THERMOPLASTS – POLYURETHANE FOAMS
  19. 19. THERMOPLAST IMMOBILIZATION
  20. 20. Video
  21. 21. • TARGET DELINEATION & DOSE PRESCRIPTION – Gross tumour volume – 60 – 70 Grays – Clinical target volume • High risk – 45 – 54 Grays • Low risk – 45 Grays – Planning target volume.
  22. 22. COMBINATION THERAPY • CONCURRENT CHEMOTHERAPY – CISPLATIN • 40mg/m² in 1pint NS IV over 20mins ( Cover bottle with black paper) after premedication • CARBOPLATIN , TAXOL • MONOCLONAL ANTIBODIES – BioMap
  23. 23. TARGETED THERAPY • Targeted therapy blocks the growth and spread of cancer by preventing cancer cells from dividing or destroying them directly. • EGFR monoclonal antibodies – cetuximab, panitumumab, zalutumumab, nimotuzumab • EGFR tyrosine kinase inhibitors – gefitinib, erlotinib, lapatinib, afatanib, dacomitinib • Vascular endothelial growth factor receptor (VEGFR) inhibitors – bevacizumab, sorafenib, sunitinib, vandetanib
  24. 24. SIDE EFFECTS
  25. 25. ORAL MUCOSITIS
  26. 26. • Symptoms include pain, Dysphagia, Odynophagia, Nausea, Vomiting, Diarrhoea – GI Toxicity. • Prevention – Midline mucosa sparing blocks – 3D treatment planning and conformational dose delivery – Topical benzydamine – anti inflammatory, analgesic and anti microbial effect
  27. 27. • Treatment – Lidocaine, milk of magnesia, chlorhexidine and diphendhydramine – Antibiotic lozenges or sucralfate
  28. 28. DERMATITIS
  29. 29. • Erythema, desquamation, oedema, necrosis or ulceration (dose and duration ) • Sweat glands and hair follicles – damaged • Alopecia permanent – Follicular fibrosis. • Treatment – Gentle cleansing with mild agent, washing with water. – Petrolatum based, castor oil, trolamine. – Steroids ameliorate the symptoms, but do not prevent. – Ulcers – Gention violet, Hydrogel dressings • If infected – Ionic silver powder, topical antibiotics • Recent years – Topical granulocyte-macrophage-colony stimulating factor, tacrolimus, platemet derived growth factor
  30. 30. • Chronic skin changes – Oral pentoxifylline (800mg/day) – Vitamin E (1000IU/day) • For 6 months – Prophylactic use of Pentoxifylline reduces late skin changes, fibrosis and soft tissue necrosis
  31. 31. XEROSTOMIA • Subjective experience of dry mouth. • 50 – 60% decrease – 1st week • Continues in dose dependent fraction • Symptoms – Systemic problems – loss of apetite, chronic oesophagitis, gastroesophageal reflux – Local problems include dental caries, periodeontal disease, atrophy and ulceration
  32. 32. • Prevention – Surgical transplantaion of salivary gland. • Submandibular gland to submental space. – Intensity modulated RT. – Amifostine therapy. • 200mg/m² 15 – 20mins prior irradiation • Treatment – Dietary and oral hygiene – Saliva substitution – Medications ( carboxymethylcellulose, porcine, bovine mucin) – Increase flow – Chewing gums, Lozenges, Vitamin C – Oral pilocarpine • 5 -10mg TID
  33. 33. SPINAL CORD • Transient myelopathy ( 2 – 4 months later ). • LHERMITTE SIGN or LHERMITTE SYNDROME. • Rarely, Permanent paralysis, presumed to be from acute infarction of cord. HEARING • Cochlear damage – SNHL ( ˃60grays ). • Concurrent Chemotherapy with Cisplatin increases risk.
  34. 34. THANKYOU

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