deoec institute of oncology department of radiotherapy
TRANSCRIPT
![Page 1: DEOEC Institute of Oncology Department of Radiotherapy](https://reader036.vdocument.in/reader036/viewer/2022062305/56649cdc5503460f949a6a3d/html5/thumbnails/1.jpg)
DEOEC Institute of OncologyDepartment of Radiotherapy
![Page 2: DEOEC Institute of Oncology Department of Radiotherapy](https://reader036.vdocument.in/reader036/viewer/2022062305/56649cdc5503460f949a6a3d/html5/thumbnails/2.jpg)
Radiology: diagnosisRadiotherapy: part of active oncotherapy (oncoradiology, radiation oncology)Oncology:chemotherapy
![Page 3: DEOEC Institute of Oncology Department of Radiotherapy](https://reader036.vdocument.in/reader036/viewer/2022062305/56649cdc5503460f949a6a3d/html5/thumbnails/3.jpg)
The branch of clinical medicine which uses ionising radiation, either alone or in combinations with other modalities, for the treatment of patients with cancer (or benign diseases). It includes responsibility for the treatment, follow up and supportive care of the patient as an integral of the multidisciplinary management of patients.
![Page 4: DEOEC Institute of Oncology Department of Radiotherapy](https://reader036.vdocument.in/reader036/viewer/2022062305/56649cdc5503460f949a6a3d/html5/thumbnails/4.jpg)
external beam radiation is delivered from outside the body by using a machine to aim high-energy rays (x-rays, gamma rays or photons). TELETHERAPY
internal radiation is delivered from inside the body by placing radioactive material, sealed in catheters or seeds, directly into the tumor. BRACHYTERAPY
![Page 5: DEOEC Institute of Oncology Department of Radiotherapy](https://reader036.vdocument.in/reader036/viewer/2022062305/56649cdc5503460f949a6a3d/html5/thumbnails/5.jpg)
1. „Direct hit”2. „Activated water”
![Page 6: DEOEC Institute of Oncology Department of Radiotherapy](https://reader036.vdocument.in/reader036/viewer/2022062305/56649cdc5503460f949a6a3d/html5/thumbnails/6.jpg)
1. „Direct hit”2. Activated
water O2 is
necessary
H2O
H+ OH- e-
H2 H2O2 H2O
oxidation
reduction
![Page 7: DEOEC Institute of Oncology Department of Radiotherapy](https://reader036.vdocument.in/reader036/viewer/2022062305/56649cdc5503460f949a6a3d/html5/thumbnails/7.jpg)
1. Lethal damage2. Sublethal damage
a) loss of reproductibility apoptosis
b) Repairc) Reoxigenistaiond) Repopulatione) Redistribution
![Page 8: DEOEC Institute of Oncology Department of Radiotherapy](https://reader036.vdocument.in/reader036/viewer/2022062305/56649cdc5503460f949a6a3d/html5/thumbnails/8.jpg)
1. Lethal damage2. Sublethal damage
a) loss of reproductibility apoptosis
b) Repairc) Reoxigenistaiond) Repopulatione) Redistribution
![Page 9: DEOEC Institute of Oncology Department of Radiotherapy](https://reader036.vdocument.in/reader036/viewer/2022062305/56649cdc5503460f949a6a3d/html5/thumbnails/9.jpg)
1. Lethal damage2. Sublethal damage
a) loss of reproductibility apoptosis
b) Repairc) Reoxigenistaiond) Repopulatione) Redistribution
EXCISIONS REPAIR
EndonucleazExonucleaz
↓Polymeraz
Liaz
MISMATCH REPAIR
![Page 10: DEOEC Institute of Oncology Department of Radiotherapy](https://reader036.vdocument.in/reader036/viewer/2022062305/56649cdc5503460f949a6a3d/html5/thumbnails/10.jpg)
1. Lethal damage2. Sublethal
damagea) loss of reproductibility
apoptosisb) Repairc) Reoxigenistaiond) Repopulatione) Redistribution
G. Steel, Basic Clinical Radiobiology 1997, second edition
In vitro effect of hypoxic conditionson radiation-induced cellular lethality
Cells are much more sensitive to x-rays in the presence of molecular oxygen than in its absence. The ratio of doses under hypoxia to those under oxia necessary to produce the same level of cell killing is close to 3.
OER = 2.8
Hypoxicoxic
50 1510 2520 30
0.001
0.01
0.1
1
10
Survi
ving f
ractio
n
Radiation dose (Gy)
OER (Oxygen enhancement ratio) = Radiation dose in hypoxia/ Radiation dose in air
![Page 11: DEOEC Institute of Oncology Department of Radiotherapy](https://reader036.vdocument.in/reader036/viewer/2022062305/56649cdc5503460f949a6a3d/html5/thumbnails/11.jpg)
1. Lethal damage2. Sublethal damage
a) loss of reproductibility
apoptosisb) Repairc) Reoxigenistaiond) Repopulatione) Redistribution
Hypoxia in tumors can results from two quite different mechanisms: chronic and acute hypoxia
Horsman MR and Overgaard J. 1992; Eur J. Cancer 28: 717-8
ChronicallyHypoxic Cells
AerobicCells
FunctionalBlood Vessel
NecroticCells
Acutely HypoxicCells
![Page 12: DEOEC Institute of Oncology Department of Radiotherapy](https://reader036.vdocument.in/reader036/viewer/2022062305/56649cdc5503460f949a6a3d/html5/thumbnails/12.jpg)
1. Isotopes isotope halfing time energy
(MeV) Ra-226 1626 y 0,830 Co-60 5,26 y 1,250 Ir-192 74,2 d 0,380 J-125 60,2 d 0,028
![Page 13: DEOEC Institute of Oncology Department of Radiotherapy](https://reader036.vdocument.in/reader036/viewer/2022062305/56649cdc5503460f949a6a3d/html5/thumbnails/13.jpg)
2. Cobalt unit Gamma-ray (photons)
Co60→ gamma-photons
![Page 14: DEOEC Institute of Oncology Department of Radiotherapy](https://reader036.vdocument.in/reader036/viewer/2022062305/56649cdc5503460f949a6a3d/html5/thumbnails/14.jpg)
3. Linear acceleratorPhotons and electrons
![Page 15: DEOEC Institute of Oncology Department of Radiotherapy](https://reader036.vdocument.in/reader036/viewer/2022062305/56649cdc5503460f949a6a3d/html5/thumbnails/15.jpg)
Precisely locate the target Hold the target fixed Accurately aim the radiation beam Shape the radiation beam to the target Deliver a radiation dose that damages
abnormal cells yet spares normal cells
![Page 16: DEOEC Institute of Oncology Department of Radiotherapy](https://reader036.vdocument.in/reader036/viewer/2022062305/56649cdc5503460f949a6a3d/html5/thumbnails/16.jpg)
Topometric-CTNo contrast media
Image fusions
![Page 17: DEOEC Institute of Oncology Department of Radiotherapy](https://reader036.vdocument.in/reader036/viewer/2022062305/56649cdc5503460f949a6a3d/html5/thumbnails/17.jpg)
GTV: gross tumor volume macroscopic tumor or tumor bed
CTV: clinical target volume: GTV+1-2 cm safety margin –microscopic tumor spreading-
PTV: planning target volume: CTV+0,5-1 cm movements of organs or breathing
![Page 18: DEOEC Institute of Oncology Department of Radiotherapy](https://reader036.vdocument.in/reader036/viewer/2022062305/56649cdc5503460f949a6a3d/html5/thumbnails/18.jpg)
![Page 19: DEOEC Institute of Oncology Department of Radiotherapy](https://reader036.vdocument.in/reader036/viewer/2022062305/56649cdc5503460f949a6a3d/html5/thumbnails/19.jpg)
Postop.Cervical cancer
![Page 20: DEOEC Institute of Oncology Department of Radiotherapy](https://reader036.vdocument.in/reader036/viewer/2022062305/56649cdc5503460f949a6a3d/html5/thumbnails/20.jpg)
3D –Target Volumes
![Page 21: DEOEC Institute of Oncology Department of Radiotherapy](https://reader036.vdocument.in/reader036/viewer/2022062305/56649cdc5503460f949a6a3d/html5/thumbnails/21.jpg)
MLC (multileaf collimator system)
![Page 22: DEOEC Institute of Oncology Department of Radiotherapy](https://reader036.vdocument.in/reader036/viewer/2022062305/56649cdc5503460f949a6a3d/html5/thumbnails/22.jpg)
TELETHERAPY: Fixed beam irradiation : direct field opposed fields 4 or more fields
TELETHERAPY: Fixed beam irradiation : direct field opposed fields 4 or more fields
![Page 23: DEOEC Institute of Oncology Department of Radiotherapy](https://reader036.vdocument.in/reader036/viewer/2022062305/56649cdc5503460f949a6a3d/html5/thumbnails/23.jpg)
BRACHYTHERAPY: Intracavital Intersticial
BRACHYTHERAPY: Intracavital Intersticial
![Page 24: DEOEC Institute of Oncology Department of Radiotherapy](https://reader036.vdocument.in/reader036/viewer/2022062305/56649cdc5503460f949a6a3d/html5/thumbnails/24.jpg)
EX. 1
![Page 25: DEOEC Institute of Oncology Department of Radiotherapy](https://reader036.vdocument.in/reader036/viewer/2022062305/56649cdc5503460f949a6a3d/html5/thumbnails/25.jpg)
EX.2
![Page 26: DEOEC Institute of Oncology Department of Radiotherapy](https://reader036.vdocument.in/reader036/viewer/2022062305/56649cdc5503460f949a6a3d/html5/thumbnails/26.jpg)
EX. 3
![Page 27: DEOEC Institute of Oncology Department of Radiotherapy](https://reader036.vdocument.in/reader036/viewer/2022062305/56649cdc5503460f949a6a3d/html5/thumbnails/27.jpg)
EX. 4
![Page 28: DEOEC Institute of Oncology Department of Radiotherapy](https://reader036.vdocument.in/reader036/viewer/2022062305/56649cdc5503460f949a6a3d/html5/thumbnails/28.jpg)
EX.5
![Page 29: DEOEC Institute of Oncology Department of Radiotherapy](https://reader036.vdocument.in/reader036/viewer/2022062305/56649cdc5503460f949a6a3d/html5/thumbnails/29.jpg)
Positioning, immobilisation devices Thermoplastic masks
![Page 30: DEOEC Institute of Oncology Department of Radiotherapy](https://reader036.vdocument.in/reader036/viewer/2022062305/56649cdc5503460f949a6a3d/html5/thumbnails/30.jpg)
Breast-boards
![Page 31: DEOEC Institute of Oncology Department of Radiotherapy](https://reader036.vdocument.in/reader036/viewer/2022062305/56649cdc5503460f949a6a3d/html5/thumbnails/31.jpg)
Conventional dose: 1,8-2 Gy/day, 5 day/week 2-7
week
Tumor killing doses: 30-78 Gy - hystology, tumor
type
- TNM stage,
KPS, ECOG
- indications
(neoadjuvant, adjuvant,
definitive, palliative)
- combinations
(RKT)
Conventional dose: 1,8-2 Gy/day, 5 day/week 2-7
week
Tumor killing doses: 30-78 Gy - hystology, tumor
type
- TNM stage,
KPS, ECOG
- indications
(neoadjuvant, adjuvant,
definitive, palliative)
- combinations
(RKT)
![Page 32: DEOEC Institute of Oncology Department of Radiotherapy](https://reader036.vdocument.in/reader036/viewer/2022062305/56649cdc5503460f949a6a3d/html5/thumbnails/32.jpg)
Tolarance of normal tissues (risk organs)
DVH: Dose-volume histograms
![Page 33: DEOEC Institute of Oncology Department of Radiotherapy](https://reader036.vdocument.in/reader036/viewer/2022062305/56649cdc5503460f949a6a3d/html5/thumbnails/33.jpg)
1. Simulation, positioning2. Topometric CT3. Treatment plan4. Resimulation5. Verification6. Treatment
![Page 34: DEOEC Institute of Oncology Department of Radiotherapy](https://reader036.vdocument.in/reader036/viewer/2022062305/56649cdc5503460f949a6a3d/html5/thumbnails/34.jpg)
1. Simulation, positioning
2. Topometric CT3. Treatment plan4. Resimulation5. Verification6. Treatment
![Page 35: DEOEC Institute of Oncology Department of Radiotherapy](https://reader036.vdocument.in/reader036/viewer/2022062305/56649cdc5503460f949a6a3d/html5/thumbnails/35.jpg)
1. Simulation, positioning
2. Topometric CT/MR
3. Treatment plan4. Resimulation5. Verification6. Treatment
![Page 36: DEOEC Institute of Oncology Department of Radiotherapy](https://reader036.vdocument.in/reader036/viewer/2022062305/56649cdc5503460f949a6a3d/html5/thumbnails/36.jpg)
1. Simulation, positioning
2. Topometric CT/MR
3. Treatment plan4. Resimulation5. Verification6. Treatment
Pictor 3D laser system
IsocenterVirtual point
![Page 37: DEOEC Institute of Oncology Department of Radiotherapy](https://reader036.vdocument.in/reader036/viewer/2022062305/56649cdc5503460f949a6a3d/html5/thumbnails/37.jpg)
1. Simulation, positioning
2. Topometric CT/MR
3. Treatment plan4. Resimulation5. Verification6. Treatment
![Page 38: DEOEC Institute of Oncology Department of Radiotherapy](https://reader036.vdocument.in/reader036/viewer/2022062305/56649cdc5503460f949a6a3d/html5/thumbnails/38.jpg)
RESULTS: 1. LTC : CR (4 mts) PR (-25-50%)
NC PD
2.Survival: Overal, Disease free, TTP
SIDE EFFECTS : early late local inflammation fibrosis
general weakness disfunction
![Page 39: DEOEC Institute of Oncology Department of Radiotherapy](https://reader036.vdocument.in/reader036/viewer/2022062305/56649cdc5503460f949a6a3d/html5/thumbnails/39.jpg)