Published on February 28, 2018
1. What, Why, How in Radiation Oncology Dr. Malhar Patel, DNB Radiation Oncologist CIMS Cancer Center
2. Evolution of Oncology!!
3. Cancer is CURABLE **Terms & conditions apply!! *If detected EARLY Cancer is CANCEL???!!!
4. What Does it Take to Make a Tumor?
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. Fundamentals of Oncology • Biology is King • Selection is Queen • Technical maneuvers are the Prince and Princess Occasionally the prince and princess try to overthrow the powerful forces of the King and Queen, sometimes with temporary apparent victories, usually to no long term avail. -Blake Cady, MD
11. RADIATION THERAPY
12. What is Radiation??!! • Treatment of tumor with Ionizing Radiation • Cobalt machine Gamma Rays • Linear Accelerators High Energy X – Rays
13. 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
14. Role of Radiotherapy • Malignant and Benign • External RT (Teletherapy) and Brachytherapy • Radical Radiotherapy and Adjuvant Radiotherapy • Concurrent Chemo-Radiotherapy • Palliative Radiotherapy
15. 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
16. 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
17. 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
18. Intensity Modulated Radiotherapy (IMRT) • Targeted Radiotherapy • Precise Treatment • High dose to target • Spares Normal Structures • High Cure Rates • Less Side Effects
19. Steps in delivering radiation • Counselling • Immobilization • Planning CT Scan/MRI/PET • Physics Planning • Image Guidance • Treatment
21. Immobilization & Imaging for planning
22. Imaging Modalities
24. Dose Planning Doctor and Physicist
25. Conventional Radiation IMRT
28. 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
29. SBRT SRS Bone Metastasis – Ca Prostate 24 Gy in 3 Fractions Acoustic Neuroma 14 Gy Single Fraction
31. 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
32. Ye Dosti Hum Nahi Todenge!!
33. Cancer Is NOT Funny Laughter is the Best Medicine
34. Thank You