Why, What and How in Radiation Oncology

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Information about Why, What and How in Radiation Oncology

Published on February 28, 2018

Author: Mogli86

Source: slideshare.net

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

20. Counselling

21. Immobilization & Imaging for planning

22. Imaging Modalities

23. Fusion

24. Dose Planning Doctor and Physicist

25. Conventional Radiation IMRT

26. Treatment

27. CBCT

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

30. Brachytherapy

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

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