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Part 1Introduction to Radiotherapy and External Beam Radiation
Deepak Khuntia, MDVice President, Medical Affairs
Varian Medical Systems
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Part 3Internal Radiation:
BrachytherapyJohn Christodouleas, MD, MPH
VP of Medical Affairs and Clinical ResearchElekta, AB
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Role of Radiation Therapy in the Management of Cancer
In the US, about 50-60 % of cancer patients receive radiation therapy at some point during their management.
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Direct and indirect effects
Photon and charged particles
Photon and charged particles
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Radiation Treatments
External
Photon
Proton
Electron
Internal
Brachytherapy
Unsealed Sources
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Radiation Work-flow
Consultation Simulation Planning Treatment
1 to 14 days
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Simulation
Positioning ImagingImmobilization
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– uses CT and MRI-based image sets to
accurately target tumors and avoid sensitive normal tissues
– permits multiple different beam approaches
Treatment Planning: Spares normal tissue while ensuring adequate dose to the tumor
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Treatment Delivery
Tools at the machine to verify appropriate patient and target positioning before and during treatment– MV X-ray, U/S, MVCT,
CBCT, KV X-ray, MR, fiducial markers, surface monitoring systems
– Can gate the machine
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Radiation and Imaging Workflow
Consultation Simulation Planning Treatment
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Adaptive Radiotherapy
Khuntia 2010
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Adaptive Radiotherapy
Consultation Simulation Planning Treatment
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Radiosurgery
Sub millimeter accuracyOne to 5 fractionsCones or MLC basedBrain or outside brainFrame or no frame
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External Radiation:Photons, electrons, protons
Caterina Brusasco, PhDCompliance Manager
IBA SA
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3 Types of Therapeutic Radiation
P
e
Photon Radiation (x-rays, gamma rays)
Electron Radiation
Particle Radiation (Proton)
Ionization DNA Damage
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Different forms of radiation interacts with tissue differently
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Photon
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Electron
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Proton and Charged Particles
Pediatric medulloblastoma Ref: Presentation Dr. Jay S. Loeffler, NPTC/MGH, ASTRO 2001
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Standard RT:Use mostly open fields with blocks on critical structures
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Conformal RT: Block shaping to more precisely match the target
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Intensity Modulated RT: Each area may have a different intensity depending on how deep, and if there are critical structures.
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Internal Radiation:Brachytherapy
John Christodouleas, MD, MPHVP of Medical Affairs and Clinical
ResearchElekta, AB
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Brachytherapy definition
• Placing a radiation source internally, either into or immediately next to the tumor, allowing precise radiation dose delivery1
1. Stewart AJ & Jones B. In Devlin Brachytherapy: Applications and techniques. 2007.
Brachytherapy works ‘from the inside, out’
External Beam Therapy works ‘from the outside, in’
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Brachytherapy has a long history
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Brachytherapy – history
• Brachytherapy first used to treat lupus and then malignant tumors1,2
1901
• Use of brachytherapy to treat a gynaecologic malignancy first reported3
1903
• Techniques developed to treat prostate cancer4
1917
• New radioactive sources, techniques and equipment, which prevented unnecessary radiation exposure to patients and clinicians led to a renaissance for brachytherapy1
1950s and 1960s
• Brachytherapy is established as a safe and effective standard of care for many gynaecological cancers5
1970s
• Brachytherapy a valued treatment option for many types of cancer, with a wealth of supporting evidence4,5
Present day
1. Gupta VK. J Medical Physics 1995;20(2):31-5. 2. Nag S. American Brachytherapy Society.3. Aronowitz JN, Aronowitz SV Robison RF. Brachyther 2007;6:293-7. 4. Blasko JC, Wallner K, Grimm PD et al. J Urol 1995;154:1096-9. 5. Viani GA, Manta GB, Stefano EJ et al. J Exp Clin Cancer Res 2009;28:47.
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Three major brachytherapy methods
69
Intracavitary
Interstitial Surface
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Brachytherapy Clinical Indications
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In some indications, it is an option. In others, it is the standard of care.
Han K et al. Int J Radiat Oncol July 2013
Survival with and without BT boost in localized cervical cancer
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Software Systems in Radiation Oncology
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Software drives all aspects of the radiation oncology workflow
Consultation Simulation Planning Treatment
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Clinical Care SoftwareElectronic medical record systems
(EMRs)
Stores the patient’s medical record
Tools for charting and medical ordering
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Radiation Treatment Planning Systems
Identify tumor and normal tissues
Define beam/implant characteristics to reach a safe/effective plan
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Radiation Treatment Management System
Pre-treatment verification – Right patient, position, body part, treatment
parameters, etc
Post-treatment record
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Software Decision Support Tools
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Thank you