4Educational Objectives By the end of this lecture you will be able to:Describe how patients are referred for radiation oncology department.Explain the stages of health care management for patients undergoing radiotherapy.Demonstrate knowledge of the terms and concepts commonly used in radiotherapy practice.
5Educational Objectives (cont.,) Identify and describe parameters of radiotherapy prescription.Discuss causes failure of radiotherapy.Explain role of quality assurance program in preventing errors.List characteristics of successful radical course of radiotherapy.
6Outlines Stages leading to radiotherapy Radiotherapy process Data in radiation oncology chartsSuccess or failure of radiotherapy
7Stages Leading to Radiotherapy Staging / investigationsMultidisciplinary TeamSymptoms/Screening/ReferralDiagnosis/ Primary surgerysurgeryor chemotherapyRadiotherapyTreatmentRadiotherapyPlanning
8Clinical Evaluation (Path., stage,etc..) Therapy DecisionsMultimodality therapyOther modalityRadiotherapyIdentify tumor extent and sensitive organsDecision about:(a) Goal (cure/palliation)(b) Modality (External Beam ± Brachytherapy)Position, immobilization Patient data acquisition (CT, MRI, Simulator)Flowchart for the process of RTTreatment Planning Decision about: fields, dose, beam-modifiersTreatment Simulation Radiographic verification of fieldsEvaluation during therapyTreatmentFollow-up
9Data in Radiotherapy charts-1 Patient-related: age, gender, etc.Diagnostic: clinical, pathological, TNM stage, previous treatment and concomitant medications.Pretreatment: decision making/consentTreatment technique: planning, simulation and delivery documentationAcute-radiation side effects: kind and degree at weekly basisOn treatment patient education
10Data in Radiotherapy charts-2 Tumor response to treatmentImpact of treatment on quality of lifeRecommendations and compliance with follow-upRecurrence, survival (with or without disease), and date and cause of death.
11Causes of radiotherapy failure-1 Indicators:Low tumor control rate,High side effectsCauses:Failure to deliver the prescribed doseFailure to treat the intended volume of tissue
12Causes of radiotherapy failure-2 Failure to deliver the prescribed dose:Error in dose calculation or distributionWedge filter in wrong orientation or wrong fieldBeam shaping block in wrong orientation or wrong fieldError in measurements of the patient's dimensionsTreatment machine malfunction (output)
13Causes of radiotherapy failure-3 Failure to treat the intended volume of tissue:Errors in determination target volumeErrors in localization of target volumeErrors in repositioning:Field displacement,Patient motion.Role of quality assurance program.
14Successful Radical Course of RT Accurate localization of target volume (TV)Effective patient immobilizationUniformly high dose of radiation to the TV whilst sparing radiosensitive critical structures and normal tissuesOptimum dose/fractionation scheduleAccurate, consistent setting-up and execution of the treatment prescription.