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PATHARAKRIT TEEWASUTRAKUL(DVM ) ONCOLOGY CLINICS SMALL ANIMAL HOSPITAL CHULALONGKORN UNIVERSITY Radiation Therapy.

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Presentation on theme: "PATHARAKRIT TEEWASUTRAKUL(DVM ) ONCOLOGY CLINICS SMALL ANIMAL HOSPITAL CHULALONGKORN UNIVERSITY Radiation Therapy."— Presentation transcript:

1 PATHARAKRIT TEEWASUTRAKUL(DVM ) ONCOLOGY CLINICS SMALL ANIMAL HOSPITAL CHULALONGKORN UNIVERSITY Radiation Therapy

2 Introduction to Radiation Therapy History 1895 Wilhelm Conrad Röntgen -Diagnosis &Therapeutic purposes 1902 Radiation induced cancer was reported 1903 suggestion to treat cancer w implanting radium 1930 Initial clinical use of radiation dose fractionation 1972 Computed Tomography and Radiation therapy D setting w tumor hypoxia and the tumor environment 1994 Am College of Veterinary Radiology Currently about 70 board-certified veterinary radiation oncologists -Residency programs in USA -Veterinary Technicians ( Barbara Kaser- Hotz.,36thWSAVA 2011) (Elizabeth McNiel.,29th Annual conference of the VCS 2009)

3 What is the Radiation Therapy รังสีที่ใช้รักษาได้แก่ รังสีเอกซ์ รังสีแกมมา นิวตรอน และพวกอนุภาคต่างๆ ส่วนใหญ่แล้วมักนิยม ใช้รังสี แกมมาจากเครื่องโคบอลต์ - 60 รังสีเอกซ์พลังงานสูง จากเครื่องเร่งอนุภาค และนิยมใช้อนุภาคอิเล็กตรอน รักษาบริเวณพื้นผิวตื้น ๆ การเลือกชนิดและพลังงาน ของรังสีรักษา ต้องพิจารณาลักษณะรูปร่าง ตลอดจนตำแหน่งที่ตั้งของก้อนมะเร็ง

4 Types of radiation 1. Electromagnetic Radiation  1.1 รังสีเอกซ์ (x-rays) source : high energy x-ray equipments  1.2 รังสีแกมมา (gamma-rays) :radioactive isotopes nucleus 2. Particle Radiation:Linear Accelerator  2.1 อนุภาคอิเล็กตรอน (Electrons)  2.2 อนุภาคอื่น ๆ เช่น โปรตรอน (Photons)

5 How does radiation kill cells?

6 Relative radiosensitivity of common animal tumours responseType of tumors High Lymphoproliferative disorders Myeloproliferative disorders Transmissible venereal tumour Mast cell tumours (variable) Sensitive Squamous cell carcinoma Basal cell carcinoma Adenocarcinoma (various ) ModerateOral melanoma low Fibrosarcoma Osteosarcoma Chondrosarcoma Haemangiopericytoma Radiation therapy and Biological response of tumor and normal tissue Relative radiosensitivity of normal animal tissue

7 How radiation dose is measured? The Absorbed dose :Gray(Gy)= SI unit 1Gray(Gy)=1joule(j) of energy absorbed by 1 kg tissue 1Gray(Gy)=100 Rad 1Rad =100ergs/g 1 Fraction =Individual radiation treatment dose Total dose= Fraction X Time of RT treatment.

8 Principles of Radiation Oncology The concept of therapeutic ratio for radiation therapy

9 Principles of Radiation Oncology The concept of therapeutic ratio for radiation therapy IdealXO Radiosensitive tumorLimited sensitive tumorRadioresistant tumor

10 Details Treatment procedure 1.Total dose (Gy) 2.Fraction size (Gy) 3.Duration of Tx. Fractionation

11 Fractionation effect Radiation dose (Gy) Cumulation Dose (Gy) Cells presentFraction killed Cell s Remaining X1X1,000,000,00010%100,000,000 X2X100,000,00010%10,000,000 X3X10,000,00010%1,000,000 X4X1,000,00010%100,000 X5X100,00010%10,000 Exponential tumor cell killing by radiation

12 4R’s radiobiology 1.Repair 2.Repopulation 3.Redistribution 4.Reoxygenation Fraction ation and Tumor biology

13 Radiation therapy Types of Radiation Therapy 1. Teletherapy or External beam therapy 2. Plesiotherapy or Brachytherapy 3. Unsealed source therapy or Nuclear medicine

14 Model Linac Linear Accelerator (4-20MeV) Linear Accelerator (4-20MeV) 1.Teletherapy or External beam therapy

15 Stand Mask Different types of animal immobilization

16 Tooth block Cat and tooth block Different type of animal immobilization

17 Position of dog during RT Dog and tooth block Different type of animal immobilization

18 Animal immobilization Different types of animal immobilization Vacuum bag

19 1.Measures of tumor volume CT scan Equipment  CT or MRI  X-rays Radiotherapy treatment planning

20 CT &MRI Radiotherapy treatment planning

21 Hand &Computer planning

22 Radiotherapy treatment planning 3D Virtual SimulationComputer planning

23 Radiotherapy treatment planning 3D Virtual simulationComputer planning

24 Multileaf collimator Other devices Radiation therapy:Beam control

25 Virtual Simulation : multiple fields RT

26 Radiotherapy treatment planning

27 Monitoring RT procedure

28 Dog and oronasal mass: canine oral melanoma Radiation Therapy multiple fields RT

29 Cat : CT scan for RT preparation Cat with nasal lymphoma Radiation therapy

30 Common tumours amenable to radiation therapy

31 Iridium-192 Strontium Plesiotherapy or Brachytherapy

32 Iodine Unsealed source therapy or Nuclear medicine

33 Acute side effects Delay side effects Common radiation therapy side effects

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35 Acute moist desquamation Delay effect :Depigmentation Common radiation therapy side effects

36 1.Radiation therapy alone Radiation Therapy in Veterinary Medicine Curative Treatment  Local and small tumor size  Almost radiosensitive tumor types Palliative Treatment  Reduce cancer pain  Destroy cutaneous metastasis tumor  Slowly tumor growth rate

37 1. Combined Radiation and Surgery 2.Combined Radiation and Systemic therapy Preoperative irradiation Intraoperative irradiation Postoperative irradiation Chemotherapy: Synergistically improve Doxorubicin Carboplatin Gemcitabine Paclitaxel are all shown to improve the effects of radiation  Adjuvant chemotherapy  Neoadjuvant Chemotherapy Immunotherapy  Melanoma vaccine Combined Radiation with Other modalities

38 Weak point Radiation Therapy in Veterinary Medicine

39 IMRT : Intensity modulated RT Rapid Arc : 4D RT Future Direction of Radiation Therapy

40 CLINICAL APPLICATION Radiation Therapy in Veterinary Medicine

41 Dog and oronasal mass: canine oral melanoma Radiation Therapy multiple fields RT

42 Cat : CT scan for RT preparation Cat with nasal lymphoma Radiation therapy

43 Use of strontium-90 plesiotherapy for the treatment of a lingual plasmacytoma in a dog. K. Ware and T. Gieger etal. Journal of Small Animal Practice (2011) 52, 220–223 1.Plasmacytoma 2.cytology 3.Therapeutic Planing 5.Post RT 4.RT 150Gy

44 Prognostic significance of specific magnetic resonance imaging features in canine nasal tumours treated by radiotherapy. P. AGTHE*, A. R. CAINE, R. N. A. GEAR et al., Journal of Small Animal Practice (2009) 50, 641–648

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47 Intensity-Modulated and Image-Guided Radiation Therapy for Treatment of Genitourinary Carcinomas in Dogs M.W. Nolan, L. Kogan, L.R. Gri ffi n, et al. J Vet Intern Med 2012;26:987–995 UB target

48 Intensity-Modulated and Image-Guided Radiation Therapy for Treatment of Genitourinary Carcinomas in Dogs M.W. Nolan, L. Kogan, L.R. Gri ffi n, et al. J Vet Intern Med 2012;26:987–995 Colon UB

49 Intensity-Modulated and Image-Guided Radiation Therapy for Treatment of Genitourinary Carcinomas in Dogs M.W. Nolan, L. Kogan, L.R. Gri ffi n, et al. J Vet Intern Med 2012;26:987–995

50 Questions


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