DEOEC Institute of Oncology Department of Radiotherapy
Radiology: diagnosis Radiotherapy: part of active oncotherapy (oncoradiology, radiation oncology) Oncology:chemotherapy
The branch of clinical medicine which uses ionising radiation, either alone or in combinations with other modalities, for the treatment of patients with cancer (or benign diseases). It includes responsibility for the treatment, follow up and supportive care of the patient as an integral of the multidisciplinary management of patients.
external beam radiation is delivered from outside the body by using a machine to aim high-energy rays (x-rays, gamma rays or photons). TELETHERAPY internal radiation is delivered from inside the body by placing radioactive material, sealed in catheters or seeds, directly into the tumor. BRACHYTERAPY
1. „Direct hit” 2. „Activated water”
1. „Direct hit” 2. Activated water O2 is necessary H 2 O H + OH - e - H 2 H 2 O 2 H 2 O oxidation reduction
1. Lethal damage 2. Sublethal damage a) loss of reproductibility apoptosis b) Repair c) Reoxigenistaion d) Repopulation e) Redistribution
1. Lethal damage 2. Sublethal damage a) loss of reproductibility apoptosis b) Repair c) Reoxigenistaion d) Repopulation e) Redistribution
1. Lethal damage 2. Sublethal damage a) loss of reproductibility apoptosis b) Repair c) Reoxigenistaion d) Repopulation e) Redistribution EXCISIONS REPAIR Endonucleaz Exonucleaz ↓ Polymeraz Liaz MISMATCH REPAIR
1. Lethal damage 2. Sublethal damage a) loss of reproductibility apoptosis b) Repair c) Reoxigenistaion d) Repopulation e) Redistribution
1. Lethal damage 2. Sublethal damage a) loss of reproductibility apoptosis b) Repair c) Reoxigenistaion d) Repopulation e) Redistribution
1. Isotopes isotope halfing time energy (MeV) Ra y 0,830 Co-60 5,26 y 1,250 Ir ,2 d 0,380 J ,2 d 0,028
2. Cobalt unit Gamma-ray (photons) Co60→ gamma-photons
3. Linear accelerator Photons and electrons
Precisely locate the target Hold the target fixed Accurately aim the radiation beam Shape the radiation beam to the target Deliver a radiation dose that damages abnormal cells yet spares normal cells
Topometric-CT No contrast media Image fusions
GTV: gross tumor volume macroscopic tumor or tumor bed CTV: clinical target volume: GTV+1-2 cm safety margin –microscopic tumor spreading- PTV: planning target volume: CTV+0,5-1 cm movements of organs or breathing
Postop. Cervical cancer
3D –Target Volumes
MLC (multileaf collimator system)
TELETHERAPY: Fixed beam irradiation : direct field opposed fields 4 or more fields TELETHERAPY: Fixed beam irradiation : direct field opposed fields 4 or more fields
BRACHYTHERAPY: Intracavital Intersticial BRACHYTHERAPY: Intracavital Intersticial
EX. 1
EX.2
EX. 3
EX. 4
EX.5
Positioning, immobilisation devices Thermoplastic masks
Breast-boards
Conventional dose: 1,8-2 Gy/day, 5 day/week 2-7 week Tumor killing doses: Gy - hystology, tumor type - TNM stage, KPS, ECOG - indications (neoadjuvant, adjuvant, definitive, palliative) - combinations (RKT) Conventional dose: 1,8-2 Gy/day, 5 day/week 2-7 week Tumor killing doses: Gy - hystology, tumor type - TNM stage, KPS, ECOG - indications (neoadjuvant, adjuvant, definitive, palliative) - combinations (RKT)
Tolarance of normal tissues (risk organs) DVH: Dose-volume histograms
1. Simulation, positioning 2. Topometric CT 3. Treatment plan 4. Resimulation 5. Verification 6. Treatment
1. Simulation, positioning 2. Topometric CT 3. Treatment plan 4. Resimulation 5. Verification 6. Treatment
1. Simulation, positioning 2. Topometric CT/MR 3. Treatment plan 4. Resimulation 5. Verification 6. Treatment
1. Simulation, positioning 2. Topometric CT/MR 3. Treatment plan 4. Resimulation 5. Verification 6. Treatment Pictor 3D laser system Isocenter Virtual point
1. Simulation, positioning 2. Topometric CT/MR 3. Treatment plan 4. Resimulation 5. Verification 6. Treatment
RESULTS: 1. LTC : CR (4 mts)PR (-25-50%) NCPD 2.Survival: Overal, Disease free, TTP SIDE EFFECTS : early late local inflammation fibrosis general weakness disfunction