Download Radiation Oncology: The Basics by Adam Maier, DO

Radiation Oncology
The Basics
Adam Maier D.O. , M.B.A
http://clinicalgate.com/basics-of-radiation-therapy-2/Types of Radiation
External Beam (Outside In)
• 3D CONFORMAL
• IMRT
• PROTONS
• ELECTRONS
Brachytherapy
(Inside Out)
http://www.slideshare.net/openmichigan/010709tlawrenceintroradoncologypreclin
It’s a Process
• PLAN
ADULT COLORING BOOKS
http://www.cnn.com/2016/01/06/health/adult-coloring-books-popularity-mental-health/
2.5 mm Slices
Cross-sectional Nodal Atlas: A Tool for
the Definition of Clinical Target Volumes in Three-Dimensional Radiation Therapy Planning. Radiology 1999; 211:815-828
http://logancancer.com/?page_id=41
https://www.researchgate.net/figure/236457344_fig3_Fig-3-Dose-volume-histogram-Optimal-radiation-treatment-plans-balance-tumor-coverage
BREAST UPDTAES
• 16 fraction vs 25 fractions regimen
(plus or minus boost)
• Prone Radiotherapy in selected patients
• Oncotype DCIS
Coming Soon
http://provisionrt.com/prone-breast-radiotherapy/
San Antonio Breast Cancer Symposium 2007
Oncotype DCIS
• RT provides no survival benefit in DCIS
• RT reduces local recurrence by 66% (relative)
• Each woman has her own “risk” of recurrence
• Traditionally based on pathologic factors
– Grade, tumor size, etc
Ohio Health Registry
• Women Age 50 Older
• Low and Intermediate grade DCIS (1-2)
• Adequate Surgical Margins (3 mm)
• Small tumors
• ER/PR positive and willing to take endocrine Tx
Lung SBRT
Stage 1 Lung Cancer
• Multiple Comorbidities
• RT reserved for medically inoperable
candidates
• Historical series patient selection bias
• Why is this important?
Screening
• Low Dose CT Scan
• 55-77 years old
• 30 pack year smoking history
• Current smokers or smoked within 15 years
NLST
Timmerman SBRT
• SBRT 18 Gy x 3 fractions
• Local Control > 90 % at 3 years with SBRT
• 3 year survival of 57 % in T1-T2 patients
• Surgical Series Survival 70%
JAMA 2010
SBRT vs Lobectomy
• Lobectomy IS the current standard of care for
operative candidates with stage 1 NSCLC
• Trials underway comparing SBRT vs lobectomy
• Difficult to accrue patients
STARS AND ROSEL POOLED DATA
•
•
•
•
•
< 4cm
Node Negative
MEDICALLY OPERABLE CANDIDATES
Pooled Date from PROSPECTIVE Phase 3
SBRT vs Lobectomy with Nodal
Dissection/Sampling
• 58 patients (NOT IDEAL)
Roth Lancet Volume 16, No. 6, p630–637, June 2015
SBRT v LOBECTOMY
• 31 SBRT and 27 surgery
• 3 year Overall Survival
– 95% with SBRT (95% CI 85-100)
– 79% with Surgery (95% CI 64-97)
– Not statistically significant
– No grade 4 events with RT
SBRT is very well tolerated
ABSCOPAL EFFECT
• Localized Irradiation of a tumor causes not
only shrinking of the irradiated tumor but also
a shrinking of tumors far from the irradiated
area
ABSCOPAL EFFECT
• HCC patient with lung
mets
• Could not tolerate
sorafenib
• Liver alone was treated
http://www.cureus.com/articles/3216-abscopal-effects-case-report-and-emerging-opportunities
• Presentation of DNA and
Cell Debris
• Apoptosis vs Necrosis
• Fraction Size
• Immune Modulation
• Timing of RT
Palliative Radiotherapy
• 10 vs 5 vs 1 treatment
– Customized to each patient
• Onset of pain relief is identical
• Duration of pain relief similar
• Local control not as good
– Spinal cord, femoral neck lesions, etc
Local Therapy
Local Toxicity
Local Therapy
Radiation Pneumonitis
• Lung and Breast (uncommon)
• 6 weeks to 6 months following completion of
Radiotherapy
• Dry Cough
• Shortness of Breath
• Worse At Night
• Not responding to Antibiotics
• Chest XRAY
Prednisone (often
60 mg/day) for 2
weeks with slow
taper
BREAST TOXICITIES
• Arm Mobility Issues
• Lymphedema
• Pneumonitis
PROSTATE
• Chronic urinary and rectal issues
• Sexual Health
PAIN
• A physician shall not be required to review and assess an
OARRS report when prescribing or personally furnishing an
opioid analgesic, benzodiazepine, or other reported drug
under the following circumstances, unless a physician
believes or has reason to believe that a patient may be
abusing or diverting reported drugs:
• (1) The reported drug is prescribed or personally furnished
to a hospice patient in a hospice care program as those
terms are defined in section 3712.01 of the Revised Code,
or any other patient diagnosed as terminally ill;
• (4) The reported drug is prescribed or personally furnished
for the treatment of cancer or another condition associated
with cancer
The BASICS
• EAT
• DRINK
• SLEEP
• ACTIVITY
• PAIN CONTROL
THANK YOU