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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