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Part 1Introduction to Radiotherapy and External Beam Radiation
Deepak Khuntia, MDVice President, Medical Affairs
Varian Medical Systems
Part 3Internal Radiation:
BrachytherapyJohn Christodouleas, MD, MPH
VP of Medical Affairs and Clinical ResearchElekta, AB
Role of Radiation Therapy in the Management of Cancer
In the US, about 50-60 % of cancer patients receive radiation therapy at some point during their management.
Direct and indirect effects
Photon and charged particles
Photon and charged particles
Radiation Treatments
External
Photon
Proton
Electron
Internal
Brachytherapy
Unsealed Sources
Radiation Work-flow
Consultation Simulation Planning Treatment
1 to 14 days
Simulation
Positioning ImagingImmobilization
– uses CT and MRI-based image sets to
accurately target tumors and avoid sensitive normal tissues
– permits multiple different beam approaches
Treatment Planning: Spares normal tissue while ensuring adequate dose to the tumor
Treatment Delivery
Tools at the machine to verify appropriate patient and target positioning before and during treatment– MV X-ray, U/S, MVCT,
CBCT, KV X-ray, MR, fiducial markers, surface monitoring systems
– Can gate the machine
Radiation and Imaging Workflow
Consultation Simulation Planning Treatment
Adaptive Radiotherapy
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Adaptive Radiotherapy
Consultation Simulation Planning Treatment
Radiosurgery
Sub millimeter accuracyOne to 5 fractionsCones or MLC basedBrain or outside brainFrame or no frame
External Radiation:Photons, electrons, protons
Caterina Brusasco, PhDCompliance Manager
IBA SA
3 Types of Therapeutic Radiation
P
e
Photon Radiation (x-rays, gamma rays)
Electron Radiation
Particle Radiation (Proton)
Ionization DNA Damage
Different forms of radiation interacts with tissue differently
Photon
Electron
Proton and Charged Particles
Pediatric medulloblastoma Ref: Presentation Dr. Jay S. Loeffler, NPTC/MGH, ASTRO 2001
Standard RT:Use mostly open fields with blocks on critical structures
Conformal RT: Block shaping to more precisely match the target
Intensity Modulated RT: Each area may have a different intensity depending on how deep, and if there are critical structures.
Internal Radiation:Brachytherapy
John Christodouleas, MD, MPHVP of Medical Affairs and Clinical
ResearchElekta, AB
Brachytherapy definition
• Placing a radiation source internally, either into or immediately next to the tumor, allowing precise radiation dose delivery1
1. Stewart AJ & Jones B. In Devlin Brachytherapy: Applications and techniques. 2007.
Brachytherapy works ‘from the inside, out’
External Beam Therapy works ‘from the outside, in’
Brachytherapy has a long history
Brachytherapy – history
• Brachytherapy first used to treat lupus and then malignant tumors1,2
1901
• Use of brachytherapy to treat a gynaecologic malignancy first reported3
1903
• Techniques developed to treat prostate cancer4
1917
• New radioactive sources, techniques and equipment, which prevented unnecessary radiation exposure to patients and clinicians led to a renaissance for brachytherapy1
1950s and 1960s
• Brachytherapy is established as a safe and effective standard of care for many gynaecological cancers5
1970s
• Brachytherapy a valued treatment option for many types of cancer, with a wealth of supporting evidence4,5
Present day
1. Gupta VK. J Medical Physics 1995;20(2):31-5. 2. Nag S. American Brachytherapy Society.3. Aronowitz JN, Aronowitz SV Robison RF. Brachyther 2007;6:293-7. 4. Blasko JC, Wallner K, Grimm PD et al. J Urol 1995;154:1096-9. 5. Viani GA, Manta GB, Stefano EJ et al. J Exp Clin Cancer Res 2009;28:47.
Three major brachytherapy methods
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Intracavitary
Interstitial Surface
Brachytherapy Clinical Indications
In some indications, it is an option. In others, it is the standard of care.
Han K et al. Int J Radiat Oncol July 2013
Survival with and without BT boost in localized cervical cancer
Software Systems in Radiation Oncology
Software drives all aspects of the radiation oncology workflow
Consultation Simulation Planning Treatment
Clinical Care SoftwareElectronic medical record systems
(EMRs)
Stores the patient’s medical record
Tools for charting and medical ordering
Radiation Treatment Planning Systems
Identify tumor and normal tissues
Define beam/implant characteristics to reach a safe/effective plan
Radiation Treatment Management System
Pre-treatment verification – Right patient, position, body part, treatment
parameters, etc
Post-treatment record
Software Decision Support Tools
Thank you
