RADTHERA

Nov. 8, 1895- Wilhelm Conrad Roentgen

discovered xrays while experimenting on
cathode ray tube

1900’s- field of radiation therapy began to grow

largely due to the groundbreaking work of Novel
Prize-winning scientist Marie Curie, who
discovered Polonium and Radium. This began
the new era in medical treatment and research.

 January 1896 – Leopold Freund and

Eduard Schiff, suggested they used in the
treatment of disease; also first successful
treatment of lupus vulgaris
 Emil Grubbe treated patient with advanced  RADIATION THERAPY
breast CA.
 February 1896- The first diagnostic x-ray was
taken at Darmouth College.
 1898 – Schiff and Freund did a successful
treatment of lupus erythematosus
 1899 – Thor Stenbeck reported first CA cured
by radiation, a basal cell cancer of the nose
 1890- less skin sparing due to large, single
dose treatment from low energy beam; causes
burns (erythema)
 Otto Walkhoff – Observed the first physiologic
effect of Radium
 1901- Henri Becquerel, had placed a tube of  A practice of exposing a disease to
radium in his pocket, where it had remained for various types of radiation while also trying
several hours; a week or two after which there to protect the unaffected parts of the
was a severe inflammation of his skin patient’s body from radiation exposure.
underneath where the radium had been kept.
 Treatment of a disease particularly
 1906 – Law of Bergonie and Tribondeau malignant tumors or cancer using ionizing
 1911 – Bela Augustin and A. de Szendeffy, radiation
developed and patented dioradin
 1920’s – Regaud and Henri Coutard – General Objectives:
implemented fractionated radiation therapy for  To deliver maximum dose to the tumor
advanced laryngeal carcinoma while giving the minimum dose to the
 1951 – Co-60 units leading to effective skin surrounding normal tissues or cells”
sparing effect
 1950’s – Medical LINACs were used The aims of radiation therapy are:
 1960’s – MV LINACs  Curative – to cure
 Gilbert Fletcher – combined surgery and  Prophylactic – to prevent distant
moderate-dose radiation therapy became the metastases
standard treatment approach of locally  Palliative – to prolong the life of the
advanced head and neck CA patient and provide the best quality of life.
 1980’s – CT Simulators
 Metastases – Transmissions of cells or
group of cells from primary tumor to site/s
elsewhere in the body

4 Specific modes of Treatment:

1. Surgery
2. Radiotheraphy
3. Cytotoxic drugs
4. Hormones treatment

 Cytotoxic drugs- (sometimes known as
antineoplastics) describe a group of
medicines that contain chemicals which are
toxic to cells, preventing their replication or
growth, and so are used to treat cancer. They
can also be used to treat a number of other
disorders such as rheumatoid arthritis and
multiple sclerosis.
 Hormone therapy- is used to treat cancers
that use hormones to grow, such as some
prostate and breast cancers.
Hormone therapy is used for two main reasons.
1. Treat cancer- Hormone therapy can stop or
slow cancer's growth and reduce the chance it
will return.
2. Ease cancer symptoms-Hormone therapy
may be used to reduce or prevent symptoms in
men with prostate cancer who are not able to
have surgery or radiation therapy
Types of hormone therapy
 Hormone therapy falls into two broad
groups, those that block the body’s ability
to produce hormones and those that
interfere with how hormones behave in the
body.
Cancers treated with hormone therapy
 Hormone therapy is used to treat prostate
and breast cancers that use hormones to
grow.
 Hormone therapy is most often used along
with other cancer treatments. The types of
treatment that you need depend on the type of
cancer, if it has spread and how far, if it uses
hormones to grow, and if you have other health
problems
Classifications of Treatment:
1. Radical – (Multiple beam radiation) the attempt,
heroic, if necessary, to remove all malignancy
present
2. Palliative (simple) – if radical treatment is
thought to be impossible, the aim is to relieve
symptoms.
Persons Involved in RadThera:
 ONCOLOGY- study of tumors
 ONCOLOGIST- doctor of med, specializing in
the study of tumors
 RADIATION ONCOLOGY- med specialty
involving the treatment of cancerous lesions
using ion rad
 RADIATION ONCOLOGIST- doctor of med
specializing in the use of ion rad in treatment of
disease and prescribes quantity of radiation
and determines the anatomic regions to be
treated
 Medical physicist -is responsible for
calibration and maintenance of the radiation-
producing equipment.
 The physicist also advises the physician about
dosage calculation and complex treatment
technique.
 Medical dosimetrist - The person
responsible for the calculation of the proper
radiation treatment dose who assist the
radiation oncologist in designing the
individual treatment plans. Devises a plan for
delivering the treatments in a manner to best
meet the physician’s goals of irradiating the
tumor while protecting vital normal structures.
 Radiation therapist -person trained to assist
and take directions from radiation oncologist in
the use of ionizing radiation for the treatment of
disease. Is responsible for obtaining
radiograph that localize the area to be treated,
administering the treatment, keeping the
accurate record of the dose delivered each
day and monitors the patient’s physical and
emotional being.
 Oncology Nurse -Educating patient about
potential radiation side effects and assisting
patients with the management of the side
effects.
Several Variation of Normal Growth:
1. Hypertrophy- of organs as in the heart muscle
when the heart has to work against increased
resistance
2. Metaplasia- replacement of cell type not
normally present in an organ
3. Hyperplasia- cells are more numerous and
more tightly packed, with high incidence of mitosis.
4. Neoplasia- means “swelling” and was originally
used for enlargement due to injury, inflammation
etc.
2 Broad classes of Neoplasms tumors:
1. Benign or simple – benign growths are
universal since they include the common
birthmarks. They are harmless and their growth is
strictly localized
and/or never widespread.
3. Malignant/cancerous – cancers; treatment Divisions of Cancer:
must aim destruction of every cancer cell or the A. Carcinoma – it is the largest and most
abolition of their capacity to reproduce. They have important group of cancers. It is applied to
the power of “invasion”. malignancies arising in surface (epithelial) tissues.
Spread from carcinoma is commonly to regional
Carcinogen- lymph nodes and also via blood, lungs, liver, brain
is a etc.
substance, b. Sarcoma – greek word for “flesh”, after the
organism or fleshy appearance of many tumors. Spread of
agent sarcoma are usually blood-borne to lungs
capable of c. Reticulosis – this system is a widespread group
causing which include the blood forming bone marrow,
cancer. lymph nodes, spleen, and parts of the liver and
Carcinogen thymus
s may occur
naturally in
the
environment  Periodical medical examination- chest film,
(such as blood and urine exams
ultraviolet rays in sunlight and certain viruses) or  Cytological examination- cervial smear(paps
may be generated by humans (such as automobile smear) test, sputum sample
exhaust fumes and cigarette smoke). Most  Radiological examination- chest film, barium
carcinogens work by interacting with a cell’s DNA meal, mammography
to produce mutations.  Highly specialized technique- thermography,
radioactive isotopes, biochemical and
hormonal exams, nuclear medicine diagnostic
test, ultrasound
 Biopsy- exam from sample of the tumor
 Biopsy report- histopathological report

Tumor radiosensitivity:
1. Highly sensitive
a. Reticulosis – (e.g. lymphosarcoma, leukemia,
Hodgkin’s (tumor of lymph
nodes: a malignant form of lymphoma)
b. Medulloblastoma
c. Neuroblastoma – associated with childhood
cancer that occurs in nervous
system; 2nd most common form of CA in children
d. Nephroblastoma
2. Sensitive
a. Basal Cell Carcinoma
b. Epithelial Carcinoma (e.g. skin, cervix, mouth
etc)
c. Carcinoma of the breast, lung, ovary.
3. Poorly sensitive
a. Sarcoma (e.g. Osteosarcoma, Fibrosarcoma)
b. Malignant melanoma
c. Glioma – Brain or spinal cord tumor
d. Carcinoma of rectum, kidneys
A. Surgery- treatment of choice
 Stomach (intestines, colon, rectum, kidneys,
etc
 Wilm’s tumor – in association of radiation of
chemotherapy
 Bone Fibrosarcoma – malignant tumor of
connective tissues
 Melanoma
 Testis – orchidectomy
B. Radiation- treatment of choice
 Mouth – (e.g. lip, tongue, cheek etc)
 Skin - except melanoma
 Uterus – cervix
 Bladder – except stage 1 growths
 Larynx – vocal cords
 Testis
 Medulloblastoma – after surgical
exploration; exploratory laparotomy
 Lymphomas – Hodgkin’s and other
(cytotoxic very often useful to alternative,
especially in late stages and leukemia’s)
C. Cytotoxic drugs- treatment of choice
 Acute Leukemia
 Choriocarcinoma
 Burkitt’s Lymphoma – cancer affecting white
blood cells; associated with a virus spread by
insects
TOPIC 2
Process of External Beam Radiation Therapy
1. Clinical Evaluation
 Initial multi-disciplinary evaluation of px
 Decision for rad thera
 Asssesstment of pathobiology of tumor
 Staging
2. Therapeutic decision making
 Selection of treatment goals/ palliation
 Choice of modalities of treatment
3. Target volume localization
 Definition of tumor extent and potential routes
of spread
 Identification of sensitive critical organs and
tissues
4. Treatment planning
 Selection of treatment technique
 Computation of dise distribution and
verification accuracy
 Determination of dose/time/ volume
relationship
5. Simulation of Treatment
 Selection of immobilization devices
 Radiographic docu of treatment ports
 Measurement of px
 Construction of px contours
 Shaping fields

2 Types of Radiation Therapy

1. External Beam Radiation Therapy (EBRT)
 Teletherapy – radiation source is at far
distance from the body
2. Brachytherapy
 Uses radioactive substances which are applied
directly within or near the tumor

External Beam Radiation Therapy (EBRT)

1.Interstitial brachytherapy- radioactive

substance are implanted in the tumor
2. Intracavitary brachytherapy- radioactive
substance is applied through body cavities by
means of tube such as those patients with 9. Follow-up Evaluation
gynecological CA Evaluation of tumor control
3. Intraluminal brachytherapy- source is applied Assesstment of complications
through tubular organs

PLANNING AND DELIVERY RAD TREATMENT:
1. A patient may be referred for radiation
therapy in a number of ways:
 A primary care physician may refer patient
for treatment
 A surgeon may refer a patient prior or after
surgery
 A patient may be referred for radiation therapy
by chemotherapist who will wish to
use chemotherapy in connection with radiation
therapy
2. The radiation therapy unit itself may be
situated in a variety of settings
 A radiation therapy unit may be found in an
office or clinic
 The unit itself may be found at any location in
the building
 Radiation Therapy unit is more often found in
the lower levels of the building more often in
the basement
a. The reason for locating the unit here is the
amount of shielding required for
the use of these units
b. Walls for Cobalt are usually 1mm thick
Probability of Radiation Therapy:
A. Cure
B. Symptotic relief
 The patient may be debilitated as a result
of previous interventions, and radiation
therapy may be considered in light of the
patients physical condition.
 If it is determined that radiation therapy is
unsuitable, the patient may be returned
to his primary care physician or referred to
another specialty treatment.
 During the course of initial evaluation, the
radiation oncologist may based on the
patients disease, outline on the patient either
the real of potential treatment portal.
 If the disease itself to simple evaluation,
the patient would go directly from
evaluation to the treatment unit
 if it decided that further evaluation is
needed, the radiation oncologist may give
a rough outline of the treatment field and
decide on the final treatment field based on
the result of simulation or treatment plan
WAYS OF OUTLINING TREATMENT
PORTAL:
 Use of indelible dyes
 Use of dyes visible under black light
 Use of tattoos
The use of this marks is necessary so that the
radiologist can accurate reproduce
the treatment of geometry
The Use of tattoos at the completion of
treatment is a method of permanently
recording the treatment field if there is a question
at some future date.
TREATMENT PLANNING:
 Before or during simulation of external
radiation therapy treatment, a decision may
have been made by the radiation oncologist in
conjunction with the physicist to prepare a
treatment plan for the patient.
 During simulation, the physicist or some other
member of the support team will make a
measurement of the contours of the patient’s
body
 The contour may be taken by a simple method
such as the placing of a piece of wire solder
on the surface of the body or by more
sophisticated control devices
 The radiation oncologist will draw into the
contour projections of the target volume that
is to be treated
 In calculating the treatment plan, the physicist
must have an accurate idea is possible of
internal anatomy surrounding the tumor
volume.

TOPIC 1
ElectroMagnetic Spectrum

2 Types of General Radiation

Critical organs:
 Kidney
 Spinal cord
 Lens of eyes

Electromagnetic Spectrum - distribution of

electromagnetic radiation according to energy.

LONGER WAVELENGHT
1. Radiofrequency – ranging from the long waves
through the broad cast band to short waves and
ultra short waves in radar
 used for transmissions of data, via modulation.
Television, mobile phones, wireless networking and
amateur radio all use radio waves
2. INFRARED LIGHT - these are produced by
molecular vibration and the excitation of the outer
electrons of the atom. Its heating effect utilized in
Physical therapy.
3. Visible Light – ranging from red, orange, yellow,
green and blue to violet
 transmitted by materials such as glass and
steel
 can be used in surgery as LASER
4. Ultraviolet – produced by the excitation of our
electrons in
 an atom it is higher that the frequency of
ultraviolet coming from the SUN. It is induced
the human body tp produced Vit. D

SHORTER WAVELENGTH:

RADIATION INTERACTION WITH MATTER: