Principles of Therapeutic Radiation &

Related Systemic Therapy

Jagadesan.P MD,DNB,ECMO
Associate Professor, Radiation Oncology, RCC JIPMER, India
 What is Therapeutic Radiation?
 Radiation is nothing but propagating energy
 Therapeutic Radiation includes those that can ionize the tissues.
• Particulate radiation like Protons, Heavy ions, Electrons
• Wave-like radiation like X-rays, γ-rays
 Types of therapeutic radiation
• Waves
• X-rays

• Particles
• Heavy (Atom stripped of its entire electron cloud leaving only +ve nucleus)
• Protons (Hydrogen nucleus)
• Carbon ions
• Light
• Electrons
Treatment Machines
Machines with focussed utility
HDR – Brachytherapy machines

Intraluminal Catheter
RADIATION TREATMENT PLANNING
 Biological changes
from damage caused by IR-induced free radicals
Tissue penetration
 Indications of Therapeutic Radiation
Definitive/ Radical (45Grays + Boost10-15Gy)
• Equivalent outcomes with added benefit of organ
conservation
• Anal cancer, Laryngeal/Hypopharyngeal cancer,
cervix/vagina/vulva cancer.
• Inoperable and Unresectability
• Nasopharynx cancer, Parameningeal & Pelvic
Rhabdomyosarcoma, Pancreatic cancer (RP extension)
• Sites with high perioperative morbidity / mortality
• Upper Esophagus, Oropharyngeal cancer, Lung cancer
 Indications of Therapeutic Radiation…
• Adjuvant (45-50Gy)
• Stomach, Periampullary, Gall Bladder
• HN, Endometrial cancer
• Brain tumors
• Soft tissue Sarcomas
• Neoadjuvant (41.4Gy to 50.4Gy)
• Mid/Lower Esophagus, Rectum, Sarcomas
• Hemostatic (acts in 24-48 hours)
• Palliative – to reduce dysphagia, discharge, bleeding
 Principles of Neoadjuvant radiation
• Better oxygenated tissues: so better oxygen-dependent radiation
killing of tumor cells
• Lower toxicities
• Improved resectability rates (R0)
• Increased stoma-free survival, Eg: Rectal cancer
 Radiation-related Toxicities
• Temporary (Surface
inflammation)
• Dermatitis
• Mucositis
• Permanent (Interstitial
inflammation)
• S/c Fibrosis
• Lung fibrosis
• Chronic proctitis/ cystitis
• Esophageal fibrosis-
stricture
 Systemic therapy related to Radiation
• Chemotherapy drugs
• Concurrent
• Neoadjuvant
• Adjuvant
• Palliative
• Hormones – Breast, Prostate
• Molecular therapy – MAbs, TKIs
 Principles of concurrent chemotherapy
• Increases the sensitivity of tumor cells to killing effects of therapeutic
radiation
• Synergistic combination of local + systemic cell killing
• Less cumulative toxicities –Local radiation toxicity and systemic drug
toxicities
• 5-Fluorouracil, Capecitabine
• Oxaliplatin, Cisplatin, Carboplatin
• Paclitaxel, Docetaxel
• Mitomycin
THANK YOU