Introduction to Radiation Therapy

What is radiotherapy? Equipment used in RT?

1. TOPIC 1 Introduction of Radiotherapy

2. Introduction 01 Principle of Radiotherapy 02 Types of Radiotherapy 03 Radiotherapy Equipment’s & Technique 04 Risk & Side Effect 05 Table of contents 2 Ref X-Ray Exp /

3. Introduction 01 3 Ref X-Ray Exp /

4. Radiation therapy? Radiotherapy? Radiation oncology? 4 Ref X-Ray Exp /

5. RADIATION THERAPY RADIATION PHYSICS Focused on the details of how, where, and how much energy can be deposited in diseased tissue in the hopes of eradicating it, while simultaneously minimizing the energy released in healthy tissue. This process requires an understanding of the nature of the radiation and the matter through which it passes and how that matter is changed as a result of the energy deposition events. RADIOBIOLOGY the radiation response of cells at the molecular level 01 02

6. Introduction 7 Ref X-Ray Exp / * Use of ionizing radiation as part of cancer treatment to control malignant cells * Radiation therapy works by damaging the DNA within cancer cells and destroying their ability to reproduce * When the damaged cancer cells are destroyed by radiation, the body naturally eliminates them. * Normal cells can be affected by radiation, but they are able to repair themselves

7. Very advanced tumors Probability of cure is very small or negligible Alleviate pain by reducing the size of a tumor E.g. bone metastasis TO CURE CANCER (Curative / adjuvant / therapeutic treatment) TO REDUCE SYMPTOMS (Palliative) Therapy has survival benefit, and it can be curative Destroy tumors that have not spread to other body parts Reduce the risk that cancer will return after surgery or chemotherapy Curative - curing a cancer, often with combination with chemotherapy (e.g. Head and Neck, cervical cancer) Adjuvant - in addition to curative surgery to reduce the risk of local recurrence (e.g. Breast cancer) 8 Radiation therapy is used two different ways: (depend on tumor type, location, stage and general health of patient) Ref X-Ray Exp /

8. Approximately 45 % are cured 22% – surgery independently or in combination 18% – radiation therapy independently or as a leading method 5% – chemotherapy independently or, more often, it is combined with surgery and radiation therapy 9 Ref X-Ray Exp /

9. Principle of Radiotherapy 02 10 Ref X-Ray Exp /

10. Radiotherapy GOAL 11 1. Delivering of an optimal dose to the tumor 2. Minimal damage of surrounding organs & tissues. Ref X-Ray Exp /

11. Type of Radiation 12 Ref X-Ray Exp / Directly ionizing radiation Electron Proton Alpha Indirectly ionizing radiation X-ray Gamma ray Neutron

12. Sources of radiation used in RT 13 Ref X-Ray Exp / Linear accelerator (Bremsstrahlung -production) High energy x-rays X – rays (Low energy) Conventional X-ray tube & Bremsstrahlung production Gamma rays From Radioactive Isotopes (Radioactivity) High energy Electrons Linear Accelerator Thermionic emission and acceleration. all

13. Types of Radiotherapy 03 14 Ref X-Ray Exp /

14. Types Of Radiation Therapy External beam radiotherapy (EBRT/ XBRT) @ teletherapy - outside the body Brachytherapy sealed radioactive sources placed precisely in the area under treatment Nuclear Medicine infusion or oral ingestion of unsealed radioactive source 15 Ref X-Ray Exp /

15. EXTERNAL-BEAM RADIATION THERAPY 3D CONFORMAL RADIATION THERAPY (3D-CRT) Detailed 3-dimensional pictures of the cancer are created, typically from CT. This allows the treatment team to aim the radiation therapy more precisely. INTENSITY MODULATED RADIATION THERAPY (IMRT) the intensity of the radiation is varied within each field unlike 3D-CRT. IMRT targets the tumor and avoids healthy tissue better than conventional 3D-CRT. PROTON BEAM THERAPY The protons go to the targeted tumor and deposit the specific dose of radiation therapy. Unlike with x-ray beams, there is very little radiation dose beyond the tumor. This limits damage to nearby healthy tissue. IMAGE-GUIDED RADIATION THERAPY (IGRT) This refers to the practice of using daily images of each treatment field to confirm patient positioning and make sure the target is in the field. This allows better targeting of the tumor and helps reduce damage to healthy tissue. 01 02 03 04

16. EXTERNAL-BEAM RADIATION THERAPY STEREOTACTIC RADIATION THERAPY (SRT) This treatment delivers a large, precise radiation therapy dose to a small tumor area. Head frames help limit movement. INTENSITY MODULATED RADIATION THERAPY (IMRT) Tomotherapy combines IMRT with the precision of CT scanning technology where it is capable of capturing images in 3-D and allows to verify patient’s setup position and to ensure high precision of radiation doses delivered to the tumour . Tomotherapy’s groundbreaking technology allows a single radiation beam to be divided into thousands of tiny, narrow beamlets that deliver radiation from all angles, in a pattern planned by Clinical Oncologists and Medical Physicists, coordinated by computers 06 05

17. —SOMEONE FAMOUS “This is a quote. Words full of wisdom that someone important said and can make the reader get inspired” 18 Ref X-Ray Exp /

18. —SOMEONE FAMOUS “This is a quote. Words full of wisdom that someone important said and can make the reader get inspired” 19 Ref X-Ray Exp /

19. INTERNAL RADIATION THERAPY PERMANENT IMPLANTS These are tiny steel seeds that contain radioactive material. The capsules are about the size of a grain of rice. They deliver most of the radiation therapy around the implant area. But some radiation may exit the patient’s body. This requires safety measures to protect others from radiation exposure. Over time, the implants lose radioactivity. And the inactive seeds remain in the body. TEMPORARY INTERNAL RADIATION THERAPY This is when radiation therapy is given in one of these ways: Needles, catheters, applicators.The radiation stays in the body for anywhere from a few minutes to a few days. Most people receive radiation therapy for just a few minutes. Sometimes, people receive internal radiation therapy for more time. If so, they stay in a private room to limit other people's exposure to the radiation. 01 02 Internal radiation therapy is also called brachytherapy. This type of radiation therapy is when radioactive material is placed into the cancer or surrounding tissue. Implants may be permanent or temporary and may require a hospital stay.

20. OTHER RADIATION THERAPY INTRAOPERATIVE RADIATION THERAPY (IORT) Delivers radiation therapy to the tumor during surgery using either external-beam or internal radiation therapy. IORT allows surgeons to move away healthy tissue in advance. SYSTEMIC RADIATION THERAPY Patients swallow or receive an injection of radioactive material that targets cancer cells. The radioactive material leaves the body through saliva, sweat, and urine. RADIOIMMUNOTHERAPY This is a type of systemic therapy. It uses monoclonal antibodies, which are proteins that are attracted to very specific markers on the outside of cancer cells, to deliver radiation directly to the tumors. RADIOSENSITIZERS AND RADIOPROTECTORS Radiosensitizers are substances that help radiation therapy better destroy tumors. Radioprotectors are substances that protect healthy tissues near the treatment area 01 02 03 04

21. External Radiation Therapy Equipment's & Technique 04 22 Ref X-Ray Exp /

22. Radiation Therapy Equipment's PARTICLE BEAM -Protons -Carbon -Neutrons GAMMA – RAYS Cobalt-60 Unit Treatment type: Gamma Knife X-RAYS Linear Accelerator Treatment type: -3DCRT -SRS/SRT -IMRT -IGRT -Rapid Arc Tomotherapy Treatment type: Cyber Knife

23. γ – Rays Cobalt Unit RADIOSURGERY “GAMMA KNIFE” 24 Ref X-Ray Exp /

24. X – Rays LINAC X-rays Single energy 4 or 6MV X-rays Dual energy 6 and 15 or 18 MV (low and high energy) Electrons 4 MeV to 21 MeV - variable 26 Ref X-Ray Exp /

25. X – Rays LINAC + MLC 27 Ref X-Ray Exp /

26. X – Rays LINAC + CBCT ( image guided ) 28 Ref X-Ray Exp /

27. 29 Ref X-Ray Exp /

28. 30 Ref X-Ray Exp / IMRT VMAT

29. X – Rays TOMOTHERAPY 31 Ref X-Ray Exp /

30. 32 Ref X-Ray Exp /

31. X – Rays CYBERKNIFE RADIOSURGERY 33 Ref X-Ray Exp /

32. X – Rays RESPIRATORY GATING 35 Ref X-Ray Exp /

33. Risk 05 37 Ref X-Ray Exp /

34. 38 Risk Ref X-Ray Exp / Usually, temporary side effects, such as fatigue Radiotherapy can damage or destroy normal cells as well as destroying cancer cells and cause treatment side effects There may be a small risk of long term, or late, permanent effects from radiotherapy Specific side effects within the area being treated may include reddening and itching of the skin 01 02 03 04

35. Thanks! Do you have any questions? 39 Ref X-Ray Exp / Please keep this slide for attribution