The document discusses cancer of the colon and rectum, including treatment options and side effects of treatment. It describes how rectal cancer is staged based on depth of penetration and lymph node involvement. Radiation therapy can help expand the surgical resection volume for some rectal cancers. The document includes images and descriptions of male and female pelvic anatomy, as well as CT, PET, and portal images related to imaging and radiation treatment planning for rectal cancer. It discusses techniques to minimize side effects of pelvic radiation and palliative uses of radiation for recurrent or metastatic disease.
6. Rectal cancers can be resected as Stage II A/B (purple) with N1 nodes but are less favorable and borderline resectable stage IIIC (red) as N2 nodes (>4) are found, stage IV are (black) metastatic. Stage 0, yellow; I, green; II, blue; III, purple; IV, red; and IV (metastatic), black. Definitions of TN on left and stage grouping on right .
33. Side Effects of Pelvic Radiation Radiation fields Radiation may hit the small bowel causing some cramps, diarrhea and fatigue
34. Side Effects of Pelvic Radiation Radiation fields Radiation may hit the bladder and rectum causing urinary burning or frequency and rectal irritation
35. Techniques to minimize radiation side effects (hitting the small bowel) using the “belly board”
39. Recurrent Mass surrounded by loops of normal bowel , so technically difficult to treat with conventional radiation cancer bowel bowel
40. Combine a CT scan and linear accelerator to ultimate in targeting (IGRT) and ultimate in delivery (dynamic, helical IMRT) ability to daily adjust the beam (ART or adaptive radiotherapy)
41. Using image guided IMRT can better target the cancer and limit the dose to normal structures Radiation dose cloud Radiation dose cloud
45. A phase I/II dose-escalation trial of Cyberknife radiation for control of primary or metastatic liver disease Early toxicity has been mild with 3 patients (13%) experiencing grade 2 or greater toxicity. In the 21 patients with >3 month follow-up, 3 (14%) have experienced a late toxicity. There have been 6 local recurrences. The lesion local recurrence rate is 17% and the patient local recurrence rate is 25%. Mean time to recurrence was 8.4 months. Conclusion: Cyberknife radiation can be delivered safely in doses up to 30 Gy in a single fraction. Accrual of long-term local control and toxicity data is ongoing.
46. Brain Mets and Radiation conventional whole brain radiation or radiosurgery (Cyberknife or Gamma knife)