MON 2011 - Slide 6 - S. Faithfull - New developments in radiotherapy: Overview and management
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MON 2011 - Slide 6 - S. Faithfull - New developments in radiotherapy: Overview and management
- 1. New developments in radiotherapy: Overview and management Prof Sara Faithfull, Faculty of Health and Medical Sciences
- 5. Changing paradigm of radiotherapy treatment T0 Additional biological assaults Treatment Direct and indirect physical and chemical effects Acute reactions Late reactions T90 17 months -10 years Follow up
- 6. The Important Role of the Nurse Assessment & side effect management Surveillance monitoring Organisational Treatment Direct and indirect physical and chemical effects Acute reactions Late reactions T90 17 months -10 years Follow up Patient education End of treatment planning Late effects management
- 11. Complexity of radiation reactions Author Genes N Endpoint Toxicity association Langsenlehner 2008 VEGFA 99 Late GU & GI morbidity Toxicity significantly associated Meyer 2008 TGFB1 445 Late sex and GU morbidity No associations Moore 2007 ATM, TGFB1, SOD2,.. 144 Late sex dysfunction No associations Peters 2005 TGFB1 141 GU & QOL changes Minor allele variants Rosenstein 2007 ATM 98 Late sex dysfunction Significant associations Suga 2008 118/ genes/450 SNPs 197 Late GU morbidity No associations detected Andreassen CN, (2010) Radio & Oncol 97 (1-8)
- 18. Intensity-modulated radiotherapy Standard RT field Conformal field IMRT Fiel d
- 19. Intensity-Modulated Radiotherapy – IMRT IMRT Field
- 20. Avoidance of normal tissues
- 22. Protons
Hinweis der Redaktion
- The main challenge to radiation oncology is to adapt to a rapidly changing environment
- Methods to improve the effectiveness of radiotherapy may produce dramatic increases in local control attempts to both improve both physical and biological damage to reduce normal tissue toxicity but also tumour damage. This may also be used to increase total dosage and hence cure as well as reducing normal tissue toxicity. The realisation of the multifaceted genetically dipsosition of the growth of tumours. Radiotherapy failure is not linked to the metastasising properties of the cancer but inherent characteristics of the individual.
- Predicting how tumours will respond to radiotherapy may identify anticipated causes of treatment failure. By being able to identify and individuals susceptibility treatment modifications can be made on an individual basis to overcome these. There are 6 major biological properties of tumours that affect response. Size of tumour important-relative radio resistance. 2. Recovery varies. Degree of recovery related to the repair capacity of the cells. Important in sparing normal tissue-potential cause of treatment failure if cancer grows in between treatments. Redistribution- time for cells to move into different phases of the cell cycle. Failure of cells to redistribute Reoxygenation-hypoxia important-key reason for tretament failure Repopulation growing cells Radiosensitivity-inherent resistance
- Predicting tumour radiosensitvity. One of the most important advances was the description of the correlation of the radiosensitivity of particular cell lines and the clinical response of the tumour. Range of sensitvities for different tumour lines. If invitro intrinsic radiosensitivity is found to predict for individual response to radiation, assays will be required to measure such radiosensitivity from tumour biopsies prior to strat of tretament. Clonogenic assays measure the regenerative capacity of tumour cells and are used in the definition of cellular response to radiation. This has been technically very difficult. Need a more radpid result. DNA damage assays. If tumour is found to be sensitive, the total dose is unlikely to be reduced. If resistant then the therapeutic options are difficult.
- IMRT is a new radiotherapy technique able to treat complex volumes and to specifically reduce the irradiation of sensitive normal structures. CLICK This patient has prostate cancer with a high risk of nodal metastases, but the radiation dose that can be delivered to those nodes is limited to 50 Gy by presence of small bowel, as can be seen. CLICK,CLICK, CLICK Standard radiotherapy would involve irradiating the larger volume to 50 Gy, and boosting the prostate to a further 20 Gy. CLICK IMRT is able to deliver a variable dose per fraction, and this can be used for selective normal tissue avoidance – in this case bowel, or to deliver a higher dose to part of the tumour, in this case we have treated the prostate to a higher dose than the pelvic nodes.