ABCs of Radiation Therapy for Patients, Family and Friends
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A presentation on radiation therapy by David Kozono, MD, PhD.
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ABCs of Radiation Therapy for Patients, Family and Friends
- 1. ABCs of Radiation Therapy for Patients, Family and Friends David Kozono, MD, PhD
- 2. What is radiation therapy? • For lung cancer, radiation therapy is most often X-rays given externally using multiple beams that converge on the part of the body with tumor. • X-rays cannot be felt, seen, heard or otherwise perceived during treatment.
- 3. How is radiation given? • Using a linear accelerator (linac) source of radiation robotic table
- 4. • Patient positioning using tattoos How is radiation aimed? http://www.rtanswers.org
- 5. • Patient positioning using tattoos How is radiation aimed? http://xkcd.com/933/
- 6. How is radiation aimed? • Imaging to assure treatment accuracy and precision X-rays for daily verification of positioning CT for weekly confirmation of target localization
- 7. How is radiation aimed? Positioning X-rays CT: Plan CT: Week 5
- 8. Lung cancer infiltrates “normal” tissues Cancer Emphysematous Lung 3 cm Cancer GTV CTV PTV GTV = gross tumor volume; CTV = clinical target volume PTV = planning target volume
- 11. The challenge unavoidable overlap of target volume and esophagus
- 12. Radiation beams
- 13. Radiation dose
- 14. Expected side effects skin reddening very rare risk of spinal cord injury pain with swallowing lung inflammation
- 15. Why are there so many treatments? • A course is anywhere from a single treatment for symptom relief, up to seven weeks of daily treatment Monday–Friday for cure • Fractionation – Dividing radiation dose into multiple sessions – Spares healthy tissues more than tumors
- 16. Why are there so many treatments? Cancer cells Little sparing with fractionation Long-term side effects Significant sparing with fractionation 1 x 2 Gy 1 x 4 Gy 0 2 4 86 1210 Fractionated 1 x 2 Gy 1 x 4 Gy Fractionated 6 x 2 Gy 3 x 4 Gy 6 x 2 Gy 3 x 4 Gy Dose (Gy) Survivalfraction(log)
- 17. Common questions and answers • Am I radioactive after treatment (safe around young children)? – For about 0.000000000000000001 seconds – So, no…perfectly safe
- 18. Common questions and answers • Can you tell if the tumor is shrinking? – The daily X-rays ± weekly CT scans are mostly to verify positioning and tumor targeting. – Tumors continue to shrink for weeks after the final treatment. – We therefore typically perform scans about two months after completion of therapy.
- 19. Common questions and answers • Will you be repeating the treatment? – Unlike chemotherapy, we typically administer a single course of treatment. – If needed, additional treatment can be given on a case-by-case basis weighing the benefits and risks.
- 20. Common questions and answers • Is all this radiation, including X-rays and CT scans, safe? – Rate of second cancers due to radiation is less than 1 in 100 and likely closer to 1 in 1000. – Side effects depend on the area of the body that is treated; treatment will only be given if the benefits will likely outweigh the risks and the risks are acceptable.
- 21. Resources • Department website – http://www.dana-farber.org/Adult-Care/Treatment-and- Support/Treatment-Centers-and-Clinical- Services/Department-of-Radiation-Oncology.aspx • American Society for Radiation Oncology – http://www.rtanswers.org/ • LUNGevity – http://www.lungevity.org/about-lung-cancer/lung- cancer-101/treatment-options/radiation-therapy