Advances in radiation oncology:Cancer care
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The document discusses advancements in radiation oncology, highlighting improved treatment modalities and outcomes for various cancers. It emphasizes the importance of radiotherapy in cancer treatment, including the use of advanced techniques and technologies such as IMRT and proton therapy. Additionally, it addresses the challenges faced in India regarding the availability of radiation therapy resources and the need for better integration of radiotherapy in cancer care policies.
![Randomized Trials documenting superiority
Reference Design Site of
Disease
Primary
Endpoint
Results P Value
JCO,2007;2
5 (31), Nov
1
Prospective
Randomize
d [2D vs.
IMRT]
T1-2b N0-
1 M0
Nsophary
nx cancer
Severe
xerostomia
@ 1 Year
@ 1 year,
Severe
xerostomia:
39.3% vs. 82.1%
0.001
JCO,2008;2
6 (13),
May 1
Multicentric
,double
blinded
RCT [IMRT
vs. CRT]
Breast Moist
desquamati
on
Moist
Desquamation:
31.2% vs. 47.8%
0.003
Lancet
Oncology,
2011;12:12
7-36
Phase III,
Multi-
centric,
RCTs [IMRT
vs. CRT]
Head &
Neck
Cancers
Parotid
Sparing
[Grade 2 or
worse
xerostomia]
@ 12 Months-
Grade 2
Xerostomia:
38% vs. 74%
@24 Months-
29% vs. 83%
0.0027
0.0001](https://image.slidesharecdn.com/advancesinradiationoncologyigims-200510115659/85/Advances-in-radiation-oncology-Cancer-care-24-320.jpg)
![Randomized Trials documenting
superiority
Reference Design Site of
Disease
Primary
Endpoint
Results P Value
Lancet
1999;353:267-
72
Randomized
Trial
[Conformal
vs.
Conventional]
Prostate Radiation
induced
proctitis
and
bleeding
RTOG ≥ 1: 37%
vs. 56%
RTOG ≥ 2 : 5%
vs. 15%
0.004
0.01
JCO 2013; 31
(36): 4488-95
Randomized
controlled
trial [IMRT
vs. CRT]
Breast Overall
cosmesis &
Skin
Telengectas
ia
Overall
cosmesis better
with IMRT [OR
0.68] &
Telengectasia
[OR 0.58]
0.027
Radiotherapy
and
Oncology;
2012;103:305-
313
Prospective
Multicentric
Study [ 2D vs.
3D]
Carcinoma
Cervix
[PDR
Brachyther
apy]
3D Brachytherapy has improved local
control and half the toxicity with 2D
Dosimetry](https://image.slidesharecdn.com/advancesinradiationoncologyigims-200510115659/85/Advances-in-radiation-oncology-Cancer-care-25-320.jpg)
![Beadle BM, MDACC. Cancer, 2013 [Ahead of
Print]
SEER Medicare analysis
[1999-2007]
A total of 3172 patients
were identified. Median
follow-up of 40 months.
CSS of IMRT vs. Non-
IMRT (84.1% versus
66.0%; P <.001) both
overall and subset wise.
Difference persisted on
multivariable analysis](https://image.slidesharecdn.com/advancesinradiationoncologyigims-200510115659/85/Advances-in-radiation-oncology-Cancer-care-27-320.jpg)
![Indigenous Design: Panacea
• Bhabhatron-II with MLC
• Integrated IGRT unit: G Ray
[Co-60 with 70 cm SSD]
• Karknidon: Ir-192
afterloader [20 Channels]
33](https://image.slidesharecdn.com/advancesinradiationoncologyigims-200510115659/85/Advances-in-radiation-oncology-Cancer-care-33-320.jpg)
Advances in radiation oncology:Cancer care
- 1. Advances in Radiation Oncology: Improvement and Outcome Dr Ajeet Kumar Gandhi MD (AIIMS), DNB (Gold Medalist) UICCF (MSKCC,USA) Assistant professor, Radiation oncology Dr RMLIMS, Lucknow
- 2. Treatment modalities • Surgery • Radiotherapy • Chemotherapy • Hormone therapy • Biological therapy/Immunotherapy • Pain and palliative care therapy • Alternative and Complimentary therapies
- 3. Radiation Therapy • Ionizing Radiation: X-rays, Gamma rays, electrons, protons
- 4. Dose (Gy) Control Complications Goal of radiation therapy
- 5. Radiation therapy cures: Saves lives • 40-50% of cancers are eliminated by radiotherapy either alone or in combination with other treatments: – Head & Neck Cancers – Lung Cancer – Cancer of Uterine Cervix – Prostate Cancer – Others: Urinary bladder, Vagina, Penis, brain tumour
- 6. Radiation therapy cures: Saves lives • Radiotherapy is given in combination with surgery/systemic therapy: – Brain tumors – Head & Neck Cancers – Breast Cancers – Lung Cancer – Gastrointestinal Cancer – Genito-urinary Cancers – Soft-tissue sarcoma – Lymphoma, Myeloma, Leukemia
- 7. Radiation therapy cures: Saves lives Benign Tumors – Acoustic Neuromas – Arteriovenous Malformations – Pituitary Adenomas – Trigeminal Neuralgia – Craniopharyngioma – Fibromatosis – Chordomas
- 8. Radiation therapy: Alleviates pain and Improves QOL • Neurological: Brain metastasis, Compressions • Pain: Tumor, bone metastasis, Nodes • Bleeding from tumor • Respiratory and obstructive symptoms
- 9. Advances in Radiation Oncology: Improving outcomes • IMRT/ IGRT/VMAT • RGRT • SBRT • Adaptive RT • 4DRT • Proton Beams and heavy ions • Image based Brachytherapy • IPSA • Real time image guided brachytherapy-SWIFT • Integrated Brachytherapy Unit
- 10. Intensity Modulated Radiotherapy is the key Complex and Irregular Anatomy for the tumor Different Nodal Volumes with different prescription Carcinoma Nasopharynx: c T4 N2c M0
- 11. Temporal Lobes Parotids Submandibular Glands larynx Brachial Plexus Constrictor Muscles Brain Stem Optic Chaisma Spinal Cord OARs for Head and Neck Radiotherapy
- 13. Advances in RO: Improving outcomes
- 14. Advances in RO: Improving outcomes
- 15. Advances in RO: Improving outcomes Cyberknife Tomotherapy
- 16. Advances in RO: Improving outcomes MRI-Guided Radiation therapy
- 17. Advances in RO: Improving outcomes Proton therapy
- 18. Technology transcends to practice Advances in RO: Improving outcomes
- 19. Metabolism: 18F-FDG 11C-Met Proliferation: 76Br-BFU (Bromo Fluro-deoxyuridine) Hypoxia:18F-EF3 (2-Nitro Imidazole marker) Advances in RO: Improving outcomes Biological targeting
- 20. Advances in RO: Brachytherapy
- 21. Advances in RO: Brachytherapy different sites Ca Prostate Ca Cervix: ISBT Soft Tissue Sarcoma Ca Breast
- 22. Advances in RO: Intra-operative radiotherapy
- 23. Advances in RO: Surface Mold Brachytherapy
- 24. Randomized Trials documenting superiority Reference Design Site of Disease Primary Endpoint Results P Value JCO,2007;2 5 (31), Nov 1 Prospective Randomize d [2D vs. IMRT] T1-2b N0- 1 M0 Nsophary nx cancer Severe xerostomia @ 1 Year @ 1 year, Severe xerostomia: 39.3% vs. 82.1% 0.001 JCO,2008;2 6 (13), May 1 Multicentric ,double blinded RCT [IMRT vs. CRT] Breast Moist desquamati on Moist Desquamation: 31.2% vs. 47.8% 0.003 Lancet Oncology, 2011;12:12 7-36 Phase III, Multi- centric, RCTs [IMRT vs. CRT] Head & Neck Cancers Parotid Sparing [Grade 2 or worse xerostomia] @ 12 Months- Grade 2 Xerostomia: 38% vs. 74% @24 Months- 29% vs. 83% 0.0027 0.0001
- 25. Randomized Trials documenting superiority Reference Design Site of Disease Primary Endpoint Results P Value Lancet 1999;353:267- 72 Randomized Trial [Conformal vs. Conventional] Prostate Radiation induced proctitis and bleeding RTOG ≥ 1: 37% vs. 56% RTOG ≥ 2 : 5% vs. 15% 0.004 0.01 JCO 2013; 31 (36): 4488-95 Randomized controlled trial [IMRT vs. CRT] Breast Overall cosmesis & Skin Telengectas ia Overall cosmesis better with IMRT [OR 0.68] & Telengectasia [OR 0.58] 0.027 Radiotherapy and Oncology; 2012;103:305- 313 Prospective Multicentric Study [ 2D vs. 3D] Carcinoma Cervix [PDR Brachyther apy] 3D Brachytherapy has improved local control and half the toxicity with 2D Dosimetry
- 26. prostate specific antigen relapse-free survival Survival benefit: IGRT vs. Non-IGRT in Prostate Cance
- 27. Beadle BM, MDACC. Cancer, 2013 [Ahead of Print] SEER Medicare analysis [1999-2007] A total of 3172 patients were identified. Median follow-up of 40 months. CSS of IMRT vs. Non- IMRT (84.1% versus 66.0%; P <.001) both overall and subset wise. Difference persisted on multivariable analysis
- 30. India is sorely under equipped, having just 1machine per 21 lakh people and would need 1215 teletherapy machines by 2020 2756 radiation oncologists, 1533 medical physicists, and 4737 radiation therapists must join the work force by 2020 to meet India’s needs.
- 31. Radiation Oncology India: Challenges & Opportunities • Patients can wait up to 2months after diagnosis before treatment is initiated in public hospitals. These delays adversely affect patient outcomes • More than 70% of India's population resides in rural settings but only 40/640 districts have LINAC • Wide regional disparity and public/private access to radiotherapy
- 32. Cost Amount of Use Health Policy Decision Indigenous Production and Design Acceptance
- 33. Indigenous Design: Panacea • Bhabhatron-II with MLC • Integrated IGRT unit: G Ray [Co-60 with 70 cm SSD] • Karknidon: Ir-192 afterloader [20 Channels] 33
- 34. Inform Govt and policy makers make radiotherapy a central component of cancer care in policies, planning and budget Plan Patient group and media: Improve general awareness about radiotherapy and it`s need Harmonize Multidisciplinary cancer care: Fully integrate radiotherapy in treatment planning Integrate Professional Societies: Education of radiotherapy professionals Invest Investment in research and use of data for Innovation