Recent Advances in Radiation Oncology: DR M Spoorthi Shelometh Department of Radiation Oncology

Recent Advances In
Radiation Oncology
Dr M Spoorthi Shelometh
Department of Radiation Oncology
Table of Contents
1. Cancer Statistics
2. History of Radiation Oncology
3. Approaches to Radiation
4. Uses of Radiation
5. Radiation Techniques
Cancer Statistics
Cancer is among the leading causes of death world wide.

There were 14.1 million new cases in 2012, which is expected to raise to 23.6
million by 2030.
Out of 14 million diagnosed new cases, more than 1 million were from India.
Incidence : 1,15,7294
Mortality : 784,821
Risk of developing cancer before 75 years
Men : 9.81%
Women : 9.42 %.
Globocon 2018 – India Fact sheet

Cancer Facts
Key Facts Key Risk factors
• Most common cause: Lip, Oral • Tobacco Use

Cavity, breast and Cervix • Alcohol Use
• 30% of cancer deaths can be • Obesity
prevented. • Low Fibre diet
• Tobacco use is the single most • Physical inactivity
important risk factor.
• Age
• STDs (HIV/HPV)
• Family history
Therapeu
tic
Modalitie
s
Introduction to Radiation
Oncology
• The use of Ionising Radiation in the treatment of malignant and
benign diseases.
• X-Rays were discovered by Roentgen.
• First Patient was treated with Radiation in 1896, just 2 months after the
discovery of X-rays.
• Radiation has been a effective tool for treating cancer more than
Century.
Early Pioneers In Radioactivity
Brief History of Radiation
Oncology
• 1st patient treated with the MV
unit in the USA.
• Stanford University, 1955.
• Recurrent Retinoblastoma
• Patient is still doing well with
good vision preservation.
Introduction to Radiation
Oncology
• Used either alone or in combination
• Shoulders a heavy burden in total management of Cancer (60-
70%).
• 40% patients require radiation therapy as primary initial
therapy.
• 16 – 20 % cancer patients require radiation therapy as part of
multi modality therapy.
Biological Basis of Radiation
• Cancer cells multiply faster than

normal cells
• DNA is the primary target
• Double stranded breaks (DSB) in
DNA
• Reproductive cell death.
Clinical Uses of Radiation
Therapy
Radiation is used broadly in 3 settings:
1. Radical
2. Adjuvant or Neo – Adjuvant
3. Palliative Care.
Delivery of Radiation Therapy
Radiation Therapy
Teletherapy Brachytherapy
Types of External Beam
Radiation Therapy
1. 2DRT
2. 3D-CRT
3. IMRT
4. IGRT
5. SRS/ SBRT
6. Particle Beam Therapy
7. IORT
Two dimensional
Radiation
Therapy (2D RT)
• Old techniques of Radiation therapy
• Treatments are planned by limited
number of beams.
• Boundaries are delineated on X-rays of
the patient
• Low conformity.
• Less effective treatment
• Relapse of the disease
Problems with Conventional 2DRT
Use of modern imaging (CT,
MRI, PET) crucial for modern
day practice.
Advances Computerization
In RT
Better understanding of
cancer biology, radiobiology
and interaction with other
modalities like surgery and
chemotherapy.
Plan and deliver treatment based
on 3D anatomic information.
Results in dose distribution which

3D- CRT conforms to the target volume.
Generally increased number of

radiation beams are used to
improve dose distribution.
IMRT
• Advanced form of 3D-CRT.

• IMRT is considered as revolutionary concept.
• Changes the intensity modulation of the beams according to
the desired dose in the tumor.
• Radiation is Modulated as per clinician advice and the site of
the cancer.
• First IMRT in South Asia.
To improve target dose uniformity
To Selectively avoid critical structures

and normal tissues
Advantag To deliver higher doses
es of
IMRT To create low dose areas surrounded
by high dose areas (concave isodose)
Focal dose escalation
Better sparing of critical structures

especially in irradiation.
What is Rapid
Arc?
Speed matters…..
Advantage
s
• Speed of delivery Highly efficient.
• IMRT quality plan
• Less MU s low peripheral dose
• Increased no of beam directions
better
• optimization  Uniform dose
distribution
• Less burden on Machine(MLC)
• Simple planning and treatment
• Can treat large volumes
• No compromises
Rapid Arc vs IMRT
Rapid Arc- Fast, Simple
and Precise
IGRT
• Frequent imaging before and also during the course of radiation

treatment.
• Rationale: Changes in patient anatomy Deviation from planned
dose  Suboptimal dose coverage  Increased dose to critical
structures  decreased local control and increased side effects.
• Examples: Breast
Gastro intestinal
Head and neck cancers
Lung
Prostate
CBCT
• Cone Beam CT is an effective IGRT tool for verification of patient

position.
• High imaging quality
• Provides sub millimeter resolution.
• It is a digital X-Ray mounted on Rotating arm of Linac. Like a digital
Camera.
• Patient set up variations and errors can occur during course of the
treatment.
• CBCT is mounted on Linear Accelerator Acquires images of the
patient in the treatment position  verify patient set-up.
SRS
• SRS is a specialized type of

external beam radiation that
uses focussed beams which
targets the well defined
tumours.
• It is used in brain and spine.
• Treatment Is delivered in single
or maximum of five fractions.
• SRS requires detailed imaging,
complex immobilization and 3D
planning systems.
SBRT
• SBRT is a treatment procedure similar to SRS but it deals wit the

tumours outside the CNS.
• High dose of radiation may improve high probability of local control
in otherwise inoperable cases.
• Trials have shown that demonstrated efficacy and acceptable acute
toxicity.
• It uses sophisticated imaging, treatment planning and immobilization
techniques.
• SBRT is used for a number of sites like Lung, Liver, Adrenals, Pancreas,
Prostate, Spine etc
Equipped with all the latest
technologies.
First hospital in Asia to offer

Rapid Arc treatment.
At
Yashoda So far we have treated around
20000 Cancer patients.
At par with the best centre of

the world.
Radiotherapy In benign
diseases
• Benign diseases generally include localised tumours or growths that
have very low potential for progression and do not invade
surrounding tissues or metastasize to distant sites.
• Examples:
1. Meningioma
2. Pituitary Adenoma
3. Craniopharyngioma
4. Acoustic Neuroma
5. AVM
6. Trigeminal Neuralgia
7. Pterygium
Myths about Radiotherapy
1. It is hot
2. It is given only during last stages of cancer
3. It is ONLY palliative
4. After surgery- No role of Radiation
5. Loss of body hair
6. Cancer spreads after giving Radiation.
7. Radiation is contagious.
Take Home Message
1. Radiation Cures Many Cancer patients

2. Unlike Olden days, with Sophisticated Techniques side
effects are negligible
3. Our Hospital is equipped with all the latest sophisticated
techniques
4. Radiation can be used in both Benign and Malignant
diseases with good outcome.

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Recent Advances In

Cancer is among the leading causes of death world wide.

Globocon 2018 – India Fact sheet

Key Facts Key Risk factors

• Most common cause: Lip, Oral • Tobacco Use

• Cancer cells multiply faster than

Results in dose distribution which

Generally increased number of

• Advanced form of 3D-CRT.

To Selectively avoid critical structures

Advantag To deliver higher doses

Focal dose escalation

Better sparing of critical structures

• Frequent imaging before and also during the course of radiation

• Cone Beam CT is an effective IGRT tool for verification of patient

• SRS is a specialized type of

• SBRT is a treatment procedure similar to SRS but it deals wit the

First hospital in Asia to offer

At par with the best centre of

1. Radiation Cures Many Cancer patients

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