PRECISION RADIO THERAPY

K.K.D.RameshPhysicist & RSO

Navodaya Cancer Hospital & Research Center

Bhopal

Multimodal approach    Surgery - operable tumors. Radiotherapy - localized disease with

favorable histology. Chemotherapy – Lymphomas,

Leukemia's. Hormonal treatment – Hormone

dependant tumor - breast & prostate.Targeted therapy–as adjuvant to–

surgery, radiotherapy, chemotherapy.Combinations of above modalities.

History of Radiotherapy I. X-Ray Units Until 1950

(I) Grenz-Ray Units <20kV (ii) Contact Therapy units 40-50 kV (iii) Superficial Therapy units 50-150 kV (iv) Ortho voltage Therapy units 200-350 kV (v) Super voltage Therapy units 500-1000 kV

II. Cobalt-60 Tele therapy units- In 1951

III. Electron Accelerator – Between 1948 & 1955

IV. Medical Linear Accelerator – 1980’s V. Particulate Radiation- Proton Therapy

Radio therapySpecialty where we use Ionizing radiation for the

treatment of Cancer

Intention of TreatmentCurativePalliative

Tumor & Normal Tissue Response

Radio therapy as a sole treatmentPre-OperativePost Operative

TechniqueExternal Radio therapy: Linear Accelerator

& Cobalt

Brachy therapy: Co60,Ir192,Cs137

Precession Radio therapy2D3D

IMRTIGRTSRSSRT

Objective

To deliver Cancerocidal dose to tumor Volume

To avoid / Minimize radiation to critical structures.

Good Quality of life

StepsImmobilizationSimulation-CT/ X-rayTreatment Planning, CT, MRI, PET

ImagingQuality AssuranceVerificationTreatment

Immobilization

CT-Simulation

Treatment Planning

Quality Assurance

Portal Verification

Treatment

ConclusionRadiotherapy treatment is a curable treatment for early

disease.The success of treatment has increased because of

Technological advancement & Quality of beam delivery system.

Imaging with MRI ,PET –CT & CT fusion has helped in delineating accurate tumor volume. PET-CT has further helped to delineate active tumor volume.

Dose escalation has increased substantially ,therefore more chances of disease control.

Use of multi leaf collimator helped in reducing the dose to critical structures and reduced long term radiation squeal.

Quality of care has improved significantly