PROs AND CONs OF
ADVANCED TECHNOLOGIES IN
RADIOTHERAPY
LAKSHMI PS IYER
CHIEF RTT
JUPITER HOSPITAL
THANE
• The world's oldest
documented case of
cancer hails from
ancient Egypt, in 1500
b.c.
• The details were
recorded on a papyrus,
documenting 8 cases
occurring on the
breast
Cancer Deaths world wide
Incidence of Ca in India
GEOGRAPHICAL ANALYSIS
• 1-northeastern states –highest • 5- Gujarat and Rajasthan leads in
cancer rate becoz of the tobacco head and neck cancers coz of pan
and burnin of the firewood masala and tobacco
• 2-west bengal –lung ,urinary • 6 – Punjab Malwa belt all cancers
bladder cancers, coz of air and more than average kidney,
water pollution. U.bladder and breast.
• 3- south and coastal india leads in • 7- Gangetic plain U.P, Bihar, WB
stomach Ca coz of spicy food gall bladder head and neck
habits cancers becoz of polluted water
• 4- Goa leads in colon cancers coz and rich diet of animal proteins
of red meat and alcohol. or fish.
• 8- Madhya Pradesh- head and
neck cancers becoz of pan masala
INTRODUCTION
From the beginning of 21st century we have come a long way since
the discovery of radiation and radioactivity.
Our heartfelt thanks to the pioneers and discoverers like Wilhelm
Conrad Roentgen, Antoine Henry Becquerel along with Marie
Sklodowska Curie and her husband Pierre Curie for providing us
with our daily bread.
Every aspect of life is and its parameters are moving toward
technologies and its advantages to mankind.
Radiotherapy also has been evolving from x-rays for treatment to
radioactive elements to mega-voltage.
X-rays evolving from diagnosis to therapy.
Change is the only thing that is permanent in this world.
Intro contd…..
• Malignancy has been in history for long but
the treatment officially started since 1897,
thus making us radiotherapy people.
• We started with
• superficial xray therapy [SXRT]
• Deep x-ray therapy [DXRT]
• Cobalt 60 gamma rays
• Caesium [teletherapy]
Intro contd……
• Then came era of linear accelerators 4MV to
15MV to variety of electron 4MeV to 21MeV
• Stereotaxy
• Gamma knife
• X-knife
• Cyber knife
• Robotic surgery
• And last but not the least Proton therapy
Intro contd….
• In the field of radiation therapy
Techniques :
Starting with the conventional square or
rectange field we have evolved to target
therapy
To a name a few different machines gives
different titles
Intro contd..
• 3DCRT
• IMRT
• IGRT
• VMAT
• RAPID ARC
• IG3D
• 3DSRT, ETC
TREATMENT OPTIONS
• SURGERICAL ONCOLOGY
• RADIATION ONCOLOGY
• MEDICAL ONCOLOGY
• SUPPORTED BY:
• HARMONE THERAPY
• IMMUNOTHERAPY
• HYPERTHERMIA
ONCOLOGY
SURGERY RADIATION MEDICINE
Radio Radio CHEMO
Resistant Lethal Sensitive
Tumors Tumors Tumors
SARCOMAS CARCINOMAS LYMPHOMAS
Sx+RT+CT RT CT +/- RT
OR
RT+CT
OR
Sx+RT
RADIATION THERAPY
• TELECOBALT
• TELE CAESIUM
• LINEAR ACCELERATORS LOW END
• LINEAR ACCELERATOR HIGH END
• BRACHYTHERAPY
• GAMMA KNIFE
• X-KNIFE
• CYBER KNIFE
• PROTON THERAPY
TELE COBALT & TELE CAESIUM
• SOURCE TO SURFACE DISTANCE WAS 80CMS
• SSD FOR CAESIUM WAS LESSER 40/30CMS
• dMAX FOR CO60 - .5CMS
• PORTALS- SQUARE OR RECTANGE ONLY
• SHIELDING POSSIBLE
• REACTION SEEN ON LATE 3RD WEEK OR EARLY
4TH WEEK
• LATE SEQUELAE ++
COBALT CONTD..
• PENUMBRA
• TANGENTS FOR BREAST WITH THE
APPLICATORS
• WEDGES FOR HOT AND COLD SPOTS
• SHIELDING THICKNESS 5CMS OF TUNGSTEN
ALLOY [4HVTs]
• POP MOULDS
• ECONOMICAL IN MAINTENANCE
LINEAR ACCELERATOR
LOW END
• TARGET TO SURFACE DISTANCE =100CMS
• Dmax – 6MV 1.5cmHIGHER ENERGIES>2cms
• WEDGES –UNIVERSAL
• PORTALS SQUARE AND RECTANGLE
• SHIELDING THICKNESS-6cms OF TUNGSTEN
ALLOY [4HVTs]
LA. LOW END…..
• PENUMBRA LESSER THAN CO60
• BREAST TANGENTS DO NOT HAVE ANY
APPLICATORS, EXCEPT FOR electrons
• REACTIONS SEEN IN THE IV WEEK
• LATE SEQUELAE ++
• ORFIT OR ACRYLIC MOULDS
• NOT REALLY ECONOMICAL IN MAINTENANCE
LINEAR ACCELERATORS
HIGH END
• The new techniques emerged with the advent
of leaves in the collimator
• MLC changed the scene of radiotherapy with
good and not so good effects
• MLC gave the Oncologists and Medical
physicist to achieve a more accurate area for
treatment without hindering the normal tissue
more.
LA high end…….
• Better target achievements lesser normal tissue
damage.
• Dose distribution is better,
• Accuracy increased ,
• Techniques like IMRT gave the upper hand to deliver
modulated intensity to the desired area
• IGRT – gave an upper hand in conforming the
treatment.
• VMAT – gave a volumetric modulation of dose
delivery
PROs
• Advantages – good response of the tumor
regression is seen
• Patient’s tolerance towards the radiation
reaction is observed
• Immobilisation devices introduced for the
treatment techniques helps for the
reproduction of the field in question with that
of the decided area of interest .
• OAR saved better.
PROs
• Refinement in the treatment planning with CT
and MRI
• Safer for the working personnel and public.
• Quicker delivery of the treatment
• No need for change of source .
CONs
• Disadvantages: Indian population has a mal-
nutrition physique.
• Reactions are seen earlier too
• Cost effectiveness –not faesible
• High maintenance- definitely not economical
neither for the management nor for the
patient.
• Prognosis wise not much of change is seen.
Discussions
• Then why do we go for the high end treatment
with all the new training for the Doctors to
Medical Physicists to technologists.
• Change is the only permanent thing in this
world . There has to be a constant thriving in a
service oriented mind so that the ups and
downs keep ‘em alert to the possibility of
achieving a cure or at least disease free
[cancer free] mankind
Discussions….
• Until we reach that stage, we can provide the
patients with a quality of life which the new high
end /advanced technologies have provided so far.
• With the tele cobalt the reaction and the suffering
or morbidity lasted longer than what we see now.
• But then radiation is radiation it does its work
whether we want it or not so mortality is not
significantly changed though, quality of life
certainly has definitely improved.
CONCLUSION
• IN Conclusion I guess all the efforts done by
the professions involved the advanced
technologies may not have taken us any closer
to the cure but definitely inspires us to look
into the possibilities of finding .
Happy ending
THANKYOU
