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may cause anatomically or physiologically undesirable sequelae and for a more extensive lesion not amenable to a surgical resection
Chemotherapy, for the treatment of micrometastases,
Definition
Radiation oncology is a clinical specialty dealing with the use of ionizing radiation ( electromagnetic and particle radiations ) in the management of patients with cancer ( and other neoplasms ), alone, or combined with other modalities such as surgery and chemotherapy
Goal :
1.Radical radiation Treatment intended to cure the patient of his or her disease . The dose is so high, involved tumor and any areas where the risk of microscopic extension present.
2.Palliative radiation Treatment intended to relieve the distressing symptoms of advanced disease ( such as ;relief of pain, luminal patency restored, skeletal integrity preserve, organ function reestablish,large mass, ulceration ). The dose given around 2/3 of full dose and in a shorter time, more simple technique, and with minimal side effect.
External radiation Radiation beams comes from outside of the body in the certain distance
2. Brachytherapy Introducing radioactive sources into body cavities ( intracavitary ) or inplanted into tissue ( interstitial ) 3. Internal radiation Radioactives fluid introduced into the body orally or intravenously
3.
4. 5. 6. 7.
Clinical evaluation : pathobiology of tumor, diagnostic workup, staging Therapeutic decision : goals ( cure or palliation ), choice of therapy, modalities Tumor localization : primary tumor, regional, sensitive organs ) Treatment planning ( simulation, computation, etc) Treatment Periodic evaluation Follow up
Radiation dose
Radiation absorbed dose ( rad ) , the old one Gy ( Grey ) equiv. with 100 cGy =100 rad , now used
routinely
four Rs of radiobiology :
1.
Repair
Linac
Iridium - 192
Radiation or photon energy react with macromolecules /water---> free-radicals----> damage the DNA
Combination Therapy
Radiation and surgery
Indications : 1. Tumors with low cure rates by either surgery or radiation 2. Anaplastic tumors with a great potential for vascular invasion 3. Tumors with a great potential for local or regional recurrence 4. Tumors with a great potential for residual disease after surgery 5. To preserve function 6. To preserve cosmesis
surgical resection Influence cell viability Sterilize limph node metastases outside operative field Influence resectability Decrease potential for dissemination Example : Colorectal tumor
surgery Eradicate new disease in adjacent area ( including limph node ) Deliver higher radiation dosage to high-risk areas
which may not be included Clinically inapparent distant meta at the time of initial therapy Inaccurate tumor localization Inadequate treatment planning Biologic tumor characterization that decrease the effect of radiation
Toxicity of radiotherapy
Skin ( erythema, desquamation ) Mucous membrane ( mucocitis ) Hair ( alopecia ) Cornea ( keratitis ) Brain (tiredness,lethargy,nausea,vomiting, somnolent ,etc ) Lung ( pneumonitis, cough, dyspneu ) GI tract ( nausea, vomoting , diarrhea ) Bladder ( urinary frequency, dysuria ) Spinal cord ( neurologic defisit ) Liver ( hepatts ) Bone marrow ( suppression of WBC and platelets )
(prolonged dryness ) Both kidney ( 20 Gy ) Ovary ( 2-6 Gy; permanent sterility ) Testis ( 3-4 Gy; permanent sterility ) Lens ( 5-10 Gy cataract formation )