traco – introduction to radiation oncology...traco – introduction to radiation oncology...
TRANSCRIPT
![Page 1: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/1.jpg)
TRACO – Introduction to Radiation Oncology
Elizabeth Nichols, MD Assistant Professor
University of Maryland Marlene and Stewart Greenebaum Cancer Center
10/11/18 [email protected]
![Page 2: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/2.jpg)
Disclosures
• Disclosures: None
![Page 3: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/3.jpg)
Outline
• Goals of cancer therapy • Goals of radiation therapy • Basics of radiation oncology
– Radiation Physics – Radiation Biology – Radiation Therapy – Patient presentations
• The future of radiation oncology
![Page 4: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/4.jpg)
Principles of cancer therapy
• Minimize therapy • Toxicity, time, cost
• Minimize negative impact on quality of life • Toxicity, function, cosmesis
• Improve quality of life • Palliation, organ preservation
• Maximize impact on quantity of life • Cure and remission
• Improve outcomes • Research
![Page 5: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/5.jpg)
Radiation Oncology
![Page 6: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/6.jpg)
The Physics of Radiation Oncology
Just the basics
![Page 7: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/7.jpg)
The Physics of Radiation Oncology
• What is radiation? – “the complete process by which energy is
emitted by one body, transmitted through an intervening medium or space, and absorbed by another body.”
![Page 8: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/8.jpg)
Types of Radiation
![Page 9: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/9.jpg)
The Electromagnetic Spectrum
![Page 10: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/10.jpg)
X Rays
![Page 11: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/11.jpg)
The Linear Accelerator
![Page 12: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/12.jpg)
Radiation therapy basics
![Page 13: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/13.jpg)
Radiation Planning Techniques
![Page 14: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/14.jpg)
Intensity Modulated Radiation Therapy
![Page 15: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/15.jpg)
Intensity Modulated Radiation Therapy
![Page 16: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/16.jpg)
Volumetric modulated arc therapy
![Page 17: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/17.jpg)
VMAT
![Page 18: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/18.jpg)
Brachytherapy
• Placing a radiation source inside or adjacent to the tumor
• Rapid dose fall-off allows maximal sparing of normal tissues (no “going trough” normal tissue to get to the tumor)
• Used commonly for tumors – in body cavities (cervix, endometrium, vagina,
nasopharynx) – close to the surface (prostate, sarcoma, tongue, lip,
breast)
![Page 19: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/19.jpg)
Plaque Simulator Isodose Plot
![Page 20: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/20.jpg)
High Dose Rate Branchy
![Page 21: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/21.jpg)
Stereotactic Radiosurgery
![Page 22: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/22.jpg)
Radiation Biology
![Page 23: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/23.jpg)
Radiation Survival Curve
![Page 24: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/24.jpg)
Fractionation
![Page 25: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/25.jpg)
The 4 “R”s of fractionated radiation
• Repair – Healthy cells repair DNA damage (so do tumor cells
unfortunately)
• Reassortment (redistribution) – Radiation causes cells to accumulate in certain
phases of the cell cycle
• Reoxygenation – Tumors reoxygenate after radiation
• Repopulation – Tumor and normal cells repopulate between doses of
radiation
![Page 26: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/26.jpg)
Repair
![Page 27: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/27.jpg)
Redistribution
![Page 28: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/28.jpg)
Cell Cycle and Radiation Sensitivity
![Page 29: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/29.jpg)
Reoxygenation
![Page 30: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/30.jpg)
Radiation Modifiers
![Page 31: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/31.jpg)
Radiation Modifiers
![Page 32: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/32.jpg)
Radiation Targets • Single Target Agents
– Growth factor receptors (EGFR, VEGFR) – DNA repair proteins (DNA-PK, Rad51) – Transcription factors (NFkB, p53 – Signal transduction proteins (Ras, PI3K, c-Abl)
• Multi-target Inhibition – Chaperone proteins (HSP90 inhibition) – Microenvironment (angiogenesis, vasculature) – Epigenetic modification
• Radiation Inducible Targets – Antigens or receptors (Fas, CEA)
![Page 33: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/33.jpg)
Radiation targets
![Page 34: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/34.jpg)
Issues for Target/Agent Development
• Mechanism – Cell type or condition specific
• Method of Targeting – Antibodies (EGFR, VEGFR) – Small molecules (Gleevec, Flavopiridol) – Gene therapy (TNFerade)
• Therapeutic ratio – Tumor > normal cells (Rad51)
![Page 35: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/35.jpg)
Immunomodulatory agents
![Page 36: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/36.jpg)
Abscopal Effect
![Page 37: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/37.jpg)
Radiation Therapy
Clinical practice
![Page 38: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/38.jpg)
Goals of radiation therapy
• Cure – Cancer localized to one organ or region
• Palliation – Cancer disseminated to multiple organs that
are causing bothersome symptoms
![Page 39: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/39.jpg)
Indications for radiation therapy • Cure
– Prostate cancer – Other urologic cancers – Breast cancer – Lung cancer – Head and Neck
Cancer – Gynecologic Cancers – Pediatric Cancers – CNS tumors – Skin cancers
• Palliation – Bone pain – Shortness of breath – Neurologic symptoms – Pain from a space
occupying lesion
![Page 40: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/40.jpg)
The Oncology Team
![Page 41: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/41.jpg)
Develop a multimodality plan
• Surgery • Radiation • Systemic therapy
– Chemotherapy – Targeted agents
• Other localized therapies – Focal ablation techniques – Focal drug delivery
![Page 42: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/42.jpg)
Treatment Process
![Page 43: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/43.jpg)
The radiation therapy treatment process
• Contouring (normal structures, target structures)
• Creation of plan (dosimetry) • Evaluation of plan (by MD) • Evaluation of plan (by physics) • Transfer of plan to treatment machine • Treatment delivery
![Page 44: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/44.jpg)
ROI Image
![Page 45: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/45.jpg)
Patient Presentations
![Page 46: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/46.jpg)
The treatment process – Patient A
• Develop a treatment plan (multimodality) • Determine the appropriate RT modality • Identify a target • Identify surrounding normal tissue at risk • Create a treatment plan (radiation) • Deliver the treatment • Follow the patient
![Page 47: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/47.jpg)
Patient A
– 55 yo F with new lump in her left breast – Suspicious abnormality on mammogram – Biopsy consistent with infiltrating ductal
carcinoma – No family history of breast cancer
![Page 48: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/48.jpg)
Treatment Plan
![Page 49: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/49.jpg)
Patient A
• Selects breast conservation • Lumpectomy and sentinel lymph node
biopsy • Pathology reveals a 3 cm tumor and 4
axillary lymph nodes • The patient receives chemotherapy • Returns to radiation oncology
![Page 50: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/50.jpg)
Determine the RT Modality
![Page 51: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/51.jpg)
Identify the target and normal tissue - Simulation
![Page 52: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/52.jpg)
Create A Plan
![Page 53: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/53.jpg)
Deliver The Treatment
![Page 54: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/54.jpg)
Patient B
• Patient B – 54 yo M with an elevated PSA on routine
exam – No prior medical problems – Biopsy consistent with adenocarcinoma of the
prostate, Gleason score of 6
![Page 55: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/55.jpg)
Develop a treatment plan
• Surgery • Surgery and radiation (based on surgical
findings) • Radiation
– Brachytherapy – External beam RT – Combination
• Radiation and hormonal therapy
![Page 56: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/56.jpg)
Images
![Page 57: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/57.jpg)
Create A Plan
![Page 58: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/58.jpg)
Image Guided Radiation Therapy
![Page 59: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/59.jpg)
Image
![Page 60: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/60.jpg)
Image
![Page 61: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/61.jpg)
Deliver the Treatment
![Page 62: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/62.jpg)
Is it all just that easy?
• Normal tissue toxicity – Acute effects – Late effects
• Stem cell depletion, chronic oxidative damage, vascular destruction, fibrosis, and more
• Radiation is dosed to normal tissue, NOT tumor!
![Page 63: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/63.jpg)
Lung - Fibrosis
![Page 64: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/64.jpg)
Lymphedema
![Page 65: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/65.jpg)
Mucositis
![Page 66: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/66.jpg)
Where do we go from here?
![Page 67: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/67.jpg)
The future of radiation • Biology
– Use radiation to induce targets for other agents – Better radiation sensitizers and protectors – Combining radiation and targeted drugs
• Physics – Improved targeting (imaging) – Improved delivery methods (equipment)
• Clinical – Translate exciting laboratory findings into the clinic – Continue to develop clinician-scientists
![Page 68: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/68.jpg)
Why Protons Can be Superior to Photons
![Page 69: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/69.jpg)
Proton Therapy
![Page 70: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/70.jpg)
Maryland Proton Treatment Center
![Page 71: TRACO – Introduction to Radiation Oncology...TRACO – Introduction to Radiation Oncology Elizabeth Nichols, MD Assistant Professor University of Maryland Marlene and Stewart Greenebaum](https://reader035.vdocuments.site/reader035/viewer/2022081406/5f1054427e708231d4489214/html5/thumbnails/71.jpg)
Take home messages
• Radiation is a tool used in cancer therapy • Radiation causes DNA damage, which can
lead to cell death • The effects of radiation can be altered by
modifying physical factors, physiologic factors, fractionation, drugs, and other variables
• Radiation can cause complications • Radiation is INTERESTING!