Radiation Therapy Sarcoma Sarcoma Exchange 9/29/2019 Raphael Yechieli MD Associate Professor of Clinical Medicine Sylvester Comprehensive Cancer Center University of Miami Miller School of Medicine @raphaelyechieli

Disclosures No financial conflicts of interest

Overview Let’s talk about radiation Discuss the role of radiation oncologists in treating sarcomas Questions and Discussion

Overview of Oncology Medical Oncology Chemotherapy travels through blood and goes everywhere Surgical Oncology Orthopedic, Urology, Ophthalmology, Dermatology, Neurosurgery, Cardiothoracic, Colorectal, Gynecologic etc. Radiation Oncology Treats cancer and other disease using radiation therapy Photons, Protons, Electrons, alpha- particles Local treatment

What is “Radiation?” “Radiation (n.): Merrian-Webster Online a: the action or process of radiating b: the process of emitting radiant energy in the form of waves or particles c(1): the combined processes of emission, transmission, and absorption of radiant energy…” E=Hν (or H/λ) Gamma ray or X-ray?

Radiation: A Brief History 1895 – Röntgen discovers x-rays (Nobel Prize 1901) 1896 – Becquerel discovers natural radioactive decay. Marie and Pierre Curie further characterize radioactive compounds. (All three win Nobel Prize in 1903) 1896 – First patients with cancer treated with x-rays by Emil Grubbe in Chicago 1901 – Thomas Edison is displaying X-ray machine at the World’s Fair when President McKinley is assassinated. 1952 – first “linear accelerator” used for treatment (USA in 1957) 1968 – Radiosurgery 1970 – CT 1975 – PET 1980 – Multi-leaf collimators, Proton therapy 1988 – Intensity modulated radiation treatment (IMRT) 2000’s – Image-guided RT (IGRT) 2019 - ??? Marie Curie (1867- 1934) Rontgen = discovered X-rays while experimenting with a vacuum tube, noticed fluorescence on a nearby piece of glass Becquerel = discovered that natural elements could emit X-rays when photographic film that he left near Uranium was partially exposed Madame Curie = characterized which elements released radiation. Won both a physics and chemistry nobel prize. She died of leukemia due to radiation exposure. All images are in public domain.

Radiation Delivery External beam RT (i.e. the linear accelerator or Linac) 3DCRT, IMRT, IGRT, VMAT Treatment Delivery Systems have brand names Image courtesy of Varian Medical Systems, Inc. All rights reserved

Truebeam

Robotic Linear Accelerator Image courtesy of Accuray, Inc. All rights reserved

Helical Linac Image courtesy of Accuray, Inc. All rights reserved

Gamma Knife Radiosurgery Gamma Knife Single high-dose radiation fraction Very conformal (i.e. tight margins) Images courtesy of Elekta.com

MR Guided Radiation

Protons

Radiation Damages DNA Normal cells- Normal repair Tumor cells – try to grow regardless and are destroyed

Sarcoma

Incidence Approximately 13,000 cases will be diagnosed in US 5000 will die from this disease About 1% of all cancers Most commonly presents in extremity

Grows along muscle tract Slide from ASTRO refresher 2016

And Practically Speaking

Multidisciplinary Management Matters Radiology Pathology Surgery Rad Onc Med Onc Support Services Experienced centers leads to better outcomes Multiple retrospective series