1. 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

2. Disclosures
No financial conflicts of interest

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

4. 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

5. 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?

6. 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)
???
Marie Curie ( )
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.

7. 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

8. Truebeam

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

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

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

12. MR Guided Radiation

13. Protons

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

15. Sarcoma

16. 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

17. Grows along muscle tract
Slide from ASTRO refresher 2016

18. And Practically Speaking

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