1. DEOEC Institute of Oncology Department of Radiotherapy

2. Radiology: diagnosis Radiotherapy: part of active oncotherapy (oncoradiology, radiation oncology) Oncology:chemotherapy

3. The branch of clinical medicine which uses ionising radiation, either alone or in combinations with other modalities, for the treatment of patients with cancer (or benign diseases). It includes responsibility for the treatment, follow up and supportive care of the patient as an integral of the multidisciplinary management of patients.

4.  external beam radiation is delivered from outside the body by using a machine to aim high-energy rays (x-rays, gamma rays or photons). TELETHERAPY  internal radiation is delivered from inside the body by placing radioactive material, sealed in catheters or seeds, directly into the tumor. BRACHYTERAPY

5. 1. „Direct hit” 2. „Activated water”

6. 1. „Direct hit” 2. Activated water O2 is necessary H 2 O H + OH - e - H 2 H 2 O 2 H 2 O oxidation reduction

7. 1. Lethal damage 2. Sublethal damage a) loss of reproductibility  apoptosis b) Repair c) Reoxigenistaion d) Repopulation e) Redistribution

8. 1. Lethal damage 2. Sublethal damage a) loss of reproductibility  apoptosis b) Repair c) Reoxigenistaion d) Repopulation e) Redistribution

9. 1. Lethal damage 2. Sublethal damage a) loss of reproductibility  apoptosis b) Repair c) Reoxigenistaion d) Repopulation e) Redistribution EXCISIONS REPAIR Endonucleaz Exonucleaz ↓ Polymeraz Liaz MISMATCH REPAIR

10. 1. Lethal damage 2. Sublethal damage a) loss of reproductibility  apoptosis b) Repair c) Reoxigenistaion d) Repopulation e) Redistribution

11. 1. Lethal damage 2. Sublethal damage a) loss of reproductibility  apoptosis b) Repair c) Reoxigenistaion d) Repopulation e) Redistribution

12. 1. Isotopes isotope halfing time energy (MeV) Ra-226 1626 y 0,830 Co-60 5,26 y 1,250 Ir-192 74,2 d 0,380 J-125 60,2 d 0,028

13. 2. Cobalt unit Gamma-ray (photons) Co60→ gamma-photons

14. 3. Linear accelerator Photons and electrons

15.  Precisely locate the target  Hold the target fixed  Accurately aim the radiation beam  Shape the radiation beam to the target  Deliver a radiation dose that damages abnormal cells yet spares normal cells

16. Topometric-CT No contrast media Image fusions

17.  GTV: gross tumor volume macroscopic tumor or tumor bed  CTV: clinical target volume: GTV+1-2 cm safety margin –microscopic tumor spreading-  PTV: planning target volume: CTV+0,5-1 cm movements of organs or breathing

19. Postop. Cervical cancer

20. 3D –Target Volumes

21. MLC (multileaf collimator system)

22. TELETHERAPY: Fixed beam irradiation : direct field opposed fields 4 or more fields TELETHERAPY: Fixed beam irradiation : direct field opposed fields 4 or more fields

23. BRACHYTHERAPY: Intracavital Intersticial BRACHYTHERAPY: Intracavital Intersticial

24. EX. 1

25. EX.2

26. EX. 3

27. EX. 4

28. EX.5

29.  Positioning, immobilisation devices  Thermoplastic masks

30.  Breast-boards

31. Conventional dose: 1,8-2 Gy/day, 5 day/week 2-7 week Tumor killing doses: 30-78 Gy - hystology, tumor type - TNM stage, KPS, ECOG - indications (neoadjuvant, adjuvant, definitive, palliative) - combinations (RKT) Conventional dose: 1,8-2 Gy/day, 5 day/week 2-7 week Tumor killing doses: 30-78 Gy - hystology, tumor type - TNM stage, KPS, ECOG - indications (neoadjuvant, adjuvant, definitive, palliative) - combinations (RKT)

32.  Tolarance of normal tissues (risk organs) DVH: Dose-volume histograms

33. 1. Simulation, positioning 2. Topometric CT 3. Treatment plan 4. Resimulation 5. Verification 6. Treatment

34. 1. Simulation, positioning 2. Topometric CT 3. Treatment plan 4. Resimulation 5. Verification 6. Treatment

35. 1. Simulation, positioning 2. Topometric CT/MR 3. Treatment plan 4. Resimulation 5. Verification 6. Treatment

36. 1. Simulation, positioning 2. Topometric CT/MR 3. Treatment plan 4. Resimulation 5. Verification 6. Treatment Pictor 3D laser system Isocenter Virtual point

37. 1. Simulation, positioning 2. Topometric CT/MR 3. Treatment plan 4. Resimulation 5. Verification 6. Treatment

38. RESULTS: 1. LTC : CR (4 mts)PR (-25-50%) NCPD 2.Survival: Overal, Disease free, TTP SIDE EFFECTS : early late local inflammation fibrosis general weakness disfunction