1. Radiotherapy for Brain Tumours What do I need to know? Dr Matthew Foote Radiation Oncologist Princess Alexandra Hospital Queensland

2. Topics to cover What is radiotherapy and how does it work ? What are the different types of radiotherapy and how does this impact on me? What are the common side effects ? What are the most common questions asked by patients and carers? What is new on the horizon?

3. What is radiotherapy ? Effective cancer treatment modality High energy X-rays damage to tumour cells Course of radiotherapy (treatment – fraction)

4. How does it work ? Ionizing radiation causes DNA breaks Repair of normal tissue Fractionation

5. How does it target my tumour ? Multiple beams Complex dose shaping Sparing surrounding structures

6. What are the different types of delivery ? Fractionated –Multiple small doses Single dose (Radiosurgery)

7. What are the machines and what does it all mean? Linear Accelerator (Linac) Tomotherapy Gammaknife Protons

8. What is a linear accelerator (Linac) ? Most common machine used to deliver therapeutic radiotherapy Used for most treatments including brain tumours

9. What about Tomotherapy ? Beam as a fan Similar to CT scan Ability to spare normal tissue

10. What about Gammaknife ? Specific indications Highly focussed stereotactic (ablative) techniques

11. What about protons ? Not currently available in Australia Specific indications May be superior in treating some paediatric brain tumours

12. All of these machine names are confusing so what does it mean for me ? Each have advantages and disadvantages May better for treating some tumours Need to discuss with your radiation oncologist what is the most appropriate.

13. What is involved in having radiotherapy ? Specifically for fractionated radiotherapy –Initial appointment –Planning of radiotherapy –Commencement of treatment

14. Why is there a gap between planning and commencement of radiotherapy ? Planning process Use multiple sets of images (MRI) Mark tumour and all important structures Design best treatment Check that the planned dose is what will be delivered RADIATION THERAPISTS AND PHYSICISTS

15. What to expect during treatment Highly variable –Location of brain –Volume that needs to be treated –Radiotherapy dose –Time since operation –Use of chemotherapy –General health factors

16. Most common on treatment effects ? ON TREATMENT Tiredness Headaches Nausea Hair loss Skin reddening Hearing difficulties ‘neuro-cognitive’ effects AFTER TREATMENT On going tiredness Hearing difficulties Hormone function Longer term neuro- cognitive effects NOT ALL MAY OCCUR AND BEST DISCUSSED WITH RADIATION ONCOLOGIST BASED ON PREVIOUS FACTORS

17. Other common questions Effects on carers and children Can I drive ? Will I be able to work ? Do I need someone with me at all times ? How do we know that the radiation is working

18. What are some new advances that we should look out for? Sparing parts of the brain –Enabled due to technological advances in delivery (Intensity Modulated Radiotherapy IMRT, tomotherapy and volumetric modulated arc therapy VMAT)

19. Other advances in radiotherapy treatment of brain tumours Utilizing better imaging techniques to better define target and normal tissue

20. Other advances for the treatment of brain tumours ? Interaction with targeted chemotherapy agents –bevacizumab (Avastin) Re-irradiation of brain tumours

21. Radiotherapy for Brain Tumours Many changes driven by technology Important for providers to educate Active area of research Better outcomes for patients and family Dr Matthew Foote – matthew_foote@health.qld.gov.au

22. 5 th ANNUAL SCIENTIFIC MEETING 7 th – 9 th August 2012 Sofitel Hotel Brisbane in conjunction with Medical Oncology Group of Australia ASM (8 th -11 th August)