Sarcoma Exchange 9292019 Raphael Yechieli MD Associate Professor of Clinical Medicine Sylvester Comprehensive Cancer Center University of Miami Miller School of Medicine raphaelyechieli No financial conflicts of interest ID: 779514
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Radiation Therapy Sarcoma Sarcoma Exchange 9/29/2019
Raphael Yechieli MDAssociate Professor of Clinical MedicineSylvester Comprehensive Cancer CenterUniversity of Miami Miller School of Medicine@raphaelyechieli
Slide2No financial conflicts of interestDisclosures
Slide3Let’s talk about radiation Discuss the role of radiation oncologists in treating sarcomasQuestions and Discussion
Overview
Slide4Surgical OncologyOrthopedic, Urology, Ophthalmology, Dermatology, Neurosurgery, Cardiothoracic, Colorectal, Gynecologic etc.Radiation OncologyTreats cancer and other disease using radiation therapy
Photons, Protons, Electrons, alpha-particlesLocal treatmentOverview of Oncology
Medical Oncology
Chemotherapy travels through blood and goes everywhere
Slide5“Radiation (n.): Merrian-Webster Onlinea: the action or process of radiatingb: the process of emitting radiant energy in the form of waves or particlesc(1): the combined processes of emission, transmission, and absorption of radiant energy…”E=Hν (or H/
λ)Gamma ray or X-ray?What is “Radiation?”
Slide6Radiation: A Brief HistoryMarie Curie (1867-1934)
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 Chicago1901 – 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 – CT1975 – PET1980 – Multi-leaf collimators, Proton therapy1988 – Intensity modulated radiation treatment (IMRT)2000’s – Image-guided RT (IGRT)2019 - ???
Slide7External beam RT (i.e. the linear accelerator or Linac)3DCRT, IMRT, IGRT, VMATTreatment Delivery Systems have brand names
Radiation DeliveryImage courtesy of Varian Medical Systems, Inc. All rights reserved
Slide8Truebeam
Slide9Robotic Linear Accelerator
Image courtesy of Accuray, Inc. All rights reserved
Slide10Helical
LinacImage courtesy of Accuray, Inc. All rights reserved
Slide11RadiosurgeryGamma KnifeSingle high-dose radiation fractionVery conformal (i.e. tight margins)Gamma Knife
Slide12MR Guided Radiation
Slide13Protons
Slide14Normal cells- Normal repairTumor cells – try to grow regardless and are destroyedRadiation Damages DNA
Slide15Sarcoma
Slide16Approximately 13,000 cases will be diagnosed in US5000 will die from this diseaseAbout 1% of all cancersMost commonly presents in extremity
Incidence
Slide17Grows along muscle tract
Slide from ASTRO refresher 2016
Slide18And Practically Speaking
Slide19Slide20Multidisciplinary Management MattersRadiologyPathologySurgeryRad Onc
Med OncSupport ServicesExperienced centers leads to better outcomesMultiple retrospective series
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