Basic information about the use and types of radiation therapy that can be used to treat common cancers

1. Radiation and Cancer
Saint Pete Catholic 2022

2. Changing Technology in the Delivery of Radiation

3. “Nothing endures but change.”
― Heraclitus

4. Basic Cancer Treatments

5. Surgery : local treatment, may be disfiguring but if the tumor can be
removed it is quite successful
Radiation: regional treatment, may have less side effects then surgery,
successful if the cancer is radio-sensitive
Chemotherapy: widespread, treats the whole body, may have
significant side effects, success depends completely on whether the
cancer is sensitive to the available drugs
Basic Cancer Treatments

6. Combined Modality Therapy in the
Treatment of Pediatric Rhabdomyosarcoma
Treatment 5 Year Survival
Surgery 10 – 20%
Surgery plus PostOp Radiation 40 – 50%
Surgery, Radiation then Chemotherapy 80 – 90%

7. •Need a cancer that is sensitive to radiation (or at
least more sensitive to radiation than the normal
structures around it) e.g. Hodgkin’s Lymphoma
•Need to be able to hit the target.
Need for Radiation to be Effective

8. Thomas Hodgkin in 1832 Boy with Hodgkin’s in 1920
Until the 1960s, among patients with an advanced stage of Hodgkin's
disease the median survival was 2 years, and only 5% of patients lived
beyond 4 years.
Currently it is curable in 85 to 95% of cases, depending on its stage

9. Survival I also very high
with chemotherapy alone
so radiation may not even
be necessary in many
patients
Shift away from maximum
treatment to aiming for the
least treatment necessary
to avoid long term
complications

10. Cancer Imaging
CT Scan

11. Using a PET scan
to help identify the
cancer target for
radiation therapy

12. VitalBeam Linac for Rapid Arc

13. Radiosurgery – using extremely well targeted
radiation to eliminate the tumor

14. Brain Metastasis
and Radiosurgery,
MRI shows complete
elimination of the tumor
with having to undergo
surgery

15. Three ways to get radiation to
hit the target
1.External Beam: radiation outside the body
2.Brachytherapy: ‘close therapy’ insert seeds,
wires, needle, balloons into the body
3.Isotope therapy: infuse radioactive particles into
the blood supply that will then find it’s way to the
cancer

16. Breast Cancer

17. Breast Radiation

18. Survival after lumpectomy and mastectomy for early-stage invasive breast cancer
Cancer 2013;119:1402
Women under 50y Women 50y or older
Survival in Months Survival in Months
Lumpectomy + Radiation
Lumpectomy + Radiation
Mastectomy Mastectomy
Study of 112,154 women in California, all Stage I or II diagnosed between 1990-2004

19. Lung
Cancer

20. Radiosurgery
of the Lung
The targeted
lesion is
totally gone
by 1 year with
no surgery
required

21. Stereotactic ablative radiotherapy versus lobectomy for operable stage I non-small-cell
lung cancer: a pooled analysis of two randomized trials
Outcome Radiation Lobectomy
OS/3y (overall survival) 95% 79%
DFS/3y (progression free) 86% 80%
Toxicity
Grade 3 10% 44%
Grade 4 0% 4%
Chang in Lancet Oncology 16:630. June 2015

22. Radiation for Prostate Cancer

23. Cure Rates with Radiation versus Surgery for Early-Stage Prostate
Cancer are the same
from the Cleveland Clinic.
Kupelian. JCO Aug 15 2002: 3376-3385

24. 10 Year Cure Rates for Patients with High-Risk
Prostate Cancer (PSA >20 or Gleason 8-10 or T3)
Treatment Number Cure Rate
Radical Prostatectomy 1,238 92%
Radiation plus Hormones 344 92%
Radiation alone 265 88%
Mayo Clinic Study (Boorjian Cancer 117;2883, 2011)

25. Radiation for Skin Cancer
Basal Cell
Squamous Cell

26. Cosmetic results for skin cancer on the nose, Mohs Surgery or Radiation

27. Isotopes in Use for Radiotherapy
Isotope Energy Half-life HVL
(mm lead)
Radium (Ra225) 0.83Mev 1626 y 16mm
Cesium (Cs 137) 0.662 30 y 6.5mm
Cobalt (Co 60) 1.25 5.26 y 11mm
Iridium (Ir 192) 0.397 73.8 d 6mm
Palladium (Pd 103) 0.020 17 d .013mm
Iodine (I 125) 0.028 59.6d .025

28. GYN Intracavitary Cesium
Temporarily place
radioactive tubes
inside the uterus to
treat the cancer
from within

29. Palladium Seeds
in the Prostate

30. Iridium balloons in the Breast

31. SIR-Spheres Y-90 resin microspheres for Liver Metastases
Normal liver cells are fed from the Portal Vein

32. SIR-Spheres Y-90 resin microspheres for Liver Metastases
The Hepatic Artery feeds the Cancer Cells

33. SIR-Spheres Y-90 resin microspheres for Liver Metastases
Insert the microspheres through the hepatic artery into the
vessels that feed the cancer

34. SIR-Spheres Y-90 resin microspheres for Liver Metastases
The microspheres get trapped in the capillary beds of the cancer and the radiation
kills only the cancer

36. Widespread Bone
Metastases…need to consider
a radioactive isotope that is
drawn into the abnormal
areas of bone…bone seeking
agent

37. Using radiation in a bone seeking agent,
like Radium 223 to hit bone cancer

39. The Logic of Immunotherapy
Cancer cells may
have unique markers
(antigens) on the
surface that can be
attacked by
antibodies.

40. Attach a radiation source to an antibody that will link to the target on the
cancer cell
Commonly used for lymphoma (Zevalin or Bexxar)

41. Commonly Used Radionuclides for Radioimmunotherapy

42. Once the antibody hooks onto the cancer cell then the radiation (Y 90) can
kill the cell

43. Once the antibody
hooks onto the cancer
cell then the radiation
(I 131) can kill the cell

44. How do you know if you are
getting the correct treatment?
Where do you go to get
trustworthy information?

45. www.NCCN.org

47. Note that as of
February 2022 the
guidelines have
already been updated
twice and are 244
pages long
These are quite
complicated but note
there is a link to patient
friendly guidelines.

48. Best source for current cancer information is the NCCN (National Comprehensive Cancer Network)
https://www.nccn.org/ https://www.nccn.org/patientresources/patient-resources