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FACET - European Journal of Cancer Care March 2005

FACET - European Journal of Cancer Care March 2005. Developments in radiotherapy treatment for cancer: implications for practice Faithfull , S. 1. Emerging Questions Which patients benefit most from radiotherapy? What is the optimal dose and fractionation schedule?

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FACET - European Journal of Cancer Care March 2005

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  1. FACET - European Journal of Cancer Care March 2005 Developments in radiotherapy treatment for cancer: implications for practice Faithfull, S.1 • Emerging Questions • Which patients benefit most from radiotherapy? • What is the optimal dose and fractionation schedule? • What impact does multi-modality radiotherapy have on patients? • What is the balance between new developments and the support required? Slide One *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

  2. FACET - European Journal of Cancer Care March 2005 Developments in radiotherapy treatment for cancer: implications for practice (continued) • Aims of radiotherapy • To achieve tumour control by delivering a homogeneous radiation dose to tumour-bearing tissues • To avoid radiation-induced complications by minimising dose to normal tissue structures Slide Two *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

  3. FACET - European Journal of Cancer Care March 2005 Developments in radiotherapy treatment for cancer: implications for practice (continued) Developments in radiotherapy Slide Three Royal Marsden NHS Foundation Trust *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

  4. FACET - European Journal of Cancer Care March 2005 Developments in radiotherapy treatment for cancer: implications for practice (continued) • Causes of failure of radiotherapy treatment (1) • Biological response to radiotherapy • Tumour physiology • Repopulation: accelerated cell proliferation • Redistribution • Re-oxygenation of hypoxic areas within the tumour • Intrinsic sensitivity of the tumour Slide Four *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

  5. FACET - European Journal of Cancer Care March 2005 Developments in radiotherapy treatment for cancer: implications for practice (continued) • Causes of failure of radiotherapy treatment (2) • New developments impact clinically in: • determining the underlying molecular basis for differences in radio-sensitivity • making possible the ability to individualise radiotherapy through biological understanding of damage mechanisms Slide Five *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

  6. FACET - European Journal of Cancer Care March 2005 Developments in radiotherapy treatment for cancer: implications for practice (continued) Tissue effects Slide Six *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

  7. FACET - European Journal of Cancer Care March 2005 Developments in radiotherapy treatment for cancer: implications for practice (continued) • Understanding the optimal dose and fractionation schedule • Adjusting fractionation regimes – hyperfractionation • Individualised radiotherapy regimes and dosages • Combined modality treatment chemo-radiation (CMT) Slide Seven *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

  8. FACET - European Journal of Cancer Care March 2005 Developments in radiotherapy treatment for cancer: implications for practice (continued) • Chemo radiotherapy and combined modality treatment • Increasing oxygenation • Perflurochemical emulsions: improving oxygen delivery to the tumour • Agents that selectively sensitise tumour cells to irradiation • Misonidazole: substitutes for O2 in fixing radiotherapy DNA damage • Fludarabine, Gemcitabine: prodrug inhibits various enzymes involved in DNA synthesis and repair • Radioprotectors: Amifostine Slide Eight *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

  9. FACET - European Journal of Cancer Care March 2005 Developments in radiotherapy treatment for cancer: implications for practice (continued) • Improving radiotherapy delivery (physical optimization) • Define target volume and normal tissues in 3D • Higher doses • Improved tumour control • Increased toxicity • Accurately determine doses to tumour and normal tissues (prognostication) • Lower volumes of structures irradiated • Lower late toxicity Slide Nine *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

  10. FACET - European Journal of Cancer Care March 2005 Developments in radiotherapy treatment for cancer: implications for practice (continued) • Technological advances • Portal imaging • Intensity Modulated therapy (IMRT) • Image-guided radiation therapy (IGRT) • Conformal therapy (CFRT) • Multileaf collimation • Stereotactic radiotherapy • Gated treatment (pulsed according to the phase of the respiratory cycle) • Therapy with portable photon sources (Intraoperative) • Prostate brachytherapy • Intraoperative brachytherapy using Flab (flexible tissue-equivalent material) Slide Ten *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

  11. FACET - European Journal of Cancer Care March 2005 Developments in radiotherapy treatment for cancer: implications for practice (continued) • Developments in supportive care with radiotherapy • Improved patient information , patient education and written consent • Nurse-led follow up • Extended therapy radiographer roles • Patient education Slide Eleven *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

  12. FACET - European Journal of Cancer Care March 2005 Developments in radiotherapy treatment for cancer: implications for practice (continued) • The challenges • Lack of assessment in radiotherapy • Large proportion of patients are palliative; may have different needs • Lack of knowledge Slide Twelve *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

  13. FACET - European Journal of Cancer Care March 2005 Developments in radiotherapy treatment for cancer: implications for practice (continued) Comparison of technology and supportive care publications Slide Thirteen *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

  14. FACET - European Journal of Cancer Care March 2005 Developments in radiotherapy treatment for cancer: implications for practice (continued) • How will high tech treatments impact on patients? • Combined modality acute side effects are more severe • Improve flexibility and individuality of treatment regimes • Lag time from treatment to development of late side effects • Need to balance of length of time of new treatments against resource implications need cost benefit evaluation Slide Fourteen *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

  15. FACET - European Journal of Cancer Care March 2005 Developments in radiotherapy treatment for cancer: implications for practice (continued) • Conclusion • Sustained radiotherapy technological development is likely to improve treatment efficacy • Essential to assess the clinical and biological nature of cancer and the patient to patient variability to optimise new developments • Ongoing multi-professional assessment of toxicity is essential to aid decision making • Optimal multi-modality management approaches and evaluation Slide Fifteen *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

  16. FACET - European Journal of Cancer Care March 2005 Developments in radiotherapy treatment for cancer: implications for practice (continued) • References and further reading • Adamson, D. (2003). The radiobiological basis of radiation side effects. In Supportive care in radiotherapy, Faithfull, S. & Wells, M. (eds). Churchill Livingstone: Edinburgh. • Bentzen, S. (1998). Towards evidence based radiation oncology: improving the design, analysis, and reporting of clinical outcome studies in radiotherapy. Radiotherapy and Oncology, 46, 5-18. • Bentzen, S. (2004). High-tech in radiation oncology: should there be a ceiling? Int. J Radiation Oncology Biol. Phys., 58, 320-330. • Burnet, N., Benson, R. & Williams, M. (2000). Improving cancer outcomes through radiotherapy. BMJ, 320, 198-199. • Colyer, H. & Hlahla, T. (1999). Information and support radiographers: a critical review of the role and its significance for the provision of cancer services. Journal of Radiotherapy in Practice, 1, 117-124. Slide Sixteen *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

  17. FACET - European Journal of Cancer Care March 2005 Developments in radiotherapy treatment for cancer: implications for practice (continued) • References and further reading (continued) • Dische, S., Joslin, C., Miller, S., Bell, N. & Holmes, J. (1998). The breast radiation litigation and the clinical oncologist. Clin Oncol, 10, 367-71. • Dixon, P. & Mackillop, W. (2001). Could changes in clinical practice reduce waiting lists for radiotherapy? Journal of Health Services Research, 6, 70-77. • Fulop, N., Allen, P., Clarke, A. & Black, N. (2003). From health technology assessment to research on the organisation and delivery of health services: addressing the balance. Health Policy, 63, 115-165. • Goldberg, Z. & Lehnert, B. (2002). radiation induced effects in unirradiated cells: A review and implications in cancer. International Journal of Oncology, 21, 337-349. Slide Seventeen *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

  18. FACET - European Journal of Cancer Care March 2005 Developments in radiotherapy treatment for cancer: implications for practice (continued) • References and further reading (continued) • Green, J., Kirwan, J., Tierney, J., Symonds, P., Fresco, L. & Collingwood, M. (2001). Systematic review and meta-analysis of randomised trials of concomitant chemotherapy and radiotherapy for cancer of the uterine, cervix: better survival and improved distant recurrence rates. Lancet, 358, 781-6. • Hill, R., Rodemann, H., Hendry, J., Roberts, S. & Anscher, M. (2001). Normal tissue radiobiology: from the laboratory to the clinic. Int.J.Radiation Oncology Biol. Phys., 49, 353-365. • Lewanski, C. & Gullick, W. (2001). Radiotherapy and cellular signalling. The Lancet Oncology, 2, 366-370. • Murthy, V. & Horwich, A. (2004). Intensity modulated radiation therapy. European Journal of Cancer, 40, 2349-2351. • Sikora, K. & Bosanquet, N. (2003). Cancer care in the United Kingdom: new solutions are needed. British Medical Journal, 327, 1044-1046. Slide Eighteen *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

  19. FACET - European Journal of Cancer Care March 2005 Developments in radiotherapy treatment for cancer: implications for practice (continued) • References and further reading (continued) • Stone, H., Coleman, C., Ansher, M. & McBride, W. (2003). Effects of radiation on normal tissue: consequences and mechanisms. The Lancet Oncology, 4, 529-36. • Symonds, R. (2001). Recent advances in Radiotherapy. BMJ, 323, 1107-10. • Tobias, J. (2000). Risk management and radiotherapy for cancer. Clinical Risk, 6, 13-16. • Wells, M. (1998). What's so special about radiotherapy nursing? European Journal of Oncology Nursing, 2, 162-168. • Wells, M. (2003). The treatment trajectory. In Supportive care in radiotherapy, Faithfull, S. & Wells, M. (eds). Churchill Livingstone: Edinburgh. Slide Nineteen *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

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