Challenges in Optimal Delivery of Radiation in Head and Neck Cancers Dr.J PAgarwal Associate Professor Department of Radiation Oncology Tata Memorial Hospital,India TMH ESTRO EBM 2005 ESTRO术
Challenges in Optimal Delivery of Radiation in Head and Neck Cancers Dr. J P Agarwal Associate Professor Department of Radiation Oncology Tata Memorial Hospital, India TMH ESTRO EBM 2005
Head and Neck Squamous Cell Carcinoma Accounts for about 4,50,000 cases worldwide* 20%of cancer burden-1,50,000 new cases in 2000 in India* TMH -25%of all new cases annually 75 present with advanced disease *Globocan,2002 IARC
Accounts for about 4,50,000 cases worldwide* 20% of cancer burden - 1,50,000 new cases in 2000 in India* TMH - 25% of all new cases annually > 75 % present with advanced disease Head and Neck Squamous Cell Carcinoma *Globocan,2002 IARC
General Management Guidelines for H&N Cancers Aim Highest loco-regional control Anatomical with functional preservation Stage 1/ll Single modality(Surgery or RT) Stage IlI /IV Combined modality Surgery RT (in most patients) Chemotherapy RT in selected patients When different modalities available,one with maximum chance of cure should be used When different modalities have same results,one offering better quality of life,with organ,function preservation and good cosmetic results should be used
General Management Guidelines for H & N Cancers Aim Highest loco- regional control Anatomical with functional preservation Stage I / II Single modality ( Surgery or RT ) Stage III / IV Combined modality Surgery + RT (in most patients) Chemotherapy + RT in selected patients When different modalities available, one with maximum chance of cure should be used When different modalities have same results, one offering better quality of life, with organ, function preservation and good cosmetic results should be used
Head And Neck Radiotherapy A Challenge for The Radiation Oncologist Tumor .Very Close proximity Of Tumor and Critical structures .Total Dose Delivery Limited by Tolerance of Normal structures .Dosimetric Challenges Due to Varying Contour/Tissue Heterogeneity Patient .Compromised Tolerance To Treatment Poor Nutritional Status and Weight Loss Inadequate oral Intake Treatment Induced Mucositis
Head And Neck Radiotherapy A Challenge for The Radiation Oncologist Tumor •Very Close proximity Of Tumor and Critical structures •Total Dose Delivery Limited by Tolerance of Normal structures •Dosimetric Challenges Due to Varying Contour/Tissue Heterogeneity Patient •Compromised Tolerance To Treatment Poor Nutritional Status and Weight Loss Inadequate oral Intake Treatment Induced Mucositis
The Goal Optimal Dose Delivery ..With Minimum Acute And Long Term Toxicity
The Goal Optimal Dose Delivery …With Minimum Acute And Long Term Toxicity
Evolution Of Head And Neck Radiotherapy 1970-2005 Escalation Of Doses Through Precise Immobilization Tissue Compensation/Customized Blocks Better Skin Sparing (Megavoltage) Integration of brachytherapy BDCRTSRT/IMRT
Evolution Of Head And Neck Radiotherapy 1970-2005 Escalation Of Doses Through Precise Immobilization Tissue Compensation/Customized Blocks Better Skin Sparing (Megavoltage) Integration of brachytherapy 3DCRT /SRT/ IMRT
Key Issues In Head And Neck Radiotherapy Set up Uncertainties Target Volume Delineation .Precise Treatment Planning Delivery .Locoregional control Overall Survival Overall Treatment Time .Nutritional support Quality of Life
Key Issues In Head And Neck Radiotherapy •Set up Uncertainties •Target Volume Delineation •Precise Treatment Planning & Delivery •Locoregional control & Overall Survival •Overall Treatment Time •Nutritional support & Quality of Life
The changing paradigm Wide field radiation Conformal radiation Clinical motivation for high-precision techniques More conformality Better sparing
The changing paradigm Wide field radiation Conformal radiation Clinical motivation for high-precision techniques More conformality = Better sparing
Key Issues In Head And Neck Radiotherapy .Set up Uncertainties .Target Volume Delineation .Precise Treatment Planning Delivery Overall Treatment time .Locoregional control ·Overall Survival. .Nutritional status Quality of life
Key Issues In Head And Neck Radiotherapy •Set up Uncertainties •Target Volume Delineation •Precise Treatment Planning & Delivery •Overall Treatment time •Locoregional control • Overall Survival. •Nutritional status & Quality of life
Conformal Radiotherapy .....The Need For Higher Accuracy Immobilization Devices used .Head Rest alone .POP with Head Rest .Mouth Bite,Nasion Chin support .Thermoplastic Moulds Varying levels of level of Uncertainty Set up errors 5 mm-I cm
Conformal Radiotherapy ……The Need For Higher Accuracy Immobilization Devices used •Head Rest alone •POP with Head Rest •Mouth Bite, Nasion & Chin support •Thermoplastic Moulds Varying levels of level of Uncertainty Set up errors 5 mm-1 cm