Radiotherapy for Brain Tumours What do I need to know? Dr Matthew Foote

Radiotherapy for Brain
Tumours
What do I need to know?
Dr Matthew Foote
Radiation Oncologist
Princess Alexandra Hospital
Queensland
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?
What is radiotherapy ?
• Effective cancer treatment modality
• High energy X-rays damage to tumour cells
• Course of radiotherapy (treatment – fraction)
How does it work ?
• Ionizing radiation causes DNA
breaks
• Repair of normal tissue
• Fractionation
How does it target my tumour ?
• Multiple beams
• Complex dose shaping
• Sparing surrounding
structures
What are the different types of delivery ?
• Fractionated
– Multiple small doses
• Single dose (Radiosurgery)
What are the machines and what does it all
mean?
• Linear Accelerator (Linac)
• Tomotherapy
• Gammaknife
• Protons
What is a linear accelerator (Linac) ?
• Most common machine used to deliver
therapeutic radiotherapy
• Used for most treatments including brain
tumours
What about Tomotherapy ?
• Beam as a fan
• Similar to CT scan
• Ability to spare normal tissue
What about Gammaknife ?
• Specific indications
• Highly focussed stereotactic (ablative)
techniques
What about protons ?
• Not currently available in Australia
• Specific indications
• May be superior in treating some paediatric
brain tumours
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.
What is involved in having radiotherapy ?
• Specifically for fractionated radiotherapy
– Initial appointment
– Planning of radiotherapy
– Commencement of treatment
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
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
Most common on treatment effects ?
• ON TREATMENT
•
•
•
•
•
•
•
• AFTER TREATMENT
Tiredness
• On going tiredness
Headaches
HearingWITH
difficulties
NOT ALL MAY OCCUR AND BEST •DISCUSSED
RADIATION
FACTORS
Nausea ONCOLOGIST BASED ON•PREVIOUS
Hormone
function
Hair loss
• Longer term neurocognitive effects
Skin reddening
Hearing difficulties
‘neuro-cognitive’ effects
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
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)
Other advances in radiotherapy treatment of
brain tumours
• Utilizing better imaging techniques to better
define target and normal tissue
Other advances for the treatment of brain
tumours ?
• Interaction with targeted chemotherapy agents
– bevacizumab (Avastin)
• Re-irradiation of brain tumours
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
5th ANNUAL SCIENTIFIC MEETING
7th – 9th August 2012
Sofitel Hotel Brisbane
in conjunction with
Medical Oncology Group of Australia ASM (8th-11th August)