late effects of radiation dr. sandra vermeulen, m.d. swedish cancer institute northwest hospital...

Late Effects of RadiationDr. Sandra Vermeulen, M.D.

Swedish Cancer Institute

Northwest Hospital Gamma Knife Center

Seattle, Washington

Learn More At:www.DoctorVermeulen.com

• The Cat’s Eye Nebula produces energy that is part of the Electromagnetic spectrum

• Located 3,000 light years away from our Milky Way Galaxy

• First planetary nebula to be discovered by the Hubble telescope

• Nebula are dying stars

• Chemical elements in the nebula emit light at very specific wavelength

- Hydrogen Atoms – Red

- Oxygen Atoms – Blue

- Nitrogen Ions – Green

Cat’s Eye Nebula


• The solar system was made from recycled elements originating from a dying star (Planetary Nebula)

• In terms of mass:

- 70% Hydrogen

- 28% Helium

- 1% Oxygen

- 1% All Remaining Elements

Our Solar System


C.H.O.N.


Carbon, Hydrogen, Oxygen and Nitrogen are so common in clouds of gas and dust in space they are simply referred to by the acronym

C.H.O.N.

Water Weight

- 65% H20

Dry Weight

- 50% Carbon

- 25% Oxygen

- 10% Nitrogen

- 15% All other elements combined

We are made from the 4 most reactive elements in the

Universe

Body Mass


Radiation Therapy Machines produce energy from the Electromagnetic Spectrum

- Linear Accelerator

- CyberKnife

- Gamma Knife

Radiation Therapy Machines


• It is the name given to the group of radiation types

• All radiation is a form of energy

• Energy in this example increases from left to right

• Energy is defined as ionizing or non-ionizing if it is large enough to remove electrons from their atoms.

The Electromagnetic Spectrum


• The effect of radiation on cancer cells is due to ionization or damage caused by the breakage of chemical bonds in the DNA molecule

• DNA damage prevents the cells from replicating

• As long as cancer cells cannot reproduce, they cannot grow in size or metastasize

DNA (DeoxyriboNucleic Acid)


SIEVERT, (REM, roentgen equivalent man, old term) is used to compare different types of radiation.

GRAY (RAD, old term) equals radiation-absorbed dose (in tissue)

QF is the quality factor and accounts for the different degree of damage produced by equal doses of different radiation types. QF is 1 for photons (the most commonly used energy in therapeutic radiation medicine)

SIEVERT= GRAY X QF

100 rad = 100 cGy = 1 Gy = 1 Sv (if the QF is 1) = 1000 mrad = 1000 mGy = 1000 mSv

Dose Equivalent


Exposure to Ionizing Radiation


Source Average Dose

Back ground radiation on earth

2 mSv/year

Crews aboard the space station

80 – 160 mSv/ 6 months

Although the type of radiation is different, 1 mSv of space irradiation is equivalent to approximately

3 chest x rays (equal to < 1 Gy)

The goal of radiation therapy is to injure more cancer cells than normal cells

To achieve this, a treatment planning session or simulation is undertaken prior to actual treatment. Many variables need to be considered including:

- Treatment Type - Field Size - Number of Treatment Beams - Beam Direction - Beam Modifiers (Blocks, Wedges, Tissue Compensators) - Computerized Dosimetery Plan - Patient Immobilization Device

Radiation Therapy Planning Session


The effects of radiation maybe temporary (because the cell is able to repair it) or permanent (by injuring the repair mechanism) and become apparent anywhere from days to weeks to months to years after exposure.

Radiation injury is a function of radiation type, dose, fraction size, volume of tissue irradiated and area of the body exposed

Side Effects


800 cGy/1 fx = 2000 cGy/5 fx = 3000 cGy/10 fx = 3500 cGy/14 fx = 4500 cGy/25 fx

50% of metastases are controlled with these doses

Control with radiosurgery alone or as a boost is 80-90%

Whole Brain Irradiation Dose Volume Equivalents


Glioblastomas and other astrocytomas do not show a response above 6000 cGy

Treatment is usually delivered to the partial brain at 180 cGy over 33 fx

Primary Brain Tumors


Radiation Side Effects


Acute Side Effect (1-6 months after Treatment)

Late Side Effects(6-24 months after Treatment)

• Skin Burns

• Hair Loss

• Fatigue

• Occasional Worsening of Neurological Symptoms

• Headaches

• Nausea / Vomiting

• Hearing Loss

• Dry Eyes

• Ataxia,

• Urinary Incontinence

• Hearing Loss

• Dry Eyes

• 10-20% risk of cognitive change, which include memory loss and apathy

The goal of any radiation treatment is to

1. Stop

2. Cure

3. Eradicate

the growth of the Cancer which will slow down or prevent worsening neurological function and eventually death

Radiation Treatment Goal


Normal Tissue Tolerance To Therapeutic Radiation


Organ cGy (Volume) Side Effect

Brain

6,000 (1/3)

5,000 (2/3)

4,500 (3/3)

InfarctionNecrosis

Optic Nerve 5,000 (no partial volume) Blindness

Lens1,000 (no partial volume) Cataract

Spinal Cord4,500 (10 cm) Infarction

Necrosis

Pituitary

4,500 Endocrine Abnormalities Sex HormonesThyroid HormoneCortisol

Dose expected to give a 5% risk of injury at 5 years

Listed in decreasing order of brain volume exposed to the effects of ionizing radiation:

- Conventional External Beam Irradiation

- 3D - Conformal Radiation Therapy

- Intensity Modulated Radiation Therapy

- Stereotactic Radiosurgery / Stereotactic Radiotherapy

Brain Volume


Medication for Radiation Side Effects


Medications Indications

Decadron Brain Swelling

Anti-Emetics Nausea

Antisiezure Drug Seizures

Hydrocortisone / Aloe Vera

Skin Irritation

Antihistamines Otitis

Artificial Tears Eye Dryness

Is there anything that can be done for long-term/chronic side effects

such as memory loss and fatigue?

Question?


• Stop smoking

• Treat all other unrelated disease conditions aggressively such as, diabetes and infections

• Get adequate rest and exercise

• Eat right/see a dietician

• See a Naturopath

- Vitamins (anti-oxidants), minerals, including omega –3 fatty acids and DHA (docosahexaenoic)/EPA (eicosapentaenoic)

• Check for and treat any progressing endocrine abnormalities

- Low thyroid, low levels of estrogens and testosterone, low levels of cortisol

• Reduce stress

- Bio-feedback therapy, psychotherapy, support groups

- Seek Spiritual comfort

• Non-traditional western medicine approach to health

- Yoga, meditation

• Hyperbaric oxygen therapy?

Things To Consider / Try To Optimize Brain Health


Question:

How do I optimize my Brain Health to receive the right therapy for my disease type?

Answer:

Get more than one opinion before starting treatment.

Question?


We are on the continued quest of study to harness

the benefits of energy produce by

the Electromagnetic Spectrum

Conclusion


late effects of radiation dr. sandra vermeulen, m.d. swedish cancer institute northwest hospital...

Documents

type of radiation

different types of radiation

ground radiation

effect of radiation

group of radiation

goal of radiation therapy

cancer cells

form of energy energy