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Radiotherapy Is the Second Method for Treating Cancer (Through Ionizing Radiations)

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Radiotherapy Is the Second Method for Treating Cancer (Through Ionizing Radiations) Cancer Radiotherapy Radiotherapy is the second method for treating cancer (through ionizing radiations) •External radiotherapy : irradiation source is situated outside the patient (RX devices, cobalt, accelerators), •Brachytherapy : radioactive sources are situated inside the patient * sealed sources : ‐intersticial brachytherapy : sources placed inside the tumour ‐ endocavitary brachytherapy : sources inside natural cavities where tumours develop * non sealed sources: ‐radioactive compounds are injected for particular tumours : I 131, P32, St189, .. In France, radiotherapy is used for the treatment of one out of two cancer patients. Half of the patients who are cured of their cancer, are treated by radiotherapy Some historical data on radiotherapy 1895: Wilhelm Conrad Röntgen in Würzburg ((y)Germany) discovers X‐rays. 1895: First therapeutic attempt to treat a local relapse of breast carcinoma by Emil Grubbe (Chicago) 1896: Discovery of natural radioactivity by Henri Becquerel in Paris 1896: First use of X‐Rays for stomach cancer by Victor Despeignes (Lyon ‐ France) 1896: Irradiation of a skin tumour in a 4‐year‐old by Léopold Freund (Vienna ‐ Austria) 1897: Thomson identifies the electrons for creating X‐Rays 1898: Discovery of radium by Pierre Curie and Maria Sklodowska Curie in Paris 1899: First real proof of cure by X ‐Rays ( two pictures taken at an interval of 30 years) 1901:First thiherapeuticuseof radium for skin 'bhhbrachytherapy' byDrDanlos (ôi(Hôpita l Saint‐Louis ‐ Paris) 1903: First scientific description of the effect of radiotherapy on lymphoma nodes (Drs Senn et Pusey) 1904: First treaty on radiotherapy by Joseph Belot in Paris 1905: Discovery of the sensitivity of seminoma to X‐Ray by Antoine Béclère in Paris 1913: Institut du Radium by Maria Sklodowska Curie and Claudius Regaud 1915:The atomic model by Ernest Rutherford (Cambridge ‐ UK) : radioactive active desintegration ‐ Development of RX tubes 1920: Structuration of French Radiotherapy by Maria Sklodowska‐Curie: Institut du Radium Some historical data on radiotherapy 1921: FdtiFoundation of the ItittInstitut du Cancer in Ville ju if (Ins titu t 'Gust ave Roussy' ‐ whowas a pathologist) with the brachytherapy unit of Jean Pierquin, Georges Richard and Simone Laborde. 1930: Institut Curie works on fractionation (Claudius Regaud, Henri Coutard, Antoine Lacassagne). 1932: Discovery of neutrons by Sir James Chadwick (Cambridge UK) 1934: Death of Marie Curie from pernicious anaemia (myelodysplasia) 1934:Discoveryofartificial radio‐elements by Irène and Frédéric Joliot‐Curie (Paris) 1934: Publication of 23% cure rate in head and neck cancer by X‐Rays ( Dr Henri Coutard ‐ Institut Curie) 1936:FrançoisBaclesse (Institut Curie) begins his work on conservative treatment of breast cancer 1948: first ZOE nuclear reactor (Frédéric Joliot) : productions of artificial radioelements 1951: First cobalt installation (Victoria Hospital ‐ London ‐ Ontario) 1952: First linear accelerator (Henry S. Kaplan in Stanford ‐ California) 1960: The 'Paris system' for brachytherapy with afterloading (Bernard Pierquin) 1973: Scanner invention par G.N. Hounsfeld (UK) 1990: First use of scanner and computers for IMRT 2000: One/two cured cancer patients owes recovery, partly to radiotherapy Physical bases of radiotherapy Radiobiology Notions Treatment parameters Main devices used in external radiotherapy Goals and results of radiotherapy Technical realisation of treatment Treatment supervision and acute side effects Late side effects Therapeutic associations Brachytherapy Notions Other particles used in radiotherapy Physical bases of radiotherapy Physical fundamentals of radiotherapy Classification of ionizing particles used in radiotherapy Several types of ionizing radiations : Non charged ionizing radiations Electromagnetic radiations Particule radiation: neutrons Charged ionizing radiations β – Radiation Accelerated electrons α‐Radiation Protons Light ions Physical fundamentals of radiotherapy Non charged ionising radiations iiiionizing partilicles or photons 1.Electromagnetic radiation: ‐X photons emitted during the rearrangement of electrons: X‐Rays tubes, accelerators; X‐ray tube is a vacuum tube ttathat produces X‐rays They are used in X‐ray machines. X‐rays are part of the electromagnetic spectrum an ionizing radiation with wavelengths shorter than ultraviolet light A high voltage power source, for example 30 to 150 kilovolts (kV), is connected across cathode and anode to accelerate the electrons. The X‐ray spectrum depends on the anode material and the accelerating voltage . ‐. Coolidge tube, (hot cathode tube), is the most widely used. Very good quality vacuum (about 10‐4 Pa, or 10‐6 Torr). electrons produced by thermionic effect from a tungsten filament heated by an electric current. The filament is the cathode of the tube. The high voltage potential is between the cathode and the anode, the electrons are thus accelerated, and then hit the anode. http://www.oncoprof.net/ ‐γ photons emitted during nuclear disintegration: ‐ 60Cobalt source,192 Ir wires, 137Cs wires are electromagnetic radiation of high freqqyuency : Gamma rays frequencies above 1019 Hz , energies above 100 keV , wavelength <10 picometers, Their main physical characteristics are: •no mass: they are propagated in a straight line; •no charge: their interaction with matter is random with important leakage after crossing any depth of matter . http://www.oncoprof.net/ Legend: γ = Gamma rays HX = Hard X‐rays SX = Soft X‐Rays EUV = Extreme ultraviolet NUV = Near ultraviolet Visible light NIR = Near infrared MIR = Moderate infrared FIR = Far infrared Radio waves: EHF = EtExtreme ly hig h frequency (Microwaves) SHF = Super high frequency (Microwaves) UHF = Ultrahigh frequency VHF = Very high frequency HF = High frequency MF = Medium frequency LF = Low frequency VLF = Very low frequency VF = Voice frequency ULF = Ultra low frequency SLF = Super low frequency http://www.oncoprof.net/ ELF = Extremely low frequency 2. Particule radiation: neutrons These partilicles are artific ia llyproddduced by cyclotrons: their route is straight throughout matter. They interact by pulling protons out of crossed tissue. At a siilimilar dose, the irreltilative bio log ica l effic iency (RBE) is approxitlimately 3 times hig her than photons. Beam of electrons moving in a circle (cyclotron motion). Lighting is caused by ionisation of gas in a http://www.oncoprof.net/ bulb. Charged ionizing radiations β – Radiation Accelerated electrons α‐Radiation Protons Light ions Physical fundamentals of radiotherapy β – Radiation β ‐ particles are emitted by certain radioactive nuclei. are electrons interact with matter by moving the electrons within tissue by electrostatic repulsion. Their route is more or less winding depending on their original energy. Their biological efficiency is very similar to that of X and γ photons. http://www.oncoprof.net/ Physical fundamentals of radiotherapy Accelerated electrons Produced by accelerators, same ppyhysical characteristics as ß Radiation Energy : chosen according to the depth of the tumour, They do not penetrate: Major advantage : sparing tissue situated deeper than the tumour. Physical fundamentals of radiotherapy α – Radiation heavy particles = positively charged helium nuclei Alpha particles consist of two protons and two neutrons bound together into a particle identical to a helium nucleus; written = He2+ or 42He2+. Net spin = zero, total energy of about 5MeV Highly ionizing low penetration Energy : chosen according to the depth at which the tumour, Major advantage : sparing tissue situated deeper than the tumour. Spontaneously produced by instable nuclei behave within matter by interacting with electrons and protons. Their route is very short; only a few millimetres in water. Their biological efficiency is 5 to 10 times higher than X or γ Photons, however their short penetration : prevents their clinical use. Physical fundamentals of radiotherapy Protons Produced by cyclotrons or synchrotrons, they loose their energy by colliding with electrons and nuclei. The in‐depth dose distribution is very different from that of photons and is concentrated within a very narrow peak (Bragg peak). Thus, proton irradiation is well adapted for deep small sized tumours situated close to radiosensitive healthy tissue. Main indications are choroidal melanoma, tumours at the base of the skull and tumours close to the spinal cord (chondroma, chondrosarcoma). The biological efficiency is less than that of neutrons http://www.oncoprof.net/ Sync hrot ro n General diagram of Synchrotron Soleil The circular ring is the synchrotron, i.e. a particle accelerator that brings electrons to very high speeds. The synchrotron emits a "synchrotron radiation", especially X‐rays; these are sent into the various beamlines (the straight lines branching out of the synchrotron). Each beamline contains scientific instruments, experiments etc. and receives an intense beam of radiation. http://www.oncoprof.net/ Varian Clinac 2100C Linear Accelerator. The linac within the Australian Synchrotron accelerate the linear particle accelerator (often shortened to linac) electron beam to energies of is a type of particle accelerator that greatly increases the 100 MeV. velocity of charged subatomic particles or ions by subjjgecting the charged particles to a series of oscillating electric potentials along a linear beamline; this method of particle acceleration was invented in 1928 by Rolf Widerøe.[1] http://www.oncoprof.net/ cyclotron is a type of particle
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