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The role of radiotherapy in the treatment of skin cancer
HOLEČKOVÁ, Ivana
Tumour diseases constitute one of the main causes of death in advanced countries. If diagnosed in time, the disease can be cured in approximately 45 % cases. Common curative methods of treating skin tumours include surgical, radiotherapeutic, chemotherapeutic or biological treatment or their combination. The subject of my thesis is the role of radiotherapy in treatment of skin tumours. I have compared the results of radiotherapeutic treatment in the period from 1981 to 1985 and from 2001 to 2005 in the oncology ward of Nemocnice České Budějovice, and also examined the count of radiated patients in comparison with the number of all reported skin tumours. On the basis of these statistical data we obtain a certain idea of the rate of use of both the above stated methods in treatment of carcinoma. The first part of my thesis is theoretical and provides a historical survey of tumour diseases, based on study of technical literature. Following the survey, I address radiotherapy in general and attend to skin anatomy; a special chapter is focused on skin cancer and its symptoms. The theoretical part describes curative methods of skin tumours. With regard to the topic of the thesis I pay larger attention to selection of a radiation source and to general planning of radiotherapeutic treatment. This part of the thesis includes a description of radiation side effects and a section discussing prevention of tumour diseases. In the practical part I compare the results of radiotherapeutic treatment of patients treated in two five-year intervals in the space of 16 years. Based on the comparison of the total number of reported oncologic diseases and the number of patients treated with radiotherapy, I arrive at the conclusion that priority is given to surgical methods rather than to radiotherapeutic ones. The reasons are obvious {--} availability of radiotherapy only in most of large centres, time {--} consumption connected with a larger number of sessions, and mental discomfort for the patient.
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The incidence of secondary tumors after irradiation for carcinoma of the uterine body.
TESAŘOVÁ, Lenka
ANNOTATION: Malignant tumours of the corpus uteri are among the most frequently occurring gynaecological conditions. Endometrial carcinoma represents 96{--}98% of all malignities in corpus uteri tumours. Occurrence of this condition in the Czech Republic: in 2007, 1726 new cases were diagnosed, which represents approximately 32.7 cases per 100 thousand women. Almost 75% of the patients are diagnosed in the first stage of the disease. The age median of the patients with a diagnosed tumour of the corpus uteri is 61 years. Secondary tumours occur from mutations several years after radiation exposure. They result from the previously administered chemotherapy or radiotherapy leading to the damage to the genetic information in the cells. The mutation affects the cells that relate to the formation of secondary malignities. The aim of my bachelor{\crq}s thesis is to find out about the occurrence of the secondary tumour with cancer of the corpus uteri among those who received radiotherapy at the Department of Oncology at Hospital České Budějovice between years 1978-98. In my thesis I evaluated the number of secondary tumours, time of their occurrence, relative risks, and whether they are located within or outside the irradiated field. The thesis is divided in two main parts: a theoretical part where I deal with the tumour itself, radiotherapy, and radiobiology; and a practical part that presents concrete statistics issuing from the aim of my work. I found out that secondary tumours occur more frequently outside the irradiated area. The results suggest that secondary tumours may occur from the effects of the ionising radiation on the organism. This probably relates to the fact that there are lethal changes within the area exposed to radiation whereas in areas receiving low doses of radiation the cells are damaged, which may, after many years, lead to the occurrence of secondary tumours. I chose this topic also to emphasise the fact that besides the curing of the primary tumour one also needs to pay attention to dispensing a routine that may aid the early detection of further tumours
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Dose vertification in external radiotherapy with the aid of in vivo dosimetry.
LINHARTOVÁ, Hana
The bachelor thesis shall focus on in-vivo dosimetry assessment at the Department of Radiotherapeutic Oncology of the Thomayer University Hospital with Polyclinic. In-vivo dosimetry is applied in regular intervals in the majority of curative patients, and it is a verification method of particularly the entrance and exit dose of irradiated fields. The thesis is aimed at evaluating this dosimetry as mentioned above, performing a comparison with the planning system, comparing individual doses, and deviations from prescribed doses. This method is independent both of the classical dosimetric procedure and also of the planning system support. Therefore the method is of high importance in the common clinical process of external radiotherapy within the framework of the quality assurance (QA) and quality control (QC) programme.
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Importace of verification treatment irradiaton position of IMRT prostate
KŘÍŽOVÁ, Marcela
Prostate cancer is the most frequent oncological disease in men. Based on the disease phase and extent, patiens with prostate carcinoma diagnosis are treated with number of different therapies including radical prostatectomy, hormone therapy, chemotherapy, brachytherapy, conventional radiotherapy, conformal radiotherapy and combination of these. This Bachelor Thesis deals with prostate carcinoma treatment using a special conformal radiotherapy method - IMRT (Intensity Modulated Radiotherapy). The first section describes the disease charakter from the clinical point of view and the disease diagnosis, followed by treatment modalities. The main part examines and describes IMRT, treatment planning and resultes from statistic evaluation of irradiation position deviations. IMRT technique allows escalation of the irradiation dose while protecting critical structures. In this way the patient can be irradiated with a total dose of 80 grays (Gy). Patients are irradiated in a linear accelerator. Modulation of the radiation beam using multileaf collimator allows irradiation of different segments of target volume with different doses, so that overal homogenity of the irradiation treatment is achieved through nonhomogenous distribution of the dose. Escalation of the irradiation dose is in a close relationship with the irradiaion position and isocentre position kontrol, so that the treatment quality is guaranteed preventing damane to surrounding healthy tissue. Fixing the patient in irradiation position as well as reproductibility of the position is of essentials importance. The isocentre in irradiation position is verified efore every fraction. Verification portal images are acquired using EPID (Electonic Portal Image Device) Portal Vision LC 250 and then compared with reference verification images acquired by CT when planning the treatment. Portal images are made up of two fields of 12x12 cm size under 0 and 90 or 270 degrees. Deviations are recorded in craniocaudal, mediolateral and anterior-posterior axes, and if they exceed 3mm, the irradiation position is corrected on the irradiation table. In this Thesis, deviations in a group of 30 patients were evaluated using the Aria-Offline Review programme which is an accesory to the treatment planning system. In one third of the statistical group of patient, deviations identified using on offline review were compared with deviations identified by start efore each fraction. Dutiny statistical processing, deviations were recorded within ranges 0-3 mm, 3,1-5 mm and over 5mm. 69% of acceptable deviations were recorded within the 0-3 mm range in the craniocaudal axis, 71% in the mediolateral axis and 67% in the anterior-posterior axis. Based on a complete analysis and evaluation of the deviations we can conclude that verification of the irradiation position in treatment of prostate carcinoma using IMRT is essentials to guarantee the irradiation treatment quality. We have also verified that deviations between 0 and 3 mm are acceptable and in no way impair the treatment quality.
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Side Effects of Radiotherapy and Patients´ Awareness of these Effects
CHMELÍKOVÁ, Helena
Oncology diseases belong to one of the most serious worldwide health problems. Each third citizen of the Czech Republic has a malign tumour in the course of life. One of the main methods of oncology disease treatment is radiotherapy. Ionizing radiation is used for the treatment but it also brings some undesirable side effects. In the practical part I focused especially on patients´ awareness of undesirable side effects of the treatment. To gain information I elaborated a questionnaire, which was filled in by 250 patients from the whole Czech Republic. The research was anonymous for both patients and hospitals, where the research was carried out. The most of patients say that the gained information is sufficient. However, 57 per cent of patients add that they would appreciate more information from other resources, especially leaflets and the Internet. The other important part of the thesis is a leaflet which informs on radiotherapy itself and on side effects and possibilities of treatment.
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The Importance of Verification Images during IMRT in the Area of Head and Neck.
MYSLÍKOVÁ, Petra
Tumours of the head and neck are the fifth most common cancers in the Czech Republic. Despite easily available medical examination and observable symptoms most patients come for treatment with various types of tumours in advanced phases which lowers their chance of being cured. The technique of IMRT has recently become the most often used curative method for the tumours of the head and neck, enabling better treatment of healthy tissues and critical organs in this area. The thesis is divided into the theoretical and practical part. In the first part, the areas of head and neck and the types of cancers found in these areas are analysed. The chapters concern symptoms, aetiology, diagnostics, prognosis and, of course, their treatment. Further, the common course of planning has been included and at the end of this part the history and presence of verification images is mentioned. The second part of this thesis includes objectives and a hypothesis. The objective of the thesis is to explore and evaluate portal verification images of target volume in tumours of the head and neck and compare these images with referential verification images as well as to state deviations in irradiation position and to prove the significance of verification images in the area of head and neck. This part also includes chapters describing methodology (with resources), and the course planning process in a patient using IMRT technology. Further, it includes the research result of the a collection of 50 patients with the tumours of the head and neck who were irradiated by IMRT technology and whose verification images of target volume were evaluated. The predicted objectives were fulfilled and the hypothesis was disproved. Verification portal images are made in oncology department once a week. I would suggest making verification portal images with a fixation mask at least twice a week in order to achieve better accuracy and control of the irradiation position.
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The evaluation of the problems of verification isodose distribution - the simulation of the treatment fields on simulator Acuity.
KOCOUREK, Michal
The verification of the treatment fields{\crq} location on a simulator is one of the main activities within the field of radiation quality. Simulation pictures are compared with reference pictures (DRR). during the simulation. If a patient{\crq}s position during the simulation differs from the reference picture, the deviations are shown in individual axes. The aim of a radiotherapy assistant is to reduce the extent of those deviations to a minimum, or at least to the range of tolerance given in a tolerance table. The accuracy of the setup is an important factor in the process of quality assurance in radiotherapy. There are two methods available for the assessment of deviations on a simulator: - the method of anatomical structures comparison - the method of picture fusion In the case of the method of comparison of anatomical structures, the level of equivalence of the pictures is ascertained by using the multi-leaf collimator{\crq}s lamellas or the degree scale shown in the picture. Further verification of the accuracy of the setup is done in the individual radiotherapists{\crq} workplaces, specifically the linear accelerator and/or the cobalt irradiator, where the DRR is mostly compared with the portal picture. The method of comparison of the anatomical structures is used more frequently at the Radiotherapeutic Clinic of the České Budějovice Hospital than the method of picture fusion.
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Toxic effects of Radiotherapy for Female Patients over 60 Years of Age with Gynecological Tumors
POLODNOVÁ, Šárka
Cervical cancer and cancer within the body of the uterus are the most frequent cancers of the female reproductive organs, the incidence of which is on the rise. Every year, more than 1,000 new cases of cervical cancer are diagnosed in the Czech Republic, as well as 1,500 cases of endometrial cancer. Surgical treatment and external radiotherapy are used during therapy and, in some cases, it is combined with brachytherapy and chemotherapy. I focused on the early toxicity of radiotherapy, which can be a limiting factor for the completion of treatment, especially in older patients. The investigated sample consists of 100 female patients who were divided into 4 groups, according to age and the primary diagnosis of these patients. Each group consists of 25 women. Patients in the first group are represented in a group of those under 60 years of age with cervical cancer; the average age is 48 years. The second group consists of patients with the same diagnosis, but who are over 60 years of age; the average age is 66 years. The third group consists of patients who are under 60 years of age who have uterine cancer; the average age is 54 years. The 4th group consists of patients who are over 60 years of age with uterine cancer; the average age is 71 years. All patients were irradiated at the Oncological Clinic of České Budějovice Hospital. In my thesis, I compared the toxicity of radiotherapy in the group of younger patients with the group of the older patients. Hematological toxicity was more frequently identified in older patients, be it the malignant cervical cancer (76%) or the endometrial cancer (52%). In younger patients, hematological complications occurred less frequently (cervix {--} 52%, body of uterus {--} 24%). Serious grade 4 toxicity was identified in one patient over 60 years of age with separate pelvis radiotherapy for cervical cancer. Grade 3 toxicity was identified in one patient from the younger group and in one patient from the older group with combined treatment for cervical cancer. In regard to non-hematological complications, toxicity was more severe in older patients too. The incidence of diarrhea in the over 60-year-olds was 64% as opposed to 48% in the younger group. The stated hypothesis of higher toxicity of treatment for older patients was confirmed during my research.
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Treatment planning problems of tumours localized in nose area
JEŽKOVÁ, Kristýna
Radiotherapy is a conservative treatment method that is utilised during therapies of tumour diseases. Its objective is to perform a homogeneous irradiation of tumour tissue and simultaneous research of surrounding healthy organs. Distribution of a dose in homogeneous material, at the moment of vertical incidence of the central ray, is not a physical problem. However, in a clinical practice, during irradiation of individual patients we daily encounter problems related to irradiation of non-homogeneous volumes and uneven surfaces. The work focuses on irradiation of tumours localised in a nose area, which is connected with the problems of irradiation of uneven surfaces. The solution is to use a simple compensation bolus. Its application can achieve a homogeneous irradiation of the targeted volume as per the recommendation by ICRU Report 50.
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The evaluation doses of irradiation on the skin of the patients after mastectomy with breast cancer by TLD and planning system with and without bolus.
GALEKOVÁ, Dominika
My Bachelor thesis deals with the evaluation of doses of radiation on skin, in patients after a breast ablation for a carcinoma, with thermoluminescence dosimeters and planning consoles under bolus and without bolus. The thesis comprises two parts, a theoretical and practical part. The theoretical part is focused on the occurrence of breast tumour diseases, classification of tumour types and prevention of breast tumour diseases, as well as on the disease diagnostics and treatment. The practical part provides evaluation of a measurement related to a dose on the surface of patient{\crq}s skin and on the surface of Rando Phantom. Measurement results are presented in tables and graphs. In the practical part, we used the Rando Phantom for measurement of thermoluminescence dosimeters, an evaluation device for the evaluation of thermoluminescence dosimeters, bolus (tissue equivalent material) which increases the dose on body surface, homogeneous. The practical part and the entire Bachelor thesis compares radiation doses on the sin of patients after total mastectomy using bolus with doses measured on the surface of a phantom. Both the phantom and the patients were irradiated under the same radiation conditions. Results of measurements conducted at ONO in the České Budějovice Hospital show that an average dose obtained from individual thermoluminescence dosimeters is 1,88 Gy in a phantom with the use of bolus, 1,5 Gy in a phantom without vthe use of bolus, 2,14 Gy in patiens after total mastectomy usány bolus and 1,76 Gy in patients after total mastectomy without using bolus. When irradiating patients without the use of bolus, the dose permeates deep into the body and is lower, while with the use of bolus, the dose keeps on the body surface and corresponds to a dose defined in the treatment plan.
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