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Radiotherapy of breast cancer
TRAKALOVÁ, Barbora
Diagnosis code C50 represents malignant neoplasm of breast. It is the most frequent tumour disease in women. In 2009, 5975 cases were newly diagnosed in women in the Czech Republic and 1607 women died of this disease. There exist many risk factors which can cause tumour such as hereditary disposition, age, menses, menopause and other factors. At the same time, we can influence many factors and so prevent the disease. Prevention is also important, whether in the form of self - investigation of breast or mammography screening, which is recoverable by insurance from the age of 45. Treatment of breast carcinoma includes a lot of medical modalities such as surgical, hormonal and biological treatment, chemotherapy and radiotherapy. This thesis deals in more details with radiotherapy which is irreplaceable in treatment of this disease. Radiotherapy is a treatment of malignant and benign tumours by means of ionising radiation. In order to treat patients with radiotherapy, a team of doctors and radiologists shall create an individual radiation plan for them including the exact target volume, critical organs, radiation technology, fractionation and particular radiation exposure, radiation position and many other data necessary to accurate irradiation. A technology of two tangential fields is the most applied technology at breast cancer treatment. This technology is also applied in Nemocnice České Budějovice a.s. where I have created a file of 60 patients with breast carcinoma treated on oncology department in the year 2011. There have been used 536 verification images on the whole, it means 1608 evaluation. In course of treatment a patient should have an identical radiation position, which is reached with irradiation and fixation aids. However, from various reasons small or bigger deviations from the optimal position happen and therefore a possibility of irradiation of another volume than the required target one can occur. It is necessary to be aware of the fact that during a treatment of oncology patients there can often appear change of weight, change of body shape of a patient and at advanced stages even also change of physical state and movability of a patient. Therefore large deviations can happen in patients with breast carcinoma namely for example in case of breast deformation or abnormal loss of weight due to the treatment. In Nemocnice České Budějovice a.s., the maximum allowed deviation for vertical, lateral and longitudinal axis is stated 0,7 cm and for rotation 3°. I have noticed the acquired deviation values from verification images into a chart and consequently into a figure where are shown the average deviations and frequencies of these deviation in particular axes for each radiation field. The biggest deviation has happened in vertical axis and the average deviation in that axis was 0,29 cm. The maximum allowed deviation was exceeded only at 3 %, so at 45 deviation from the total evaluation. This thesis should prove the fact that verification images enable to prevent possible errors during radiotherapy. This hypothesis has been confirmed because only 3 % evaluation exceeded the maximum allowed deviations. Verification images enable us to disclose wrong irradiation position, therefore only the target volume is irradiated and follows no irradiation of the surrounding healthy tissue and critical organs.
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Treatment of Bronchogenic Carcinoma
RAČÁKOVÁ, Jana
My bachelor thesis deals with the issue of lung cancer and its treatment with radiotherapy. I have chose this topic to get a better overview of methods and how the disease is treated by radiotherapy. At the very beginning there is a short characteristic of lung cancer. Lung carcinoma is one of the most common causes of death from malignant tumor. By this disease are usually affected men between 40-70 years but even women are no exception. The patient is endangered by both, intensive growth of the tumor and metastasis to surrounding organs. Main cause is smoking thus heavy smokers have much greater likelihood to be affected by the tumor. The first part of the work is practical. There is described and discussed the issue of lung cancer and its treatment options. I also describe the possibility of lung cancer diagnosing and overview of TNM classification (T is the size of the tumor, N is the involvement of regional lymph nodes and M is called distant metastases). Then, only marginally, I mention surgical and chemotherapy treatment. More attention is given to treatment by radiotherapy and fractionation regimens and potential side effects. The very first objective of the thesis was presentation of irradiation techniques of lung cancer from history into the present. Those techniques were mentioned at the beginning of the practical part, to illustrate how the techniques are being developed so as to allow much better quality of healthcare to a patient and to make the work of a radiologist assistant easier. I also presented the algorithm of lung cancer treatment at oncology department of Nemocnice České Budějovice, a.s. where I describe the treatment of a patient gradually form the diagnosis until the first irradiation. The second, and the main, objective of my thesis was to create a series of patients treated at the oncology department of Nemocnice České Budějovice, a.s. and to compare the setting of irradiation position using the verification software. The file of 67 patients with the lung cancer diagnosis was made at oncology dept. of Nemocnice České Budějovice, a.s. in the period of March 2012 to March 2013. According to my hypothesis the verification system is an essential part of radiation treatment. My results also confirm the fact. By creating verification images it is possible in most cases to prevent potential mistakes (exceeding the maximum tolerated deviations) when adjusting the irradiation position of a patient. By making a control image of a patient per week it is possible, for a radiologist assistant, to balance the any excess deviation and then the patient is not necessarily irradiated with the surrounding , healthy, organs. Unfortunately the verification system does not allow 100% accuracy (derivations in all directions and angles are always in tolerance, but we are very close to this goal. In order to achieve higher quality in treating patients with this method there are two option. The first on is to use IGRT-image (Guided Radiation Therapy) which is an image guided radiotherapy, that allows more precise control of the patient before each fraction and also improves the orientation of the target volume and critical organs before each fraction, or during it. It means improving of the verification system but because of high cost it is not used in Nemocnice České Budějovice, a.s. The second option how to improve the healthcare service is using the technique of breath gating radiotherapy, which is a technique that allows to irradiate the patient only in a certain phase of a breath cycle. This technique means to apply substantially higher dose to the target volume with greater accuracy.
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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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