radiation oncology

1. HEMI BODY IRRADIATION
&
TUMOR REGISTRY
Dr. Taruni Bhattacharya
D.N.B. Resident

2. Difference with TBI
• Field size needed is smaller.
• Less side effects
• Stem cell support not needed
• Different therapeutic goal.

3. AIM
• To give a sufficiently high dose to alleviate
effects of symptomatic diseases & at the same
time,maintaining a sufficiently low dose to
minimize complications.
• Delay progression of existing asymptomatic
mets & clinical development of new mets

4. CLINICAL INDICATION
1) Palliation of widely disseminated metastatic
disease
2) Adjuvant therapy for Ewing’s Sarcoma &
Brochogenic Ca
3) Lower Hemi Body Irradiation for ovarian
ablation in Metastatic Breast Cancer.

5. TECHNIQUE
• Bottom of L4 separates upper & lower HBI
• A/P parallel opposed fields used
• Patient positioned with vertical beam
allowing coverage of hemibody
• Shielding of previously irradiated areas to
reduce toxicity(salivary glands,lungs)
• Dose prescribed to mid-plane of the patient
at the central axis of the beam.

8. DOSE
• 6Gy:upper HBI
• 8Gy:lower HBI and Middle HBI
• For treating the other half of the body
wait for 6-8 weeks apert to allow a sufficient
recovery of blood cells & irradiated marrow.
• Planned sequential upper and lower HBI 6-8
wks apart,used to treat multiple
myeloma,malignant lymphoma.

9. COMPLICATIONS
• M/C S/E: nausea and vomiting(when abdomen is
included within fields)
Occur shortly after radiation admin & last a few
hours.
Rx:Premedication with steroids & antiemetics.
• Intestines:diarrohea occurs when significant volume
is irradiated.It’s severity can be limited by limiting
dose to 6Gy
• Hematological recovery:within 4-6 wks usually

10. • Lungs: HBI can cause interstitial pneumonitis,
with cough and breathlessness at around 6
weeks, although this may be delayed by up to
6 months
R/o pneumonitis is less with single fraction
dose 7Gy
For 8Gy Upper body TBI use lung blocks.
• Reversible alopecia, dry mouth, parotid
swelling, stomatitis and fatigue are other s/e
seen.

15. CANCER REGISTRY
• CANCER registration is the process of
systematically and continuously collecting
information on malignant neoplasm.
• Broadly, there are two types of cancer
registries:
1.Hospital
2.population based

17. National Cancer Registry Programme
Commenced by ICMR with a network of cancer
registries across the country in December 1981.
Started with three PBCR -Bangalore, Chennai and
Mumbai and three HBCR -Chandigarh, Dibrugarh
and Thiruvananthapuram
Now there are 28 PBCR and 7 HBCR sites in India

18. USES
• Resource of information for clinicians,
researchers, scientists, policy makers,and the
public
• Identifying High-Risk Groups
• Increasing Screening in underserved areas
• Investigating possible cancer causes
• Evaluating patterns of clinical care

20. Objectives of this programme
• To generate reliable data on magnitude and
patterns of cancer
• Undertake epidemiological studies based on results
of registry data
• Help in designing, planning, monitoring and
evaluation of cancer control activities under the
National Cancer Control Programme (NCCP)
• Develop training programmes in cancer registration
and epidemiology

21. Cancer registration in India is active and voluntary
– Active method: The workers from registry,
scan through the patient records in different
hospitals, clarify incomplete or contradictory
information, and abstract data with collection of data
from hospital record interviews of patients.
– Passive method: The hospitals in areas with
compulsory notification and the hospital
cancer registries, abstract the information
from the patient records on a specified
proforma and send it to the registry.

22. POPULATION BASED CANCER
REGISTRY
Data collection by-
1.Facilities
2.Clinicians and pathologists
3.Death certificates

23. Hospital Based Cancer Registries
• The primary purpose -to contribute to patient care by
providing readily accessible information on the patients
• Data - used for clinical research and for epidemiological
purposes
• Within the hospital: a registry is maintained which is an
integral part of the hospital ’s cancer programme or
health care delivery system
• HBCR have no denominator of population at risk .
Incidence rate cannot be derived from such data.
However, cancer extent,stages,therapy and
survival rate information are more reliable on such
data

24. THANK YOU