RADIATION ONCOLOGY NEW TECHNIQUES TECHNOLOGIES YoYo Chi Radiation

COMING UP v DCAT for SABR lung patients using FFF v DIBH for left

SABR / SBRT v Stereotactic Ablative Body Radiotherapy / Stereotactic Body Radiotherapy v Highly

FRACTIONATIONS Conventional v 60 Gy/30#, 2 Gy/# SABR/SBRT v 45 Gy/3#, 15 Gy/# v

SABR TREATMENT v Minimum of 8 treatment beams with multiple couch angles v 1

SO… DCAT! v Dynamic Conformal Arc Therapy (DCAT) v Dose delivered in a continuous

DCAT FOR SABR LUNG PATIENTS USING FFF v Appointment time 1 hour 30 minutes

DIBH v Deep Inspiration Breath Hold v Technique where patient holds breath during treatment

LEFT-SIDED BREAST CANCER v Heart sits on the left side v Conventional treatment planning

HOW TO ACHIEVE BREATH HOLD v Active Breathing Coordinator (ABC) v Monitor breathing pattern

PAEDIATRIC TEAM v Organise appointments + liase with other teams v Liason for parents

PLAY SESSIONS v Generally >3 yo v Play sessions in CT + TMT v

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RADIATION ONCOLOGY NEW TECHNIQUES + TECHNOLOGIES Yo-Yo Chi Radiation Therapist

COMING UP v DCAT for SABR lung patients using FFF v DIBH for left sided breast cancer patients v Christchurch Oncology Paediatric Team

DCAT FOR SABR LUNG PATIENTS USING FFF

SABR / SBRT v Stereotactic Ablative Body Radiotherapy / Stereotactic Body Radiotherapy v Highly precise, image guided dose delivery v Highly conformal ablative dose v Typically ≥ 8 Gy v Tight margin around tumour v Fewer treatments v Typically 1 -5 treatments v High max doses in target is allow

FRACTIONATIONS Conventional v 60 Gy/30#, 2 Gy/# SABR/SBRT v 45 Gy/3#, 15 Gy/# v EQD 2= 112. 5 Gy v 48 Gy/4#, 12 Gy/# v EQD 2= 88. 2 Gy

CRITERIA

SABR TREATMENT v Minimum of 8 treatment beams with multiple couch angles v 1 hour treatment appointment v Imaging v After setup v Prior to turning radiation on v After treatment v Often patients have difficulty with pain from lying in treatment position for so long

SO… DCAT! v Dynamic Conformal Arc Therapy (DCAT) v Dose delivered in a continuous arc v Target remains inside the open field for the entire treatment

DCAT Another Technique

EVEN BETTER… FFF!

DCAT FOR SABR LUNG PATIENTS USING FFF v Appointment time 1 hour 30 minutes v Radiation “on” time – 1. 5 minutes v Faster treatment = less discomfort = less movement

QUESTIONS?

DEEP INSPIRATION BREATH HOLD

DIBH v Deep Inspiration Breath Hold v Technique where patient holds breath during treatment v At Canterbury Regional Cancer and Haematology Service – leftsided breast cancer

LEFT-SIDED BREAST CANCER v Heart sits on the left side v Conventional treatment planning cannot avoid a small portion of heart v Potential side effect is cardiac toxicity v Increase cardiac morbidity v Increase cardiac mortality

Free Breathing DIBH

HOW TO ACHIEVE BREATH HOLD v Active Breathing Coordinator (ABC) v Monitor breathing pattern v Holds breath at predetermine lung volume – consistent v Radiation will only turn on in breath hold v Patient is always in control

QUESTIONS?

CHRISTCHURCH ONCOLOGY PAEDIATRIC TEAM

PAEDIATRIC TEAM v Organise appointments + liase with other teams v Liason for parents and children having RT v Organise buddies v Play sessions v Come up with awesome ideas to make the RT journey FUN!

PLAY SESSIONS v Generally >3 yo v Play sessions in CT + TMT v Familiarise children with the department to develop trust and compliance v Sessions consist of department tour and dedicated play session v Child and age dependent v Buddy present to establish relationship with child and family

QUESTIONS?