Q&A

Recommendations Issued For Palliative Radiation Therapy For Symptomatic Bone Metastases

In a clinical practice guideline issued by the American Society for Radiation Oncology and published in Practical Radiation Oncology, evidence-based recommendations are presented for the use of palliative external beam radiation therapy (RT) for symptomatic bone metastases.

Sarah Alcorn, M.D., Ph.D., M.P.H., from the University of Minnesota in Minneapolis, and colleagues developed evidence-based recommendations for palliative external beam RT in symptomatic bone metastases. Five key questions regarding palliative RT were addressed.

The authors noted that RT is recommended for managing pain from bone metastases and spine metastases with or without spinal cord or cauda equina compression for palliative RT. Regarding other RT modalities, surgery and postoperative RT are conditionally recommended over RT alone for patients with spine metastases causing spinal cord or cauda equina compression. For spine metastases with spinal cord or cauda equina compression, dexamethasone is recommended. Postoperative RT is recommended for patients with nonspine bone metastases requiring surgery.

For symptomatic bone metastases, conventional RT is recommended in 800 cGy in one fraction (800 cGy/1fx), 2,000 cGy/5fx, 2,400 cGy/6fx, or 3,000 cGy/10fx. In patients ineligible for surgery and receiving conventional RT for spinal cord or cauda equina compression, 800 cGy/1fx, 1,600 cGy/2fx, 2,000 cGy/5fx, or 3,000 cGy/10fx are recommended. In selected patients with good performance status without surgery or neurological symptoms/signs with symptomatic bone metastases, stereotactic body RT is conditionally recommended over conventional palliative RT. Whole-person assessment is necessary for determination of an optimal RT approach/regimen.

"The use of conformal radiation and dose escalation for symptomatic bone metastases has moved from the experimental domain toward routine clinical care for many patients," Alcorn said in a statement.

More information: Sara Alcorn et al, External Beam Radiation Therapy for Palliation of Symptomatic Bone Metastases: An ASTRO Clinical Practice Guideline, Practical Radiation Oncology (2024). DOI: 10.1016/j.Prro.2024.04.018

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Citation: Recommendations issued for palliative radiation therapy for symptomatic bone metastases (2024, May 30) retrieved 5 June 2024 from https://medicalxpress.Com/news/2024-05-issued-palliative-therapy-symptomatic-bone.Html

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School Of Radiation Therapy Course Descriptions

Introduction to Radiation Therapy I-II

This two-semester course will provide the student with the fundamentals of radiation oncology. The history of cancer and radiation therapy will be discussed. Technical aspects of treatment machines and the effects of combined therapies will be discussed. In addition, this course will review calculations necessary for the various patient setups and treatments. The course will also introduce many concepts that will be taught in greater depth in subsequent classes in the senior year.

Treatment Setups I-II

This two-semester course is geared for first-year students. It is designed to provide an introduction into the various basic clinical patient setups that students encounter in their clinical rotations. The clinical setups will be broken down into their basic components and analyzed, with emphasis into the rationale for each. Practical surface anatomy will be covered. Students will be instructed on the methods and techniques used in accurately setting up a patient for treatment. Discussion on simulation concepts and principles will be presented. An integral part of the course is the review of simulation films and CTs. The class will provide a solid foundation of clinical setup skills that students will build on during their clinical rotations.

Methods of Patient Care

This course is designed to provide the student with foundational concepts in the assessment and evaluation of the patient for service delivery. Psychological and physical needs and factors affecting treatment outcome will be presented and examined. Routine and emergency care procedures and infection control will be presented. The basic information required for the student therapist to understand the medical implications of radiation therapy and side effects for treatment to various organs will be provided. The more common chemotherapeutic agents will be introduced, and the methods of administration and possible side effects will be discussed.

Medical Terminology

This course will establish a foundation in the standardized language of medical practice, including abbreviations and symbols. Knowledge of medical terms and their meanings will be used as a preparatory tool for reading, understanding, interpreting, and applying prescriptions to radiation therapy. It will help to give the student a deeper understanding of medical terms as they relate to radiation oncology.

Record Keeping

This course will familiarize the student with the patient electronic chart and its content. All components of the legal document will be defined and discussed, ensuring students the ability to use proper documentation and find any information necessary regarding the patient's treatment.

Clinical Anatomy I-II

This two-semester course will include anatomy and physiology of the human body; emphasis on anatomy of the skeletal, muscular, circulatory, nervous, respiratory, digestive, excretory, reproductive, and endocrine systems. The course will explore the clinical aspects of human anatomy in radiation oncology and include CT images of various areas.

Radiation Physics I-II

The course content of the first semester is designed to establish a basic knowledge of physics pertinent to developing an understanding of radiation used in the clinical setting. Fundamental physics units, measurements, principles, atomic structure, and types of radiation are emphasized. Also presented are fundamentals of x-ray generating equipment, x-ray production, and its interaction with matter. Students will be introduced to units used in radiation therapy, including the metric system and SI units. The student will be instructed in the basic mathematical functions and skills needed to perform all essential calculations encountered in the radiation therapy profession.

The second semester is designed to expand on the concepts and theories introduced during the first semester Physics course. Detailed analysis of the structure of matter, properties of radiation, nuclear transformation, x-ray production, and interactions of ionizing radiation are emphasized. Also presented are treatment units used in external radiation therapy, measurement and quality of ionizing radiation produced, absorbed dose measurement, dose distribution, and scatter analysis. In addition, the course will include properties of photon and electron beams, electron beam therapy, brachytherapy, gamma ray constants of isotopes, calculation of brachytherapy dose in clinical applications, systems of implant dosimetry, and implant techniques.

Ethics & Law in Radiation Therapy

This course will establish a foundation of professional practice for the radiation therapist as part of the radiation-therapy team. Ethical behavior for caregivers will be defined and discussed with focus on the interdependence of the radiation therapist and patient.

Radiation Protection

The student will be provided with the basic principles and concepts of radiation protection and safety. Radiation health and safety requirements of federal and state regulatory agencies, accreditation agencies, and health care organizations are incorporated. Specific responsibilities of the radiation therapist are discussed, examined, performed, and evaluated.

Principles of Radiography

This course is designed to establish a knowledge base in factors that govern and influence the production and recording of radiographic images for patient simulation, treatment planning, and treatment verification in radiation oncology. Radiation oncology imaging equipment and related devices will be emphasized.

Radiobiology

This course is designed to present basic concepts and principles of radiation biology. The interactions of radiation with cells, tissues and the body and resultant biophysical event will be presented. Discussion of the theories and principles of tolerance dose, time-dose relationships, fractionation schemes, survival curves and the relationship to the clinical practice of radiation therapy will be discussed, examined, and evaluated.

Pathology

This course will introduce the student to the concept of diseases. Emphasis will be placed on different types of pathologies in various organ systems, causative factors, and biological behavior. Etiology and clinical manifestations will be described.

Clinical Radiation Oncology I-II / Board Review

This two-semester courses will provide the student with the fundamentals of clinical radiation oncology. The medical, biological, and pathological aspects as well as the physical and technical aspects will be discussed. The diagnosis, treatment prescription, the documentation of treatment parameters and delivery, emergency procedures, and patient condition and education needs will also be presented, discussed, examined, and evaluated. The course is also designed to examine and evaluate the management of neoplastic disease using knowledge in arts and sciences, while promoting critical thinking and the basis of ethical clinical decision making. The epidemiology, etiology, detection, diagnosis, patient condition, treatment, and prognosis of neoplastic disease will be presented, discussed, and evaluated in relationship to histology, anatomical site, and patterns of spread. Oncologic emergencies and management of such will be discussed. The radiation therapists' responsibility in the management of neoplastic disease will be examined and linked to the skills required to analyze complex issues and make informed decisions while appreciating the character of the profession. This course is designed to be taught over a period of two semesters.  During class times, when a lecture is not scheduled, or the lecturer or physician becomes unavailable, the lecture time will be used for board review and the original lecture will be rescheduled.  Students will be required to submit a research paper within specified guidelines, which may be submitted to CART as part of a student competition.

Treatment Planning I-II

This two-semester course is designed to establish factors that influence and govern clinical planning of patient treatment. Included are isodose description, patient contouring, radiobiological considerations, dosimetry calculations, compensation, and clinical application of treatment beams. Optimal treatment planning is emphasized along with particle beams. Attention is given to the rationale, theory, and calculations for each method. Class demonstrations and projects are incorporated to complement specific content areas and are focused on clinical applications. In addition, approximately half of the second semester is spent discussing various brachytherapy procedures including techniques, rationale, and calculations. In addition, students will be assigned a two-week clinical rotation in the treatment-planning department and a one-week rotation in brachytherapy.

Quality Assurance

To comprehend quality management as it relates to aspects of radiation therapy. Quality management protocols will be presented as they apply to patient care, record keeping, documentation, and equipment and radiation output. In addition, proper billing protocol, billing compliance, and managed care will be discussed as per ASRT guidelines.

Image Review

This course will ensure the student's proficiency at reading and analyzing films, CTs and treatment fields. Organs and structures will be located radiographically and discussed in relation to anatomical landmarks. Typical treatment fields, including borders, blocking, and nodal chains, will be identified and discussed.

Registry Examination Preparation

During this course students will be given supplementary material on information previously taught. The goal of this class is to reinforce knowledge learned from previous courses. Student therapists will be given a comprehensive review of topics presented during the first three semesters of the program and will progress to review the classes taught over the fourth semester. Multiple teaching aides and styles will be utilized, including PowerPoints, handouts, short exams as well as full length exams similar in format to registry exams.

At the end of the fourth semester, student therapists will be given a comprehensive review of topics presented during the two years of the program by various instructors. Several practice type tests will be administered, including computerized tests to simulate the style of the registry exam, as outlined in the Radiation Therapy Certification Handbook. These multiple-choice questions will be devised by instructors and students and will include questions from semester course exams in addition to questions from review books. During this review, eligibility requirements, the application process, and exam security will be emphasized.  Also, during the last year, when there are no specific lectures scheduled during a class period, the time scheduled for Clinical Radiation Oncology will be utilized to review for the boards.

In addition, students may also participate in a registry review seminar and student competition in Chicago during a weekend in April partially sponsored by the program.  Students may also participate in a 2-day Registry Review seminar/webinar through Thomas Jefferson Hospital and/or a 3-day registry review seminar/webinar through the New England Society of Radiation Therapists.  Attendance at these seminars is strictly on a voluntary basis and at the students' own expense.  The program may choose to sponsor a webinar of one of these seminars through a grant.

In addition, workshops will be presented for professional development.  These workshops include such topics as licensure and certification, resume preparation, interview skills, etc.

Graduation Requirements

To qualify for graduation from the training program, students must meet the following requirements:

The program offers 539.75 hours of didactic courses and 2077 hours of clinical experience; the student must complete 85% of these hours.

Satisfactory completion of all courses with a grade point average of 75% or better.

Completion of monthly clinical evaluation with a grade point average of at least a 75%.

Successful completion of required clinical competencies by June of the senior year.

Return of any equipment/books borrowed from the school and/or medical library.

Fulfillment of all monetary obligations.

Completion of all program assessment forms/evaluations/surveys, financial aid entrance and exit interviews, if applicable.

Grading System

The grading system for the Radiation Therapy Program is a numerical one. A minimum Grade Point Average of 75% is required for graduation. There are no repeated courses, incompletes, or withdrawals in the Radiation Therapy Program.

To pass each course the student must receive a grade of 75% or better. If a student falls below 75% on any academic course or clinical rotation, he/she will be placed on probation. If the student does not improve by the end of the semester and fails a didactic course, he/she will be dismissed from the program.

If a first year student fails any academic course or two clinical rotations within a 12-month period, or if a senior student fails any academic course or one clinical rotation in his/her second year, the student will be dismissed from the program. If any student is in danger of failing, the Program Director and Clinical Coordinators must be notified midway through the clinical rotation or semester.

Using Radiation Therapy To Treat Brain Tumors

Most patients with brain tumors receive one of two types of radiation: external beam radiation, in which the tumor is treated over the course of several weeks, or radiosurgery, in which patients receive a high dose of radiation in one to five treatments to destroy the tumor.

Stereotactic radiosurgery uses 3D imaging to target high doses of radiation to the tumor with minimal impact on surrounding healthy tissue. It is used in small cancerous and noncancerous tumors and can be delivered in a few ways:

Gamma Knife: A Gamma Knife is not a knife at all but rather many tiny beams of radiation focused on a tumor with extreme accuracy.

Linear accelerator: A linear accelerator aims high-energy beams to a precise point on the body.

Proton beam: Using positively charged particles in atoms, proton therapy is focused on the tumor; virtually none of the radiation exits beyond the tumor.

Radiosurgery targets each tumor individually and helps to spare normal tissue from being treated with radiation.

Radiation treatment plans are tailored to each patient.

Radiation therapy is not one-size-fits-all. The volume, dose, type and duration of radiation are tailored to fit each person and their specific tumor. A treatment plan is designed that considers the size, location and type of your brain tumor. Radiation therapy can be used to treat brain tumors by itself or after surgery, to ensure that leftover cancer cells are destroyed.

Better precision.

Radiation therapy must be accurately delivered to successfully destroy the tumor and prevent the tumor from coming back. Improvements made over the years—including improved imaging to better target the tumor and align the patient during radiation treatment—allows doctors to minimize damage to surrounding tissues and organs. Today, the accuracy with which treatment can be delivered is within millimeters, thus limiting excess exposure of healthy tissues to radiation.

Better precision has allowed for a newer approach in radiation therapy, known as hypofractionated stereotactic radiotherapy, which delivers high doses of radiation over two to five days to destroy the tumor.

Larger brain tumors have been difficult to treat with radiosurgery as the risk of treatment increases with the size of the tumor. However, research has shown that if spread that dose is spread over two to five days instead of one day, the tolerance is better, and a more effective dose for larger tumors can often be achieved.

Though side effects from brain radiation vary, fatigue and hair loss are the most reported. However, most patients find they can continue their regular activities throughout treatment.

Improved safety.

A common misconception when patients hear the word radiation is that radiation will cause cancer. While that is possible, the risk of developing a second cancer from radiation is extremely low. Modern radiation therapy techniques have improved effectiveness and safety, and radiation oncologists continue to discover ways to limit exposure and reduce the risk of secondary cancers from radiation.

It is important to note that if a secondary cancer were to occur from radiation therapy, it would not likely develop until many years after radiation exposure. Also, the risk of developing secondary cancer decreases with time, according to the American Cancer Society.

Another misconception is that radiation therapy can pose a risk to people around you. External beam radiation passes right through the body like an X-ray. Patients do not leave their treatments radioactive. You will not expose anyone to radiation by receiving this type of treatment.

Radiation therapy continues to evolve through research conducted by Mayo Clinic and others. In addition to advances in machinery, imaging has improved to help guide more accurate radiation treatment for patients.

2024 Mayo Clinic News Network. Distributed by Tribune Content Agency, LLC.

Citation: Using radiation therapy to treat brain tumors (2024, May 6) retrieved 5 June 2024 from https://medicalxpress.Com/news/2024-05-therapy-brain-tumors.Html

This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.

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