Radiation

 Stephanie@ons 

Welcome to the ONS Hot Topics Chat on Radiation. We will be starting shortly.

 Stephanie@ons 

Welcome to today's Hot Topic Chat! Today's speaker is Mary Ann Robbins who will be talking to us about Radiation. Welcome Mary Ann!

 Mary Ann 

Good evening. I have been in radiation therapy for many years and have worked in various radiation settings. Any questions?

 Mary Ann 

Who has radiation experience?

 Stephanie@ons 

Please type your questions for Mary Ann at any time.

 lisae 

I do but I'm not your typical candidate

 Mary Ann 

How is that?

 lisae 

I've been in veterinary medicine for 20 years in oncology

 lisae 

both med and rad onc

 Mary Ann 

Are you a Vet?

 lisae 

credentialed vet technologist

 Mary Ann 

What questions do you have?

 sdgiroud 

I have one

 lisae 

Just wanted to get a feel for how you all do things on your end

 Mary Ann 

Go ahead

 sdgiroud 

I am working in a new cancer center in Radiation Therapy. I was wondering what is your policy on treatment for pts with pacemakers or internal defibs

 Mary Ann 

Good question.

 sdgiroud 

specifically tx to chest

 Mary Ann 

First you have to find out the make/model of the pacemaker and call the company to fine out the tolerance. We usually then have the patient be evaluated by a cardiologist.

 sdgiroud 

What if the pt doesn’t know the make or model?

 Mary Ann 

We also get pre and post vital signs during every treatment. If they are very brittle the resident will monitor the patient during treatment.

 Mary Ann 

That information has to be recorded somewhere like the operation note.

 sdgiroud 

I have worked in large and small centers. this one is a rural area

 Mary Ann 

Contacting the company is the first step.

 sdgiroud 

In a few places we put pt on monitor each tx

 sdgiroud 

Ok that is what I have been reading lately that they all vary

 Mary Ann 

We have done that too, and will sometimes do it depending on how dependent the patient is

 sdgiroud 

Ok it’s hard to write a policy with that though.

 sdgiroud 

Thanks for help.

 Mary Ann 

If you want to give me your email I will send you the guidelines we have created.

 shecatar 

Help what is tumor lysis syndrome does it also occur for radiation therapy? Or for chemo only?

 Mary Ann 

Tumor lysis syndrome can be seen with very large bulky tumors (Lymphoma), but is usually seen with patients getting chemotherapy for those bulky tumors.

 sdgiroud 

it occurs with a lot of cell kill and it is a release of uric acid in blood

 sdgiroud 

pts need 2 b on allopurinol at start of chemo tx

 Mary Ann 

Thank you for the help.

 Mary Ann 

Another question?

 shecatar 

Thanks

 Mary Ann 

How many of you are familiar with IGRT (Image guided radiation therapy)?

 lisae 

I am

 shecatar 

Using dye?

 Mary Ann 

No dye is not used.

 sdgiroud 

Is it like IMRT?

 Mary Ann 

This mean while the patient is on the treatment table they are able to take pictures to help localize the tumor.

 shecatar 

ic a nuclear medicine

 Mary Ann 

OBI or onboard imaging uses KV or x-rays to that PA and lateral images and Cone beam CT adds a 3D look at soft tissue

 sdgiroud 

Is it something like a gamma knife?

 Mary Ann 

Not in nuclear medicine or like gamma knife.

 sdgiroud 

what diseases can it be used in

 Mary Ann 

It is like being able to see the tumor on the treatment table so you can make real time adjustments. This allows the fields to be smaller.

 Mary Ann 

This is used in prostate, head and necks, lung. Pretty much all cancers.

 Mary Ann 

Patients use to have large fields put on them for treatment to allow for error. This decrease the error since you can adjust the field every day.

 Stephanie@ons 

So, are the patients experiencing less toxicity or side effects?

 Mary Ann 

Yes the smaller fields allow normal tissue to be spared the beams of the radiation therapy.

 sdgiroud 

What would be the typical number of treatments?

 Mary Ann 

The same number of treatments. It is a guiding system for the therapist.

 Mary Ann 

Let me give you an example of a man being treated for prostate cancer.

 Mary Ann 

The prostate gland can move depending on how much air/gas the patient has in his system.

 Mary Ann 

During each daily treatment the therapist take a picture and make adjustments so the prostate is treated and the normal surrounding tissues spared.

 Mary Ann 

Does this help?

 Mary Ann 

IMRT stands for intensity-modulated radiation therapy.

 Mary Ann 

Another way to deliver higher doses of radiation to the tumor while avoiding adjacent tissue.

 Stephanie@ons 

Is there something that determines if a patient receives one type of treatment over the other?

 Stephanie@ons 

Welcome Steph199, please ask any radiation questions that you have for Mary Ann.

 Mary Ann 

Treatment is determined by the size tumor, the location and if there is disease in other places.

 Mary Ann 

The two most common side effects from radiation therapy are fatigue and skin reactions. Any questions about skin care?

 shecatar 

Is there special precaution for IGRT?

 sdgiroud 

How do you tx moist desquamation?

 Mary Ann 

The same precautions as with any type of radiation

 shecatar 

o.k.

 Mary Ann 

With moist desquamation the most important thing is to keep the skin clean and prevent further damage. The range of treatment can be from dressings such as Vigilon and Mepilex (which are expensive) to Aquaphor covered by telfa.

 Mary Ann 

What do you do?

 sdgiroud 

we use either domboros or even silvadene

 Mary Ann 

Good patient education is important too. Let them know that if will heal in about 2-3 weeks.

 Mary Ann 

How do the patients like the Dumboro soaks and Silvadene?

 sdgiroud 

Education makes a big difference in skin reactions

 sdgiroud 

They do ok with it the. Dr explains and then I review it.

 sdgiroud 

The Drs I work with are old army Drs. A little old school

 shecatar 

I’m reading at the varian technology now and I like to ask which is more effective igrt or imrt?

 Mary Ann 

They are not the same. IGRT helps set up for IMRT.

 sdgiroud 

So you could use igrt for imrt?

 Mary Ann 

Yes, think of IGRT as the eyes that let you see what you need to treat.

 sdgiroud 

So is this different machine?

 sdgiroud 

Or just an upgrade?

 Mary Ann 

IGRT and IMRT can be added to a linear accelerator

 Mary Ann 

It is an upgrade.

 shecatar 

Is it 3d?

 Mary Ann 

Where are you working? And what type of machine do you have?

 shecatar 

me here in Riyadh military hospital but I’m assign in chemo not in radiation

 Mary Ann 

The Cone Beam CT (part of IGRT) allows for a 3d picture. IMRT planning allow for a 3d planning and treatment.

 sdgiroud 

I’m working in Seymour In, We have a linac

 Mary Ann 

How old is your linac?

 Mary Ann 

Any other questions?

 sdgiroud 

our linac is little over 2 years old

 Mary Ann 

Any questions about brachytherapy?

 Mary Ann 

There is low dose rate(LDR) and high dose rate (HDR)

 sdgiroud 

When do they use ldr?

 Mary Ann 

Cervical cancer patients that will have implants in for 2-3 days. Prostate seeds are considered LDR.

 Mary Ann 

You can even do LDR on head and neck tumors and sarcomas

 sdgiroud 

oh ok I don’t think I have ever heard that term

 shecatar 

ldr is temporary?

 Mary Ann 

Low dose rate means the radiation is being delivered slowly over a period of time.

 sdgiroud 

LDR

 Mary Ann 

Most brachytherapy is temporary, but the seed implants decay over time, but the seeds remain in the prostate.

 shecatar 

So patient is radio active for a 2-4 days ?

 Mary Ann 

Depends how long the radioactive source is in them.

 Stephanie@ons 

Welcome ellenocn, please ask your radiation questions for Mary Ann.

 Mary Ann 

Actually the patient is not radioactive. The source is radioactive.

 Stephanie@ons 

The transcripts for the chat will be posted on the ONS website with in the week.

 Mary Ann 

Brachytherapy means that the radioactive source is placed within or in contact with the tumor.

 Mary Ann 

This can be interstitial, intracavitary, superficial, intraluminal or intravascular.

 sdgiroud 

We had a sales person try to sell us a intra-op Rt machine

 ellenocn 

HI- Sorry had to join late. Just wondering how much you are seeing amifostine being used- what kind of success? Some of our GYN/ONC is using it for protection from Taxol neuropathies now. Any tips on avoiding the BP drop or nausea?

 sdgiroud 

it uses x-rays during surg.

 Mary Ann 

We do IORT (intraoperative), but not that often. If you are small hospital not sure if you will use it much.

 Mary Ann 

We used to use Amifostine a lot, but now we use it very seldom.

 ellenocn 

Someone said to give quickly to avoid drop in BP- 3-5 seconds- true?

 sdgiroud 

I have seen amifostine used in head and necks

 Mary Ann 

Premedicate your patient with an antiemetic and have them drink plenty of fluids.

 Mary Ann 

That is true. That amifostine give quickly is better than a slow push infusion.

 sdgiroud 

I know some Drs order iv fluids prior and some increase oral intake.

 sdgiroud 

We gave it IM

 ellenocn 

I give IVF bolus

 ellenocn 

IM???

 Mary Ann 

The trick with IV amifostine is that you have to make sure that the therapist are ready to treatment them within the time frame.

 Mary Ann 

We give is SQ, but that is off label.

 ellenocn 

What is time frame?

 sdgiroud 

Sorry SQ

 Stephanie@ons 

If you have any last questions please email them to sjardine@ons.org and I will get them to Mary Ann to answer.

 Mary Ann 

It has been a long time since I gave IV amifostine and I can't remember, but I think it is within 30 minutes.

 Mary Ann 

Any last questions?

 Mary Ann 

Thank you and it has been a pleasure. Good night.

 ellenocn 

Less BP drop with sq?

 Mary Ann 

Yes, less BP drop with sq

 ellenocn 

Thanks

 sdgiroud 

Thanks for the info.

 shecatar 

thanks hope there is also a topic for chemo administrations

 Stephanie@ons 

You can go back and read the past transcripts on chemotherapy and other topics.

 shecatar 

hmm the site is under construction

 shecatar 

o.k. I’ll check if its already finish upgrading

 Stephanie@ons 

The site was just changed yesterday so I would give it till next week and then go to the education tab and do a program search for chat transcripts.

 shecatar 

okay

 Stephanie@ons 

Join us next month for the topic of Bloodless therapies.

 shecatar 

I’ll try if it coincide with my day off

 shecatar 

only Thursday and Friday

 Stephanie@ons 

Thank you both for coming.