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Late Effects of Radiation Dr. Sandra Vermeulen, M.D. Swedish Cancer Institute Northwest Hospital Gamma Knife Center Seat

Late Effects of Radiation Dr. Sandra Vermeulen, M.D. Swedish Cancer Institute Northwest Hospital Gamma Knife Center Seattle, Washington. Learn More At: www.DoctorVermeulen.com. Cat’s Eye Nebula. The Cat’s Eye Nebula produces energy that is part of the Electromagnetic spectrum

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Late Effects of Radiation Dr. Sandra Vermeulen, M.D. Swedish Cancer Institute Northwest Hospital Gamma Knife Center Seat

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  1. Late Effects of Radiation Dr. Sandra Vermeulen, M.D. Swedish Cancer Institute Northwest Hospital Gamma Knife Center Seattle, Washington Learn More At:www.DoctorVermeulen.com

  2. Cat’s Eye Nebula • The Cat’s Eye Nebula produces energy that is part of the Electromagnetic spectrum • Located 3,000 light years away from our Milky Way Galaxy • First planetary nebula to be discovered by the Hubble telescope • Nebula are dying stars • Chemical elements in the nebula emit light at very specific wavelength • - Hydrogen Atoms – Red • - Oxygen Atoms – Blue • - Nitrogen Ions – Green Learn More At:www.DoctorVermeulen.com

  3. Our Solar System • The solar system was made from recycled elements originating from a dying star (Planetary Nebula) • In terms of mass: • - 70% Hydrogen • - 28% Helium • - 1% Oxygen • - 1% All Remaining Elements Learn More At:www.DoctorVermeulen.com

  4. C.H.O.N. Carbon, Hydrogen, Oxygen and Nitrogen are so common in clouds of gas and dust in space they are simply referred to by the acronym C.H.O.N. Learn More At:www.DoctorVermeulen.com

  5. Body Mass Water Weight - 65% H20 Dry Weight - 50% Carbon - 25% Oxygen - 10% Nitrogen - 15% All other elements combined We are made from the 4 most reactive elements in the Universe Learn More At:www.DoctorVermeulen.com

  6. Radiation Therapy Machines Radiation Therapy Machines produce energy from the Electromagnetic Spectrum - Linear Accelerator - CyberKnife - Gamma Knife Learn More At:www.DoctorVermeulen.com

  7. The Electromagnetic Spectrum • It is the name given to the group of radiation types • All radiation is a form of energy • Energy in this example increases from left to right • Energy is defined as ionizing or non-ionizing if it is large enough to remove electrons from their atoms. Learn More At:www.DoctorVermeulen.com

  8. DNA (DeoxyriboNucleic Acid) • The effect of radiation on cancer cells is due to ionization or damage caused by the breakage of chemical bonds in the DNA molecule • DNA damage prevents the cells from replicating • As long as cancer cells cannot reproduce, they cannot grow in size or metastasize Learn More At:www.DoctorVermeulen.com

  9. Dose Equivalent SIEVERT, (REM, roentgen equivalent man, old term) is used to compare different types of radiation. GRAY (RAD, old term) equals radiation-absorbed dose (in tissue) QF is the quality factor and accounts for the different degree of damage produced by equal doses of different radiation types. QF is 1 for photons (the most commonly used energy in therapeutic radiation medicine) SIEVERT= GRAY X QF 100 rad = 100 cGy = 1 Gy = 1 Sv (if the QF is 1) = 1000 mrad = 1000 mGy = 1000 mSv Learn More At:www.DoctorVermeulen.com

  10. Exposure to Ionizing Radiation Although the type of radiation is different, 1 mSv of space irradiation is equivalent to approximately3 chest x rays (equal to < 1 Gy) Learn More At:www.DoctorVermeulen.com

  11. Radiation Therapy Planning Session The goal of radiation therapy is to injure more cancer cells than normal cellsTo achieve this, a treatment planning session or simulation is undertaken prior to actual treatment. Many variables need to be considered including: - Treatment Type - Field Size - Number of Treatment Beams - Beam Direction - Beam Modifiers (Blocks, Wedges, Tissue Compensators) - Computerized Dosimetery Plan - Patient Immobilization Device Learn More At:www.DoctorVermeulen.com

  12. Side Effects The effects of radiation maybe temporary (because the cell is able to repair it) or permanent (by injuring the repair mechanism) and become apparent anywhere from days to weeks to months to years after exposure. Radiation injury is a function of radiation type, dose, fraction size, volume of tissue irradiated and area of the body exposed Learn More At:www.DoctorVermeulen.com

  13. Whole Brain Irradiation Dose Volume Equivalents 800 cGy/1 fx = 2000 cGy/5 fx = 3000 cGy/10 fx = 3500 cGy/14 fx = 4500 cGy/25 fx 50% of metastases are controlled with these doses Control with radiosurgery alone or as a boost is 80-90% Learn More At:www.DoctorVermeulen.com

  14. Primary Brain Tumors Glioblastomas and other astrocytomas do not show a response above 6000 cGy Treatment is usually delivered to the partial brain at 180 cGy over 33 fx Learn More At:www.DoctorVermeulen.com

  15. Radiation Side Effects Learn More At:www.DoctorVermeulen.com

  16. Radiation Treatment Goal The goal of any radiation treatment is to 1. Stop 2. Cure 3. Eradicate the growth of the Cancer which will slow down or prevent worsening neurological function and eventually death Learn More At:www.DoctorVermeulen.com

  17. Normal Tissue Tolerance To Therapeutic Radiation Dose expected to give a 5% risk of injury at 5 years Learn More At:www.DoctorVermeulen.com

  18. Brain Volume Listed in decreasing order of brain volume exposed to the effects of ionizing radiation:- Conventional External Beam Irradiation- 3D - Conformal Radiation Therapy- Intensity Modulated Radiation Therapy- Stereotactic Radiosurgery / Stereotactic Radiotherapy Learn More At:www.DoctorVermeulen.com

  19. Medication for Radiation Side Effects Learn More At:www.DoctorVermeulen.com

  20. Question? Is there anything that can be done for long-term/chronic side effects such as memory loss and fatigue? Learn More At:www.DoctorVermeulen.com

  21. Things To Consider / Try To Optimize Brain Health • Stop smoking • Treat all other unrelated disease conditions aggressively such as, diabetes and infections • Get adequate rest and exercise • Eat right/see a dietician • See a Naturopath • - Vitamins (anti-oxidants), minerals, including omega –3 fatty acids and DHA (docosahexaenoic)/EPA (eicosapentaenoic) • Check for and treat any progressing endocrine abnormalities • - Low thyroid, low levels of estrogens and testosterone, low levels of cortisol • Reduce stress • - Bio-feedback therapy, psychotherapy, support groups • - Seek Spiritual comfort • Non-traditional western medicine approach to health • - Yoga, meditation • Hyperbaric oxygen therapy? Learn More At:www.DoctorVermeulen.com

  22. Question? Question: How do I optimize my Brain Health to receive the right therapy for my disease type? Answer: Get more than one opinion before starting treatment. Learn More At:www.DoctorVermeulen.com

  23. Conclusion We are on the continued quest of study to harness the benefits of energy produce by the Electromagnetic Spectrum Learn More At:www.DoctorVermeulen.com

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