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61916_7552_127245658..

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  • Title slide
  • Let me explain the problem with this graph:
    (explain 1st curve) :
    (explain 2nd curve):
    The problem can be defined as follows: Normal tissue tolerance is the limiting factor for tumour control.
  • This means,an increase in tumour dose necessitates a decrease in toxicity in order to increase tumour control. This is expressed as an increase of the therapeutic ratio.
  • The effect of radiotherapy on the control of tumours is dependent on the radiation dose given as illustrated with this curve. However, higher doses of radiation also increase the chances for normal tissue damage. Therefore, our therapeutic window lays within these two curves. If we would now be able to modulate the biology of a tumour in order to sensitize the tumour to radiation, we could possibly shift the tumor dose/effect curve to the left, thereby increasing the therapeutic window. The same dose of radiation would than increase the tumour curve rate. This is meant by sensitizing tumour to radiation by targeting biological pathways in cancer cells
  • Standard slide with 2 logos
  • When we as radiation oncologists treat cancer patients with radiotherapy , we deliver ………, however the cure rate of tumors varies widely indicating differences in outcome determined by biology
  • When we as radiation oncologists treat cancer patients with radiotherapy , we deliver ………, however the cure rate of tumors varies widely indicating differences in outcome determined by biology
  • De intekening van het doelvolume is in rood weergegeven.
  • Standard slide with 2 logos
  • Standard slide with 2 logos
  • Acknowledgements slide with 3 logos
  • Standard slide with 2 logos
  • Standard slide with 2 logos
  • Transcript

    • 1. The use of Radiotherapy inThe use of Radiotherapy in Cancer.Cancer.
    • 2. What is radiotherapy?What is radiotherapy? The treatment of cancer with ionising radiation is called Radiotherapy or Radiation Oncology. Radiotherapy is one of three main disciplines within the science of oncology.The other two disciplines are surgery and chemotherapy. Radiotherapy is a clinical science, with clinical, physical (radiophysics) and biological (radiobiology) aspects.
    • 3. What is Radiotherapy- Radiation Oncology (RT)? CLINIC BIOLOGY 1. Tumour 2. Normal tissue PHYSICS RT
    • 4. The five components of Radiation Oncology Clinic Biology Physics Molecular Imaging Radiation Oncology Computer science
    • 5. The three “C” of radiation Oncology - “C” for cure - “C” for cheap - “C” for conservative treatment
    • 6. Cured by surgery and/or radiotherapy (30) Cured by chemotherapy (2) Treatment of solid cancers 100 new cases Skin & in situ cervical ca. (30) Localised & operable (48) Advanced (22) Relapsed (18) Candidates for chemotherapy (40) Potentially curable (5) Incurable (35) Possible life prolongation (10)
    • 7. “C” for cheap The total costs for radiotherapy are only 5 % of the total costs for cancer treatment in Sweden and in the European Community. Swedish Council of Medical Technology Assessment in Healthcare, EC.
    • 8. “C” for conservative treatment - Breast - Larynx - Rectum, Anal canal - Bladder - Penis -Eye… NB: Non exhaustive list
    • 9. Radiotherapy tackles all hallmarks of cancerRadiotherapy tackles all hallmarks of cancer Solimini et al. Cell 2007
    • 10. Reduce the number of tumour cells to be killed by e.g. surgery Doublings Cells Grams
    • 11. Tumour control Effect Tumour Dose The problemThe problem 100% Normal tissue damage
    • 12. Tumour control Effect Tumour Dose Normal tissue damage Increase the therapeutic ratioIncrease the therapeutic ratio
    • 13. Normal tissue damageTumour control Effect Tumor Dose 100% Increase the therapeutic ratioIncrease the therapeutic ratio
    • 14. 0 20 40 60 80 100 120 140 160 180 10 15 20 25 30 35 40 5-yearsurvival(%) SER (days) D. De Ruysscher et al. J Clin Oncol 2006 Integration of chemotherapy and radiotherapyIntegration of chemotherapy and radiotherapy
    • 15. Lokalisatie The four parts of radiotherapy Intekening doelvolume en gezond weefsel Treatment planningBestraling en verificatie
    • 16. Delineation of the target volumes and the normal tissues liver pancreas stomach left kidney heart liver liver stomach pancreas heart skinskin skin target volume target volume target volume
    • 17. alvleesklier stomach left kidney right kidney heart spinal cord spleen liver target volume Patient modelling in 3D
    • 18. 3-D patient model3-D patient model
    • 19. ProblemProblem
    • 20. Do nothing?Do nothing? ⇒ Large systematic error
    • 21. Radius and volume ( )Radius and volume ( ) A (small) reduction of the margin (5 mm) leads to a 50 % reduction of the volume Volume peel = volume flesh ∏3 3 4 r Verellen D et al. Nature Rev Cancer 2007
    • 22. Manual PET-CT contouring Automatic PET-CT contouring + manual editing van Baardwijk et al. Int J Radiat Oncol Biol Phys 2007
    • 23. Automatic contouringAutomatic contouring of tumors on theof tumors on the basis of 4D-FDG-basis of 4D-FDG- PET-CT scans:PET-CT scans: Correlation withCorrelation with pathologypathology I x x KJ Stroom et al. Int J Radiat Oncol Biol Phys 2007
    • 24. • Bepaling bestralingsrichtingen (bundels) met optimalisatie van: - bundelenergie - bundelrichting - bundeldosis - bundelgrootte en -vorm Treatment planning Dosisverdeling
    • 25. Dose-Volume Histogram (DVH) zonder aanpassing heart target volume
    • 26. Radiotherapy using CT-PET, e.g.: lung cancer with atelectasis
    • 27. What is radiotherapy?What is radiotherapy? The treatment of cancer with ionising radiation is called Radiotherapy or Radiation Oncology. Radiotherapy is one of three main disciplines within the science of oncology.The other two disciplines are surgery and chemotherapy. Radiotherapy is a clinical science, with clinical, physical (radiophysics) and biological (radiobiology) aspects.

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