- unique dose distribution (matterhorn like – Bragg Peak)
Imaging for RT Planing (incl. CT-MRI/PET) Stage shift up to 30%
Preclinical research: Metabolic image guided RT (mIGRT) with repeated FDG-PET during RT?
Intensity modulated RT (IMRT) Voxel by voxel RT for complex volumes (high/low dose)
IMRT: Maximal dose in the tumor (red), minimal dose in the adjacent normal tissue (blue)
Therapeutic Index of RT: Reason for fractionated radiotherapy (daily low dose)
There is nothing magic about fractionation Small fractions (daily dose) = high total dose Large fractions (daily dose) = low total dose Equivalent effect: 5 x 8 Gy = 30 x 2 Gy (Various math. models for „effective dose“ (NSD, E/alpha) E.g.: Large, radioresistant tumors with radiosensitive adjacent normal tissue need a small daily dose and high total dose
Radiotherapy in NSCLC 75 % of lung cancer patients need radiotherapy Primary radical radiotherapy (Stage I – IIIB) Adjuvant, radical radiotherapy (Stage IIB – IIIA) Radical radiotherapy in local recurrence (Stage I – III) Palliative radiotherapy (Any stage)
NSCLC Stage I/II The role of radical radiotherapy
- Radical surgery: Gold-standard
Radical RT: 10-30% less effective (historic)
- Is „state of the art“ radical RT more effective ?