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Modern radiation treatment
Karin Haustermans
Department of Radiation Oncology, University Hospitals Leuven, Belgium
On behalf of ESTRO – European Society for Radiotherapy & Oncology
European Prostate Awareness Day 2015
Radiation oncology
• Medical use of ionizing radiation in the treatment of
cancer
• About 50% of all cancer patients receive radiation therapy
at some point during their treatment
• Monotherapy or combined with other treatment modalities
• Curative or palliative setting
Radiation oncology
• Ultimate goal of radiation therapy:
• To maximize tumor targetting,
• While sparing the surrounding normal tissue
• Inevitably some radiation dose is always deposited in the
healthy tissues…
Therapeutic ratio
“Ballistic Equipment”
Rifle
Ammunition
“Game Search”
Binoculars
Experience
“Aiming for the target”
Telescopic sight
Steady Hand
Dose Delivery Target Definition Target Localization
Hunting cancer cells with IR
Dose delivery
2D-RT 3D-CRT IMRT IMAT1990 2000 2010
2D-RT
3D-CRT
IMRT
IMAT
Dose delivery
• IMAT
• Further optimization of
IMRT technique
• 360° rotation of gantry
• Fast delivery
• Highly conformal
Target definition
• Advances in treatment planning and radiation delivery,
thanks to advances in imaging
Conventional
radiotherapy
3D-Conformal
radiotherapy
Intensity
modulated
radiotherapy
Anatomical
imaging
Functional
imaging
Multimodality
imaging
Target definition
• Anatomical & functional
imaging
T2w MRI DCE MRI
DW MRI:
b1000
DW MRI: ADC
map
PSMA PET-CT
TRUS MR/CT
Target localization
• Importance of target localization
• INTER-fraction: between treatments
• Bowel or bladder filling
• Positioning or set-up errors
• Tumor shrinkage
• Weight loss
• INTRA-fraction: during treatment
• Breathing, swallowing, cardiac motion
• Patient movement (e.g. due to pain)
Target localization
• Imaging for position verification!
• In-room and/or on-board (EPID, cone-beam CT, MV/kV RX)
• Image quality
• Image registration
“Conformal Dose Delivery”
Accurate Dose Delivery
IMRT
“Imaging”
Anatomical Imaging
Functional Imaging
“Motion”
Inter/Intra-fraction
Positioning verification
Dose Delivery Target Definition Target Localization
State-of-the-art summary
Dose delivery
• Adequate dose escalation without increasing toxicity?
• Focal boost to the dominant lesion in addition to standard dose
to the whole organ
• Rationale
• PCa is multifocal
• Dominant lesion is biological driver
• PCa often recurs at the site of the dominant lesion
• Dose-response relationship
Dose delivery
• Hadron therapy: charged particles
Thariat et al Nat Rev Clin Oncol 2013
Dose delivery
• Unique physical and radiobiological properties: Bragg peak
Dose delivery
• Stereotactic body radiotherapy (SBRT)
• Large dose per fraction
• Hypofractionation
• E.g. SBRT for oligometastatic PCa Ponti E et al Clin Genitourin Cancer 2015
“Physical optimization”
 Hadron therapy
 SBRT
“Biological optimization”
 Focal boosting
“Adaptive therapy”
 IGRT
 Adaptive RT
Dose Delivery Target Definition Target Localization
Future prospects: summary
THANK YOU

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Modern Radiation Treatment

  • 1. Modern radiation treatment Karin Haustermans Department of Radiation Oncology, University Hospitals Leuven, Belgium On behalf of ESTRO – European Society for Radiotherapy & Oncology European Prostate Awareness Day 2015
  • 2. Radiation oncology • Medical use of ionizing radiation in the treatment of cancer • About 50% of all cancer patients receive radiation therapy at some point during their treatment • Monotherapy or combined with other treatment modalities • Curative or palliative setting
  • 3. Radiation oncology • Ultimate goal of radiation therapy: • To maximize tumor targetting, • While sparing the surrounding normal tissue • Inevitably some radiation dose is always deposited in the healthy tissues… Therapeutic ratio
  • 4. “Ballistic Equipment” Rifle Ammunition “Game Search” Binoculars Experience “Aiming for the target” Telescopic sight Steady Hand Dose Delivery Target Definition Target Localization Hunting cancer cells with IR
  • 5. Dose delivery 2D-RT 3D-CRT IMRT IMAT1990 2000 2010 2D-RT 3D-CRT IMRT IMAT
  • 6. Dose delivery • IMAT • Further optimization of IMRT technique • 360° rotation of gantry • Fast delivery • Highly conformal
  • 7. Target definition • Advances in treatment planning and radiation delivery, thanks to advances in imaging Conventional radiotherapy 3D-Conformal radiotherapy Intensity modulated radiotherapy Anatomical imaging Functional imaging Multimodality imaging
  • 8. Target definition • Anatomical & functional imaging T2w MRI DCE MRI DW MRI: b1000 DW MRI: ADC map PSMA PET-CT TRUS MR/CT
  • 9. Target localization • Importance of target localization • INTER-fraction: between treatments • Bowel or bladder filling • Positioning or set-up errors • Tumor shrinkage • Weight loss • INTRA-fraction: during treatment • Breathing, swallowing, cardiac motion • Patient movement (e.g. due to pain)
  • 10. Target localization • Imaging for position verification! • In-room and/or on-board (EPID, cone-beam CT, MV/kV RX) • Image quality • Image registration
  • 11. “Conformal Dose Delivery” Accurate Dose Delivery IMRT “Imaging” Anatomical Imaging Functional Imaging “Motion” Inter/Intra-fraction Positioning verification Dose Delivery Target Definition Target Localization State-of-the-art summary
  • 12. Dose delivery • Adequate dose escalation without increasing toxicity? • Focal boost to the dominant lesion in addition to standard dose to the whole organ • Rationale • PCa is multifocal • Dominant lesion is biological driver • PCa often recurs at the site of the dominant lesion • Dose-response relationship
  • 13. Dose delivery • Hadron therapy: charged particles Thariat et al Nat Rev Clin Oncol 2013
  • 14. Dose delivery • Unique physical and radiobiological properties: Bragg peak
  • 15. Dose delivery • Stereotactic body radiotherapy (SBRT) • Large dose per fraction • Hypofractionation • E.g. SBRT for oligometastatic PCa Ponti E et al Clin Genitourin Cancer 2015
  • 16. “Physical optimization”  Hadron therapy  SBRT “Biological optimization”  Focal boosting “Adaptive therapy”  IGRT  Adaptive RT Dose Delivery Target Definition Target Localization Future prospects: summary