24° CORSO RESIDENZIALE DI AGGIORNAMENTO con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO) Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose Trattamenti ipofrazionati ed ipofrazionati-accelerati: effetti sul controllo tumorale e sulla tossicità (inclusa consequential late-toxicity)

1. Trattamenti ipofrazionati ed
ipofrazionati-accelerati: effetti sul
controllo tumorale e sulla tossicità
(inclusa consequential late-toxicity)
Mariangela Boccardi

2. 1991
2D

3. Radiotherapy Technique Evolution

4. Serial vs. parallel organs:
ICRU 62 definition

5. 4500
cGy
Spinal cord
Dmax
Series organs:
D max ≤X Gy

6. Vx ≤ Y %
x1
Y1
%
x1 x2 x3 x4
Y1
Y2
Y3
Y4
%
Dmean
Parallel organs:

7. Dose Volume Histogram (DVH)
Dmax
V x (Gy) <= y %
Dmean

8. Scale of Toxicity

10. 1) to provide a critical overview of the current state of knowledge
on quantitative dose–response and dose–volume relationships for clinically
relevant normal-tissue endpoints;
2) to produce practical guidance allowing the clinician to categorize
toxicity risk based on dose–volume parameters or model results;
3) to identify future research avenues that would help improve
risk estimation or mitigation of early and late side effects of radiation
therapy.

11. ?
?

12. CHANGES IN ORGAN VOLUME/SHAPE
DURING RT

13. Shrinkage and
change in the medial parotid gland
position during RT

14. PRV spinal cord = OAR + 2-3 mm

15. Pericardial disease
Ischemic heart disease
Congestive heart failure
Valvular disease

16. ……Dose–volume histograms
including only partial
volumes!!!!
Preferably, data used for
NTCP analyses should
include the full organ volume
When this is not possible,
either a standard method of
normalization, or absolute
volumes should be used
NTCP

17. - Lack in evolving fractionation schedules data
- Lack in combined modality therapy data
- Limited applicability to children
Limitations

18. “….in the methods of extracting data from the
literature”
small numbers of events in
individual series
combine complication data from
different institutions and protocols.
Limitations

19. …… to pool data from single Institutionsin order to produce
more effective predictive models

20. …. to introduce imaging during side effects follow up
• Imaging of anatomic effect
(structural)
• Imaging of functional effect

21. HYPOFRACTIONATION
RE-IRRADIATION
SBRT
SRS
SRT
IMRT