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61916_7552_127245658..

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  1. 1. The use of Radiotherapy inThe use of Radiotherapy in Cancer.Cancer.
  2. 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. 3. What is Radiotherapy- Radiation Oncology (RT)? CLINIC BIOLOGY 1. Tumour 2. Normal tissue PHYSICS RT
  4. 4. The five components of Radiation Oncology Clinic Biology Physics Molecular Imaging Radiation Oncology Computer science
  5. 5. The three “C” of radiation Oncology - “C” for cure - “C” for cheap - “C” for conservative treatment
  6. 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. 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. 8. “C” for conservative treatment - Breast - Larynx - Rectum, Anal canal - Bladder - Penis -Eye… NB: Non exhaustive list
  9. 9. Radiotherapy tackles all hallmarks of cancerRadiotherapy tackles all hallmarks of cancer Solimini et al. Cell 2007
  10. 10. Reduce the number of tumour cells to be killed by e.g. surgery Doublings Cells Grams
  11. 11. Tumour control Effect Tumour Dose The problemThe problem 100% Normal tissue damage
  12. 12. Tumour control Effect Tumour Dose Normal tissue damage Increase the therapeutic ratioIncrease the therapeutic ratio
  13. 13. Normal tissue damageTumour control Effect Tumor Dose 100% Increase the therapeutic ratioIncrease the therapeutic ratio
  14. 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. 15. Lokalisatie The four parts of radiotherapy Intekening doelvolume en gezond weefsel Treatment planningBestraling en verificatie
  16. 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. 17. alvleesklier stomach left kidney right kidney heart spinal cord spleen liver target volume Patient modelling in 3D
  18. 18. 3-D patient model3-D patient model
  19. 19. ProblemProblem
  20. 20. Do nothing?Do nothing? ⇒ Large systematic error
  21. 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. 22. Manual PET-CT contouring Automatic PET-CT contouring + manual editing van Baardwijk et al. Int J Radiat Oncol Biol Phys 2007
  23. 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. 24. • Bepaling bestralingsrichtingen (bundels) met optimalisatie van: - bundelenergie - bundelrichting - bundeldosis - bundelgrootte en -vorm Treatment planning Dosisverdeling
  25. 25. Dose-Volume Histogram (DVH) zonder aanpassing heart target volume
  26. 26. Radiotherapy using CT-PET, e.g.: lung cancer with atelectasis
  27. 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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