The use of Radiotherapy in Cancer.. What is radiotherapy? The treatment of cancer with ionising radiation is called Radiotherapy or Radiation Oncology.

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Presentation transcript:

The use of Radiotherapy in Cancer.

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.

What is Radiotherapy- Radiation Oncology (RT)? CLINIC BIOLOGY 1. Tumour 2. Normal tissue PHYSICS RT

The three “C” of radiation Oncology - “C” for cure - “C” for cheap - “C” for conservative treatment

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)

“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.

“C” for conservative treatment - Breast - Larynx - Rectum, Anal canal - Bladder - Penis -Eye… NB: Non exhaustive list

Radiotherapy tackles all hallmarks of cancer Solimini et al. Cell 2007

Reduce the number of tumour cells to be killed by e.g. surgery Doublings Cells Grams

Tumour control Effect Tumour Dose The problem 100% Normal tissue damage

Tumour control Effect Tumour Dose Normal tissue damage Increase the therapeutic ratio

Normal tissue damage Tumour control Effect Tumor Dose 100% Increase the therapeutic ratio

D. De Ruysscher et al. J Clin Oncol 2006 Integration of chemotherapy and radiotherapy

Lokalisatie The four parts of radiotherapy Intekening doelvolume en gezond weefsel Treatment planning Bestraling en verificatie

Delineation of the target volumes and the normal tissues liver pancreas stomach left kidney heart liver stomach pancreas heart skin target volume

alvleesklier stomach left kidney right kidney heart spinal cord spleen liver target volume Patient modelling in 3D

3-D patient model

Problem

Do nothing?  Large systematic error

Radius and volume ( ) A (small) reduction of the margin (5 mm) leads to a 50 % reduction of the volume Volume peel = volume flesh Verellen D et al. Nature Rev Cancer 2007

Manual PET-CT contouring Automatic PET-CT contouring + manual editing van Baardwijk et al. Int J Radiat Oncol Biol Phys 2007

Automatic contouring of tumors on the basis of 4D-FDG- PET-CT scans: Correlation with pathology I x x KJ Stroom et al. Int J Radiat Oncol Biol Phys 2007

Bepaling bestralingsrichtingen (bundels) met optimalisatie van: - bundelenergie - bundelrichting - bundeldosis - bundelgrootte en -vorm Treatment planning Dosisverdeling

Dose-Volume Histogram (DVH) zonder aanpassing heart target volume

Radiotherapy using CT-PET, e.g.: lung cancer with atelectasis

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.