6 th CCO May 2010 Radiation dose painting in Head and Neck treatment: how far are we ? Vincent GREGOIRE, MD, PhD, Hon. FRCR Radiation Oncology Dept., Head.

Slides:

Advertisements

Similar presentations

CTOS, Boca Raton, 2005 A Radiation Treatment Planning Comparison for Lower Extremity Soft Tissue Sarcoma: Can the Future Surgical Wound Be Spared? Anthony.

Advertisements

Challenges in Optimal Delivery of Radiation in Head and Neck Cancers Dr. J P Agarwal Associate Professor Department of Radiation Oncology Tata Memorial.

H. AlHussain, I. Busca, L. Eapen,, S. El-Sayed The Ottawa Hospital Cancer Center, University of Ottawa Department of Radiation Oncology.

Indications for adjuvant radiation therapy with or without lymph nodes in salivary gland cancer Claus Rödel Department of Radiation Therapy University.

Para-spinal Tumors Encircling the Spinal Cord IMRT Comparison of Several Target Definitions.

Multi-tracer analysis for patient’s following using multi-observation statistical image fusion : a feasibility study S. David 1, M. Hatt 1, P. Fernandez.

IMRT vs. BRACHYTHERAPY FOR SOFT TISSUE SARCOMA. EXTERNAL RT IN STS NCI Trial (Yang JC et al, JCO 1998) Extremity / Superficial Trunk STS (n=141) LSS Alone.

Impact of imaging on newer radiation techniques in Gynaecological cancer.

Radiotherapy for Brain Tumours What do I need to know? Dr Matthew Foote Radiation Oncologist Princess Alexandra Hospital Queensland.

Stereotactic Body Radiation Therapy (SBRT): The optimal indication for operable tumors in inoperable patients D.Katsochi 1, S.Kosmidis 1, A.Fotopoulou.

The Health Roundtable 1-1b_HRT1215-Session_HEGI_JOHNSON_WESTMEAD_NSW Volumetric Modulated Arc Therapy for Stereotactic Body Radiotherapy in Early Lung.

Radiotherapy Planning for Esophageal Cancers Parag Sanghvi, MD, MSPH 9/12/07 Esophageal Cancer Tumor Board Part 1.

بسم الله الرحمن الرحيم و قل رب زدنى علماً ﴿و قل رب زدنى علماً﴾ صدق الله العظيم.

Treatment Guidelines for Pre-operative Radiation Therapy for Retroperitoneal Sarcoma: Preliminary Consensus of an International Expert Panel EH Baldini,

Shannon M MacDonald 1, Salahuddin Ahmad 2, Stefanos Kachris 3, Betty J Vogds 2, Melissa DeRouen 3, Alicia E Gitttleman 3, Keith DeWyngaert 3, Maria T Vlachaki.

Update on 18 F-Fluorodeoxyglucose/Positron Emission Tomography and Positron Emission Tomography/ Computed Tomography Imaging of Squamous Head and Neck.

IMRT for the Treatment of Anal Cancer Kristen O’Donnell, MS3 December 12, 2007.

Comparison of Rectal Dose Volume Histograms for Definitive Prostate Radiotherapy Among Stereotactic Radiotherapy, IMRT, and 3D-CRT Techniques Author(s):

Clinical decisions in the optimization process II. Emphasis on the avoidance of normal tissue complications Avi Eisbruch University of Michigan.

Evaluating a Nomogram for the Development of Radiation Pneumonitis in Locally Advanced Non-Small Cell Lung Cancer Treated with 3D and Intensity Modulated.

Data Mining to Aid Beam Angle Selection for IMRT Stuart Price-University of Maryland Bruce Golden- University of Maryland Edward Wasil- American University.

INTRODUCTION  The majority of clinical trials addressing outcomes in limited- stage small cell lung cancer (LS-SCLC) following definitive chemoradiotherapy.

Predictive models validated by clinical data: new strategies for fractionation Dr. M. Benassi Dr. S. Marzi.

Vincent Grégoire, Peter Levendag et. al. DELINEATION OF THE CTV IN THE N 0 NECK OF PATIENTS WITH HEAD & NECK SQUAMOUS CELL CARCINOMA. ANATOMICAL BOUNDARIES.

A Phase II Study to Evaluate the Safety and Toxicity of Sparing Radiation to the Pathologic N0 Side of the Neck in Squamous Cell.

Phase II Trial of Continuous Course Re- irradiation Concurrent with Weekly Cisplatinum and Cetuximab for Recurrent Squamous Cell Carcinoma of The Head.

CTOS Soft Tissue Sarcoma of the Extremity Comparison of Conformal Post-operative Radiotherapy (CRT) and Intensity Modulated Radiotherapy (IMRT)

BREAST MRI IN RADIATION THERAPY PLANNING MARSHA HALEY, M.D. ASSISTANT PROFESSOR UNIVERSITY OF PITTSBURGH CANCER INSTITUTE PITTSBURGH, PENNSYLVANIA, USA.

STATEMENTS 2008 on Head and Neck Cancer Stephane TEMAM, M.D. PhD. Department of Head and Neck Surgery Mucosal Melanoma.

IMRT. 3DCRT vs IMRT Treated Volume Tumor Target Volume Intensity Modulation Treated Volume Critical structure Target Volume Collimator "Classical" Conformation.

Image-Guided Adaptive Therapy for the Treatment of Lung Cancer

Clinical decisions in the optimization process I. Emphasis on tumor control issues Avi Eisbruch University of Michigan.

Comparison of SIB-IMRT and Conventional Accelerated Hyper-fractionated IMRT With Concurrent Cisplatin and Etoposide for Limited Disease SCLC Baosheng Li.

Physics of carbon ions and principles of beam scanning G. Kraft Biophysik, GSI, Darmstadt, Germany PTCOG43 Educational Satellite Meeting: Principles of.

Workshop on Advanced Technologies in Radiation Oncology Kian Ang.

Albert J. Chang, MD, PhD 1 Farrokh Dehdashti, MD 2 Perry W. Grigsby, MD, MS 1 Department of Radiation Oncology 1 Department of Radiology and Nuclear Medicine.

Taipei VGH Practice Guidelines: Oncology Guidelines Index Cancer of Oral Cavity Version Table of Content StagingStaging, Manuscript Taipei Veterans.

Radiation Therapy Trials - Quality Assurance:  patient safety  adherence to protocol constraints  uniformity of patient treatments  efficient review.

Adaptive radiotherapy in Head and Neck cancer Dr Maria Najim TCRC Fellow.

Saad El Din I, M.D *, Abd El AAl H, M.D *, Makaar W, M.D *, El Beih D, M.Sc †, Hashem W, M.Sc * *Department of Clinical Oncology and Radiotherapy, Kasr.

Head & Neck Ca. (Epithelial tumors) Mohamad KADRI. MD. Clinical oncology. Medical director of AlBerouni University Hospital President of Syrian Association.

SARC018: A SARC PILOT MULTICENTER STUDY OF PREOPERATIVE RADIATION AND SURGERY IN PATIENTS WITH HIGH- RISK DESMOID TUMORS Robert S. Benjamin, M.D.

Dynamic Contrast Enhanced (DCE)-MRI as a Predictor of Response in Head & Neck Squamous Cell Carcinoma (HNSCC) : Initial Analysis A.Shukla-Dave 1,2, N.

Taipei Veterans General Hospital Practices Guidelines Oncology Rectal Cancer Version

Taipei Veterans General Hospital Practices Guidelines Oncology Oral Cavity Cancer Version

A statistical analysis was performed on the volumes.

Locally Recurrent Head and Neck Cancer (Salvage IMRT - Dose, fractionation, volumes) Eddy S. Yang, MD, PhD Professor and Vice Chair of Translational Sciences.

Modern Radiation Oncology

Intensity modulated radiation therapy for definitive treatment of paraortic relapse in patients with endometrial cancer Shervin M. Shirvani, MD, Ann.

Automatic treatment planning improves the clinical quality of head and neck cancer treatment plans Christian Rønn Hansen, Anders Bertelsen, Irene Hazell,

Modern Radiation Therapy for Extranodal Lymphomas: Field and Dose Guidelines From the International Lymphoma Radiation Oncology Group Joachim Yahalom,

Marked Tumor Response and Fatal Hemoptysis During Radiation for Lung Cancer in a Human Immunodeficiency Virus-Positive Patient Taking Nelfinavir Christopher.

Image–Guided Radiation Therapy for Non–small Cell Lung Cancer

*Can the volume predict the acute reactions ?

Karla Leach, BS, CMD Texas Center for Proton Therapy-Irving, TX

Insert tables Insert figure

Intensity modulated radiation therapy for definitive treatment of paraortic relapse in patients with endometrial cancer Shervin M. Shirvani, MD, Ann.

Volumetric Modulated Arc Therapy (VMAT) versus Intensity Modulated Radiation Therapy (IMRT) for Anal Carcinoma Heather Ortega, BSRT(T), CMD, Kerry Hibbitts,

Radiation Oncology Department, Bank of Cyprus Oncology Center.

A Multi-Institutional Dosimetric Evaluation of Proton Versus Photon Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma F. Khan, B. Nguyen,

Automatic treatment planning improves the clinical quality of head and neck cancer treatment plans Christian Rønn Hansen, Anders Bertelsen, Irene Hazell,

Image–Guided Radiation Therapy for Non–small Cell Lung Cancer

Thesis Title Title –Volumetric and dosimetric comparison of gross tumor volumes between PET-CT and CT simulation images in head and neck radiotherapy planning.

Safety of differential radiation dosing in lymph node positive necks treated with IMRT Stephen Sozio, MBS, Zorimar Rivera-Núñez, PhD, Omar Mahmoud, MD,

Results of a Multicentric In Silico Clinical Trial (ROCOCO): Comparing Radiotherapy with Photons and Protons for Non-small Cell Lung Cancer Erik Roelofs,

Intensity-Modulated Radiotherapy for Lung Cancer: Current Status and Future Developments Clara Chan, MD, Stephanie Lang, MSc, Carl Rowbottom, PhD, Matthias.

Technical Advances of Radiation Therapy for Thymic Malignancies

Prostate-specific membrane antigen positron emission tomography/computed tomography as a potential tool to assess and guide salivary gland irradiation

Planning techniques of proton boost

Patterns-of-Care for Thoracic Stereotactic Body Radiotherapy among Practicing Radiation Oncologists in the United States Megan E. Daly, MD, Julian R.

Presentation transcript:

6 th CCO May 2010 Radiation dose painting in Head and Neck treatment: how far are we ? Vincent GREGOIRE, MD, PhD, Hon. FRCR Radiation Oncology Dept., Head and Neck Oncology Program & Center for Molecular Imaging and Experimental Radiotherapy, Université Catholique de Louvain, St-Luc University Hospital, Brussels, Belgium

6 th CCO May 2010 This house believes that … RO will be (even more) multidisciplinary… RO will be conformal (e.g. IMRT, proton, hadrons)… RO will be tailored (based on imaging and molecular profiling) and adaptive … RO will be associated with targeted agents …

6 th CCO May 2010 The current practice: Conformality…?

6 th CCO May Intensity Modulated Radiation Therapy (IMRT) Radiotherapy in HNSCC Adaptive IMRT

6 th CCO May 2010 DAHANCA: EORTC: Radio/EDUCATION.htm RTOG: Conformal radiotherapy and IMRT in Head and Neck Tumors

6 th CCO May 2010 Oropharyngeal Carcinoma Which CTV for the neck? Grégoire et al., 2000

6 th CCO May 2010 Ant.symphysis menti / platysma Post.hyoid bone / submandibular gland Lat.ant. belly of digastric m. (Ia) mandible / platysma (Ib) Med.ant. belly of digastric m. (Ib) Cra.geniohyoid m./mandible (Ia) mylohyoid m, submandibular gland (Ib) Cau.hyoid bone Level Ia and Ib RP LII LIb LIa CT-based delineation of lymph node levels in the neck: Brussels- Rotterdam consensus guidelines

6 th CCO May 2010 H&N IMRT practice heterogeneity among Dutch Radiation Oncologists Rasch et al., 2007

6 th CCO May 2010 Oropharyngeal SCC T2-N0-M0 SIB-IMRT: 30x2.3 Gy 30x1.85 Gy PRV Spinal cord Left parotid Right parotid Larynx PTV 55.5 Gy PTV 69 Gy IMRT for Head and Neck Tumors

6 th CCO May 2010 ≥ grade 3 mucositis: IMRT vs 3D-CRT Acute toxicity with IMRT Vergeer, 2009

6 th CCO May 2010 Parotid gland sparing in IMRT for HNSCC Nutting, 2009

6 th CCO May 2010 The current practice: Conformality…? Yes !

6 th CCO May 2010 The current practice: Tailoring…?

6 th CCO May 2010 The Gross Tumor volume (GTV) Daisne et al., Radiology, 233: , 2004

6 th CCO May cm 18 F-FDG PET CAT Scan Macroscopy Daisne et al, 2004

6 th CCO May 2010 Impact of imaging modality on dose distribution Image-Guided Radiation Therapy in HNSCC CT-based target volumeFDG PET-based target volume

6 th CCO May 2010 Validation protocol in locally advanced HNSCC Apport de l'imagerie fonctionnelle par Tomographie par Emission de Positrons (TEP) dans le ciblage biologique par radiothérapie de conformation (3D-CRT) et par modulation d'intensité (IMRT) de tumeurs ORL Use of functional imaging with PET for target volume delineation in 3D-CRT/IMRT for head and neck tumors Prof. V. Grégoire, UCL St-Luc, Brussels, Belgium Prof. E. Lartigau, COL, Lille, France Dr. JF Daisnes, Cliniques St-Elisabeth, Namur, Belgium

6 th CCO May 2010 Survival is non-flat (higher in resistant areas) Non-flat doseFlat dose More similar survival across entire tumor Far more efficient use of dose Mean Tumor Dose = 2 Gy Courtesy of D. De Ruysscher “Dose painting” by number…

6 th CCO May 2010 “Dose painting” : the physics issue

6 th CCO May 2010 [ 18 F]-FDG TEPRegistered autoradiography Résolution 2.3 mmRésolution 0.1 mm N. Christian, 2010 Biological heterogeneity

6 th CCO May 2010 Metabolism: 18 F-FDG 11 C-Met Proliferation: 76 Br-BFU Hypoxia: 18 F-EF3 Which biological pathways? …

6 th CCO May 2010 FDGFLTCuATSM Spatially “complex” target Jeraj et al, 2010

6 th CCO May 2010 The current practice: Tailoring…? Great hope but still in the research arena!

6 th CCO May 2010 The current practice: Adaptation…?

6 th CCO May 2010 C. Monet, 1894 The Cathedral of Rouen 4D-IMRT

6 th CCO May 2010 CTMRI (T2)FDG-PET PRE-R/ WEEK 3 WEEK 5 (Week 2) (Week 4)

6 th CCO May 2010 Mean slope: -0.93% / treat day (p<0.05) Medial shift: 3.21mm after 25# (p<0.05) Mean slope: -1.03% / treat day (p<0.05) No shift Variation in parotid volumes during RT-CH… (70 Gy – 3 courses on w1, w4, w7) Homolateral parotid Heterolateral parotid Castadot & Lee, 2010

6 th CCO May 2010 Variation in CT Target volumes during RT-CH (70 Gy – 3 courses on w1, w4, w7) Castadot & Lee, 2010 Mean slope: -3.18% / treat day (p<0.05) Lateral shift: 1.26mm after 25# (p<0.05) GTV T, CT Mean slope: -2.55% / treat day (p<0.05) Lateral shift: 1.52mm after 25# (p<0.05) CTV T 70 Gy, CT

6 th CCO May 2010 Mean slope: -0.47% / treat day (p<0.05) No shift Mean slope: -0.41% / treat day (p<0.05) Medial shift: 1.76mm after 25# (p<0.05) Variation in prophylactic CTVs during RT-CH… (70 Gy – 3 courses on w1, w4, w7) Homolateral CTV N 50 Gy, CT Heterolateral CTV N 50 Gy, CT Castadot & Lee, 2010

6 th CCO May → 14Gy 14 → 25Gy25 → 35Gy35 → 45Gy45 → 69Gy Total Dose really received by each volume element of the patient + w2→w0 + w3→w0 + w4→w0 + w5→w0 Castadot & Lee, 2008

6 th CCO May 2010 Classic CT-based planningAdaptive PET-based planning 58%67%73%98%100%99%Adaptive PET-based 81%82%83%98%99% Classic PET-based 66%80%85%100% 99%Adaptive CT-based 100% Classic CT-based V 100 V 95 V 90 V 80 V 50 V 10 Planning P<0.001 Geets, 2007 Impact on dose distribution SIB-IMRT 30x2.3 Gy 30x1.85 Gy

6 th CCO May 2010 « Classical » CT-based « Classical » PET-based « Real » CT-based « Real » PET-based Adaptive CT-based Adaptive PET-based Homolat Parotid D mean (Gy) Heterolat Parotid D mean (Gy) SC D 2 (Gy) Larynx D 5 (Gy) Oral cavity D mean (Gy) Mandible D 2 (Gy) Homolat Submax gl D mean (Gy) Heterolat Submax gl D mean (Gy) Skin V 65Gy (cc) V 95% (cc) Dose distribution after biological adaptive IMRT Castadot & Lee, 2010

6 th CCO May 2010 The current practice: Adaptation…? Geometric adaptation, yes! Biologic & dosimetric adaptation, under validation!

6 th CCO May 2010

6 th CCO May 2010 This house believes that … … conformal …, tailored …, and adaptive … How far are we? Probably not too far … But don’t jump to quickly into routine practice… Wait for validation!