Treatment Techniques for the Pelvis Region - Prostate - (- Cervix Ca -) Uwe Götz, Bernd Schicker Institute of Radiation Oncology Limburg, Germany Treatment.

Slides:



Advertisements
Similar presentations
Anatomy-based MLC Field Optimization for the Treatment of Gynecologic Malignancies Myriam Bouchard M.D. Nadeau S, Germain I, Raymond P.E., Harel F, Beaulieu.
Advertisements

Physics 2: IMRT in Cervix Cancer Tomas Kron, PhD Peter MacCallum Cancer Centre AUSTRALIA.
Conformal Radiotherapy for Head and Neck Cancer Conformal Radiotherapy in Head and Neck Cancer B. Schicker, U. Götz, I. C. Kiricuta ISRO-Limburg - Germany.
Para-spinal Tumors Encircling the Spinal Cord IMRT Comparison of Several Target Definitions.
Radiotherapy in prostate cancer Dr.Mina Tajvidi Radiation oncologist.
Stereotactic Body Radiation Therapy (SBRT): The optimal indication for operable tumors in inoperable patients D.Katsochi 1, S.Kosmidis 1, A.Fotopoulou.
Radiotherapy Planning for Esophageal Cancers Parag Sanghvi, MD, MSPH 9/12/07 Esophageal Cancer Tumor Board Part 1.
Radiotherapy Treatment Planning
11. – , Athens 8th European Conference on Medical Physics DOSIMETRY AUDITS IN RADIOTHERAPY IN THE CZECH REPUBLIC Irena Koniarová Daniela Ekendahl.
بسم الله الرحمن الرحيم و قل رب زدنى علماً ﴿و قل رب زدنى علماً﴾ صدق الله العظيم.
به نام خداوند بخشایندۀ بخشایشگر
(بسم الله الرحمن الرحيم)
ICRU 50 & ICRU 62 Paweł Kukołowicz Holycross Cancer Centre
TWO FIELD BREAST PLAN VS. OPTIMIZED CONFORMAL BREAST PLAN: COMPARISON OF PLAN PARAMETERS Authors: Borko Basarić, Ozren Čudić, Milan Teodorović, Borislava.
Conformal Therapy for Lung Cancer B. Schicker, F.J. Schwab*, U. Götz Institute of Radiotherapy and Radiation Oncology St. Vincenz-Krankenhaus Limburg *Clinic.
Measurement of Dose to Critical Structures Surrounding the Prostate from Intensity-Modulated Radiation Therapy (IMRT) and Three Dimensional Conformal Radiation.
Comparison of Rectal Dose Volume Histograms for Definitive Prostate Radiotherapy Among Stereotactic Radiotherapy, IMRT, and 3D-CRT Techniques Author(s):
Научно-практический центр протонной лучевой терапии и радиохирургии (Москва-Дубна) A SYSTEM FOR MEASUREMENT OF A THERAPEUTIC PROTON BEAM DOSE DISTRIBUTION.
H Ariyaratne1,2, H Chesham2, J Pettingell2, K Sikora2, R Alonzi1,2
Radiation Protection in Radiotherapy
Factors Influencing the Dose to Rectum During the Treatment of Prostate Cancer with IMRT Nandanuri M.S. Reddy, PhD, Brij M. Sood, MD, and Dattatreyudu.
CTOS Soft Tissue Sarcoma of the Extremity Comparison of Conformal Post-operative Radiotherapy (CRT) and Intensity Modulated Radiotherapy (IMRT)
MRI SIMULATION FOR CONFORMAL RADIATION THERAPY OF PROSTATE CANCER Pasquier D 1-3, Palos G 3, Castelain B 1, Lartigau E 1,2, Rousseau J 2,3 1 Department.
Medical Accelerator F. Foppiano, M.G. Pia, M. Piergentili
1 Radiotherapy, hadrontherapy and treatment planning systems. Faiza Bourhaleb INFN-Torino University Med 1er-Morocco  Radiotherapy  Optimization techniques.
Investigation of 3D Dosimetry for an Anthropomorphic Spine Phantom R. Grant 1,2, G. Ibbott 1, J. Yang 1, J. Adamovics 3, D Followill 1 (1)M.D. Anderson.
Part VIII:Medical Exposures in Radiotherapy Lecture 6: Determination of dose to the patient in Radiotherapy II IAEA Post Graduate Educational Course on.
F. Foppiano, M.G. Pia, M. Piergentili
Somvilai Mayurasakorn, MD. Division of Therapeutic Radiology and Oncology, Faculty of Medicine, Chiang Mai University Somvilai Mayurasakorn, MD. Division.
Introduction to Radiation Therapy
Optimization of Volumetric Modulated Arc Therapy (VMAT) Planning Strategy Using Ring-shaped ROI for Localized Prostate cancer Kentaro Ishii, Masako Hosono,
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.
Principles and Practice of Radiation Therapy
Development of elements of 3D planning program for radiotherapy Graphical editor options  automated enclose of contour  correction of intersections 
External Beam Radiotherapy for Differentiated Thyroid Cancer
CT Multi-Slice CT.
Kasey Etreni BSc., MRT(T), RTT, CTIC
Intensity modulated radiation therapy for definitive treatment of paraortic relapse in patients with endometrial cancer  Shervin M. Shirvani, MD, Ann.
Electron Beam Therapy.
Modern Radiation Therapy for Extranodal Lymphomas: Field and Dose Guidelines From the International Lymphoma Radiation Oncology Group  Joachim Yahalom,
Feasibility of hippocampal sparing radiation therapy for glioblastoma using helical Tomotherapy Dr Kamalram THIPPU JAYAPRAKASH1,2,3, Dr Raj JENA1,4 and.
Introduction Materials & Methods Results Conclusion
Evaluation Of RTOG Guidelines For Monte Carlo Based Lung SBRT Planning
Image–Guided Radiation Therapy for Non–small Cell Lung Cancer
Quality of treatment plans and accuracy of in vivo portal dosimetry in hybrid intensity- modulated radiation therapy and volumetric modulated arc therapy.
Figure 1. (a) Dose distribution of dynamic conformal photon therapy
Figure 1. The (a) anterior–posterior and (b) right-lateral fields and (c, d) the isodose distributions of two axial planes in one patient with T2 stage.
RTOG 0126 A Phase III Randomized Study of High Dose 3D-CRT/IMRT versus Standard Dose 3D-CRT/IMRT in Patients Treated for Localized Prostate Cancer Bijoy.
CONTACT Catalina A. Riley
Karla Leach, BS, CMD Texas Center for Proton Therapy-Irving, TX
Implementation of Object Spot Avoidance in Proton Pencil Beam Treatment on Whole Breast with Implant Metal Injector Peng Wang, PhD, DABR, Karla Leach,
Insert tables Insert graphs 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,
Conformal Photon-Beam Radiotherapy of Prostate Carcinoma
Investigating the efficacy of Bolus-assisted Electron-Arc Therapy (BEAT) for chest wall irradiation in post-mastectomy breast cancer patients Vigil.
A simple technique for an accurate shielding of the lungs during total body irradiation  Hana Mekdash, Bilal Shahine, Wassim Jalbout, Chirine Chehab, Helena.
Clinical Radiation Oncology NMT232 L 10
Chapter 17 Intensity-Modulated Radiation Therapy
Technical Advances of Radiation Therapy for Thymic Malignancies
Innovations in the Radiotherapy of Non–Small Cell Lung Cancer
Clinical and radiobiological evaluation of a method for planning target volume generation dependent on organ-at-risk exclusions in magnetic resonance.
Hot and cold spots are common problems associated with planning:
Cone beam CT based dose calculation in the thorax region
Figure 3 Target volume definitions
Technical Innovations and Patient Support in Radiation Oncology
Constantinos Zamboglou, Matthias Eiber, Thomas R
Planning techniques of proton boost
Technical Innovations and Patient Support in Radiation Oncology
Volumetric and dosimetric comparison of two delineation guidelines for the radiation treatment of laryngeal squamous cell carcinoma  C. Bondue, S. Racadot,
Presentation transcript:

Treatment Techniques for the Pelvis Region - Prostate - (- Cervix Ca -) Uwe Götz, Bernd Schicker Institute of Radiation Oncology Limburg, Germany Treatment Techniques for the Pelvis Region - Prostate

Textbook Techniques Treatment Techniques for the Pelvis Region - Prostate Perez & Prady – Principles and Practice of Radiation Oncology... A variety of techniques have been used, raging from parallel anteroposterior portals with perineal appositional field to lateral portals (box techniques) or rotational fields to supplement the dose to the prostate. In recent years, three-dimesional conformal radiotherapy (3-D CRT) and intensity modulated irradiation techniques have been used increasingly in selected centers. My Opinion: - Treatment Planing based on Radiograph should be history ! - CT based Treatment Planning should be standard – 3-D CRT!

3-D Conformal Treatment Planning Treatment Techniques for the Pelvis Region - Prostate Definition of 3-D CRT: - CT Dataset for Treatment Planning, Spaceing cm. - Delination and Definition of the Organs at Risk (OR) and Target Volume in each CT slice. - Definition of the field (gantry and collimator angle and field borders) under the Beams Eye View (BEV) of the Treatment Planning System (TPS) - Planning and optimisation of the Dose distribution in each CT slice. - Dose Distribution conformal to TV and OR; ICRU Recomondations

Target Volume Treatment Techniques for the Pelvis Region - Prostate - CT Dataset with 22 CT Slices - Spaceing 0.5 cm.

Treatmen Planning – AP / PA Fields Treatment Techniques for the Pelvis Region - Prostate

Treatmen Planning – AP / PA Treatment Techniques for the Pelvis Region - Prostate

DVH – AP / PA Fields Treatment Techniques for the Pelvis Region - Prostate

Treatmen Planning – Box Fields Treatment Techniques for the Pelvis Region - Prostate

DVH – Box Fields Treatment Techniques for the Pelvis Region - Prostate

DVH – AP / PA Fieds vs Box Fields Treatment Techniques for the Pelvis Region - Prostate

Improvement – Box Fields Treatment Techniques for the Pelvis Region - Prostate Homegneous Dose Distribution the Target Volume Quality Index of 94 OK High Dose to the Oragn at Risk (Rectum) NOT OK !!!

Improvement – Box Fields Treatment Techniques for the Pelvis Region - Prostate High Dose to the Organ at Risk (Rectum) NOT OK !!! Solution: Find the area at the OR with high dose level

Find the Area at the OR with a high dose level

Modification of the AP / PA Fields Treatment Techniques for the Pelvis Region - Prostate Area that should be protected to reduce the dose dowards the OR Solution: Shielding by a satelite or Multi Leaf Collimator

Field Setup of the Box Technique Treatment Techniques for the Pelvis Region - Prostate

180° Field / Collimator Rotation to 270°

Dose Volume Histohgram Treatment Techniques for the Pelvis Region - Prostate

DVH – Box vs Improved Box Treatment Techniques for the Pelvis Region - Prostate

Advanced Techniques - Crossfire Technique - Treatment Techniques for the Pelvis Region - Prostate Clinical Case: 70-year old patient Diagnosis: Adenocarcinoma of the prostate. PSA- Increase to 8.22 ng/ml. Histology: Medium- to low graded differentiated adenocarcinoma of the prostate; tumor stadium pT3a, N0, M0, G2, R1 (Gleason-Grading: 7). Therapy: Status after radical perineal prostaticovesiculectomy. For a better tolerance, at an aimed total dose of 76.4 Gy, the therapy starts with the boost series applied to the tumor bed (Dose per fraction: 2.0 Gy; total dose: 26.0 Gy). The main series provides the box of the prostate and the loco regional lymphatic drainage area with a dose per fraction of 1.8 Gy at an total dose of 50.4 Gy.

Advanced Techniques Treatment Techniques for the Pelvis Region - Prostate Target Volume Definition: The target volume of the primary series contains the primary tumor and the lymph nodes. Normally the target volume contains the primary tumor which means the prostate and the seminal vesicles. In the case of smaller tumors the seminal vesicles could be excluded from the target volume. In the cranial area the target volume begins at the bifurcation of the A. iliaca communis in the A. Iliaca interna and externa.

Advanced Techniques Treatment Techniques for the Pelvis Region - Prostate Target Volume:

Advanced Techniques Treatment Techniques for the Pelvis Region - Prostate Patient Modell: Room View Target Volume (red) Urinary Bladder (blue) Tectum (green)

Advanced Techniques Treatment Techniques for the Pelvis Region - Prostate Beam Setup: A monoisocenter technique composed by eight fixed fields with individual absorbers and wedges are arranged around the patient in a nearly equidistant angle was developed. The lateral fields only cover the whole target volume. The fields with a diagonal beam direction respectively limit to one side of the target volume and enable in this way an adaption to its biconcave shape.

Advanced Techniques Treatment Techniques for the Pelvis Region - Prostate Physical Treatment Planning: The common isocenter of all fields is located in the center of the body, in this case 6 cm in the dorsal direction of the cranial edge of the symphysis. Here the eight fields are divided into three groups. The first two groups form a self- contained functional unit in which the field- and absorber borders as well as the weighting have to be reconciled with each other.

Advanced Techniques Treatment Techniques for the Pelvis Region - Prostate Group I - Field 1 to 3: Dose adaption to the concave part in the direction to the urinary bladder and the cranial divided area of the target volume. For the beam direction of the field 2 and 3 in the beam´s eye view a gantry position is searched in which the tangent to the ventral tip of the target volume coincides with the center of the “bottom” of the target volume.

Advanced Techniques Treatment Techniques for the Pelvis Region - Prostate An individual absorber in field 2 (in field 3 correspondingly symmetrical) protects in the complete cranial part of the target volume the contra lateral side of the target volume (arrow). Caudalward both fields cover the target volume at its complete width. Because of the half sided absorbing in the cranial part a symmetrical underdosage is the result, which is compensated through a separate field (field 1). Its beam direction is at gantry position 0° and enables with the central absorber, especially in the bipartite area of the target volume, a maximum protection of the healthy tissue. The caudal field boundary of field 1 geometrically coincides with the caudal edge of the absorber of field 2 (and 3) what can be seen in the beam’s eye view.

Advanced Techniques Treatment Techniques for the Pelvis Region - Prostate The caudal field boundary of field 1 geo- metrically coincides with the caudal edge of the absorber of field 2 (and 3) what can be seen in the beam’s eye view.

Advanced Techniques Treatment Techniques for the Pelvis Region - Prostate Group II - Field 4 to 6 Dose adaption to the concave area to the rectum and in the cranial divided part of the target volume. The interplay of the field 4 to 6 is similar. Here the absorber (arrow) is shown which enables to adapt the course of the isodoses to the concave shape of the target volume in the area of the rectum. Cranialward the field ends near the bifurcation of the target volume. Cranialward field 4 from 180° links up to the fields 5 and 6.

Advanced Techniques Treatment Techniques for the Pelvis Region - Prostate Group II - Field 4 to 6 Cranialward field 4 from 180° links up to the fields 5 and 6.

Advanced Techniques Treatment Techniques for the Pelvis Region - Prostate Group III - Field 7 and 8 Relief of the normal tissue ventral- and dorsalward of the target volume. The fields 7 and 8 are a variation of the conventional “Box”-Technique. But they are inclined dorsalward in that way (here 2°), that the dorsal field boundaries coincides in the relevant area of the rectum.

Advanced Techniques Treatment Techniques for the Pelvis Region - Prostate All fields with a diagonal beam direction are equipped with a 60° wedge (with the tip in the lateral direction), to relieve the area which is covered by all the fields and is situated in the center of the target volume (yellow area). Field configuration in the middle section of the target volume.

Advanced Techniques Treatment Techniques for the Pelvis Region - Prostate Beam Parameter:

Advanced Techniques Treatment Techniques for the Pelvis Region - Prostate Dose Distribition

Advanced Techniques Treatment Techniques for the Pelvis Region - Prostate Dose Distribution

Advanced Techniques Treatment Techniques for the Pelvis Region - Prostate Dose Distribution

Advanced Techniques Treatment Techniques for the Pelvis Region - Prostate Dose Distribution

Advanced Techniques Treatment Techniques for the Pelvis Region - Prostate Dose Distribution

Advanced Techniques Treatment Techniques for the Pelvis Region - Prostate Dose Volume Histogram

2nd International Symposium on Target Volume Definition - Limburg - May 30 - June Conformal Technique for CERVIX CARCINOMA Short Overview Bernd Schicker Uwe Götz and I. Chr. Kiricuta ISRO-Limburg - Germany

TARGET VOLUME DEFINITION 2nd International Symposium on Target Volume Definition - Limburg - May 30 - June

LIMBURG-TECHNIQUE 2nd International Symposium on Target Volume Definition - Limburg - May 30 - June

Field set up in the „V“-shape area of the PTV 2nd International Symposium on Target Volume Definition - Limburg - May 30 - June

Field set up in the cranial and caudal part of the PTV

2nd International Symposium on Target Volume Definition - Limburg - May 30 - June How to use the marker in the „V“-shaped area of the PTV

FIELD PARAMETER 2nd International Symposium on Target Volume Definition - Limburg - May 30 - June

How to use a MLC 2nd International Symposium on Target Volume Definition - Limburg - May 30 - June

DOSE DISTRIBUTION in sagittal reconstructed slices 2nd International Symposium on Target Volume Definition - Limburg - May 30 - June A B C BC A

DOSE DISTRIBUTION in CT-slices 2nd International Symposium on Target Volume Definition - Limburg - May 30 - June

DOSE DISTRIBUTION in CT-slices 2nd International Symposium on Target Volume Definition - Limburg - May 30 - June

DOSE DISTRIBUTION in CT-slices 2nd International Symposium on Target Volume Definition - Limburg - May 30 - June

DOSE DISTRIBUTION in CT-slices 2nd International Symposium on Target Volume Definition - Limburg - May 30 - June

DOSE VOLUME HISTOGRAM 2nd International Symposium on Target Volume Definition - Limburg - May 30 - June

Treatment Techniques for the Pelvis Region - Prostate Thank You Very Much