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

Slides:



Advertisements
Similar presentations
Barbara Vanderstraeten Ghent University Hospital 19 January 2008
Advertisements

Biologiske modeller i stråleterapi Dag Rune Olsen, The Norwegian Radium Hospital, University of Oslo.
DEOEC Institute of Oncology Department of Radiotherapy.
‘A little to a lot or a lot to a little’ ­ the crucial question to be raised in conformal radiation therapy Professor Dag Rune Olsen, PhD Institute for.
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.
TREATMENT PLANNING PHOTONS & ELECTRONS Karen P. Doppke 3/20/2007.
Radiation Therapy (RT). What is cancer? Failure of the mechanisms that control growth and proliferation of the cells Uncontrolled (often rapid) growth.
Radiotherapy in prostate cancer Dr.Mina Tajvidi Radiation oncologist.
What is radiation therapy (RT)? Cancer treatment Tumor versus normal tissues External photon beam RT.
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.
Clinical application of TCP ・ NTCP. Lyman JT. Complication probability as assessed from dosevolume histograms. Radiat Res Suppl 1985; 8:S13–S19. Because.
Neoadjuvant Adjuvant Curative Palliative Neoadjuvant Radiation therapy the results of a phase III study from Beijing demonstrated a survival benefit.
Radiotherapy Planning for Esophageal Cancers Parag Sanghvi, MD, MSPH 9/12/07 Esophageal Cancer Tumor Board Part 1.
Radiotherapy for Kidney cancer
Time, Dose, and Fractionation
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):
Data Mining to Aid Beam Angle Selection for IMRT Stuart Price-University of Maryland Bruce Golden- University of Maryland Edward Wasil- American University.
Simplified IMRT Plans Can Be Delivered with Conventional Jaws Ping Xia, Ph.D. University of California San Francisco.
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.
First Year Workshop 2014 Miriam Lafiandra
CTOS Soft Tissue Sarcoma of the Extremity Comparison of Conformal Post-operative Radiotherapy (CRT) and Intensity Modulated Radiotherapy (IMRT)
Dose-Volume Based Ranking of Incident Beams and its Utility in Facilitating IMRT Beam Placement Jenny Hai, PhD. Department of Radiation Oncology Stanford.
The Increased Biological Effectiveness of Heavy Charged Particle Radiation: From Cell Culture Experiments to Biophysical Modelling Michael Scholz GSI Darmstadt.
Prostate Support Group Dr Duncan McLaren Consultant Oncologist.
Vischioni Barbara MD, PhD Centro Nazionale Adroterapia Oncologica
N.B. for a given fraction size
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.
Laurie Cuttino MD, Dorin Todor PhD, Douglas Arthur MD, Rohini George, Lynn Pacyna CMD Medical College of Virginia Campus Department of Radiation Oncology.
1 Radiotherapy, hadrontherapy and treatment planning systems. Faiza Bourhaleb INFN-Torino University Med 1er-Morocco  Radiotherapy  Optimization techniques.
A Tumour Control Probability based approach to the development of Plan Acceptance Criteria for Planning Target Volume in Intensity Modulated Radiation.
Mathematical Modelling within Radiotherapy: The 5 R’s of Radiotherapy and the LQ model. Helen McAneney 1 and SFC O’Rourke 1,2 1 School Mathematics and.
Brachytherapy and GYN malignancy
Cancer.orgPredict Results of a multicentric in silico clinical trial (ROCOCO): comparing radiotherapy with photons and protons for non-small cell lung.
Optimization of Volumetric Modulated Arc Therapy (VMAT) Planning Strategy Using Ring-shaped ROI for Localized Prostate cancer Kentaro Ishii, Masako Hosono,
Karolina Kokurewicz Supervisors: Dino Jaroszynski, Giuseppe Schettino
Taipei VGH Practice Guidelines: Oncology Guidelines Index Cancer of Oral Cavity Version Table of Content StagingStaging, Manuscript Taipei Veterans.
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.
Reducing excess imaging dose to cancer patients receiving radiotherapy Adam Schwertner, Justin Guan, Xiaofei Ying, Darrin Pelland, Ann Morris, Ryan Flynn.
SARC018: A SARC PILOT MULTICENTER STUDY OF PREOPERATIVE RADIATION AND SURGERY IN PATIENTS WITH HIGH- RISK DESMOID TUMORS Robert S. Benjamin, M.D.
TEMPLATE DESIGN © Optimization of Cancer Radiation Treatment Schedules Jiafen Gong* and Thomas Hillen Department of Mathematical.
 Multidisciplinary Effort › Surgery › Radiation › Systemic Rx (chemo, “drugs”)
UNIVERSAL SURVIVAL CURVE AND SINGLE FRACTION EQUIVALENT DOSE: USEFUL TOOLS IN UNDERSTANDING POTENCY OF ABLATIVE RADIOTHERAPY CLINT PARK, M.D. M.S., LECH.
Measurements of the photon and neutron dose delivered to organs outside the radiation beams for 3DCRT and IMRT radiotherapy A. Kowalik 1, W. Jackowiak.
방사선종양학과 - 혈액종양내과 Joint Conference 경희의료원 방사선종양학과 R4 공 문 규.
RBE: open issues and next challenges Francesco Tommasino Workshop: la radiobiologia in INFN Trento, Maggio 2016.
Taipei Veterans General Hospital Practices Guidelines Oncology Oral Cavity Cancer Version
Modern Radiation Oncology
Hypofractionated radiotherapy for breast cancer
Extending intracranial treatment options with Leksell Gamma Knife® Icon™ Key Statements from Customer Perspective by University Medical Centre Mannheim.
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
Image–Guided Radiation Therapy for Non–small Cell Lung Cancer
IMRT delivery of preoperative, high dose radiotherapy to a large volume, with Simultaneous Integrated Boost (SIB) in retroperitoneal sarcomas: The Ottawa.
*Can the volume predict the acute reactions ?
A Comparative Study of Biological Effects of VHEE, Protons and other Radiotherapy Modalities Kristina Small University of Manchester, Christie NHS Foundation.
Insert tables Insert figure
Modern Treatment Planning
Volumetric Modulated Arc Therapy (VMAT) versus Intensity Modulated Radiation Therapy (IMRT) for Anal Carcinoma Heather Ortega, BSRT(T), CMD, Kerry Hibbitts,
Insert tables Insert graphs Insert figure
Image–Guided Radiation Therapy for Non–small Cell Lung Cancer
Figure 2 Nonmalignant tissue can be spared from radiation
Chapter 17 Intensity-Modulated Radiation Therapy
Technical Advances of Radiation Therapy for Thymic Malignancies
Constantinos Zamboglou, Matthias Eiber, Thomas R
Planning techniques of proton boost
Presentation transcript:

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

Surviving Cell Fraction SF N0= initia cell number before irradiation N = surviving cell number after irradiation SF SF =N/ N0 D(Gy)

Dose Fractionaction Schedules LQ Model and Dose Fractionaction Schedules Surviving cell fraction a fractionated delivery of total dose D in equal fractions of dose d is assumed damage repair and cell proliferation are absent a linear term attribuited to non-reparaible DNA lesions b quadratic term attribuited to two reparaible lesions interacting to kill the cell a/b involves the efficacy of different dose fractionations : large values of a/b damage depends on D small values of a/b damage is affected by both D and d

Dose Fractionaction Schedules LQ Model and Dose Fractionaction Schedules Biological Effective Dose for a single tissue: same BED results in the same SF a drops out of BED BED depends only on the better-known a/b

to the dose per fraction Hypofractionation Schedules Damage to the tumor is sensitive to the dose per fraction Rationale tumor a/b be 1.5 Gy (*) late-responding tissue a/b be 3 Gy same late complications Dstd be the total dose in 2 Gy fractions DHF be the total dose in 3 Gy fractions Example: Prostate (*)FOWLER J., CHAPPELL R. and RITTER M., 2001 Is a/b for prostate tumors really low? Int. J. Radiation Oncology Biol. Phys., 50(4) 1021-1031

BED Calculations Tumor: Normal tissues: same late complications ---> lower dose prescribtion in spite of this the tumor BED increases

to the dose per fraction Hyperfractionation Schedules Damage to the tumor is insensitive to the dose per fraction Rationale Example: tumor a/b be 10 Gy late-responding tissue a/b be 3 Gy same late complications Dstd be the total dose in 2 Gy fractions DHF be the total dose in 1.2 Gy fractions Head and Neck

BED Calculations Tumor: Normal tissues: same late complications ---> higher dose prescribtion ---> increased tumor BED (!) acutely respondig tissues, for ex. mucosa, also experience increased BED

normalized to 2 Gy per fraction (NTD) using BED: Normalized total dose If the fraction size is different from dref = 2 Gy the physical total dose can be converted to the biologically equivalent total dose normalized to 2 Gy per fraction (NTD) using BED: NTD

dose-volume histogram Normalized dose-volume histogram With the advent of 3DCRT (three dimensional conformal radiation therapy) the dose delivery is often characterized by steep dose gradients and inhomogeneous dose distributions, especially within sensitive structures; NTD formulation may be used to take into account the actual fractionation for each structure at each voxel: Normalized DVH

A Time-dependent Effect: Repopulation number of fractions lag time before accelerated repopulation begins unperturbed doubling time accelerated tumor clonogen doubling time overall treatment duration MOHAN R., WU Q., MANNING M., SCHMIDT-U. R., 2000 Radiobiological considerations in the design of fractionation strategies for intensity-modulated radiation therapy of head and neck cancers Int J Radiat Oncol Biol Phys 46 (3) 619-630

Including Repopulation NTD Including Repopulation For a given fractionation strategy for which repopulation is considered, the corresponding NTD can be derived from the new SF: the equation system can be solved adopting an iterative search of nNTD and Tt,NTD number of days in all the weekends

Simultaneous Integrated Boost Conventional treatments: are often divided into two phases, initial large photon fields followed by a boost to a reduced volume IMRT techniques: allow a simultaneous treatment (SIB simultaneous integrated boost) produce more conformal dose distributions reduce normal tissue doses are biologically more effective

Head and neck (HN): Standard radiotherapy: D  70 Gy to gross tumor (in 2 phases, photon + electron fields) 50 Gy  D  70 Gy to surrounding tissues (photons) D  50 Gy to lymph nodes at risk (photons) dose per fraction d = 1.8 - 2 Gy Treatment time Tt  7 weeks

Head and neck (HN): IMRT brainstem parotid spinal cord GTV Limph nodes 7 or more IMRT fields

Head and neck (HN): tumor parameters MOHAN R., WU Q., MANNING M., SCHMIDT-U. R., 2000 Radiobiological considerations in the design of fractionation strategies for intensity-modulated radiation therapy of head and neck cancers Int J Radiat Oncol Biol Phys 46 (3) 619-630 WU Q., MANNING M., SCHMIDT-ULLRICH R. and MOHAN R., 2000 The potential for sparing of parotids and escalation of biologically dose with intensity-modulated radiation treatments of head and neck cancers: a treatment design study Int J Radiat Oncol Biol Phys 46 (1) 195-205

HN : normal tissue a/b values dose per fraction is significant are affected by the total dose same or lower doses and lower dose per fraction are delivered to normal tissues outside the target volume dose to normal tissues embedded within the target volume may be significantly higher and possible late effects need to be investigated SIB:

Nasopharynx carcinoma Example: Nasopharynx carcinoma GTV: 69.3 Gy/2.1Gy CTV: 60 Gy/1.8 Gy parotid GTV CTV GTV (positive nodes)

Dose-Volume Histograms PTV 60 Gy PTV 69.3Gy spinal cord right parotid brainstem left parotid

Dose-Volume Histograms Normalized Dose-Volume Histograms spinal cord right parotid left parotid

Example: Prostate carcinoma Prostate: 77 Gy/2.2 Gy Lymph nodes: 59.5 Gy/1.7 Gy lymph nodes prostate

Example: Pelvic irradiation Uterus: 70.4 Gy/2.2 Gy Lymph nodes: 57.5 Gy/1.8 Gy bowel lymph nodes uterus

Pelvic and para-aortic irradiation Example: Pelvic and para-aortic irradiation VisibleTumor: 66 Gy/2.2 Gy Lymph nodes : 54 Gy/1.8 Gy para-aortic lymph nodes Kidneys GTV

Physical and Biolgical Conformality Rationale for the adoption of IMRT is also the ability to spatially customize 3D-dose delivery to supposed tumor foci of increased radioresistence or proliferative capabilities new imaging techniques are necessary to define more precisely the edges of the visible tumor and its surroundings  BTV (biological target volume) is derived from metabolic, functional and genotypic data a better knowledge of tumor radiobiologic characteristics not only improve the target identification but also support the choice of different dose prescribtions in each tumor subvolumes

Biologically conformal boost dose optimization Some approaches are described in literature to convert the physical dose into an “effective” dose transforming the biological image (PET, fMRI, ect) into a dose efficiency distribution; a relative dose efficiency (0 <e(x)< 1) may be introduced to represent the radiation effect on the tumor at each point x (*) ; the optimization algorithm can be forced to compensate for regionally variable radiosensitivity in order to achieve the best intensity modulation; the assumption is that the effective dose should be homogeneous: effective dose (*) ALBER M., PAULSEN F., ESCHMANN S.M. and MACHULLA H. J., 2003 On biologically conformal boost dose optimization Phys. Med. Biol. 48 N31-N35

The cumulative dose-volume histogram of the target volume and the histogram showing the effective dose distribution

Biologically conformal boost dose optimization A similar approach has been proposed(*) to integrate the information coming from metabolic and functional images within the inverse planning process: conventional prescription dose conventional tolerance dose empirical coefficients correlated with metabolic informations correlated with functional informations Tumor Sensitive structures (It was supposed a linear relation between the metabolic information and the prescribed dose but the formalism can be extended to any other relation) (*) XING LEI et al., 2002 Inverse planning for functional image-guided intensity-modulated radiation therapy Phys. Med. Biol. 47 3567-3578

Conclusions LQ-model may be used to design the most appriopriate fractionation schedules (iperfractionation or ipofractionation depending on a/b values) for some tumors (short doubling time) the repopulation effect has to be included on SF formalism high conformality of IMRT plans allows to deliver simulateneous boost (SIB), that may be advantageous in different clinical situations SIB techniques force to account for altered fractionations (different doses are delivered in the same number of fractions) the lack of reliable radiobiological data has limited until now their use for making clinical predictions but the integration of physical and biological conformality will greatly improve the efficacy of radiotherapy