1. The use of Radiotherapy in Cancer.

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

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

5. 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)

6. “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.

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

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

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

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

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

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

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

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

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

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

20. 3-D patient model

21. Problem

22. Do nothing?  Large systematic error

23. 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

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

25. 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

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

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

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

31. 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.