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The use of Radiotherapy in The use of Radiotherapy in Cancer.Cancer.
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What is radiotherapy?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.
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What is Radiotherapy- Radiation Oncology (RT)?
CLINICBIOLOGY1. Tumour2. Normal tissue
PHYSICS
RT
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180º310º
217º
The five components of Radiation Oncology
Clinic Biology
PhysicsMolecular Imaging
Radiation Oncology
Computer science
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The three “C” of radiation Oncology
- “C” for cure
- “C” for cheap
- “C” for conservative treatment
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Cured by surgery and/orradiotherapy (30)
Cured bychemotherapy (2)
Treatment of solid cancers
100 new cases
Skin & in situcervical ca. (30)
Localised & operable (48) Advanced (22)
Relapsed (18)
Candidates for chemotherapy (40)
Potentially curable (5) Incurable (35)
Possiblelife prolongation (10)
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“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.
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“C” for conservative treatment
- Breast
- Larynx
- Rectum, Anal canal
- Bladder
- Penis
-Eye…
NB: Non exhaustive list
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Radiotherapy tackles all hallmarks of cancerRadiotherapy tackles all hallmarks of cancer
Solimini et al. Cell 2007
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Reduce the number of tumour cells to be killed by e.g. surgery
Doublings Cells Grams
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Tumour control
Effe
ct
Tumour Dose
The problemThe problem
100%Normal tissue damage
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Tumour control
Effe
ct
Tumour Dose
Normal tissue damage
Increase the therapeutic ratioIncrease the therapeutic ratio
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Normal tissue damageTumour control
Effe
ct
Tumor Dose
100%
Increase the therapeutic ratioIncrease the therapeutic ratio
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0 20 40 60 80 100 120 140 160 180
10
15
20
25
30
35
40
5-ye
ar s
urv
ival
(%
)
SER (days)
D. De Ruysscher et al. J Clin Oncol 2006
Integration of chemotherapy and radiotherapyIntegration of chemotherapy and radiotherapy
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Lokalisatie
The four parts of radiotherapy
Intekening doelvolumeen gezond weefsel
Treatment planningBestraling en verificatie
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Delineation of the target volumes and the normal tissues
liver
pancreas
stomach
left kidney
heart
liverliver
stomach
pancreas
heart
skinskin
skin
target volume
target volume target volume
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alvleesklierstomach
left kidney
right kidney
heart
spinal cord
spleen
liver
target volume
Patient modelling in 3D
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3-D patient model3-D patient model
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ProblemProblem
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Do nothing?Do nothing?
Large systematic error
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Radius and volume ( )Radius and volume ( )
A (small) reduction ofthe margin (5 mm) leads to a 50 %reduction of the volume
Volume peel = volume flesh
3
3
4r
Verellen D et al. Nature Rev Cancer 2007
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Manual PET-CT contouring Automatic PET-CT contouring + manual editing
van Baardwijk et al. Int J Radiat Oncol Biol Phys 2007
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Automatic contouring Automatic contouring of tumors on the of tumors on the
basis of 4D-FDG-basis of 4D-FDG-PET-CT scans:PET-CT scans:Correlation with Correlation with
pathologypathology
I
x x
KJStroom et al. Int J Radiat Oncol Biol Phys 2007
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• Bepaling bestralingsrichtingen (bundels) met optimalisatie van:- bundelenergie- bundelrichting- bundeldosis
- bundelgrootte en -vorm
Treatment planning
Dosisverdeling
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Dose-Volume Histogram (DVH)
zonder aanpassing
heart
target volume
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Radiotherapy using CT-PET, e.g.: lung cancer with atelectasis
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What is radiotherapy?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.