The use of Radiotherapy in The use of Radiotherapy in Cancer.Cancer.

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.

What is Radiotherapy- Radiation Oncology (RT)?

CLINICBIOLOGY1. Tumour2. Normal tissue

PHYSICS

RT

180º310º

217º

The five components of Radiation Oncology

Clinic Biology

PhysicsMolecular Imaging

Radiation Oncology

Computer science

The three “C” of radiation Oncology

- “C” for cure

- “C” for cheap

- “C” for conservative treatment

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)

“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.

“C” for conservative treatment

- Breast

- Larynx

- Rectum, Anal canal

- Bladder

- Penis

-Eye…

NB: Non exhaustive list

Radiotherapy tackles all hallmarks of cancerRadiotherapy tackles all hallmarks of cancer

Solimini et al. Cell 2007

Reduce the number of tumour cells to be killed by e.g. surgery

Doublings Cells Grams

Tumour control

Effe

ct

Tumour Dose

The problemThe problem

100%Normal tissue damage

Tumour control

Effe

ct

Tumour Dose

Normal tissue damage

Increase the therapeutic ratioIncrease the therapeutic ratio

Normal tissue damageTumour control

Effe

ct

Tumor Dose

100%

Increase the therapeutic ratioIncrease the therapeutic ratio

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

Lokalisatie

The four parts of radiotherapy

Intekening doelvolumeen gezond weefsel

Treatment planningBestraling en verificatie

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

alvleesklierstomach

left kidney

right kidney

heart

spinal cord

spleen

liver

target volume

Patient modelling in 3D

3-D patient model3-D patient model

ProblemProblem

Do nothing?Do nothing?

Large systematic error

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

Manual PET-CT contouring Automatic PET-CT contouring + manual editing

van Baardwijk et al. Int J Radiat Oncol Biol Phys 2007

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

• Bepaling bestralingsrichtingen (bundels) met optimalisatie van:- bundelenergie- bundelrichting- bundeldosis

- bundelgrootte en -vorm

Treatment planning

Dosisverdeling

Dose-Volume Histogram (DVH)

zonder aanpassing

heart

target volume

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

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.