radioterapia)stereotassica) … · f-deodato.ppt author: annamaria created date: 11/13/2015...
TRANSCRIPT
![Page 1: RADIOTERAPIA)STEREOTASSICA) … · F-Deodato.ppt Author: Annamaria Created Date: 11/13/2015 11:18:34 AM](https://reader036.vdocuments.mx/reader036/viewer/2022071100/5fd8ccb9147ed57be7780bdd/html5/thumbnails/1.jpg)
RADIOTERAPIA)STEREOTASSICA)EXTRACRANICA)IN)PAZIENTI)CON)MALATTIA)
OLIGOMETASTATICA:)RISULTATI)DI)UNO)STUDIO)DI)DOSE4
ESCALATION)!)
F. Deodato 1, AG. Morganti 1,2, G. Macchia 1, A. Ianiro 3, C. Annese 1, C. Digesù 1, M. Ferro 1, V. Picardi 1, S. Mignogna 4, G. Torre 1,4, S. Cammelli 2, A. Cortesi 2, P. Assalone 5, M. Nuzzo 1, GA. Mariano 1, L. Di Lullo 5, L. Caravatta 1,6, S. Manfrida 7, V. Valentini 1,7, S. Cilla 3. UO Radioterapia Oncologica 1, UO Fisica Sanitaria 3, UO Oncologia Generale 4, Fondazione Giovanni Paolo II, Campobasso; UO Radioterapia Oncologica, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale – DIMES, Università di Bologna, Bologna 2; UO Oncologia Medica, Ospedale Veneziale, Isernia 5; Radioterapia sperimentale, Centro di Radioterapia e Medicina Nucleare, P.O. Businco, Cagliari 6; Cattedra di Radioterapia, Università Cattolica del S. Cuore, Roma 7.
![Page 2: RADIOTERAPIA)STEREOTASSICA) … · F-Deodato.ppt Author: Annamaria Created Date: 11/13/2015 11:18:34 AM](https://reader036.vdocuments.mx/reader036/viewer/2022071100/5fd8ccb9147ed57be7780bdd/html5/thumbnails/2.jpg)
Background)
• I trattamenti stereotassici extracranici sono stati effettuati in varie neoplasie toracico-addomino-pelviche con buoni risultati sia in termini di controllo locale sia di tossicità
• Negli studi presenti in letteratura sono riportati:
• dosi diverse • modalità di prescrizione diverse • set-up dei fasci utilizzati diversi
![Page 3: RADIOTERAPIA)STEREOTASSICA) … · F-Deodato.ppt Author: Annamaria Created Date: 11/13/2015 11:18:34 AM](https://reader036.vdocuments.mx/reader036/viewer/2022071100/5fd8ccb9147ed57be7780bdd/html5/thumbnails/3.jpg)
ObieBvo)primario:))Definizione! della! dose! massima! tollerata! (MTD)!del!tra:amento!SBRT!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
ObieBvo)
Studio)di)dose)escalaIon))
ObieBvo)secondario:))Correlazione!tra!da?!dosimetrici!e!tossicità!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
![Page 4: RADIOTERAPIA)STEREOTASSICA) … · F-Deodato.ppt Author: Annamaria Created Date: 11/13/2015 11:18:34 AM](https://reader036.vdocuments.mx/reader036/viewer/2022071100/5fd8ccb9147ed57be7780bdd/html5/thumbnails/4.jpg)
Materiali)e)metodi)
Dose Escalation STereotactic RadiOtherapY 1
Level Lung intra-
parenchimal tumors
Para- Mediastinal tumors or
tumors near chest wall
Extra-thoracic tumors
Retreatment ESRT-boost
ESRT-boost
with prior radiotherapy dose precedente > 60 Gy
or retreatment of pancreatic or pelvic
cancer
with prior radiotherapy < 60
Gy
(after RT dose < 50
Gy)
(after RT dose > 50
Gy)
1 25 Gy 25 Gy 25 Gy 20 Gy 25 Gy 25 Gy 20 Gy
2 37.5 Gy 30 Gy 30 Gy 25 Gy 30 Gy 30 Gy 25 Gy
3 45 Gy 35 Gy 35 Gy 30 Gy 35 Gy 35 Gy 30 Gy
4 50 Gy 40 Gy 40 Gy 35 Gy 40 Gy
5 45 Gy 45 Gy 40 Gy 45 Gy
6 50 Gy 50 Gy 45 Gy 50 Gy
![Page 5: RADIOTERAPIA)STEREOTASSICA) … · F-Deodato.ppt Author: Annamaria Created Date: 11/13/2015 11:18:34 AM](https://reader036.vdocuments.mx/reader036/viewer/2022071100/5fd8ccb9147ed57be7780bdd/html5/thumbnails/5.jpg)
StereoBody Frame (ELEKTA)
Materiali)e)metodi)
![Page 6: RADIOTERAPIA)STEREOTASSICA) … · F-Deodato.ppt Author: Annamaria Created Date: 11/13/2015 11:18:34 AM](https://reader036.vdocuments.mx/reader036/viewer/2022071100/5fd8ccb9147ed57be7780bdd/html5/thumbnails/6.jpg)
! Abdominal Compression
Materiali)e)metodi)
![Page 7: RADIOTERAPIA)STEREOTASSICA) … · F-Deodato.ppt Author: Annamaria Created Date: 11/13/2015 11:18:34 AM](https://reader036.vdocuments.mx/reader036/viewer/2022071100/5fd8ccb9147ed57be7780bdd/html5/thumbnails/7.jpg)
Materiali)e)metodi)
PTV = CTV+5-10 mm (A-P e L-L)
CTV+5-15 mm (C-C)
Organ Motion evaluation in all pts
![Page 8: RADIOTERAPIA)STEREOTASSICA) … · F-Deodato.ppt Author: Annamaria Created Date: 11/13/2015 11:18:34 AM](https://reader036.vdocuments.mx/reader036/viewer/2022071100/5fd8ccb9147ed57be7780bdd/html5/thumbnails/8.jpg)
Fields Set-up: tetrahedral static beam configuration: 4 no-coplanar fields (plus 0° e 90° orthogonal) for daily isocenter verification
Reference point: ICRU 62 CH4
VMAT
Materiali)e)metodi)
![Page 9: RADIOTERAPIA)STEREOTASSICA) … · F-Deodato.ppt Author: Annamaria Created Date: 11/13/2015 11:18:34 AM](https://reader036.vdocuments.mx/reader036/viewer/2022071100/5fd8ccb9147ed57be7780bdd/html5/thumbnails/9.jpg)
Mean Dose in 5 fx: 35 Gy (20-50)
Median age: 69 (35-90)
Results: 281 lesions (213 patients)
RisultaI)
PTV
Mean
Min
Max
in cc
34,4
1,45
281,20
![Page 10: RADIOTERAPIA)STEREOTASSICA) … · F-Deodato.ppt Author: Annamaria Created Date: 11/13/2015 11:18:34 AM](https://reader036.vdocuments.mx/reader036/viewer/2022071100/5fd8ccb9147ed57be7780bdd/html5/thumbnails/10.jpg)
Response % OR 82 PD 3
Median F-Up: 17 (3-131) Tox > G3 2
% CR 58 PR 24
RisultaI)
Results: 281 lesions (213 patients)
![Page 11: RADIOTERAPIA)STEREOTASSICA) … · F-Deodato.ppt Author: Annamaria Created Date: 11/13/2015 11:18:34 AM](https://reader036.vdocuments.mx/reader036/viewer/2022071100/5fd8ccb9147ed57be7780bdd/html5/thumbnails/11.jpg)
Survival Plot
0 50 100 150Time
0.0
0.2
0.4
0.6
0.8
1.0
Sur
vivo
r Fun
ctio
n
Local Control Survival Plot
0 50 100 150Time
0.0
0.2
0.4
0.6
0.8
1.0
Sur
vivo
r Fun
ctio
n
Distant Metastasis Free Survival
RisultaI)
2y: 71% 4y: 62%
2y: 46% 4y: 39%
![Page 12: RADIOTERAPIA)STEREOTASSICA) … · F-Deodato.ppt Author: Annamaria Created Date: 11/13/2015 11:18:34 AM](https://reader036.vdocuments.mx/reader036/viewer/2022071100/5fd8ccb9147ed57be7780bdd/html5/thumbnails/12.jpg)
Level Lung intra-
parenchimal tumors
Para- Mediastinal tumors or
tumors near chest wall
Extra-thoracic tumors
Retreatment ESRT-boost
ESRT-boost
with prior radiotherapy dose precedente > 60 Gy
or retreatment of pancreatic or pelvic
cancer
with prior radiotherapy < 60
Gy
(after RT dose < 50
Gy)
(after RT dose > 50
Gy)
1 25 Gy 25 Gy 25 Gy 20 Gy 25 Gy 25 Gy 20 Gy
2 37.5 Gy 30 Gy 30 Gy 25 Gy 30 Gy 30 Gy 25 Gy
3 45 Gy 35 Gy 35 Gy 30 Gy 35 Gy 35 Gy 30 Gy
4 50 Gy 40 Gy 40 Gy 35 Gy 40 Gy
5 45 Gy 45 Gy 40 Gy 45 Gy
6 50 Gy 50 Gy 45 Gy 50 Gy
Dose Escalation STereotactic RadiOtherapY 1
RisultaI)
![Page 13: RADIOTERAPIA)STEREOTASSICA) … · F-Deodato.ppt Author: Annamaria Created Date: 11/13/2015 11:18:34 AM](https://reader036.vdocuments.mx/reader036/viewer/2022071100/5fd8ccb9147ed57be7780bdd/html5/thumbnails/13.jpg)
Conclusioni)
!!!
• ESRT up to a dose of 50 Gy in five fractions is
well tolerated as
• esclusive treatment
• retreatment
• boost
• Maximum tolerated dose not reached
• Further dose escalation is ongoing
![Page 14: RADIOTERAPIA)STEREOTASSICA) … · F-Deodato.ppt Author: Annamaria Created Date: 11/13/2015 11:18:34 AM](https://reader036.vdocuments.mx/reader036/viewer/2022071100/5fd8ccb9147ed57be7780bdd/html5/thumbnails/14.jpg)