Neue Techniken in der Strahlentherapie
Frederik Wenz Department of Radiation Oncology
University Medical Centre Mannheim University of Heidelberg
Volume Concepts – ICRU50
GTV – gross tumor volume
PSA > 10ug/l Gleason 7 ECE 2 – 3 mm
PTV TV
CTV
PTV deformation organ movement intrafraction interfraction set-up error
3D-CRT IMRT
< 4 min, < 400 MU, CI ~ 1.4, HI ~ 1.1
PTV TV
CTV
PTV deformation organ movement intrafraction interfraction set-up error
Patient Movement (Interfractional)
Slow Movement
Fast Movement (intrafractional)
PTV TV
CTV
image
(re-)plan
correct
verify
• imaging in spatial & temporal proximity to therapy • 3D imaging • soft tissue imaging
Prostate Cancer IMRT/IGRT
B-Mode Acquisition and Targeting
Prostate Cancer IMRT/IGRT
… wait for reconstruction
Image Guided Radiotherapy (IGRT) – Cone Beam CT
CT and Cone Beam before matching
CT XVI
CT XVI
Synergy IMRT/IGRT
CT and Cone Beam after matching
CT XVI
XVI CT
Synergy IMRT/IGRT
Image Guided Radiosurgery
Image Guided Radiotherapy (IGRT) – Cone Beam CT
~ 2 min
Planning CT in breathhold CBCT without breathhold
20 sec
multiple breathhold CBCT breathhold planning CT free breathing CBCT
29.7.2002 19.09.2002
26.11.2002
06.02.2003
15.05.2003
18.08.2003
SBRT Lunge 09/09
11/09
10/10
6 Wo pRT
SBRT Leber
Never make predictions, especially not about the future
IMRT 13 min max 7 mm
Future trends in IMRT/IGRT: tracking
www.elekta.com www.aapm.org BMBF EZ 0705/Boda Univ Utrecht
DRG meets DEGRO
- IGRT - imaging in temporal and spatial proximity to RT - 3D volumetric, soft tissue contrast, daily - allows full potential of precision RT (IMRT, SBRT) - Oncologic imaging - morphological (fidelity), functional - increasingly important for RT („where is no tumor“) - challenge: lymph node imaging - „new“ imaging changes after novel RT treatment
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