Stråleterapi
stereotaktisk stråleterapi
rapid arc
IGRT /gating
ÅRSMØDE 2013
Azza Khalil
Lunge Kræft og Strålbehandling
Kurative
– Ca 25% af operable stadium I (ca 200)
– Recidiv efter operation
– Stadium III (ca 1000)
Palliative
-primær tumor
-Metastasis
Fra conventional strålebehandling til
IMRT
Stereotaxi
SBRT
Curative Treatment of
Stage I NSCLC in Patients
With Severe COPD
Overall survival of 88 medically inoperable NSCLC patients
treated with SBRT stratified by the age-adjusted Charlson
Co-morbidity score
Neil Kopek , Merete Paludan , Jørgen Petersen , Anders Traberg Hansen , Cai Grau , Morten Høyer
Radiotherapy and Oncology Volume 93, Issue 3 2009 402 - 407
Survival outcomes for patients with Stage I NSCLC with
severe ventilatory dysfunction after surgery or SBRT
David Palma , Frank Lagerwaard , George Rodrigues , Cornelis Haasbeek , Suresh Senan
International Journal of Radiation Oncology*Biology*Physics Volume 82, Issue 3 2012 1149 - 1156
2013: RapidArc SBRT
(n=50)
Rapid arc
Anders Traberg Hansen
"central or perihilar" tumors
Kaplan-Meier plot of time from treatment until grade 3 to 5 treatment related toxicity
comparing patients with tumors in the central (perihilar and central mediastinal) regions from
those with more peripheral tumors.
Timmerman R et al. JCO 2006;24:4833-4839
©2006 by American Society of Clinical Oncology
Pretreatment and 3-month posttreatment CT scan
showing excellent response of centrally located
tumor treated in 5 fractions
A phase-II study of SBRT in patients with
centrally located tumours
Hilus (LC 4)
Odense /Rishospital /Aarhus
Image Guided Radiation Therapy
IGRT
Steps involved in Radiotherapy
• Fixation
• Planning-CT
• Target delineation
• Dose planning
• (QA)
• Patient setup before treatment
• Treatment
• Post-treatment evaluation (dose reconstruction) ?
Perfekt knogle match, men tumor mis-match
M. Knap et al 2010
Skin tatoos compared to ITV
M
SI
2.4
AP
1.7
LR
0.4
Σ
4.0
2.5
3.0
σ
3.4
3.0
2.5
Margin
(mm)
12.3
8.4
9.3
Set up errors
Number of scans
80
70
60
50
40
30
20
10
0
0 1 2
3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
3D shift (mm)
3D mean: 7.3 - 2.9 mm
M. Knap et al 2010
Improvement over the past years
• 2010 : 4D-CT
• Tumor match
From S. Korreman, ESTRO IGRT course, 2009
• CT detector width (typical big bore): 2.4 cm (16 x 1.5 mm)
• Typical breath cycle ~ 4 – 5 seconds (scan-pitch adjusted to this)
Lunge SBRT: CBCT-match på tumor
• Match på tumor
• Match
med ”structure
VOI” = GTV + 1
cm
Shift of tumor and lymp nodes
N
T
GTV T + 2mm
CTV N
GTV T
Match N
5mm
PTV N
Respiratory Gating/ Breast
Dose reconstruction – snapshot
Planning situation
Treatment situation:
Target moves
Dose reconstruction in TPS:
Isocenter moves
(shifting whole pt)
•Esben Worm & Per Poulsen
Tracking simulation
•Esben Worm & Per Poulsen
Reconstructed DVH
DVH for CTV
Fraction 1
Delivered CTV dose at first fraction:
• ∆D95 = 7%
Tracking simulation (including
system latencies)
•Esben Worm & Per Poulsen
Future SBRT treatments ?
Tak