Folie 1

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
correct
verify
(re-)plan
• 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
Image Guided Radiotherapy (IGRT) – Cone Beam CT
… wait for reconstruction
Synergy
IMRT/IGRT
CT and Cone Beam before matching
CT
XVI
XVI
CT
Synergy
IMRT/IGRT
CT and Cone Beam after matching
CT
XVI
XVI
CT
Image Guided Radiosurgery
Image Guided Radiotherapy (IGRT) – Cone Beam CT
Planning
CT in
breathhold
CBCT
without
breathhold
~ 2 min
20 sec
multiple
breathhold
CBCT
breathhold
planning CT
free
breathing
CBCT
09/09
SBRT Lunge
11/09
29.7.2002
10/10
19.09.2002
26.11.2002
6 Wo pRT
06.02.2003
15.05.2003
18.08.2003
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
BMBF EZ 0705/Boda
www.aapm.org
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