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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