1. Evidencia clínica en IMRT Ignacio Sisamón.

2. Lancet Oncol 2008; 9: 367–375

3. IMRT Tumores de Cabeza y Cuello. Ignacio Sisamón.

7. Tumores de Cabeza y Cuello.

10. Tumores de Cabeza y Cuello. 68 pts (93.8% WHO tipo 2-3). 70/59.4 Gy (2.12/1.8Gy x fx). If T2b+ or N+ concurrent cisplatin, adjuvant cisplatin/5-FU. Outcome: Prescribed IMRT given to 84%; prescribed chemo 65%. 2-year LC 93%, LRC 89%, DMFR 85%. 2-year PFS 93%, OS 80%. Acute grade 4 mucositis occurred in 4.4%, worst late grade 3 toxicities: esophagus 4.7%; mucous membranes 3.1%; xerostomia, 3.1%. grade 2 xerostomia at 1 year from start of IMRT was 13.5%. 2 patients complained of grade 3 xerostomia, and none had grade 4 xerostomia.

12. 25 pts stage IIB to IVB NPC. 67.5/2.25Gy to post-CT GTV, 54-60 Gy at 1.8-2 Gy/fx to hr-CTV 48/1.6Gy to elective neck. Median follow-up of 29 months

21. Tumores de Cabeza y Cuello.

23. Tumores de Cabeza y Cuello.

24. Tumores de Cabeza y Cuello.

26. Retrospective. 20 larynx and 11 hypopharynx patients, treated with IMRT and concurrent platinum-based chemo. Most Stage IV disease. Median F/U 2.2 years RT dose painting GTV 70/2.12 Gy/fx, high-risk CTV 59.4/1.8 Gy/fx, (typically Levels II-IV; Levels I or V not routinely contoured unless judged high risk), low-risk CTV 54/1.64 Gy/fx (uninvolved contralateral neck and base of skull). Chemo cisplatin 100 mg/m2 Q3W or carbo 60-70 mg/m2 + 5-FU 600 mg/m2. Outcome: 2-year LC 86%, RC 94%, laryngectomy-free 89%, DM-free 92%, OS 63%. Toxicity: No late G2+ xerostomia. PEG-dependent hypopharynx 31% vs. larynx 15% Conclusion: IMRT + chemo encouraging LR control in advanced larynx/hypopharynx. However, high rate of PEG dependency

27. IMRT Tumores Ginecológicos. Ignacio Sisamón.

28. Tumores Ginecológicos. Irradiación de la pelvis + Braquiterapia Irradiacion de cadenas para-Aorticas Combinacion con Quimioterapia Intestino delgado – Recto – Vejiga Toxicidad hematológica

29. Tumores Ginecológicos.

32. Tumores Ginecológicos. Mundt AJ, Roeske JC, Lujan AE, et al. Initial clinical experience with intensity-modulated whole-pelvis radiation therapy in women with gynecologic malignancies. Gynecol Oncol 2001; 82: 456–63. Mundt AJ, Mell LK, Roeske JC. Preliminary analysis of chronic gastrointestinal toxicity in gynecology patients treated with intensity-modulated whole pelvic radiation therapy. Int J Radiat Oncol Biol Phys 2003; 56: 1354–60. Beriwal S, Jain SK, Heron DE, et al. Clinical outcome with adjuvant treatment of endometrial carcinoma using intensity-modulated radiation therapy. Gynecol Oncol 2006; 102: 195–99. Bouchard M, Nadeau S, Gingras L, et al. Clinical outcome of adjuvant treatment of endometrial cancer using aperture-based intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys 2008; 71: 1343–50.

33. IMRT Tumor de Mama. Ignacio Sisamón.

34. Tumores de Mama. Dificultades de conformación de dosis Heterogeneidad de dosis en Volumen Irradiado. Toxicidad cutánea aguda y crónica Toxicidad pulmonar Toxicidad cardiovascular

35. Tumores de Mama.

36. Tumores de Mama. The control arm patients were 1.7 times more likely to have a change in breast appearance than the IMRT arm patients after adjustment for year of photographic assessment (95% confidence interval 1.2–2.5, p = 0.008).

37. Tumores de Mama.

38. RTC Phase III to compare conventional (tangential field) fractionated whole breast treatment (Arm A) vs accelerated partial breast irradiation plus intensity-modulated radiotherapy (Arm B). 259 pts were randomized and treated. The mean value of the ratio PTV/ipsilateral breast volume was 21%. The rate of G1 and G2 acute skin toxicity: 22% and 19% in Arm A, respectively. Tolerance in Arm B was excellent with only 5% G1 and 0.8% G2 acute skin toxicity. The planning constraints were fully satisfied in most patients.

39. Mar del Plata

40. IMRT Tumores Cerebrales Primarios. Ignacio Sisamón.

41. Tumores de SNC Iuchi T, Hypofractionated high-dose irradiation for the treatment of malignant astrocytomas using simultaneous integrated boost technique by IMRT. Int J Radiat Oncol Biol Phys 2006; 64: 1317–24. Fuller CD, Standard fractionation IMRT of primary and recurrent glioblastoma multiforme. Radiat Oncol 2007; 2: 26. Tasas similares de SG asi como de EA. Mejoria en SG y SLP a 1 y 2 años.

43. Tumores de Sistema Nervioso Central. Patients received conformal radiotherapy after definitive surgery (125 patients had undergone gross total, 17 near total, and 11 subtotal resection). Doses of 59,4 Gy (n=131) or 54,0 Gy (n=22) were prescribed to a 10 mm margin around the target volume. We have used the term conformal radiotherapy to refer to conformal and IMRT.

44. IMRT Tumores de Tórax. (pulmón y mesotelioma) Ignacio Sisamón.

45. Tumores de Torax.

47. IMRT Tumores Gastrointestinales. Ignacio Sisamón.

49. Tumores Gastrointestinales. Pelvic regions and inguinal nodes receiving 45 Gy. Primary sites and Involved nodes were boosted to 51.5 Gy. 53 patients were treated with concurrent chemotherapy and IMRT Median follow-up was 14.5 months (range, 5.2 to 102.8 ms)

50. Tumores Gastrointestinales. CANAL ANAL.

51. Tumores Gastrointestinales. Grade 4 diarrhea occurred in 1 of 8 (13%) patients. The remaining toxicities were grade 1 or 2. Am J Clin Oncol 2008;31: 264–270 stage II or III rectal adenocarcinoma received capecitabine and SIB-IMRT delivering 55/2.2Gy to GTV simultaneously delivering 45/1.8Gy to regional lymph nodes and areas at risk for harboring microscopic disease. Total mesorectal excision followed 6 weeks later. 8 patients were evaluable. Median follow-up of 26 months (range, 15–40), all patients were alive without evidence of recurrent disease. The crude pCR rate was 38% with 50% achieving down-staging. Of 3 patients who had tumors within 5 cm of the anal verge, 2 underwent sphincter-sparing procedures. RECTO

53. Tumores Gastrointestinales. PANCREAS The PARC study is designed as an open, controlled, prospective, randomized phase II trial. Patients in study arm A will be treated with chemoradiation using IMRT combined with gemcitabine and simultaneous cetuximab infusions. The median total dose for the GTV is to be 54.0/2.16 Gy and for the CTV 45.0/1.8 Gy. BMC Cancer 2005, 5:131