by Karin Haustermans

1. Modern radiation treatment
Karin Haustermans
Department of Radiation Oncology, University Hospitals Leuven, Belgium
On behalf of ESTRO – European Society for Radiotherapy & Oncology
European Prostate Awareness Day 2015

2. Radiation oncology
• Medical use of ionizing radiation in the treatment of
cancer
• About 50% of all cancer patients receive radiation therapy
at some point during their treatment
• Monotherapy or combined with other treatment modalities
• Curative or palliative setting

3. Radiation oncology
• Ultimate goal of radiation therapy:
• To maximize tumor targetting,
• While sparing the surrounding normal tissue
• Inevitably some radiation dose is always deposited in the
healthy tissues…
Therapeutic ratio

4. “Ballistic Equipment”
Rifle
Ammunition
“Game Search”
Binoculars
Experience
“Aiming for the target”
Telescopic sight
Steady Hand
Dose Delivery Target Definition Target Localization
Hunting cancer cells with IR

5. Dose delivery
2D-RT 3D-CRT IMRT IMAT1990 2000 2010
2D-RT
3D-CRT
IMRT
IMAT

6. Dose delivery
• IMAT
• Further optimization of
IMRT technique
• 360° rotation of gantry
• Fast delivery
• Highly conformal

7. Target definition
• Advances in treatment planning and radiation delivery,
thanks to advances in imaging
Conventional
radiotherapy
3D-Conformal
radiotherapy
Intensity
modulated
radiotherapy
Anatomical
imaging
Functional
imaging
Multimodality
imaging

8. Target definition
• Anatomical & functional
imaging
T2w MRI DCE MRI
DW MRI:
b1000
DW MRI: ADC
map
PSMA PET-CT
TRUS MR/CT

9. Target localization
• Importance of target localization
• INTER-fraction: between treatments
• Bowel or bladder filling
• Positioning or set-up errors
• Tumor shrinkage
• Weight loss
• INTRA-fraction: during treatment
• Breathing, swallowing, cardiac motion
• Patient movement (e.g. due to pain)

10. Target localization
• Imaging for position verification!
• In-room and/or on-board (EPID, cone-beam CT, MV/kV RX)
• Image quality
• Image registration

11. “Conformal Dose Delivery”
Accurate Dose Delivery
IMRT
“Imaging”
Anatomical Imaging
Functional Imaging
“Motion”
Inter/Intra-fraction
Positioning verification
Dose Delivery Target Definition Target Localization
State-of-the-art summary

12. Dose delivery
• Adequate dose escalation without increasing toxicity?
• Focal boost to the dominant lesion in addition to standard dose
to the whole organ
• Rationale
• PCa is multifocal
• Dominant lesion is biological driver
• PCa often recurs at the site of the dominant lesion
• Dose-response relationship

13. Dose delivery
• Hadron therapy: charged particles
Thariat et al Nat Rev Clin Oncol 2013

14. Dose delivery
• Unique physical and radiobiological properties: Bragg peak

15. Dose delivery
• Stereotactic body radiotherapy (SBRT)
• Large dose per fraction
• Hypofractionation
• E.g. SBRT for oligometastatic PCa Ponti E et al Clin Genitourin Cancer 2015

16. “Physical optimization”
 Hadron therapy
 SBRT
“Biological optimization”
 Focal boosting
“Adaptive therapy”
 IGRT
 Adaptive RT
Dose Delivery Target Definition Target Localization
Future prospects: summary

17. THANK YOU