From 2D to 3D Conformal Radiation Therapy (3D-CRT) and IMRT: The AC - - PowerPoint PPT Presentation

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From 2D to 3D Conformal Radiation Therapy (3D-CRT) and IMRT: The AC - - PowerPoint PPT Presentation

Mar 06, 2024 146 likes •543 views

From 2D to 3D Conformal Radiation Therapy (3D-CRT) and IMRT: The AC Camargo Hospital experience Paulo Eduardo Novaes MD, PhD PhD Paulo Eduardo Novaes MD, Hospital AC Camargo So Paulo So Paulo - - Brasil Brasil Hospital AC

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From 2D to 3D Conformal Radiation Therapy (3D-CRT) and IMRT: The AC Camargo Hospital experience Paulo Eduardo Novaes MD, Paulo Eduardo Novaes MD, PhD PhD

Hospital AC Camargo Hospital AC Camargo – – São Paulo São Paulo -

  • Brasil

Brasil

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Hospital AC Camargo – São Paulo – Brasil www.accamargo.org.br

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Hospital AC Camargo

Reference Cancer Center - Brazil Founded: 1953 - Beds: 250 - Surgical rooms: 30 Actuation: Assistance, learn and research Multidisciplinary approach – Integrated Services Radiation Therapy Department: 2000 patients/year

Linacs (4), Radiosurgery (Brain-lab M3), IORT (surgical room) 3D-

TPS (ARIA) – 3D-CRT and IMRT

HDRB (Ir192), Prostate Brachy (I125), Ophtalmic Brachy (I125/Ru103)

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To To deliver deliver effective effective dose to dose to the the tumor tumor sparring sparring the the neighbouring neighbouring normal normal tissues tissues

1895 2009

Radio-biological knowledge Improve clinical care Colaborative Protocols Information network Technological advances

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2D

  • Planning

Planning based based on

  • n clinical

clinical exam exam and and bone bone landmarks landmarks

  • Conventional

Conventional simulation simulation – – x x-

  • rays

rays films films

  • Normal

Normal organs

  • rgans and

and crictical crictical structures structures visualization visualization: : dificult dificult

  • Field

Field arrangement arrangement: : simple simple -

  • co

co-

  • planar

planar

  • Dose

Dose distribution distribution studies studies: : limited limited -

  • points

points

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Cervix cancer - EBRT

AP Lateral

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3D

  • Planning

Planning besed besed on

  • n tumor

tumor and and normal normal tissues tissues visualization visualization

  • CT

CT-

  • simulation

simulation: CT/MRI/PET : CT/MRI/PET

  • Dose

Dose deliver deliver: : improved improved – – image image fusion fusion

  • Field

Field arrangement arrangement: : complex complex – – multiple multiple -

  • non

non coplanar coplanar fields fields

  • Dose

Dose distribution distribution: DVH : DVH – – precise (volume) precise (volume)

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From 2D to 3D

Steps

New concepts: GTV, CTV, PTV, OAR Delineation rules and dose-constraints DVH: familiarization – interpretation From SSD to Isocenter techniques To improve immobilization systems and lead blocks

construction – multi-leaf collimators

Permanent staff trainning - QA program development Technical maintenance Collaborative programs and protocols – expert visits

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Simulation CT 3D-Planning

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Image Fusion – CT/MRI/Pet scan

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3D-CRT/year

317 968 710 627 450 305 227 100 200 300 400 500 600 700 800 900 1000 2002 2003 2004 2005 2006 2007 2008

Radiation Therapy Department Hospital AC Camargo – São Paulo

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Intensity Modulated Radiation Therapy IMRT IMRT

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From 3D to IMRT

Steps

New concept: Inverse treatment planning Delineation rules and dose-constraints: similar DVH: familiarization – interpretation To improve immobilization systems and multi-leaf

collimators

Permanent staff trainning – Technical maintenance QA program development –Photon fluence maps Collaborative programs and protocols – expert visits

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Multi-leaf collimators

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3D vs. IMRT: 3D vs. IMRT: Maps of Intensity Maps of Intensity

Computer Film

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Child Child 10 10 years years old

  • ld

Rabdomyosarcoma of the tongue

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Isocenter Isocenter

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IMRT IMRT fields fields

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Isodose Isodose 47.5 47.5Gy Gy (95%) (95%)

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Comparison Comparison

3D IMRT

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Comparison Comparison

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DVH IMRT DVH IMRT

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Isodose Isodose Mandible Mandible

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IMRT/year

IMRT - HOSPITAL A. C. CAMARGO

244 199 64 44 6

10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 170 180 190 200 210 220 230 240 250 260 270 280 290 300

2004 2005 2006 2007 2008

NUMBER

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IMRT sites

IMRT - ANATOMIC SITES (INCLUDING THREE MONTHS 2009) 168 280 33 150 50 100 150 200 250 300 H&N CNS PRT OTHERS

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2D and 3D + IMRT/year

500 1000 1500 2000 2500 2003 2004 2005 2006 2007 2008 3D + IMRT 2D Total

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3D-CRT and IMRT

Conclusions

Natural radiation therapy evolution Permanent improvement Clinical experience progressive Collaborative studies - Definitive results New horizon on radiation therapy Atractive - Risks and Benefits New questions ....

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Real gain ?

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