La Radioterapia stereotassica: tre realtà territoriali a confronto

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La Radioterapia stereotassica: tre realtà

territoriali a confronto

Francesco Deodato

Fondazione di Ricerca e Cura ‘Giovanni Paolo II’

Università Cattolica S. Cuore Campobasso

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• 2002: 3D conformal RT

• 2003: extracranial stereotactic RT (ESRT)

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StereoBody Frame (ELEKTA)

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Abdominal Compression

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The studies published to date were characterized by small series and very different methods in terms of:

• dose

• fractionation

• techniques

• evaluation modalities

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Dose Escalation STereotactic RadiOtherapY 1 DESTROY-1

Level

Lung intra- parenchimal

tumors

Para- Mediastinal

tumors or tumors near chest

wall

Extra- thoracic

tumors

Retreatment ESRT- boost

ESRT- boost with prior radiotherapy

> 60 Gy or retreatment of pancreatic or pelvic

cancer

with prior radiotherapy <

60 Gy

(after RT dose

< 50 Gy)

(after RT dose >

50 Gy)

1 25 Gy 25 Gy 25 Gy 20 Gy 25 Gy 25 Gy 20 Gy

2 37.5 Gy 30 Gy 30 Gy 25 Gy 30 Gy 30 Gy 25 Gy

3 45 Gy 35 Gy 35 Gy 30 Gy 35 Gy 35 Gy 30 Gy

4 50 Gy 40 Gy 40 Gy 35 Gy 40 Gy

5 45 Gy 45 Gy 40 Gy 45 Gy

6 50 Gy 50 Gy 45 Gy 50 Gy

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Fields Set-up: tetrahedral static beam configuration:

4 no-coplanar fields (plus 0° e 90° orthogonal) for daily isocenter verification

Reference point: ICRU 62

CH₄

ELEKTA Roadshow Catania 27 Marzo 201

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ESRT: 30/03/2005

TC pre ESRT: 27/01/2005

TC post ESRT: 28/06/2005

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Active Breath Coordinator (ABC)

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2009

2012

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0 20 40 60 80 100

0 20 40 60 80 100 120

Dose (%)

Volume (%)

Stereo

Stereo IMRT

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• 2004: IMRT (prostate ca, breast ca)

• 2005: IMRT SIB (H&N, pleural mesothelioma)

• 2006: IMRT (endom & cervical ca); IMRT SIB (prostate ca, brain tumors)

• 2007: 4D RT (fiducials e ABC);

• 2008: IGRT (PET-TC)

• 2009: VMAT (vaginal vault, prostate)

• 2010: VMAT (H&N SIB, prostate SIB, Rectum SIB)

• 2011: VMAT Radiosurgery (lung, bone, hepatic), VMAT (endometrial SIB, brain SIB)

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Fields Set-up: tetrahedral static beam configuration:

4 no-coplanar fields (plus 0° e 90° orthogonal) for daily isocenter verification

Reference point: ICRU 62

CH₄

VMAT

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VMAT based Dose Escalated Stereotactic RadiOtherapY 2 (Radiosurgery)

Leve

l Lung Liver Bone Advanced Vertebrae

(after 25 Gy)

1 26 Gy 26 Gy 12 Gy 16 Gy 8 Gy 2 28 Gy 28 Gy 14 Gy 18 Gy 10 Gy 3 30 Gy 30 Gy 16 Gy 20 Gy 12 Gy 4 32 Gy 32 Gy 18 Gy 22 Gy

5 34 Gy 20 Gy 24 Gy

6 22 Gy

7 24 Gy

Reference point: Rosel Protocol

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VMAT Radiosurgery: liver

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2012

2014

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2019

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• 2007: 4D RT (fiducials e ABC);

• 2012: Hybrid-IMRT (mammella)

• 2013: Adaptive RT

• 2014: Stereotactic-SIB-VMAT (prostata e nodulo dominante)

• 2015: VMAT-SIB prostata e linfonodi pelvici

• 2016: Breath-Hold lung Stereo-VMAT

• 2017: Breath-Hold liver Stereo-VMAT

• 2018: Vessel-sparing Stereotactic-SIB-VMAT (prostate ca and DIL)

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X ²⁰¹⁷ ²⁰¹⁸ X

2019

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Sistema di ricostruzione ottica superficiale

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• 2007: 4D RT (fiducials e ABC);

• 2012: Hybrid-IMRT (mammella)

• 2013: Adaptive RT

• 2014: Stereotactic-SIB-VMAT (prostata e nodulo dominante)

• 2015: VMAT-SIB prostata e linfonodi pelvici

• 2016: Breath-Hold lung Stereo-VMAT

• 2017: Breath-Hold liver Stereo-VMAT

• 2018: Vessel-sparing Stereotactic-SIB-VMAT (prostate ca and DIL)

• 2019: IGRT (CBCT), FFF/SRT-SRS

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• 2019: IGRT (CBCT), FFF/SRT-SRS, Surface Guided Radiotherapy (SGRT),

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5 Gy

Results: dose distribution

32 Gy

32 Gy 20 Gy 32 Gy

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Grazie per l’attenzione

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La Radioterapia stereotassica: tre realtà territoriali a confronto

StereoBody Frame (ELEKTA)

Abdominal Compression

Dose Escalation STereotactic RadiOtherapY 1 DESTROY-1

Fields Set-up: tetrahedral static beam configuration:

Reference point: ICRU 62

Active Breath Coordinator (ABC)

Fields Set-up: tetrahedral static beam configuration:

Reference point: ICRU 62

VMAT

VMAT based Dose Escalated Stereotactic RadiOtherapY 2 (Radiosurgery)

Reference point: Rosel Protocol

VMAT Radiosurgery: liver

X 2017 2018 X

2019

Sistema di ricostruzione ottica superficiale

Grazie per l’attenzione

X ²⁰¹⁷ ²⁰¹⁸ X