Rapid calculation of biological effects in ion radiotherapy
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Abstract:
We describe a method for fast calculation of biological effects after ion irradiation. It is an alternative derivative of the established local effect model (LEM) and has been integrated into GSI's TRiP98 treatment planning system. We show that deviations from our classic approach for treatment planning are less than 5% for therapeutical doses, but calculational speed can be improved by one to two orders of magnitude. This will allow sophisticated methods of treatment planning for ion irradiation, taking biological effects fully into account.Keywords:
Biological effect
Relative biological effectiveness
PET-CT is becoming more and more important in various aspects of oncology. Until recently it was used mainly as part of diagnostic procedures and for evaluation of treatment results. With development of personalized radiotherapy, volumetric and radiobiological characteristics of individual tumour have become integrated in the multistep radiotherapy (RT) planning process. Standard anatomical imaging used to select and delineate RT target volumes can be enriched by the information on tumour biology gained by PET-CT. In this review we explore the current and possible future role of PET-CT in radiotherapy treatment planning. After general explanation, we assess its role in radiotherapy of those solid tumours for which PET-CT is being used most.In the nearby future PET-CT will be an integral part of the most radiotherapy treatment planning procedures in an every-day clinical practice. Apart from a clear role in radiation planning of lung cancer, with forthcoming clinical trials, we will get more evidence of the optimal use of PET-CT in radiotherapy planning of other solid tumours.
PET-CT
Clinical Practice
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Radiation therapy has been used in the management of cancer for more than a century. Its goal is to deliver a high therapeutic dose of radiation to a tumour whilst sparing healthy normal tissue. In order to achieve this continuous developments and innovations in the planning and delivery of radiation therapy treatment are made. Technological advances in radiation therapy have resulted in significant improvement in the planning and delivery of this cancer treatment, yielding decreased normal tissue toxicity, increased tumour control and good patient quality of life. One of the arguably greatest developments in radiation therapy is the introduction of image guided radiation therapy (IGRT), which allows for imaging in the radiation therapy treatment room with adjustments per individual patient to account for geometric deviations. Reviewed literature from January 2012 to August 2016 was sourced to discuss and critically evaluate the different technological developments in radiation therapy.
Image-guided radiation therapy
Cancer Therapy
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The increasing interest in combined positron emission tomography (PET) and computed tomography (CT) to guide lung cancer radiation therapy planning has been well documented. Motion management strategies during treatment simulation PET/CT imaging and treatment delivery have been proposed to improve the precision and accuracy of radiotherapy. In light of these research advances, why has translation of motion-managed PET/CT to clinical radiotherapy been slow and infrequent? Solutions to this problem are as complex as they are numerous, driven by large inter-patient variability in tumor motion trajectories across a highly heterogeneous population. Such variation dictates a comprehensive and patient-specific incorporation of motion management strategies into PET/CT-guided radiotherapy rather than a one-size-fits-all tactic. This review summarizes challenges and opportunities for clinical translation of advances in PET/CT-guided radiotherapy, as well as in respiratory motion-managed radiotherapy of lung cancer. These two concepts are then integrated into proposed patient-specific workflows that span classification schemes, PET/CT image formation, treatment planning, and adaptive image-guided radiotherapy delivery techniques.
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Radiation oncology
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This mini-review describes how to perform PET/CT based radiotherapy dose planning and the advantages and possibilities obtained with the technique for radiation therapy. Our own experience since 2002 is briefly summarized from more than 2,500 patients with various malignant diseases undergoing radiotherapy planning with PET/CT prior to the treatment. The PET/CT, including the radiotherapy planning process as well as the radiotherapy process, is outlined in detail. The demanding collaboration between mould technicians, nuclear medicine physicians and technologists, radiologists and radiology technologists, radiation oncologists, physicists, and dosimetrists is emphasized. We strongly believe that PET/CT based radiotherapy planning will improve the therapeutic output in terms of target definition and non-target avoidance and will play an important role in future therapeutic interventions in many malignant diseases. Keywords: PET/CT, radiotherapy planning, malignant diseases
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Radiotherapy is an integral part of the therapeutic arsenal in oncology and it is estimated that two-thirds of cancer patients will receive radiation therapy at some time during the course of their illness. The multiple steps undertaken in radiotherapy are often unknown by the medical profession and the purpose of this article is to trace it. From the decision to implement a radiotherapy treatment, taken by a multidisciplinary team, to the application of ionizing irradiation by the linear accelerator, there are important intermediary steps such as consultation with the radiotherapist, simulation, contouring of the volumes and planning. Setting up a radiotherapy treatment takes time and precision is required at each step. Technologies evolve constantly and we are also systematically looking for treatment optimization. Our goal is to achieve individualized radiotherapy.
Radiation oncology
Medical physicist
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Abstract There has been tremendous technological development in the field of radiation oncology, mainly during the last few decades. Parallel advancements in imaging and accelerator technologies have contributed significantly to the same. Present-day radiation therapy is aimed at precision, in terms of physical accuracy of both its planning and delivery. This has been made possible by improvements in defining the target (use of various radiological and functional imaging modalities), advanced radiotherapy planning methods (intensity-modulated radiation therapy and recent emergence of particle therapy), and robust verification techniques (image-guided radiation therapy). These developments have enabled delivery of adequate tumoricidal doses conforming to the target, thereby improving disease control with reduced normal tissue toxicity in a wide range of malignancies. Elucidation of molecular pathways determining radioresistance or systemic effects of radiotherapy and strategies for therapeutic manipulation of the same are also being explored. Overall, we look forward to ensuring basic radiotherapy access to all patients, and precision radiation therapy to appropriate candidates (triaged by disease anatomy or biology and associated cost-effectiveness).
Radiation oncology
Modalities
Radioresistance
Particle Therapy
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The effects of a hyperthermal treatment of one hour on radiation damage to baby rat cartilage and mouse intestine were compared for 250 kVp X irradiation and cyclotronproduced neutron irradiation (mean energy of about 7.5 MeV). Heat, in the range 41.0°C–43.0°C, caused no observable gross tissue injury when given alone. When heat was given immediately before radiation, the radiation damage was enhanced. There were no qualitative differences between response after fast neutrons and after X rays. Thermal enhancement ratios (TER) were similar for the two tissues and were not affected by the type of radiation used. Thus, the relative biological effectiveness (RBE) of fast neutrons compared with X rays was not markedly altered by combining radiation with hyperthermia.
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Relative biological effectiveness
Biological effect
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Biological effect
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