Post on 26-Mar-2020
La Radioterapia
stereotassica: tre realtà
territoriali a confronto
Francesco Deodato
Fondazione di Ricerca e Cura ‘Giovanni Paolo II’ Università Cattolica S. Cuore
Campobasso
• 2002: 3D conformal RT
• 2003: extracranial stereotactic RT (ESRT)
La Radioterapia stereotassica extracranica
StereoBody Frame (ELEKTA)
La Radioterapia stereotassica extracranica
Abdominal Compression
La Radioterapia stereotassica extracranica
ELEKTA Roadshow Trani 11 Marzo 2019
HOTEL SAN PAOLO AL CONVENTO Via statuti Marittimi, 111
The studies published to date were characterized by small series and very
different methods in terms of:
• dose
• fractionation • techniques
• evaluation modalities
La Radioterapia stereotassica extracranica
ELEKTA Roadshow Trani 11 Marzo 2019
HOTEL SAN PAOLO AL CONVENTO Via statuti Marittimi, 111
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
La Radioterapia stereotassica extracranica
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
INTERNATIONAL AIRPORT HOTEL Via S. Giuseppe La Rena, 94
La Radioterapia stereotassica extracranica
La Radioterapia stereotassica extracranica
La Radioterapia stereotassica extracranica
ESRT: 30/03/2005
TC pre ESRT: 27/01/2005
TC post ESRT: 28/06/2005
La Radioterapia stereotassica extracranica
Active Breath Coordinator (ABC)
La Radioterapia stereotassica extracranica
ELEKTA Roadshow Trani 11 Marzo 2019
HOTEL SAN PAOLO AL CONVENTO Via statuti Marittimi, 111
2009
2012
La Radioterapia stereotassica extracranica
0
20
40
60
80
100
0 20 40 60 80 100 120
Dose (%)
Vo
lum
e (
%)
Stereo
Stereo IMRT
La Radioterapia stereotassica extracranica
ELEKTA Roadshow Trani 11 Marzo 2019
HOTEL SAN PAOLO AL CONVENTO Via statuti Marittimi, 111
• 2002: 3D conformal RT
• 2003: extracranial stereotactic RT (ESRT)
• 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)
La Radioterapia stereotassica extracranica
• 2010: VMAT (H&N SIB, prostate SIB, Rectum SIB)
• 2011: VMAT Radiosurgery (lung, bone, hepatic), VMAT (endometrial SIB, brain SIB)
ELEKTA Roadshow Trani 11 Marzo 2019
HOTEL SAN PAOLO AL CONVENTO Via statuti Marittimi, 111
La Radioterapia stereotassica extracranica
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
La Radioterapia stereotassica extracranica
ELEKTA Roadshow Trani 11 Marzo 2019
HOTEL SAN PAOLO AL CONVENTO Via statuti Marittimi, 111
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 La Radioterapia stereotassica extracranica
La Radioterapia stereotassica extracranica
VMAT Radiosurgery: liver
La Radioterapia stereotassica extracranica
ELEKTA Roadshow Trani 11 Marzo 2019
HOTEL SAN PAOLO AL CONVENTO Via statuti Marittimi, 111
La Radioterapia stereotassica extracranica
ELEKTA Roadshow Trani 11 Marzo 2019
HOTEL SAN PAOLO AL CONVENTO Via statuti Marittimi, 111
2012
2014
2014
La Radioterapia stereotassica extracranica
ELEKTA Roadshow Trani 11 Marzo 2019
HOTEL SAN PAOLO AL CONVENTO Via statuti Marittimi, 111
2019
La Radioterapia stereotassica extracranica
ELEKTA Roadshow Trani 11 Marzo 2019
HOTEL SAN PAOLO AL CONVENTO Via statuti Marittimi, 111
La Radioterapia stereotassica extracranica
ELEKTA Roadshow Trani 11 Marzo 2019
HOTEL SAN PAOLO AL CONVENTO Via statuti Marittimi, 111
• 2002: 3D conformal RT
• 2003: extracranial stereotactic RT (ESRT)
• 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)
La Radioterapia stereotassica extracranica
• 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)
X X 2018 2017
2019
La Radioterapia stereotassica extracranica
Sistema di ricostruzione ottica superficiale
La Radioterapia stereotassica extracranica
ELEKTA Roadshow Trani 11 Marzo 2019
HOTEL SAN PAOLO AL CONVENTO Via statuti Marittimi, 111
• 2002: 3D conformal RT
• 2003: extracranial stereotactic RT (ESRT)
• 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)
• 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
La Radioterapia stereotassica extracranica
ELEKTA Roadshow Trani 11 Marzo 2019
HOTEL SAN PAOLO AL CONVENTO Via statuti Marittimi, 111
• 2019: IGRT (CBCT), FFF/SRT-SRS, Surface Guided Radiotherapy (SGRT),
La Radioterapia stereotassica extracranica
ELEKTA Roadshow Trani 11 Marzo 2019
HOTEL SAN PAOLO AL CONVENTO Via statuti Marittimi, 111
5 Gy
5 Gy
Results: dose distribution
32 Gy
32 Gy 20 Gy
32 Gy
La Radioterapia stereotassica extracranica
Grazie per l’attenzione
ELEKTA Roashow Catania 27 Marzo 2019
INTERNATIONAL AIRPORT HOTEL Via S. Giuseppe La Rena, 94
La Radioterapia stereotassica extracranica