RADIOTHERAPY- CURRENT SITUATION AND FUTURE TRENDS
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1 HOSPITAL OF LITHUANIAN UNIVERSITY OF HEALTH SCIENCES KAUNO KLINIKOS RADIOTHERAPY- CURRENT SITUATION AND FUTURE TRENDS Prof. Elona Juozaitytė Perspectives of Czech- Lithuanian Research Partnerships
2 About Lithuanian University of Health Sciences The largest institution of higher education for biomedical sciences in Lithuania; Integration of studies, research and clinical practice. Consists of two main academies: Medical Academy and Veterinary Academy. Includes 7 faculties, 6 research institutes, two animal clinics and the Hospital of LUHS. Over 7,000 students. Problem-based learning is a teaching method practiced by the Faculty of Medicine.
3 Hospital of Lithuanian University of Health Sciences Kauno klinikos The largest health care institution in Lithuania. Established in Providing high-quality, accessible medical services for patients from Lithuania, EU and other countries.
4 Hospital in numbers 35 clinical departments; 4 affiliated hospitals; 10 diagnostic and interventional units; 2400 hospital beds; 16 rare disease management coordination centers; Area m 2 Buildings - 26 Hospital of Lithuanian University of Health Sciences Kauno klinikos
5 Annually more than outpatient consultations; hospital admissions; emergency department visits; operations; 130 ongoing clinical trials. Hospital of Lithuanian University of Health Sciences Kauno klinikos
6 Staff Physicians 1200 (more than 450 PhDs) Nurses 2400 In education process: Residents 1000 Students 5000 PhD students-120 Hospital of Lithuanian University of Health Sciences Kauno klinikos
7 Cancer diagnostics and treatment Oncology institute. Multidisciplinary oncology centre: collaboration in cancer care among 24 different clinical departments ; Up to cancer patients annually; Cancer prevention and screening; Integration of education, research and clinical practice; Infrastructure for all cancer sites; Rare cancer diagnosis and treatment options; Affiliated Hospital of Oncology; Palliative care unit. Hospital of Lithuanian University of Health Sciences Kauno klinikos Hospital of Lithuanian University of Health Sciences Kauno klinikos
8 Kauno Klinikos major provider of oncology services in Lithuania Hospital of LUHS Kauno Kli... National Cancer Institute Vilnius University Hospital S... Klaipeda University Hospital Public Institution Republican... Public Institution Republican... Hospital of Lithuanian University of Health Sciences Kauno klinikos
9 Diagnostic facilities Innovative diagnostic radiology centre with facilities for computed tomography, magnetic resonance imaging, ultrasound, DEXA bone density scanning, mammography, radioisotope scanning, X-ray and others Hospital of Lithuanian University of Health Sciences Kauno klinikos
10 Diagnostic facilities PET-CT scanner has brought new possibilities for detecting tumours before, during and after treatment, for cancer patients radiotherapy planning and follow-up of cancer patients. Hospital of Lithuanian University of Health Sciences Kauno klinikos
11 Diagnostic facilities Clinical laboratory and pathological anatomy clinics are fully equipped for clinical chemistry, genetic, hematologic, microbiologic and other diagnostic analysis. Laboratory performs more different diagnostic analysis /year. Hospital of Lithuanian University of Health Sciences Kauno klinikos
12 Radiotherapy infrastructure Radiotherapy in Kaunas is part of multimodality cancer care system; Four modern linear accelerators; IMRT, IGRT and stereotactic intracranial and body radiotherapy; Extensive HDR and LDR brachytherapy programme. Hospital of Lithuanian University of Health Sciences Kauno klinikos
13 Treatment machines & software Linear acceleretors Clinac 2100CD Clinac DMX Varian ix with conbeam CT Varian Trilogy with conbeam CT Planning CT GE LightSpeedRT Planning software Eclipse Brainlab Oncentra Brachytherapy Nucletron Microselectron HD Oncology Information System Aria Hospital of Lithuanian University of Health Sciences Kauno klinikos
14 Role of radiation oncology for cancer control If RT is a treatment of choice, it is indicated when it offers: The best chance to cure The best improvement of local control The best of organ/function preservation The best palliation and/or The least side-effects
15 Why radiotherapy? Cured patients: 40% with RT (49% - surgery, 11% - chemotherapy) Indication to cure or improve survival 85% of the cases Overall 50% of new cancer patients would benefit from RT or least once Radiotherapy is one of the most cost-effective cancer treatment. Ahmad AS, Ormiston-Smith N, Sasieni PD. Br J Cancer 2015 Price P., Sikora K Jacobs S et al Delaney et al. 2005
16 Improving radiotherapy delivery
17 New techniques Dose Big Protons Stereotactic RT IGRT IMRT Conformal RT low small target Conventional RT big
18 Radiotherapy wish list Conform radiation to tumour; Maximum damage to tumour; Minimum damage to surrounding healthy tissue. Precision vs. accuracy: IMRT (precise) vs. IGRT (accurate)
19 Head & neck cancer 3D-RT VS IMRT Hospital of Lithuanian University of Health Sciences Kauno klinikos
20 Intensity modulation; Image guidance; Stereotactic approach: radiosurgery, Stereotactic intracranial radiotherapy, stereotactic body radiotherapy, Dose intensive treatment; High precision radiotherapy Short treatment time. Hospital of Lithuanian University of Health Sciences Kauno klinikos
21 Lung cancer: patients live longer with Radiosurgery than with Surgery Chang JY et al. Stereotactic ablative radiotherapy versus lobectomy for operable stage I nonsmall-cell lung cancer: a pooled analysis of two randomised trials. Lancet Oncol. 2015
22 Stereotactic Radiotherapy Hospital of Lithuanian University of Health Sciences Kauno klinikos
23 Brachytherapy HDR and LDR techniques Gynecological tumors; Prostate; Head&neck; Breast cancer. Hospital of Lithuanian University of Health Sciences Kauno klinikos
24 Brachytherapy main tumour sites 28% 4% 1% 67% Oncogynecology Prostate HEN Other Hospital of Lithuanian University of Health Sciences Kauno klinikos Guedea et al. Radiother & Oncol 97: 514, 2010
25 CT based brachytherapy in oncogynecology Hospital of Lithuanian University of Health Sciences Kauno klinikos
26 MR based brachytherapy in oncogynecology Hospital of Lithuanian University of Health Sciences Kauno klinikos
27 Prostate cancer HDR brachytherapy Hospital of Lithuanian University of Health Sciences Kauno klinikos
28 Multicatheter breast cancer interstitial brachytherapy techniques Hospital of Lithuanian University of Health Sciences Kauno klinikos
29 Breast cancer multicatheter interstitial brachytherapy treatment planning Hospital of Lithuanian University of Health Sciences Kauno klinikos
30 Head & neck cancer brachytherapy V. Rudzianskas, E. Juozaityte, A. Inciura Interstitial High-dose-rate Brachytherapy for Recurrent and Previously Irradiated Head-and-Neck Cancer. Proceedings of the American Society for Radiation Oncology 54th Annual Meeting,2012 Rudzianskas V, Inciura A, Juozaityte E, Reirradiation of recurrent head and neck cancer using high-dose-rate brachytherapy. Acta Otorhinolaryngol Ital Oct;32(5): Hospital of Lithuanian University of Health Sciences Kauno klinikos
31 Head & neck cancer brachytherapy Hospital of Lithuanian University of Health Sciences Kauno klinikos
32 Advances in Radiotherapy Development constrained by Imaging; Computing.
33 Future trends - Protons
34 Our research areas: Prognostic and predictive molecular markers of solid tumors; Radiobiology research; Target Volume Delineation using 18 F-FDG-PET/CT images; Molecular mechanisms of sensitivity and resistance to radiotherapy in breast cancer or other cell lines; Association between common genetic variations with individual patient variability in normal tissue late radiation toxicities; Linac-based fractionated stereotactic radiotherapy vs. intensity modulated radiotherapy; New brachytherapy techniques. LUHS Oncology institute
35 Research & Biomedical technologies Centre for the Latest pharmaceutical and Health technologies within the Santaka Valley Open access infrastructure Facilities for implementation of R&D activities Cooperation with foreign science institution and business entities Lithuanian university of health sciences
36 Distinctive features of the research in Lithuanian university of Health Sciences are: Research pathway starts from undergraduate level; Unity of the studies, research and clinical practice; Research area - from molecular mechanisms via clinical practice till population level; Orientation towards personalised medicine.
37 Summary Lithuanian University of Health Sciences and hospital Kauno klinikos is one of the best platforms for research and radiotherapy development, since it has: Well equipped diagnostic and treatment facilities Large flow of patients suffering from cancer Experience in implementation of R&D activities Open and ready for cooperation with researchers and business sector
38 ESTRO s vision for 2020 Every cancer patient in Europe will have access to state of the art radiation therapy, as part of a multidisciplinary approach where treatment is individualised for the specific patient s cancer, taking account of the patient s personal circumstances
39 Thank you for your attention!
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