Translational Radiation Oncology, Physics & Supportive Care (TROP) Mark De Ridder, Wim Distelmans & Dirk Verellen
Tumor hypoxia: perfusion and diffusion limited oxygenation Hypoxia acute chronic 100 100 µ 2 Brown and Wilson, Nat Rev Cancer 2004
Prognostic significance of pre-treatment tumor oxygenation P < 0.05 3
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Translation of new radiation techniques 5
3D Conformal Radiotherapy postero-anterior beam (40% of the dose) 2 opposing latero-lateral lateral fields (60% of the dose) 6
Tomotherapy Hi Art II System Fusion of a Linac and a CT-scan 7
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small bowel PTV To do: Decrease CTV-PTV margin: limit the volume of healthy tissue that is intentionally irradiated Image-guided Radiotherapy 9
Skin drawings & lasers 10
IGRT: MV-CT positioning Planning CT MV-CT prior to treatment AUTOMATIC co-registration 11
based on laser-skin marks (mm) Lat Ant Post Cran Caud 15 16 14 10 10 based on daily MV-CT (mm) Lat Ant Post Cran Caud 8 11 7 10 10 12
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80 Small Bowel NTCP (%) 70 60 50 40 30 20 10 IMRT IMRT/IGRT 3D-CRT 14 0 0 100 200 300 400 V15 (cc)
Acute toxicity 15
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The VERO project 17
Simultaneous Integrated Boost 18
Partial tumor boost Tumoricidal dose on > 60% of the volume Virtual volume reduction No repopulation of tumor cells included in the partial boost volume lower probability for local recurrence Gastro-intestinal cancers such as hepatic malignancies and pancreatic cancer 19
PET: Hypoxia markers 20
Biological boost 21
Clinical trials: open Randomized trial comparing conventional vs short-course reduced volume conformal post-surgery radiation treatment in women with stage I or II breast cancer. Randomized trial of preoperative radiotherapy with a simultaneous integrated boost compared to chemoradiotherapy for ct3-4 rectal cancer. Phase 2 trial of helical tomotherapy for oligometastatic colorectal cancer. Phase 2 trial of stereotactic body radiotherapy for oligometastatic non small cell lung carcinoma (NSCLC). (VERO) Computed Tomography as tools for patient-individualized radiation therapy in locally advanced non-small cell lung cancer. Feasability study for stereotactic body radiotherapy with dynamic tracking on the VERO SBRT system. 22
Clinical trials: opening Biological modulated radiotherapy for locally advanced pancreatic cancer on the VERO-SBRT system. Randomised phase II study of single fraction radiotherapy with the VERO SBRT system for painful bone metastases of the spine with or without the early introduction of supportive care: a one-day care program. Arginase as a predictive biomarker and molecular target in chemo/radiotherapy of metastatic colorectal cancer. Feasibility study of breast cancer boosts with the VERO SBRT system Whole brain radiotherapy with hippocampal sparing and simultaneous integrated boost for multiple brain metastasis (fiber tracking) Phase III trial of hypofractionated vs. standard fractionated stereotactic radiotherapy for prostate cancer (VERO) 23
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Our TROP Team ZAP: Mark De Ridder, Wim Distelmans, Dirk Verellen, Em. Guy Storme Post-docs: Nicolas Christian, Anne Hoorens, Guy Soete, Marieke Vermeersch, Valeri Verovski, Vincent Vinh- Hung PhD students: Samuel Bral, Peter Covens, Tom Depuydt, Benedikt Engels, Thierry Gevaert, Jiang Heng, Steven Lelie, Kenneth Poels Researchers @ Radiotherapy UZ Brussel Technical personnel: Ka Lun Law, Harijati Versmessen 25