HOSPITAL OF LITHUANIAN UNIVERSITY OF HEALTH SCIENCES KAUNO KLINIKOS RADIOTHERAPY- CURRENT SITUATION AND FUTURE TRENDS Prof. Elona Juozaitytė Perspectives of Czech- Lithuanian Research Partnerships
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.
Hospital of Lithuanian University of Health Sciences Kauno klinikos The largest health care institution in Lithuania. Established in 1940. Providing high-quality, accessible medical services for patients from Lithuania, EU and other countries.
Hospital in numbers 35 clinical departments; 4 affiliated hospitals; 10 diagnostic and interventional units; 2400 hospital beds; 16 rare disease management coordination centers; Area - 378 749 m 2 Buildings - 26 Hospital of Lithuanian University of Health Sciences Kauno klinikos
Annually more than 1 200 000 outpatient consultations; 95 000 hospital admissions; 84 000 emergency department visits; 60 000 operations; 130 ongoing clinical trials. Hospital of Lithuanian University of Health Sciences Kauno klinikos
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
Cancer diagnostics and treatment Oncology institute. Multidisciplinary oncology centre: collaboration in cancer care among 24 different clinical departments ; Up to 10 000 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
Kauno Klinikos major provider of oncology services in Lithuania 14000 12000 10000 8000 6000 4000 2000 0 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
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
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
Diagnostic facilities Clinical laboratory and pathological anatomy clinics are fully equipped for clinical chemistry, genetic, hematologic, microbiologic and other diagnostic analysis. Laboratory performs more 2 500 000 different diagnostic analysis /year. Hospital of Lithuanian University of Health Sciences Kauno klinikos
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
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
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
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. 2008 Jacobs S et al. 2009 Delaney et al. 2005
Improving radiotherapy delivery
New techniques Dose Big Protons Stereotactic RT IGRT IMRT Conformal RT low small target Conventional RT big
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)
Head & neck cancer 3D-RT VS IMRT Hospital of Lithuanian University of Health Sciences Kauno klinikos
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
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
Stereotactic Radiotherapy Hospital of Lithuanian University of Health Sciences Kauno klinikos
Brachytherapy HDR and LDR techniques Gynecological tumors; Prostate; Head&neck; Breast cancer. Hospital of Lithuanian University of Health Sciences Kauno klinikos
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
CT based brachytherapy in oncogynecology Hospital of Lithuanian University of Health Sciences Kauno klinikos
MR based brachytherapy in oncogynecology Hospital of Lithuanian University of Health Sciences Kauno klinikos
Prostate cancer HDR brachytherapy Hospital of Lithuanian University of Health Sciences Kauno klinikos
Multicatheter breast cancer interstitial brachytherapy techniques Hospital of Lithuanian University of Health Sciences Kauno klinikos
Breast cancer multicatheter interstitial brachytherapy treatment planning Hospital of Lithuanian University of Health Sciences Kauno klinikos
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. 2012 Oct;32(5):297-303. Hospital of Lithuanian University of Health Sciences Kauno klinikos
Head & neck cancer brachytherapy Hospital of Lithuanian University of Health Sciences Kauno klinikos
Advances in Radiotherapy Development constrained by Imaging; Computing.
Future trends - Protons
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
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
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.
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
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
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