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Imrt A New Treatment Method For Nasopharyngeal Cancer
IMRT is a new treatment method for nasopharyngeal cancer that has the potential to improve local control, especially for T3 and T4 tumors, reduce post-irradiation complications, and reduce the rate of distant metastasis. A study of 13 NPC patients treated with IMRT found that it resulted in reduced acute reactions and improved dosimetry compared to conventional radiotherapy. Further research is needed to optimize target definition and dose distribution in IMRT for NPC.
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Introduction of IMRT as a new treatment option for nasopharyngeal cancer by medical professionals.
Efficacy of conventional radiotherapy in NPC, with statistics showing local control rates and complications.Key issues for improving NPC treatment including local control, late sequelae, and distant metastasis reduction.
Objectives of the study including preliminary results, CT target defining, and strategies for IMRT.
Details on dose calculation through inverse planning and quality assurance processes in IMRT.
Methods for verifying treatment position through simulation and portal imaging to ensure accuracy.
Presentation of acute reactions, dosimetry results, and evaluation of responses to IMRT.Comparison of IMRT effectiveness against conventional or 3-D conformal radiotherapy presenting DVH data and observations.
Thank you and closure of the presentation highlighting specialty in IMRT for nasopharyngeal cancer.
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Imrt A New Treatment Method For Nasopharyngeal Cancer
- 1. IMRT - ANew Treatment Method for Nasopharyngeal Cancer Wen-Shan Liu 1 , Hsiang-Chi Kuo 1 , Bin S. Teh 2 , E. Brian Butler 2 1 Chung Shan Medical & Dental College Hospital 2 Department of Radiation Oncology, Baylor College of Medicine
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- 3. Is conventional radiotherapygood enough for NPC? Local control T1 - T2: 80 - 90 % T3 - T4: 20 - 60 %
- 4. Grade III -IV Complications Temporal lobe necrosis: 2 - 33.3 % Hearing impairment: 3 - 30.9 % Cranial neuropathy: 0 - 4.2 %
- 5. Normal tissue complicationsOtitis media: 5 - 41.8 % Trismus: 3 - 12 % Xerostomia: 35 - 100 % Neck fibrosis: 3 - 36.4 % Osteonecrosis: 0 - 2 %
- 6. Three Major Issuesof the NPC How to improve the local control especially for T3 and T4 patients How to reduce the post-irradiation late sequelae How to reduce the ratio of distant metastasis
- 7. The potential benefitof IMRT for NPC Improve the local control especially for concave shape tumors Reduce the post-irradiation complications Reduce the rate of distant metastasis by improving the local control
- 8. Contents To presentthe preliminary results of IMRT for nasopharyngeal cancer To present the CT-based target defining for nasopharyngeal cancer To demonstrate the fractionation strategies for intensity-modulated radiation therapy of nasopharyngeal cancer
- 9. Patients and MethodsSept to Dec 2000: 13 patients Staging: T1-2, N0-2, M0 (AJCC 1997) Age: from 24 to 72 years old Male : female = 10 : 3
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- 11. The procedures ofIMRT for nasopharyngeal cancer Immobilization Imaging acquisition and contouring Dose calculation with inverse planning Quality assurance Verification the position Portal imaging with EPID IMRT
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- 13. Imaging acquisition andcontouring
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- 16. Dose calculation withinverse planning Varians Helios planning system
- 17. Dose limits ofinverse planning
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- 19. IMRT QA andTreatment MLC Controller TPS Leaf Motion Treatment Machine Record and Verify Log File Indep. MU Calc. DMLC Port Film/ DRR Comparison Film/Ion Chamber Verification ?
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- 22. Verification the treatmentposition by simulation
- 23. Verification the treatmentposition by portal imaging (EPID)
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- 31. Response evaluation byCT scan
- 32. Response evaluation byCT scan
- 33. Discussion How todefine the treatment targets? How to decide the doses to the different targets and different critical organs? Is the IMRT really better than conventional radiotherapy?
- 34. How to definethe treatment targets?
- 35. How to definethe treatment targets? Medial : c-spine body and pharyngeal wall Lateral : excluding parotid, sternocleido-mastoid & pterygoid Post .: tip of spinous process
- 36. How to definethe treatment targets? Medial : c-spine body and pharyngeal lumen Lateral : edge of sternocleidomastoid m. or medial 2/3 Post .: tip of spinous process
- 37. How to decidethe doses to the different targets and different critical organs? SMART : simultaneous modulated accelerated radiation therapy, Dr. Butler and Dr. Teh, 1999 SIB : simultaneous integrated boost, Dr. Mohan and Dr. Wu, 2000
- 38. SMART IMRTSchedule Primary target: 2.4 Gy per fraction Secondary target: 2.0 Gy Butler EB, Teh BS, Grant WH et al: SMART (simultaneous modulated accelerated radiation therapy) boost: A new accelerated fractionation schedule for the treatment of head and neck cancer with intensity modulated radiotherapy. Int J Radiat Oncol Biol Phys, v45, no.1, pp21-32, 1999
- 39. SIB IMRTSchedule Primary target: 2.2 Gy per fraction Secondary target: 1.8 Gy Mohan R, Wu Q, Maning M and Schmidt-Ullrich R: Radiobiological considerations in the design of fractionation strategies for intensity-modulated radiation therapy of head and neck cancers. Int J Radiat Oncol Biol Phys, v46, No.3, pp619-630, 2000
- 40. Is the IMRTreally better than conventional or 3-D conformal radiotherapy?
- 41. IMRT Two opposed
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- 43. IMRT Two opposed
- 44. DVH of 3-Dconformal radiotherapy
- 45. DVH of intensity-modulatedradiotherapy
- 46. Lower skin reactionwith IMRT technique
- 47. IMRT must beapplied very carefully!
- 48. Dawson LA, AnzaiY, Marsh L et al: Patterns of local-regional recurrence following parotid-sparing conformal and segmental intensity-modulated radiotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys, V46, No.5, pp1117-1126, 2000
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