Keterangan
Emerging advances in Radiation Oncology aims at defining the current role and future potential of technological, medical physics and molecular/biological innovations for their incorporation into routine clinical practice in radiation oncology. Dr Pradeep will help us understand where advances in technology are best practices and quality assurance methodologies can be disseminated and what kind of scientific knowledge is being exchanged.
Ringkasan
- Radiation oncology utilizes high-energy radiations, such as photons, protons, and electrons, to treat cancer. It can be categorized into teletherapy (external beam), stereotactic radiotherapy (focused, high-dose), and brachytherapy (internal radioactive source). Teletherapy techniques include 3D-CRT, IMRT, IGRT, and adaptive radiation therapy.
- Radiation therapy plays a role in 60-70% of cancer treatments, serving as adjuvant (post-surgery), definitive (organ preservation), or palliative care. It's used to eradicate microscopic residual disease after surgery, to preserve organ function in advanced cases, and to manage symptoms and improve quality of life in metastatic settings.
- The development of radiation therapy has evolved from radioactive materials to linear accelerators equipped with multi-leaf collimators (MLCs) for beam shaping. Computer-aided planning systems optimize dose distribution to spare normal tissues while targeting tumors effectively, leading to conformal radiotherapy.
- Intensity-modulated radiation therapy (IMRT) modulates the radiation beam's intensity to precisely target tumors while minimizing dose to surrounding healthy tissues. IMRT techniques include "step and shoot" (beam on/off) and dynamic arc therapy (continuous beam), each with distinct advantages and disadvantages.
- Challenges in conformal radiotherapy include increased costs, resource requirements, susceptibility to motion errors, and the potential for geographic misses. Proper patient positioning, immobilization, and accurate target delineation are critical to minimize errors.
- Modern radiation planning incorporates various imaging modalities such as MRI, PET-CT, and spectroscopy, for precise tumor localization and differentiation from normal tissues. Image registration techniques are crucial for fusing these images and incorporating them into treatment plans.
- Image-guided radiotherapy (IGRT) utilizes real-time imaging to track organ motion and adjust treatment delivery accordingly. 4D planning captures tumor movement over time, enabling more accurate targeting, particularly in the lungs and other mobile organs. Techniques like gating and tracking are used to manage motion during treatment.
- Adaptive radiotherapy modifies treatment plans during the course of therapy to account for changes in tumor size, shape, and location. This helps to ensure optimal dose delivery and minimize side effects, especially in areas prone to anatomical changes like the head and neck. Helical tomotherapy utilizes a linear accelerator mounted on a CT scanner to deliver radiation in a helical fashion, allowing for highly conformal treatments with binary MLCs.
- Stereotactic radiotherapy (SRS/SBRT) delivers high doses of radiation in a few fractions, achieving a high biological effective dose. Gamma Knife and CyberKnife are specialized systems for SRS, offering precise targeting and minimal side effects. CyberKnife uses image guidance and robotic motion to track and correct for patient movement.
- Brachytherapy involves placing radioactive sources directly into or near the tumor, using imaging for precise placement and treatment planning. The transition from low-dose-rate (LDR) to high-dose-rate (HDR) brachytherapy has enabled shorter treatment times. Image-guided brachytherapy utilizes CT and MRI to optimize treatment planning and source placement.
- MRI-guided linear accelerators (MRI-Linacs) integrate MRI imaging with radiation therapy, enabling real-time adaptive planning and precise tumor targeting. MRI-Linacs offer the potential to personalize treatment based on functional imaging and real-time anatomical changes.
- Flash radiotherapy is an emerging technique that delivers ultra-high doses of radiation in a fraction of a second. This may offer improved normal tissue sparing and tumor control compared to conventional radiation therapy. Initial results in animal models and early human trials are promising.
- Challenges in flash radiotherapy include modifying existing linear accelerators to deliver ultra-high doses, developing quality assurance protocols, and evaluating new fractionation schedules. Despite the challenges, the potential benefits of flash radiotherapy for cancer treatment are significant.
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