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1、螺旋断层放疗Tomo 的技术特征和临床价值螺旋断层层放疗疗的技术术特征与临临床价值值Dr Mesh Meta：全球第一位使用TOMO的放疗科主任What is Tomo Really Good At? Daily Image Guidance Very large field set-ups Craniospinal, whole abdomen, TMI Multiple lesions/prescriptions Brain, bone, others H/N multiple prescriptions Complicated geometries and set-ups Mesothe
2、lioma, retreatments, Avoidance Exploiting radiobiology Altered fractionation, SBRT, Theragnostics Adaptive radiotherapy+ +Fast Binary MLC (Multileaf Collimator)Continuous Gantry RotationSimultaneous Couch Movement高调制The Key Technology of Helical TomoTherapy多角度长覆盖 Modulated beams throughout one 360 d
3、egree rotation. The process continues for all rotationsBinary MLCIntensity levels in one modulated beamOne beamlet within the beamModulated Beam DeliveryHelically Delivered Dose DistributionsWhat is Tomo Really Good At? Daily Image Guidance Very large field set-ups Craniospinal, whole abdomen, TMI M
4、ultiple lesions/prescriptions Brain, bone, others H/N multiple prescriptions Complicated geometries and set-ups Mesothelioma, retreatments, Avoidance Exploiting radiobiology Altered fractionation, SBRT, Theragnostics Adaptive radiotherapyImage Guidance via Image FusionColored segments = MVCT Grey se
5、gments = planning CTA Statistical Analysis of H Mehta MP, Fowler, IJROBP 2001; Belani C, Mehta M, JCO, 2005; Adkison, Mehta: TCRT, 2008 2000: Evidence for accelerated repopulation in NSCLC 2001: TDF method to overcome resistance 2005: Evidence for benefit of accelerated RT 2008: Accelerated HT with
6、low toxicities, ? survival improvementBINDose/ FXDoseBED N12.285760 22.5363.2570 32.7769.2580 437590 53.2280.5100Lower than Expected Toxicities; Survival Improved?Lower than Expected Toxicities; Survival Improved?Grade 2 Pneumonitis13 %Grade 2 Esophagitis15 %Grade 3 Pneumonitis0 %Grade 3 Esophagitis
7、0 %2 year Survival47%Median Survival18 monthsNo Chemo 43%, Neoadjuvant 24%, Adjuvant 33%As Compared to 21.5% Expected Two Year SurvivalStereotactic Body Radiotherapy with 4D IM-IGRTHodge W, Mehta MP. Acta Oncol. 2006;45:890-6 N = 23, in press88% 4 Y LC78% 4 Y CSSProstate: Exploiting / (Fractional Se
8、nsitivity)Prostate: Exploiting / (Fractional Sensitivity)Fowler JF, Ritter M, IJROBP, 2001 2000: Rectal balloon immobilization technique 2001: Data Analysis for low prostate / 2002: Prostate Hypofx PO1 protocol 2004: Prostate Hypofx multi-institutional RO1 2009: Initial data analysisBINDose/F XFxsDo
9、se BED 312.942264.6812823.631658.0812834.31251.6126BINNF/U (mo)2YPF S BED 10110326.395%8421092195%7931009.395%74Prostate: Keeping Toxicities LowProstate: Keeping Toxicities LowTomotherapy SRS: AVM as a Model Rt. Occipital AVM Vol = 5.01cc 2+ hours planning time 11 isocenters 4 collimator changes 3+
10、hours on the tablePinnacle-Thick Solid Match-DashedOriginal PlanMatchSoisson E, Tome W, Mehta MP, U WisconsinTomos ChoiceOriginal PlanChoiceOriginal PlanMatchLinac MatchChoiceVolRx4.76cc4.75cc4.77ccTC 95%95%95%PIV9.8cc9.5cc7.44cc12GyVol22.2cc27.6cc23.3ccPITV1.961.891.49CN2.172.101.64CGI6048.357TimeH
11、ours20.5min18.2 minVolRx = Volume of target receiving prescription TC = Target Coverage VolRx/TV HI= Max Dose/Rx PITV=PIV/TV CI = VolRx/PIV CN= 1/(CI x TC)What is Tomo Really Good At? Daily Image Guidance Very large field set-ups Craniospinal, whole abdomen, TMI Multiple lesions/prescriptions Brain,
12、 bone, others H/N multiple prescriptions Complicated geometries and set-ups Mesothelioma, retreatments, avoidance Exploiting radiobiology Altered fractionation, SBRT, Theragnostics Adaptive radiotherapyAdaptive RadiotherapyWeek 1Week 3Calculate daily dosesModify original contoursMap hot dose levelsC
13、ontour hot spot and make it a constraintAdaptive RadiotherapyPre-RT KvCT; intra-RT MvCTSCLC after 18 Gy+Discrete Beam AnglesContinuous Couch Motion=Moving CouchFast Binary MLC (Multileaf Collimator)TomoDirectWBRTMultiple lesionsEfficient, IMRT, accurate simple fields e.g. TangentsTomoDirect + Tomo:
14、The Breast SolutionDynamic Jaw Saves Time: Whole Abdominal RTtreatment time regular 2.5cm 17 minutes, dose penumbra!djdc 5cm: 5.5 minutes, minimized penumbra HeidelbergThe Next Frontier: Theragnostic XRTThe Next Frontier: Theragnostic XRT Basic premise: Deliver non-homogenous RT doses to different t
15、umor sub-volumes, based on an analysis of local control probability derived from predictive functional imaging difference maps early in treatment. The ultimate in “personalized XRT”Generate a baseline agnostic planObtain baseline and early in-treatment functional imagingCorrelate maps with eventual
16、outcomeDevelop a prescription modelTest the model in a theragnostic dose-painting trialDose Painting: Feasibility StudiesDose Painting: Feasibility StudiesIMRT: HT Dose PaintingIMPT (Spot Scan) Dose PaintingEarly treatment planning results confirm that we can deliver Non-homogenous doses that mimic functional imaging mapsThank
