Radyoterapide Teknik Gelişmeler ve IGRT (Görüntü Kılavuzluğunda Radyoterapi)

Radyoterapi alanında son yıllarda gözlenen hızlı gelişmeler teknolojideki gelişmelere paralel olarak gitmektedir. Kullanılan cihazların gelişmesi tedavi tekniklerine ve planlama sistemlerine doğrudan yansımıştır. Bu sayede radyoterapinin temel prensibi olan normal dokuların etkilendiği ışın dozunu azaltıp, tümör dozunu artırmak artık daha kesin ve doğruluk oranı yüksek olarak yapılmaktadır. IMRT gibi komplike tedavi planlamalarının uygulanmaya başlaması ile beraber tedavi kalitesini ve doğruluğunu artırmak amacıyla IGRT metodu da geliştirilmiştir. Bu yöntem; tedavi odasında uygulanan iki ve üç boyutlu anatomik görüntüleme ve tedavi alanlarının kontrol işlemidir ve ancak yüksek teknolojik özelliklere sahip cihazlar ile yapılabilmektedir. Bu derlemede son yıllarda radyoterapi alanında meydana gelen bu büyük teknolojik gelişmeleri ve son 1 yıldır kullanma şansını bulduğumuz IGRT deneyimimizi paylaşmak istiyoruz

Clinical adoption patterns of 0.35 Tesla MR-guided radiation therapy in Europe and Asia

BACKGROUND Magnetic resonance-guided radiotherapy (MRgRT) utilization is rapidly expanding, driven by advanced capabilities including better soft tissue imaging, continuous intrafraction target visualization, automatic triggered beam delivery, and the availability of on-table adaptive replanning. Our objective was to describe patterns of 0.35 Tesla (T)-MRgRT utilization in Europe and Asia among early adopters of this novel technology. METHODS Anonymized administrative data from all 0.35T-MRgRT treatment systems in Europe and Asia were extracted for patients who completed treatment from 2015 to 2020. Detailed treatment information was analyzed for all MR-linear accelerators (linac) and -cobalt systems. RESULTS From 2015 through the end of 2020, there were 5796 completed treatment courses delivered in 46,389 individual fractions. 23.5% of fractions were adapted. Ultra-hypofractionated (UHfx) dose schedules (1-5 fractions) were delivered for 63.5% of courses, with 57.8% of UHfx fractions adapted on-table. The most commonly treated tumor types were prostate (23.5%), liver (14.5%), lung (12.3%), pancreas (11.2%), and breast (8.0%), with increasing compound annual growth rates (CAGRs) in numbers of courses from 2015 through 2020 (pancreas: 157.1%; prostate: 120.9%; lung: 136.0%; liver: 134.2%). CONCLUSIONS This is the first comprehensive study reporting patterns of utilization among early adopters of a 0.35T-MRgRT system in Europe and Asia. Intrafraction MR image-guidance, advanced motion management, and increasing adoption of on-table adaptive RT have accelerated a transition to UHfx regimens. MRgRT has been predominantly used to treat tumors in the upper abdomen, pelvis and lungs, and increasingly with adaptive replanning, which is a radical departure from legacy radiotherapy practices

Output factors of ionization chambers and solid state detectors for mobile intraoperative radiotherapy (IORT) accelerator electron beams

WOS: 000458309000003PubMed ID: 30632271Purpose The electron energy characteristics of mobile intraoperative radiotherapy (IORT) accelerator LIAC((R)) differ from commonly used linear accelerators, thus some of the frequently used detectors can give less accurate results. The aim of this study is to evaluate the output factors (OFs) of several ionization chambers (IC) and solid state detectors (SS) for electron beam energies generated by LIAC((R)) and compare with the output factor of Monte Carlo model (MC) in order to determine the adequate detectors for LIAC((R)). Methods The OFs were measured for 6, 8, 10, and 12 MeV electron energies with PTW 23343 Markus, PTW 34045 Advanced Markus, PTW 34001 Roos, IBA PPC05, IBA PPC40, IBA NACP-02, PTW 31010 Semiflex, PTW 31021 Semiflex 3D, PTW 31014 Pinpoint, PTW 60017 Diode E, PTW 60018 Diode SRS, SNC Diode EDGE, and PTW 60019 micro Diamond detectors. Ion recombination factors (k(sat)) of IC were measured for all applicator sizes and OFs were corrected according to k(sat). The measured OFs were compared with Monte Carlo output factors (OFMC). Results The measured OFs of IBA PPC05, PTW Advanced Markus, PTW Pinpoint, PTW microDiamond, and PTW Diode E detectors are in good agreement with OFMC. The maximum deviations of IBA PPC05 OFs to OFMC are-1.6%, +1.5%, +1.5%, and +2.0%; for PTW Advanced Markus +1.0%, +1.5%, +2.0%, and +2.0%; for PTW Pinpoint +2.0%, +1.6%, +4.0%, and +2.0%; for PTW microDiamond-1.6%, +2%, +1.1%, and +1.0%; and for PTW Diode E-+1.7%, +1.7%, +1.3%, and +2.5% for 6, 8, 10, and 12 MeV, respectively. PTW Roos, PTW Markus, IBA PPC40, PTW Semiflex, PTW Semiflex 3D, SNC Diode Edge measured OFs with a maximum deviation of +5.6%, +4.5%, +5.6%, +8.1%, +4.8%, and +9.6% with respect to OFMC, while PTW Diode SRS and IBA NACP-02 were the least accurate (with highest deviations-37.1% and-18.0%, respectively). Conclusion The OFs results of solid state detectors PTW microDiamond and PTW Diode E as well as the ICs with small electrode spacing distance such as IBA PPC05, PTW Advanced Markus and PTW Pinpoint are in excellent agreement with OFMC. The measurements of the other detectors evaluated in this study are less accurate, thus they should be used with caution. Particularly, PTW Diode SRS and IBA NACP-02 are not suitable and their use should be avoided in relative dosimetry measurements under high dose per pulsed (DPP) electron beams

Dose escalation with intensity modulated radiotherapy in the treatment of locally advanced cervical cancer

Purpose/Objective: The standard treatment of locally advanced cervical cancer is concurrent chemoradiation. Radiotherapy with newer treatment technologies such as intensity modulated radiotherapy (IMRT) seems to be effective with minimized toxicity

An unusual case of mammary gland-like carcinoma oi vulva: Case report and review of literature

Introduction: Accessory breast tissue is a very rare finding in the general population with an incidence of one to two percent. An even rarer occurrence is accessory mammary-like tissue which developed breast carcinoma. The authors present a case of aggressive and metastatic carcinoma of vulvar originating from mammary-like tissue. Case: A 73-year-old Caucasian female presented with a lesion in her left vulva. The lesion was ulcerated and fragile. A dermatologist had evaluated the lesion and took a punch biopsy. Result was vulvar carcinoma. She was admitted to the gynecologic oncology clinic then after and was operated. After a radical vulvectomy and bilateral inguinal lymphadenectomy she received adjuvant radiotherapy because of lymph node metastasis. One year after the finish of radiotherapy patient was found to have lung and femur metastasis. She began to receive systemic chemotherapy for metastasis. Conclusion: Primary mammary-like adenocarcinoma of the vulva is exceedingly rare. There is no consensus about the diagnosis, treatment, and follow up of these patients in literature. However, given that histological data confirms these cancers are behaving like breast cancers instead of known patterns of vulva cancer, the best treatment practices for breast cancer may be applied to treat these vulvar carcinoma patients