Treatment Planning in
Radiotherapy
Dr. Yasser Al Ajrami
Mr. Kazem al Habash
7/15/2024 Al-Azhar University - Gaza
Introduction
• Radiation therapy (also radiotherapy or radiation
oncology, sometimes abbreviated to XRT) is the
medical use of ionizing radiation as part of cancer
treatment to control malignant cells (not to be
confused with radiology, the use of radiation in medical
imaging and diagnosis).
• Radiotherapy may be used for curative or adjuvant
cancer treatment. It is used as palliative treatment
(where cure is not possible and the aim is for local
disease control or symptomatic relief) or as therapeutic
treatment (where the therapy has survival benefit and
it can be curative).
• Radiotherapy is used for the treatment of malignant
tumors (cancer), and may be used as the primary
therapy.
• It is also common to combine radiotherapy with
surgery, chemotherapy, hormone therapy or some
mixture of the three. Most common cancer types can
be treated with radiotherapy in some way.
• The precise treatment intent (curative, or palliative
adjuvant, neoadjuvant) will depend on the tumour
type, location, and stage, as well as the general health
of the patient.
How it work?
• The therapeutic use of IR is based on it’s biological
action, that is, it’s ability to cause changes in cells,
tissues, organs, the body as a whole. It depends
on the ABSORBED DOSE (AD) – e n e r g y transmitted
to irradiated tissues (Gy).
• To spare normal tissues (such as skin or organs which
radiation must pass through in order to treat the
tumour), shaped radiation beams are aimed from
several angles of exposure to intersect at the tumour,
providing a much larger absorbed dose there than in
the surrounding, healthy tissue.
The Process of Radiation Treatment
IMAGING IS
CENTRAL TO EACH
Diagnosis STEP IN THE Following/Evaluation
PROCESS
Prescription
Delivery
Simulation
Verification
Planning
• Dose
• The amount of radiation used in radiation therapy is
measured in gray (Gy), and varies depending on the type
and stage of cancer being treated. For curative cases, the
typical dose for a solid epithelial tumor ranges from 60 to
80 Gy, while lymphoma tumors are treated with 20 to 40
Gy.
• Fractionation
• The total dose is fractionated (spread out over time) for
several important reasons. Fractionation allows normal
cells time to recover, while tumor cells are generally less
efficient in repair between fractions. Fractionation also
allows tumor cells that were in a relatively radio-resistant
phase of the cell cycle during one treatment to cycle into a
sensitive phase of the cycle before the next fraction is
given. Similarly, tumor cells that were chronically or acutely
hypoxic (and therefore more radioresistant) may
reoxygenate between fractions, improving the tumor cell
kill.
• Types of radiation therapy
• the three main divisions of radiotherapy are:
• external beam radiotherapy (EBRT or XBRT) or teletherapy,
• brachytherapy or sealed source radiotherapy,
• and systemic radioisotope therapy or unsealed source
radiotherapy.
• The differences relate to the position of the radiation source;
• external is outside the body,
• brachytherapy uses sealed radioactive sources placed precisely
in the area under treatment,
• and systemic radioisotopes are given by infusion or oral
ingestion.
• Brachytherapy can use temporary or permanent placement of
radioactive sources.
• The temporary sources are usually placed by a technique
called afterloading. In afterloading a hollow tube or
applicator is placed surgically in the organ to be treated,
and the sources are loaded into the applicator after the
applicator is implanted. This minimizes radiation exposure
to health care personnel.
• Particle therapy is a special case of external beam
radiotherapy where the particles are protons or heavier
ions.
• Introperative radiotherapy is a special type of radiotherapy
that is delivered immediately after surgical removal of the
cancer. This method has been employed in breast cancer
(TARGeted Introperative radioTherapy), brain tumours and
rectal cancers.
Anatomical imaging
• CT
• MRI
Biological imaging
• PET
• SPECT
• fMRI
• MRSI
• PET\CT
• PET\MRI
Machine: CT sim
• Particle Therapy
• In particle therapy (Proton therapy), energetic
ionizing particles (protons or carbon ions) are
directed at the target tumor. The dose increases
while the particle penetrates the tissue, up to a
maximum (the Bragg peak) that occurs near the end
of the particle's range, and it then drops to (almost)
zero. The advantage of this energy deposition
profile is that less energy is deposited into the
healthy tissue surrounding the target tissue.
Treatment of tumors may be:
RADICAL RT– complete cure of the patients –
Indications: an early stages (I-II).
PALLIATIVE RT - a temporary improvement of
patients life, life prolongation (stages III- IV).
SYMPTOMATIC RT - to alleviate the most
severe manifestations of the disease
Approximately 45 % are cured
– surgery (independently or in combination)
– radiation therapy (independently or as a
leading method)
– chemotherapy (independently or, more
often, it is combined with surgery and
radiation therapy)
Factors of therapeutic dose
limitation
• tolerance of normal tissues
around a tumour,
• acute responses of tissues
• late radiation effects
• photons
Radiations for • electrons
radiotherapy • beta particles
• heavy particles
(protons, neutrons)
• X-Rays
Sources of • linacs
radiotherapeutic • cyclic accelerators
• nuclear reactors
radiations
• radionuclides
Methods of radiotherapy
On distance Source – Target
• Distant irradiation
• Contact irradiation
(Brachytherapy)
Machines: Linear accelerator
Brachytherapy
Principles of Radiotherapy
1. Delivering of an optimal dose to the
tumor
2. Minimal damage of surrounding
organs & tissues.
3. Measures stimulating protective
forces of the body
Techniq.
Clinical-dosimetric planning of
RT:
Treatment planning system
The main clinical-dosimetric
task is to create the most
favorable spatial distribution
of absorbed radiation doses in
patient’s body
EXTERNAL BEAM
THERAPY
Methods of patient’s irradiation
1. S t a t i c irradiation can be performed
through:
• Single field technique
• Multiple field technique
2. M o b i l e irradiation:
• Rotational
• Next time we Cont.,
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