ESTRO 2024 - Abstract Book

S115

Invited Speaker

ESTRO 2024

Kari Tanderup

Aarhus University Hospital, Danish Center of Particle Therapy, Aarhus, Denmark

Abstract:

Over the past two decades, notable technical advancements have transformed the landscape of radiotherapy for cervix cancer. The substantial progress achieved can be attributed primarily to innovative approaches in image guidance, applied in both external beam radiotherapy (EBRT) and brachytherapy (BT). In EBRT, the integration of intensity-modulated radiotherapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) has been facilitated by the capability to monitor patient position and anatomical changes through daily on-board imaging, particularly Cone Beam CT (CBCT). The EMBRACE study highlighted a roughly 20% reduction in the body volume irradiated to the prescribed dose in IMRT-treated patients compared to conformal radiotherapy. Recent randomized clinical studies (PARCER and NRG RTOG 1203) have further confirmed the lower toxicity associated with IMRT/VMAT, showcasing the potential benefits of these techniques. Ongoing advancements, such as daily CBCT image guidance and adaptive radiotherapy, have demonstrated additional possibilities to reduce irradiated volumes during treatment. Careful monitoring on CBCT of target dose has allowed for PTV margin reduction and improved conformality during treatment planning. Addressing inter-planner variations in treatment planning, emerging approaches with automated treatment planning hold promise to reduce discrepancies and enhance overall planning quality. In brachytherapy, the incorporation of MRI guidance represents a significant leap forward, enabling the individualization of doses compared to the traditional point A dose approach. The improved visualization of the target has catalyzed the development of new hybrid applicators, which combine intracavitary and interstitial (IC/IS) techniques. With MRI guidance and the adoption of these innovative IC/IS applicators, substantial enhancements in target dose have been achieved, accompanied by an average reduction of around 20% in irradiated body volumes compared to historical point A dose practices. While commercially available automated treatment planning for brachytherapy is not yet widespread, in-house developments have demonstrated its potential to enhance both the speed and quality of brachytherapy treatment planning.

3512

Technological developments and future prospects

Daniela Thorwarth

Section for Biomedical Physics, Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany

Abstract:

In this presentation, technological developments for the application of dose painting radiotherapy in the last 25 years will be discussed. Recent technical innovations, such as online adaptive radiotherapy with protons and photons, hybrid positron emission tomography (PET)- and magnetic resonance imaging (MRI)-Linacs offer a range of new dose painting possibilities. Current hardware and workflow options as well as first clinical dose painting trial results will be reviewed for different radiotherapy modalities.