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Improved radiotherapy treatment of lung cancer using intensity modulated photon and proton radiation therapy combined with breathing adaptive techniques

PhD student: Sebastian Sarudis

Supervisors: Anna Bäck, Anna Karlsson Hauer and Jan Nyman

Aims:
• Study the dosimetrical and radiobiological impact of interplay effects between organ motions and the dynamic delivery of intensity modulated radiation therapy in the lung region.
• Study the impact of breathing adaptation for dynamic treatments of lung tumors to determine if the internal target volume (ITV) and the interplay effects can be decreased.

Absorbed dose escalation to tumors in the lung may improve the clinical outcome and increase survival. The escalation of the dose is often limited by the tolerance doses of the surrounding normal tissue. Avoiding irradiation of well functional parts of the lung, and allowance of higher doses to other parts, has the potential to decrease lung complications and thereby make it possible for dose escalation. To achieve this, intensity modulated radiation photon (IMRT), including volumetric modulated arc therapy (VMAT), or proton (IMPT) therapy techniques are needed. One important concern that needs to be taken into account for IMRT, VMAT and IMPT is the dynamic nature of the dose delivery and the interplay effects that can be introduced in combination with patient breathing motions.
The interplay effects could demote the accuracy and precision of the treatments in the lung region. Increasing the understanding of interplay effects and their impact on dose distribution to dynamic targets gives possibilities to improve the accuracy of predicting the radiobiological effect using radiobiological models for tumor control probability and normal tissue complication probability. Using radiobiological parameters for treatment plan evaluation and optimization has the potential to give better agreement between desired and actual treatment outcome but requires accurate estimations of the radiobiological effect.

The method to study interplay effects that will be developed in this study can be applied to other treatment sites with dynamic targets as well. It will contribute as a tool which helps reducing the uncertainties in the dose delivery to all dynamic targets and make it possible to improve the optimization of the treatment plans for such targets with reduced side effects and increased quality of life after treatment or increased tumor control.

Page Manager: Johan Spetz|Last update: 12/9/2014
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