UroToday - Helical Tomotherapy: Experiences of the First 150 Patients in Heidelberg - Abstract

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Wednesday, 06 February 2008

Department of Radiation Oncology, University of Heidelberg, INF 400, 69120,

Heidelberg, Germany.

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Helical tomotherapy was introduced into clinical routine at the Department

of Radiation Oncology, University Hospital of Heidelberg, Germany, in July

2006. This report is intended to describe the experience with the first 150

patients treated with helical tomotherapy. Patient selection, time effort,

handling of daily image guidance with megavoltage (MV) CT, and quality of

radiation plans shall be assessed.

Between July 2006 and May 2007, 150 patients were treated with helical

tomotherapy in the University Hospital of Heidelberg. Mean age was 60 years

with a minimum of 30 years and a maximum of 85 years. 79 of these patients

received radiotherapy as a part of multimodal treatment pre- or

postoperatively, 17 patients received treatment as a combined

radiochemotherapy. 76% were treated with curative intent. Radiotherapy sites

were central nervous system (n = 7), head and neck (n = 28), thoracic (n =

37), abdominal (n = 58) and skeletal system (n = 20). Most common tumor

entities were prostate cancer (n = 28), breast cancer (n = 17),

gastrointestinal tumors (n = 19), pharyngeal carcinoma (n = 14), lymphoma (n

= 13), metastatic disease (bone n = 14, liver n = 6, lung n = 4, lymph node

n = 2), sarcoma (n = 8), malignant pleural mesothelioma (n = 5), ovarian

cancer treated with whole abdominal irradiation (n = 4), lung cancer (n =

3), skin malignancies (n = 3), chordoma (n = 2), meningioma (n = 2), one

ependymoma and one medulloblastoma treated with craniospinal axis

irradiation (n = 2), and others (n = 4). Nine patients were treated with

single-fraction radiosurgery, nine with image-guided spinal reirradiation,

and twelve patients were treated at multiple targets simultaneously. A

pretreatment MV-CT scan was performed in 98.2% of the 3,026 fractions

applied. After matching with the kilovoltage planning CT, corrections for

translations and rotation around longitudinal axis (roll) were done.

Mean time on table was 24.8 min for the mentioned tumor entities with

fractionated radiation, mean treatment time 10.7 min. Mean correction vector

after MV-CT registration was 6.9 mm. With helical tomotherapy it was

possible to achieve highly conformal dose distributions for targets of all

sizes and multiple targets within one procedure. Image guidance with MV-CT

allowed daily position correction and safe and precise treatment

application. This was feasible even if the desired immobilization was not

possible due to obesity, claustrophobia, pain, or neurologic or orthopedic

impairment.

Helical tomotherapy and daily image guidance with MV-CT could fast be

introduced into daily clinical routine. This technique allows precise

intensity-modulated radiotherapy (IMRT) in standard cases and offers new

treatment options in a huge variety of difficult cases.

Written by

Sterzing F, Schubert K, Sroka- G, Kalz J, Debus J, Herfarth K.

Reference

Strahlenther Onkol. 2008 Jan.

doi:10.1007/s00-6

PubMed Abstract

PMID:18188517