Tomoterapia ed ipofrazionamento

Current imaging methods permit an accurate target definition in radiotherapy considered as a fundamental requirement for precise treatment execution. The combination of PET/CT and tomotherapy has as its objective the early, accurate recognition of tumor extension (staging), optimal definition of treatment volume and complete response of the treated lesion, providing a valid alternative to surgery not only in advanced disease but also in potential surgical cases. This new technical approach has resulted in a previously unreachable level of selectivity in radiation therapy, together with more reliable target definition, better control of target position, improved patient set up reproducibility and dramatically dose fall-off between tumor and surrounding normal tissues. The clinical result consists not only in the possibility to deliver significantly higher dose but also the realization of hypofractionated treatments. Metabolically guided radiotherapy and hypofractionation can result in a series of advantages: improvement in treatment quality (set-up error reduction, effective dose fall-off and control of target movement); elevated disease control for the possibility of higher dose radiation and reduced side effects; greater frequency of complete clinical response with possibility of avoiding surgery; improved patient management (in terms of logistic and economic problems); more patients treated per machine with significant reduction of waiting list (the time factor from radiobiological perspective is an important variable to disease control); cost containment (by means of hypofractionation it is possible to reduce the number of treatment and consequently the total cost of therapy). To this end both methodological and clinical protocols have been drown up at our Institution (Hospital San Raffaele: HSR) and approved by the Ethics Committee. The clinical protocols are relative to treatment of pulmonary neoplasm, prostate cancer, head and neck cancer, pancreatic cancer, lung and liver lesions. In this paper the following issues will be considered: prostate cancer (radical and adjuvant treatment), liver and lung lesions and locally advanced pancreatic cancer. Copyright © 2007 by new Magazine edizioni s.r.l.