Improved treatment quality, planning and treatment delivery time through new technologies for intensity modulated whole abdominopelvic radiation therapy in ovarian cancer

• Applicant: Dr. Nathalie Rochet
• Subject Area: Nuclear Medicine, Radiotherapy, Radiobiology
• Term: from 2012 to 2013
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 230949589

Despite the aggressiveness of the current standard treatment, consisting of surgery and chemotherapy, the prognosis for patients with advanced ovarian cancer remains poor. Most of the patients will experience tumor recurrence, in the vast majority of cases within the peritoneal cavity, and will die of it. Ovarian cancer is a radiosensitive tumor; therefore in the 50s and 60s, whole abdominopelvic radiotherapy (WART) was a standard adjuvant treatment. As the radiation field is very large and includes several organs at risk (bone marrow, kidneys, liver), WART using the conventional ap/pa technique is associated with a high rate of severe side effects. As a matter of fact, radiotherapy has been increasingly abandoned in the management of ovarian cancer.Now that radiotherapy equipment and techniques have improved, new techniques like intensity-modulated radiotherapy (IMRT) allow a more accurate irradiation of complex target volumes. As shown for the first time in Heidelberg, intensity-modulated WART is feasible, enables an excellent coverage of the peritoneal cavity while effectively sparing organs at risk and is well tolerated by patients. However, to date, intensity-modulated WART remains a very elaborate and time consuming procedure and is therefore marginally available.Emerging technologies in the field of radiotherapy now have the potential to improve treatment quality as well as treatment planning and delivery time.Multicriteria optimization is a planning optimization method designed to improve planning time and plan quality for IMRT. This new tool also makes the complex optimization procedure much easier and intuitive for physicians to use than conventional software.Volumetric modulated arc therapy (VMAT) from Elekta Medical Systems is a new high-speed IMRT technology which allows the radiation dose to be delivered accurately and efficiently in significantly shorter treatment time. Proton therapy is a type of particle therapy which has, due to the peculiar physical properties of protons, the ability to more precisely localize the radiation dosage when compared with other types of external beam radiotherapy using x-rays. This increased precision of proton therapy is used to reduce unwanted side effects, by limiting the dose to normal tissue and to treat tumors with a higher dose. Proton pencil-beam scanning is an emerging technique in the field of proton therapy which enables intensity modulated proton therapy (IMRT), making the treatment of larger and complex target volumes possible. To our knowledge, none of the above mentioned technologies has been used for intensity-modulated WART therapy so far.The goal of my research fellowship at the Department of Radiation Oncology at Massachusetts General Hospital - Harvard Medical School in Boston is to study these techniques in the light of their potential to improve WART. At the end, the obtained results will be compared with the previous data from Heidelberg.

• DFG Programme: Research Fellowships
• International Connection: USA
• Host: Professor Dr. Thomas Bortfeld