Helical Tomotherapy: Image-guided Intensity Modulated Radiation Therapy

Ki Chang Keum

doi:10.5124/jkma.2008.51.7.619

J Korean Med Assoc > Volume 51(7); 2008 > Article

Keum: Helical Tomotherapy: Image-guided Intensity Modulated Radiation Therapy

Focused Issue of This Month

Cancer Therapy Using State-of-the-Art Radiotherapy Devices

Journal of the Korean Medical Association

Journal of the Korean Medical Association 2008; 51(7): 619-629.

Published online: July 31, 2008

DOI: http://dx.doi.org/10.5124/jkma.2008.51.7.619

Helical Tomotherapy: Image-guided Intensity Modulated Radiation Therapy

Ki Chang Keum, MD

Department of Radiation Oncology, Yonsei University College of Medicine, Korea. kckeum@yuhs.ac

Abstract

Helical tomotherapy is an image-guided, intensity-modulated radiation therapy delivery system, a hybrid between a linear accelerator and a helical CT scanner. With its unique design features, tomotherapy has improved dose conformity and homogeneity of the target volumes, and conformal avoidance of the adjacent normal tissues. The daily pretreatment megavoltage computed tomography (MVCT) is a powerful tool used in image guided treatment delivery and patient setup verification. If anatomic changes occur during the course of treatment, MVCT images are utilized in correcting target volumes and constructing appropriate adaptive plans. Helical tomotherapy can be applied to more complicated cases, where conventional techniques find their limits: complex tumors with critical organ sparing, simultaneous irradiation of multiple targets, large volume and large superficial tumor irradiation, and recurrent tumor re-irradiation are a few examples. Tomothearpy may change the current paradigm in radiation oncology in the near future. Further studies regarding clinical implementation and treatment outcome of helical tomotherapy will be needed.

Helical tomotherapy; Image-guided; IMRT; MVCT

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Figure 1

Hi-Art tomotherapy machine.

Figure 2

Tomotherapy plan for tonsillar cancer.

Figure 3

Shifting in parotid gland location due to patient's weight loss after radiation therapy for nasopharyngeal cancer: MVCT merged images (A) before, and (B) during tomotherapy (arrow: parotid gland).

Figure 4

Flow chart for tomotherapy with an adaptive plan.

Figure 5

Dose distribution in metastatic spinal tumor irradiation.

Figure 6

Tomotherapy planning in a complicated case of multiple metastases including sternum and the whole spine.

Figure 7

Dose distribution in cranio-spinal irradiation.

Figure 8

Comparisons of 3D conformal RT, LINAC based IMRT and tomotherapy for whole abdominal irradiation, using specific organ dose-volume histograms (A) Liver (B) Left kidney (C) Bone marrow.

Figure 9

Dose distribution in irradiation of skin metastasis from breast cancer.

Figure 10

A 72-year-old man who received tomotherapy for scalp angiosarcoma (A) before, (B) immediately after, (C) 3 months after tomotherapy.

Figure 11

Re-irradiation of recurrent lacrimal sac cancer previously treated with 60 Gy eight years ago: CT images (A) before re-irradiation (B) immediately after and (C) 1 year after tomotherapy, and (D) FDG-PET Image 1 year after tomotherapy (arrow: recurred mass).

Figure 12

Complete remission in recurrent rectal cancer after re-irradiation with tomotherapy: (A) before re-irradiation (B) 1 month after, and (C) 4 month after tomotherapy (upper: CT images, lower: PET-CT fusion images) (arrow: recurred mass).