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. 2005 Jul 25;5(1):78-84.
doi: 10.1102/1470-7330.2005.0012.

Complications of Radiotherapy: Improving the Therapeutic Index

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Free PMC article

Complications of Radiotherapy: Improving the Therapeutic Index

Matthew Beasley et al. Cancer Imaging. .
Free PMC article

Abstract

For every course of radiotherapy treatment, the potential benefit has to be weighed against the risk of normal tissue damage. Radiation-induced proctitis during and after radical radiotherapy for prostate cancer can be decreased by reducing both the size of the target volume and the margins required around this volume. In the future, target volumes could be reduced by both CT/MRI co-registration and dose painting using MR spectroscopy of choline and citrate in the prostate. Improved immobilisation and image-guided radiotherapy should allow reduced margins without compromising the effectiveness of treatment. Similarly, in breast radiotherapy treatment, lung and cardiac complications can be reduced by better patient positioning and ensuring that doses to the heart and lung are minimised during radiotherapy treatment planning. Cosmesis can be improved by using 3D breast planning techniques rather than the conventional 2D approach. These ongoing improvements and developments in radiotherapy treatment planning are leading to treatments which offer both better tumour volume coverage, and are minimising the risk of treatment-related complications. In time, these changes should allow the escalation in dose delivered to the tumour volume with the potential for increased cure rates.

Figures

Figure 1
Figure 1
Idealised dose–response curve. For increase in dose from level 1 to 2 there is a small increase in tumour control but a much larger increase in treatment complication probability.
Figure 2
Figure 2
Dose volume histogram (DVH) for rectum in radical prostate radiotherapy showing that 20% of the rectum receives over 50 Gy for this patient.
Figure 3
Figure 3
Radiotherapy treatment planning film for breast radiotherapy showing cardiac shielding. Maximum heart distance (MHD)=1 cm, central lung distance (CLD)=2 cm.
Figure 4
Figure 4
CT generated digitally reconstructed radiograph (DRR) of breast treatment field showing that cardiac shielding is not compromising dose to outlined tumour bed in this patient.

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