Speaker
Description
Ane Appelt, PhD, is Professor of Clinical Medical Physics at Rigshospitalet and the Technical University of Denmark, and Visiting Professor at the University of Leeds, UK. A clinically trained medical physicist, her research focuses on the development and implementation of novel radiotherapy methods & technology, with reirradiation as a major research theme.
Her work in reirradiation spans clinical practice, methodology and technical development, including deformable image registration, cumulative dose evaluation, radiobiological dose rescaling and treatment plan optimisation. She has worked closely with industry partners to translate developments into commercial treatment planning software. She founded the ESTRO Physics Working Group on Reirradiation, is a core member of the ESTRO Reirradiation Focus Group, and co-leads the international Reirradiation Collaborative Group (ReCOG). Her work has contributed to international consensus recommendations for reirradiation and to the development of multicentre clinical studies and prospective trials.
Summary
As cancer survival improves and the use of radiotherapy expands, increasing numbers of patients are considered for reirradiation. Safe and effective treatment requires information from previous radiotherapy to be evaluated and incorporated into treatment planning, but doing so introduces substantial technical and methodological challenges.
This presentation will review approaches to evaluating and accounting for previously delivered dose in reirradiation. This includes image registration and dose mapping between anatomies, rescaling to equieffective dose, and accumulation and evaluation of dose across multiple treatment courses. A key focus will be incorporation of previous dose directly into optimisation of reirradiation treatment plans. This requires optimisation objectives and cost functions that account for cumulative equieffective dose, while addressing situations in which previously delivered dose already exceeds specified constraints in individual voxels.
Finally, the presentation will consider uncertainty throughout this workflow. Registration, dose mapping and radiobiological modelling all introduce uncertainties that may vary substantially across the patient anatomy. Approaches for estimating spatially varying uncertainties, propagating these into cumulative dose evaluation, and incorporating uncertainty and robustness directly into reirradiation treatment plan optimisation will be discussed.