Considerations about radiooncology for the 21st century

Problems of radiooncology: Radiation therapy and surgery are the principal methods to treat tumors. But, many tumor patients can not yet be cured. Radiooncology: Consequent application of the target volume concept and tolerance dose concept in treatment planning and dose specification will gain improved, evaluable clinical results and thus the biological objectives for treatment optimization. Dosimetry and planning: Tissue substituting detectors allow precise and fast 3D-absorbed dose measurement, dosimetric treatment planning and quality assurance. Improved physical and anatomical 3D-patient models from wide gantry CT, MRI and PET, Monte Carlo and biology based inverse planning, as well as complete beam models (spectra, fluence, dose) delivered with identical, pre-set accelerators, will enable 3D-conformal therapy planning. Dose delivery and verification: Compact, precise RT-systems (e.g. high frequency minac-microtrons) with dynamic MLC for all types of radiation and comprehensive radiotherapy-data and imaging-data networks with clear defined open interfaces and standardized protocols, together with precise digital simulators, diagnostic quality RT-verification and RT-tomography for integrated synergetic presentation of verification, control and documentation, permit optimal curative conformation therapy of target volumes of 1st, 2nd, 3rd order under optimal sparing of organs art risk. Recommendations: New oncological concepts, physical ideas and technical ways are demanded to overcome this situation, a challenging task for medical physicists. Radiobiological knowledge and medical physics understanding, needed for radiooncologists and medical physicists as well as for developing engineers and sales managers, will help to improve tumor radiotherapy