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Wang L, Sanders J, Ward JF, Lee SR, Poenisch F, Swanson DM, Sahoo N, Zhu XR, Ma J, Kudchadker RJ, Choi SL, Nguyen QN, Mayo LL, Shah SJ, Frank SJ. A Novel Polymer-Encapsulated Multi-Imaging Modality Fiducial Marker with Positive Signal Contrast for Image-Guided Radiation Therapy. Cancers (Basel) 2024; 16:625. [PMID: 38339376 PMCID: PMC10854757 DOI: 10.3390/cancers16030625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 01/22/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Current fiducial markers (FMs) in external-beam radiotherapy (EBRT) for prostate cancer (PCa) cannot be positively visualized on magnetic resonance imaging (MRI) and create dose perturbation and significant imaging artifacts on computed tomography (CT) and MRI. We report our initial experience with clinical imaging of a novel multimodality FM, NOVA. METHODS We tested Gold Anchor [G-FM], BiomarC [carbon, C-FM], and NOVA FMs in phantoms imaged with kilovoltage (kV) X-rays, transrectal ultrasound (TRUS), CT, and MRI. Artifacts of the FMs on CT were quantified by the relative streak artifacts level (rSAL) metric. Proton dose perturbations (PDPs) were measured with Gafchromic EBT3 film, with FMs oriented either perpendicular to or parallel with the beam axis. We also tested the performance of NOVA-FMs in a patient. RESULTS NOVA-FMs were positively visualized on all 4 imaging modalities tested. The rSAL on CT was 0.750 ± 0.335 for 2-mm reconstructed slices. In F-tests, PDP was associated with marker type and depth of measurement (p < 10-6); at 5-mm depth, PDP was significantly greater for the G-FM (12.9%, p = 10-6) and C-FM (6.0%, p = 0.011) than NOVA (4.5%). EBRT planning with MRI/CT image co-registration and daily alignments using NOVA-FMs in a patient was feasible and reproducible. CONCLUSIONS NOVA-FMs were positively visible and produced less PDP than G-FMs or C-FMs. NOVA-FMs facilitated MRI/CT fusion and identification of regions of interest.
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Affiliation(s)
- Li Wang
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Jeremiah Sanders
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (J.S.); (J.M.)
| | - John F. Ward
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Stephen R. Lee
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Falk Poenisch
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (F.P.); (N.S.); (X.R.Z.); (R.J.K.)
| | - David Michael Swanson
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Narayan Sahoo
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (F.P.); (N.S.); (X.R.Z.); (R.J.K.)
| | - Xiaorong Ronald Zhu
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (F.P.); (N.S.); (X.R.Z.); (R.J.K.)
| | - Jingfei Ma
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (J.S.); (J.M.)
| | - Rajat J. Kudchadker
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (F.P.); (N.S.); (X.R.Z.); (R.J.K.)
| | - Seungtaek L. Choi
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (S.L.C.); (Q.-N.N.); (L.L.M.); (S.J.S.)
| | - Quynh-Nhu Nguyen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (S.L.C.); (Q.-N.N.); (L.L.M.); (S.J.S.)
| | - Lauren L. Mayo
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (S.L.C.); (Q.-N.N.); (L.L.M.); (S.J.S.)
| | - Shalin J. Shah
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (S.L.C.); (Q.-N.N.); (L.L.M.); (S.J.S.)
| | - Steven J. Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (S.L.C.); (Q.-N.N.); (L.L.M.); (S.J.S.)
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Hanzlikova P, Vilimek D, Vilimkova Kahankova R, Ladrova M, Skopelidou V, Ruzickova Z, Martinek R, Cvek J. Longitudinal analysis of T2 relaxation time variations following radiotherapy for prostate cancer. Heliyon 2024; 10:e24557. [PMID: 38298676 PMCID: PMC10828070 DOI: 10.1016/j.heliyon.2024.e24557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 12/02/2023] [Accepted: 01/10/2024] [Indexed: 02/02/2024] Open
Abstract
Aim of this paper is to evaluate short and long-term changes in T 2 relaxation times after radiotherapy in patients with low and intermediate risk localized prostate cancer. A total of 24 patients were selected for this retrospective study. Each participant underwent 1.5T magnetic resonance imaging on seven separate occasions: initially after the implantation of gold fiducials, the required step for Cyberknife therapy guidance, followed by MRI scans two weeks post-therapy and monthly thereafter. As part of each MRI scan, the prostate region was manually delineated, and the T 2 relaxation times were calculated for quantitative analysis. The T 2 relaxation times between individual follow-ups were analyzed using Repeated Measures Analysis of Variance that revealed a significant difference across all measurements (F (6, 120) = 0.611, p << 0.001). A Bonferroni post hoc test revealed significant differences in median T 2 values between the baseline and subsequent measurements, particularly between pre-therapy (M 0 ) and two weeks post-therapy (M 1 ), as well as during the monthly interval checks (M 2 - M 6 ). Some cases showed a delayed decrease in relaxation times, indicating the prolonged effects of therapy. The changes in T 2 values during the course of radiotherapy can help in monitoring radiotherapy response in unconfirmed patients, quantifying the scarring process, and recognizing the therapy failure.
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Affiliation(s)
- Pavla Hanzlikova
- Department of Radiology, University Hospital Ostrava, Czech Republic
- Department of Imaging Methods, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Dominik Vilimek
- Department of Cybernetics and Biomedical Engineering, Faculty of Electrical Engineering and Computer Science, VSB - Technical University of Ostrava, 17. listopadu 15, Ostrava – Poruba, 708 00, Czech Republic
| | - Radana Vilimkova Kahankova
- Department of Cybernetics and Biomedical Engineering, Faculty of Electrical Engineering and Computer Science, VSB - Technical University of Ostrava, 17. listopadu 15, Ostrava – Poruba, 708 00, Czech Republic
| | - Martina Ladrova
- Department of Cybernetics and Biomedical Engineering, Faculty of Electrical Engineering and Computer Science, VSB - Technical University of Ostrava, 17. listopadu 15, Ostrava – Poruba, 708 00, Czech Republic
| | - Valeria Skopelidou
- Institute of Molecular and Clinical Pathology and Medical Genetics, University Hospital Ostrava, 70852, Ostrava, Czech Republic
- Institute of Molecular and Clinical Pathology and Medical Genetics, Faculty of Medicine, University of Ostrava, 70300, Ostrava, Czech Republic
| | - Zuzana Ruzickova
- Faculty of Medicine, University of Ostrava, 70300 Ostrava, Czech Republic
- Department of Oncology, University Hospital Ostrava, 70852 Ostrava, Czech Republic
| | - Radek Martinek
- Department of Cybernetics and Biomedical Engineering, Faculty of Electrical Engineering and Computer Science, VSB - Technical University of Ostrava, 17. listopadu 15, Ostrava – Poruba, 708 00, Czech Republic
| | - Jakub Cvek
- Faculty of Medicine, University of Ostrava, 70300 Ostrava, Czech Republic
- Department of Oncology, University Hospital Ostrava, 70852 Ostrava, Czech Republic
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Ainsworth V, Moreau M, Guthier R, Zegeye Y, Kozono D, Swanson W, Jandel M, Oh P, Quon H, Hobbs RF, Yasmin-Karim S, Sajo E, Ngwa W. Smart Radiotherapy Biomaterials for Image-Guided In Situ Cancer Vaccination. NANOMATERIALS (BASEL, SWITZERLAND) 2023; 13:1844. [PMID: 37368273 PMCID: PMC10303169 DOI: 10.3390/nano13121844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 06/28/2023]
Abstract
Recent studies have highlighted the potential of smart radiotherapy biomaterials (SRBs) for combining radiotherapy and immunotherapy. These SRBs include smart fiducial markers and smart nanoparticles made with high atomic number materials that can provide requisite image contrast during radiotherapy, increase tumor immunogenicity, and provide sustained local delivery of immunotherapy. Here, we review the state-of-the-art in this area of research, the challenges and opportunities, with a focus on in situ vaccination to expand the role of radiotherapy in the treatment of both local and metastatic disease. A roadmap for clinical translation is outlined with a focus on specific cancers where such an approach is readily translatable or will have the highest impact. The potential of FLASH radiotherapy to synergize with SRBs is discussed including prospects for using SRBs in place of currently used inert radiotherapy biomaterials such as fiducial markers, or spacers. While the bulk of this review focuses on the last decade, in some cases, relevant foundational work extends as far back as the last two and half decades.
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Affiliation(s)
- Victoria Ainsworth
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD 21201, USA; (M.M.); (H.Q.); (R.F.H.)
- Department of Physics, Medical Physics, University of Massachusetts Lowell, Lowell, MA 01854, USA (M.J.); (E.S.)
| | - Michele Moreau
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD 21201, USA; (M.M.); (H.Q.); (R.F.H.)
- Department of Physics, Medical Physics, University of Massachusetts Lowell, Lowell, MA 01854, USA (M.J.); (E.S.)
| | - Romy Guthier
- Department of Physics, Medical Physics, University of Massachusetts Lowell, Lowell, MA 01854, USA (M.J.); (E.S.)
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA; (Y.Z.); (D.K.); (S.Y.-K.)
| | - Ysaac Zegeye
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA; (Y.Z.); (D.K.); (S.Y.-K.)
- Department of Cell and Molecular Biology, Northeastern University, Boston, MA 02115, USA
| | - David Kozono
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA; (Y.Z.); (D.K.); (S.Y.-K.)
| | - William Swanson
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY 10065, USA;
| | - Marian Jandel
- Department of Physics, Medical Physics, University of Massachusetts Lowell, Lowell, MA 01854, USA (M.J.); (E.S.)
| | - Philmo Oh
- NanoCan Therapeutics Corporation, Princeton, NJ 08540, USA;
| | - Harry Quon
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD 21201, USA; (M.M.); (H.Q.); (R.F.H.)
| | - Robert F. Hobbs
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD 21201, USA; (M.M.); (H.Q.); (R.F.H.)
| | - Sayeda Yasmin-Karim
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA; (Y.Z.); (D.K.); (S.Y.-K.)
- Department of Radiation Oncology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Erno Sajo
- Department of Physics, Medical Physics, University of Massachusetts Lowell, Lowell, MA 01854, USA (M.J.); (E.S.)
| | - Wilfred Ngwa
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD 21201, USA; (M.M.); (H.Q.); (R.F.H.)
- Department of Physics, Medical Physics, University of Massachusetts Lowell, Lowell, MA 01854, USA (M.J.); (E.S.)
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Brown K, Ghita M, Prise KM, Butterworth KT. Feasibility and guidelines for the use of an injectable fiducial marker (BioXmark ®) to improve target delineation in preclinical radiotherapy studies using mouse models. F1000Res 2023; 12:526. [PMID: 38799243 PMCID: PMC11116939 DOI: 10.12688/f1000research.130883.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Preclinical models of radiotherapy (RT) response are vital for the continued success and evolution of RT in the treatment of cancer. The irradiation of tissues in mouse models necessitates high levels of precision and accuracy to recapitulate clinical exposures and limit adverse effects on animal welfare. This requirement has been met by technological advances in preclinical RT platforms established over the past decade. Small animal RT systems use onboard computed tomography (CT) imaging to delineate target volumes and have significantly refined radiobiology experiments with major 3Rs impacts. However, the CT imaging is limited by the differential attenuation of tissues resulting in poor contrast in soft tissues. Clinically, radio-opaque fiducial markers (FMs) are used to establish anatomical reference points during treatment planning to ensure accuracy beam targeting, this approach is yet to translate back preclinical models. METHODS We report on the use of a novel liquid FM BioXmark ® developed by Nanovi A/S (Kongens Lyngby, Denmark) that can be used to improve the visualisation of soft tissue targets during beam targeting and minimise dose to surrounding organs at risk. We present descriptive protocols and methods for the use of BioXmark ® in experimental male and female C57BL/6J mouse models. RESULTS These guidelines outline the optimum needle size for uptake (18-gauge) and injection (25- or 26-gauge) of BioXmark ® for use in mouse models along with recommended injection volumes (10-20 µl) for visualisation on preclinical cone beam CT (CBCT) scans. Injection techniques include subcutaneous, intraperitoneal, intra-tumoral and prostate injections. CONCLUSIONS The use of BioXmark ® can help to standardise targeting methods, improve alignment in preclinical image-guided RT and significantly improve the welfare of experimental animals with the reduction of normal tissue exposure to RT.
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Affiliation(s)
- Kathryn Brown
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, BT9 7AE, UK
| | - Mihaela Ghita
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, BT9 7AE, UK
| | - Kevin M Prise
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, BT9 7AE, UK
| | - Karl T Butterworth
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, BT9 7AE, UK
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Moreau M, Richards G, Yasmin-Karim S, Narang A, Deville C, Ngwa W. A liquid immunogenic fiducial eluter for image-guided radiotherapy. Front Oncol 2022; 12:1020088. [PMID: 36620560 PMCID: PMC9812550 DOI: 10.3389/fonc.2022.1020088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Fiducials are routinely used to provide image-guidance during radiotherapy. Here, a new nanoparticle-based liquid immunogenic fiducial is investigated for its potential to provide image-guidance, while also enhancing treatment outcomes. Methods This fiducial, liquid immunogenic fiducial eluter (LIFE) biomaterial, is formulated with natural biodegradable polymers, chitosan and sodium alginate with radio-sensitizing nanoparticles, and immunoadjuvant like anti-CD40 monoclonal antibody. Once administered intra-tumorally, this liquid smart radiotherapy biomaterial congeals within the calcium rich tumor microenvironment. The potential use of LIFE biomaterial for providing image guidance in magnetic resonance imaging (MRI) and computed tomography (CT) was investigated over different time period in a pre-clinical tumored mouse model. Results Results showed that the LIFE biomaterial can provide both MRI contrast and CT imaging contrast over 3-weeks, with gradual decrease of the contrast over time, as the LIFE biomaterial biodegrades. Results also showed the LIFE biomaterial significantly slowed tumor growth and prolonged mice survival (p < 0.0001) over time. Discussion The results highlight the potential use of the LIFE biomaterial as a multi-functional smart radiotherapy biomaterial that could be developed and optimized for hypo-fractionated radiotherapy applications and combining radiotherapy with immunoadjuvants.
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Affiliation(s)
- Michele Moreau
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States,Department of Radiation Oncology and Molecular Radiation Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, United States,Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States,*Correspondence: Michele Moreau, ; Wilfred Ngwa,
| | - Geraud Richards
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
| | - Sayeda Yasmin-Karim
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
| | - Amol Narang
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Curtiland Deville
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Wilfred Ngwa
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States,Department of Radiation Oncology and Molecular Radiation Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, United States,Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States,*Correspondence: Michele Moreau, ; Wilfred Ngwa,
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Hybrid 3D T1-weighted gradient-echo sequence for fiducial marker detection and tumor delineation via magnetic resonance imaging in liver stereotactic body radiation therapy. Phys Med 2022; 95:9-15. [DOI: 10.1016/j.ejmp.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/08/2022] [Accepted: 01/11/2022] [Indexed: 11/24/2022] Open
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Yasue K, Fuse H, Asano Y, Kato M, Shinoda K, Ikoma H, Fujisaki T, Tamaki Y. Investigation of fiducial marker recognition possibility by water equivalent length in real-time tracking radiotherapy. Jpn J Radiol 2021; 40:318-325. [PMID: 34655387 DOI: 10.1007/s11604-021-01207-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/30/2021] [Indexed: 12/28/2022]
Abstract
Real-time tumor tracking radiotherapy (RTRT) systems typically use fiducial markers implanted near the tumor to track the target using X-ray fluoroscopy. Template pattern matching, used in tracking, is often used to automatically localize the fiducial markers. In radiotherapy of the liver, the thickness of the body that can recognize the fiducial markers must be clinically assessed. The purpose of this study was to quantify the recognition of fiducial markers according to body thickness in stereotactic body radiotherapy of the liver using clinical images obtained using SyncTraX FX4. The recognition scores of fiducial markers were examined in relation to water equivalent length (WEL), tube current, and each flat panel detector. The relationship between the contrast ratio of the fiducial marker and the background and the WEL was also investigated. The average recognition score was found to be less than 20 when the WEL was greater than 25 cm. The probability of successful tracking of image recognition was mostly smaller than 0.8 when the WEL was over 30 cm. The relationship between WEL and tube current did not significantly differ between 100 and 140 mA, but there was a significant difference (p < 0.05) for all other combinations. To ensure tracking of fiducial markers during SBRT, if the WEL representing body thickness is longer than 25 cm, the X-ray fluoroscopy arrangement should be determined based on the WEL.
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Affiliation(s)
- Kenji Yasue
- Graduate School of Health Sciences, Ibaraki Prefectural University of Health Sciences, 4669-2, Ami, Inashiki, Ibaraki, 300-0394, Japan.,Department of Radiation Technology, Ibaraki Prefectural Central Hospital, 6528, Koibuchi, Kasama, Ibaraki, 309-1793, Japan
| | - Hiraku Fuse
- Department of Radiological Sciences, Ibaraki Prefectural University of Health Sciences, 4669-2, Ami, Inashiki, Ibaraki, 300-0394, Japan.
| | - Yuto Asano
- Department of Radiation Technology, Ibaraki Prefectural Central Hospital, 6528, Koibuchi, Kasama, Ibaraki, 309-1793, Japan
| | - Miho Kato
- Department of Radiation Technology, Ibaraki Prefectural Central Hospital, 6528, Koibuchi, Kasama, Ibaraki, 309-1793, Japan
| | - Kazuya Shinoda
- Department of Radiation Technology, Ibaraki Prefectural Central Hospital, 6528, Koibuchi, Kasama, Ibaraki, 309-1793, Japan
| | - Hideaki Ikoma
- Department of Radiation Technology, Ibaraki Prefectural Central Hospital, 6528, Koibuchi, Kasama, Ibaraki, 309-1793, Japan
| | - Tatsuya Fujisaki
- Department of Radiological Sciences, Ibaraki Prefectural University of Health Sciences, 4669-2, Ami, Inashiki, Ibaraki, 300-0394, Japan
| | - Yoshio Tamaki
- Department of Radiation Oncology, Ibaraki Prefectural Central Hospital, 6528, Koibuchi, Kasama, Ibaraki, 309-1793, Japan
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Kong V, Hansen VN, Hafeez S. Image-guided Adaptive Radiotherapy for Bladder Cancer. Clin Oncol (R Coll Radiol) 2021; 33:350-368. [PMID: 33972024 DOI: 10.1016/j.clon.2021.03.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 03/30/2021] [Indexed: 12/12/2022]
Abstract
Technological advancement has facilitated patient-specific radiotherapy in bladder cancer. This has been made possible by developments in image-guided radiotherapy (IGRT). Particularly transformative has been the integration of volumetric imaging into the workflow. The ability to visualise the bladder target using cone beam computed tomography and magnetic resonance imaging initially assisted with determining the magnitude of inter- and intra-fraction target change. It has led to greater confidence in ascertaining true anatomy at each fraction. The increased certainty of dose delivered to the bladder has permitted the safe reduction of planning target volume margins. IGRT has therefore improved target coverage with a reduction in integral dose to the surrounding tissue. Use of IGRT to feed back into plan and dose delivery optimisation according to the anatomy of the day has enabled adaptive radiotherapy bladder solutions. Here we undertake a review of the stepwise developments underpinning IGRT and adaptive radiotherapy strategies for external beam bladder cancer radiotherapy. We present the evidence in accordance with the framework for systematic clinical evaluation of technical innovations in radiation oncology (R-IDEAL).
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Affiliation(s)
- V Kong
- Radiation Medicine, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - V N Hansen
- Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
| | - S Hafeez
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK.
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Oglesby RT, Lam WW, Stanisz GJ. A strategy to prevent a temperature-induced MRI artifact in warm liquid phantoms due to convection currents. NMR IN BIOMEDICINE 2021; 34:e4494. [PMID: 33586271 DOI: 10.1002/nbm.4494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/16/2021] [Accepted: 02/02/2021] [Indexed: 06/12/2023]
Abstract
MRI phantom studies often fail to mimic the temperature of the human body, which can negatively impact accuracy. An artifact induced by increasing temperature in liquid phantoms was observed, presenting a significant challenge to temperature-controlled experiments. In this study we characterize and provide a solution to eliminate this temperature-induced MRI artifact. Low concentration (0.5-2.5 mM) agar phantoms were prepared. Utilizing a temperature-controlled phantom holder, T1 - and T2 -weighted structural images were acquired at 7 T along with quantitative B0 , B1 , T1 , T2 and ADC maps at both 25 and 37°C. Additionally, computer simulations were conducted to demonstrate the fluid flow and thermal flux patterns in water to provide an insight into the origins of the artifact. Evidence from computer simulation and quantitative MRI strongly suggest the artifact was caused by heat transfer in the form of natural convection leading to structured patterns of signal loss in MR images. The artifact was present up to agar concentrations of 1.5 mM (T1 = 3068 ± 16 ms, T2 = 1052 ± 20 ms, ADC = 2.29 ± 0.36 × 10-3 mm2 /s at 25°C; T1 = 3928 ± 44 ms, T2 = 1122 ± 24 ms, ADC = 2.64 ± 0.49 × 10-3 mm2 /s at 37°C), above which point increased sample viscosity no longer allows for convection currents, thereby eliminating the artifact. The methodology described in this work simplifies quantitative MR acquisition of liquid phantoms at physiological temperature by suppressing convection currents with relatively small changes to intrinsic MR parameters (T1 increased by 1.4% and T2 decreased by 17% for 1.5 mM agar at 25°C).
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Affiliation(s)
- Ryan T Oglesby
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
- Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Wilfred W Lam
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Greg J Stanisz
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
- Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Neurosurgery and Paediatric Neurosurgery, Medical University of Lublin, Lublin, Poland
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Wang W, Hansen AE, Sun H, Fliedner FP, Kjaer A, Jensen AI, Andresen TL, Henriksen JR. Carbohydrate based biomarkers enable hybrid near infrared fluorescence and 64Cu based radio-guidance for improved surgical precision. Nanotheranostics 2021; 5:448-460. [PMID: 34055574 PMCID: PMC8156217 DOI: 10.7150/ntno.60295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/04/2021] [Indexed: 01/15/2023] Open
Abstract
Increasing numbers of lung tumors are identified at early disease stages by diagnostic imaging in screening programs, but difficulties in locating these during surgical intervention has prevented an improved treatment outcome. Surgical biomarkers that are visible on diagnostic images, and that provide the surgeon with real-time image guidance during the intervention are thus highly warranted to bridge diagnostic precision into enhanced therapeutic outcome. In this paper, a liquid soft tissue marker for near infrared fluorescence and radio-guidance is presented. The biocompatible marker is based on the carbohydrate ester, sucrose acetate isobutyrate, ethanol, and a multifunctional naphthalocyanine dye, which enable near infrared fluorescence image-guided resection at short, medium and long tissue depths. Naphthalocyanine dyes have high quantum yields and may further act as chelators of radionuclides. Upon injection of the liquid marker, a gel-like depot is formed in situ at the site of injection, wherein the fluorescent dye and radionuclide is retained. The radiolabeled markers were optimized for minimal fluorescence quenching and high retention of the positron emission tomography radionuclide 64Cu. The performance of the radiolabeled marker was tested in vivo in mice, where it displayed high photostability over a period of 4 weeks, and high retention of 64Cu for 48 hours. The retention and biodistribution of 64Cu was quantified via PET/CT, and the fluorescence emission by an in vivo imaging system. The presented data demonstrate proof-of-concept for naphthalocyanine markers as multimodal imaging agents that can bridge the precision of diagnostic imaging into surgical interventions.
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Affiliation(s)
- Wenbo Wang
- Technical University of Denmark, Department of Health Technology, Building 423, 2800 Lyngby, Denmark.,Center for Nanomedicine and Theranostics, Technical University of Denmark, 2800 Lyngby, Denmark
| | - Anders E Hansen
- Technical University of Denmark, Department of Health Technology, Building 423, 2800 Lyngby, Denmark.,Center for Nanomedicine and Theranostics, Technical University of Denmark, 2800 Lyngby, Denmark
| | - Hongmei Sun
- School of Bioengineering and Food, Key Laboratory of Fermentation Engineering, (Ministry of Education), Key Laboratory of Industrial Microbiology in Hubei, National '111' Center for Cellular Regulation and Molecular Pharmaceutic, Hubei province Cooperative Innovation Center for Industrial Fermentation, Hubei University of Technology, Wuhan 430068, China
| | - Frederikke P Fliedner
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Department of Biomedical Sciences, Rigshospitalet and University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Andreas Kjaer
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Department of Biomedical Sciences, Rigshospitalet and University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Andreas I Jensen
- Technical University of Denmark, The Hevesy Laboratory, Department of Health Technology, 4000 Roskilde, Denmark.,Center for Nanomedicine and Theranostics, Technical University of Denmark, 2800 Lyngby, Denmark
| | - Thomas L Andresen
- Technical University of Denmark, Department of Health Technology, Building 423, 2800 Lyngby, Denmark.,Center for Nanomedicine and Theranostics, Technical University of Denmark, 2800 Lyngby, Denmark
| | - Jonas R Henriksen
- Technical University of Denmark, Department of Health Technology, Building 423, 2800 Lyngby, Denmark.,Center for Nanomedicine and Theranostics, Technical University of Denmark, 2800 Lyngby, Denmark
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11
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Hijab A, Tocco B, Hanson I, Meijer H, Nyborg CJ, Bertelsen AS, Smeenk RJ, Smith G, Michalski J, Baumann BC, Hafeez S. MR-Guided Adaptive Radiotherapy for Bladder Cancer. Front Oncol 2021; 11:637591. [PMID: 33718230 PMCID: PMC7947660 DOI: 10.3389/fonc.2021.637591] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/11/2021] [Indexed: 12/14/2022] Open
Abstract
Radiotherapy has an important role in the curative and palliative treatment settings for bladder cancer. As a target for radiotherapy the bladder presents a number of technical challenges. These include poor tumor visualization and the variability in bladder size and position both between and during treatment delivery. Evidence favors the use of magnetic resonance imaging (MRI) as an important means of tumor visualization and local staging. The availability of hybrid systems incorporating both MRI scanning capabilities with the linear accelerator (MR-Linac) offers opportunity for in-room and real-time MRI scanning with ability of plan adaption at each fraction while the patient is on the treatment couch. This has a number of potential advantages for bladder cancer patients. In this article, we examine the technical challenges of bladder radiotherapy and explore how magnetic resonance (MR) guided radiotherapy (MRgRT) could be leveraged with the aim of improving bladder cancer patient outcomes. However, before routine clinical implementation robust evidence base to establish whether MRgRT translates into improved patient outcomes should be ascertained.
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Affiliation(s)
- Adham Hijab
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom.,Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Boris Tocco
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom.,Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Ian Hanson
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom.,Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Hanneke Meijer
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, Netherlands
| | | | | | - Robert Jan Smeenk
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Gillian Smith
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Jeff Michalski
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Brian C Baumann
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Shaista Hafeez
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom.,Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, United Kingdom
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12
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Fischman V, Ivanovic V, Jalisi S. A Bioresorbable Fiducial for Head and Neck Cancer. Otolaryngol Head Neck Surg 2020; 163:554-556. [DOI: 10.1177/0194599820921864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We aim to evaluate a novel bioresorbable fiducial for marking tumor bed margins in head and neck cancers (HNCs) to improve upon current use of nonresorbable materials. A feasibility test was done placing the marker (L-lactide and ε-caprolactone) in an orange for computed tomography (CT) and applesauce for T1-, T2-, and PD-weighted magnetic resonance imaging (MRI) image acquisition, using routine clinical parameters. The resulting CT and MRI images showed excellent delineation of the marker with all of its margins well seen without adjacent artifact. The marker appeared similar to air on CT and MRI, surrounded by fluid-like appearance of the medium. Surgical bed appearance when radiotherapy is planned should not produce any artifact near the marker, and there should be no inherent marker-related artifact. These pilot CT and MR images show clinical utility for intraoperative marking of positive margins in the skull base or neck to guide future treatment and monitoring.
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Affiliation(s)
- Victoria Fischman
- Tufts University School of Medicine, Boston, Massachusetts, USA
- Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Vladimir Ivanovic
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Scharukh Jalisi
- Division of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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13
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Hansen AE, Henriksen JR, Jølck RI, Fliedner FP, Bruun LM, Scherman J, Jensen AI, Munck af Rosenschöld P, Moorman L, Kurbegovic S, de Blanck SR, Larsen KR, Clementsen PF, Christensen AN, Clausen MH, Wang W, Kempen P, Christensen M, Viby NE, Persson G, Larsen R, Conradsen K, McEvoy FJ, Kjaer A, Eriksen T, Andresen TL. Multimodal soft tissue markers for bridging high-resolution diagnostic imaging with therapeutic intervention. SCIENCE ADVANCES 2020; 6:eabb5353. [PMID: 32875113 PMCID: PMC7438096 DOI: 10.1126/sciadv.abb5353] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/07/2020] [Indexed: 05/11/2023]
Abstract
Diagnostic imaging often outperforms the surgeon's ability to identify small structures during therapeutic procedures. Smart soft tissue markers that translate the sensitivity of diagnostic imaging into optimal therapeutic intervention are therefore highly warranted. This paper presents a unique adaptable liquid soft tissue marker system based on functionalized carbohydrates (Carbo-gel). The liquid state of these markers allows for high-precision placement under image guidance using thin needles. Based on step-by-step modifications, the image features and mechanical properties of markers can be optimized to bridge diagnostic imaging and specific therapeutic interventions. The performance of Carbo-gel is demonstrated for markers that (i) have radiographic, magnetic resonance, and ultrasound visibility; (ii) are palpable and visible; and (iii) are localizable by near-infrared fluorescence and radio guidance. The study demonstrates encouraging proof of concept for the liquid marker system as a well-tolerated multimodal imaging marker that can improve image-guided radiotherapy and surgical interventions, including robotic surgery.
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Affiliation(s)
- Anders E. Hansen
- DTU Health Technology, Section for Biotherapeutic Engineering and Drug Targeting, Center for Nanomedicine and Theranostics, Technical University of Denmark, Kgs. Lyngby DK-2800, Denmark
| | - Jonas R. Henriksen
- DTU Health Technology, Section for Biotherapeutic Engineering and Drug Targeting, Center for Nanomedicine and Theranostics, Technical University of Denmark, Kgs. Lyngby DK-2800, Denmark
| | - Rasmus I. Jølck
- DTU Health Technology, Section for Biotherapeutic Engineering and Drug Targeting, Center for Nanomedicine and Theranostics, Technical University of Denmark, Kgs. Lyngby DK-2800, Denmark
| | - Frederikke P. Fliedner
- Dept. of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Dept. of Biomedical Sciences, Copenhagen University Hospital (Rigshospitalet) and University of Copenhagen, Copenhagen, DK-2200, Denmark
| | - Linda M. Bruun
- DTU Health Technology, Section for Biotherapeutic Engineering and Drug Targeting, Center for Nanomedicine and Theranostics, Technical University of Denmark, Kgs. Lyngby DK-2800, Denmark
| | - Jonas Scherman
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund SE-222 42, Sweden
| | - Andreas I. Jensen
- DTU Health Technology, The Hevesy Laboratory, Technical University of Denmark, Roskilde DK-4000, Denmark
| | - Per. Munck af Rosenschöld
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund SE-222 42, Sweden
| | - Lilah Moorman
- Department of Veterinary Clinical and Animal Sciences, University of Copenhagen, Frederiksberg DK-1870, Denmark
| | - Sorel Kurbegovic
- Dept. of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Dept. of Biomedical Sciences, Copenhagen University Hospital (Rigshospitalet) and University of Copenhagen, Copenhagen, DK-2200, Denmark
| | - Steen R. de Blanck
- Department of Oncology, Copenhagen University Hospital (Rigshospitalet), Copenhagen DK-2100, Denmark
| | - Klaus R. Larsen
- Department of Respiratory Medicine, Copenhagen University Hospital (Bispebjerg and Frederiksberg Hospital), Copenhagen DK-2400, Denmark
| | - Paul F. Clementsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, DK-2100, Denmark
| | - Anders N. Christensen
- DTU Compute, Section for Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby DK-2800, Denmark
| | - Mads H. Clausen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital (Rigshospitalet), Copenhagen DK-2100, Denmark
| | - Wenbo Wang
- DTU Health Technology, Section for Biotherapeutic Engineering and Drug Targeting, Center for Nanomedicine and Theranostics, Technical University of Denmark, Kgs. Lyngby DK-2800, Denmark
| | - Paul Kempen
- DTU Health Technology, Section for Biotherapeutic Engineering and Drug Targeting, Center for Nanomedicine and Theranostics, Technical University of Denmark, Kgs. Lyngby DK-2800, Denmark
| | - Merete Christensen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital (Rigshospitalet), Copenhagen DK-2100, Denmark
| | - Niels-Erik Viby
- Department of Cardiothoracic Surgery, Copenhagen University Hospital (Rigshospitalet), Copenhagen DK-2100, Denmark
| | - Gitte Persson
- Department of Oncology, Herlev-Gentofte Hospital, Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen DK-2200, Denmark
| | - Rasmus Larsen
- DTU Compute, Section for Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby DK-2800, Denmark
| | - Knut Conradsen
- DTU Compute, Section for Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby DK-2800, Denmark
| | - Fintan J. McEvoy
- Department of Veterinary Clinical and Animal Sciences, University of Copenhagen, Frederiksberg DK-1870, Denmark
| | - Andreas Kjaer
- Dept. of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Dept. of Biomedical Sciences, Copenhagen University Hospital (Rigshospitalet) and University of Copenhagen, Copenhagen, DK-2200, Denmark
| | - Thomas Eriksen
- Department of Veterinary Clinical and Animal Sciences, University of Copenhagen, Frederiksberg DK-1870, Denmark
| | - Thomas L. Andresen
- DTU Health Technology, Section for Biotherapeutic Engineering and Drug Targeting, Center for Nanomedicine and Theranostics, Technical University of Denmark, Kgs. Lyngby DK-2800, Denmark
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14
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Evaluation of a Novel Liquid Fiducial Marker, BioXmark ®, for Small Animal Image-Guided Radiotherapy Applications. Cancers (Basel) 2020; 12:cancers12051276. [PMID: 32443537 PMCID: PMC7280978 DOI: 10.3390/cancers12051276] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 12/17/2022] Open
Abstract
BioXmark® (Nanovi A/S, Denmark) is a novel fiducial marker based on a liquid, iodine-based and non-metallic formulation. BioXmark® has been clinically validated and reverse translated to preclinical models to improve cone-beam CT (CBCT) target delineation in small animal image-guided radiotherapy (SAIGRT). However, in phantom image analysis and in vivo evaluation of radiobiological response after the injection of BioXmark® are yet to be reported. In phantom measurements were performed to compare CBCT imaging artefacts with solid fiducials and determine optimum imaging parameters for BioXmark®. In vivo stability of BioXmark® was assessed over a 5-month period, and the impact of BioXmark® on in vivo tumour response from single-fraction and fractionated X-ray exposures was investigated in a subcutaneous syngeneic tumour model. BioXmark® was stable, well tolerated and detectable on CBCT at volumes ≤10 µL. Our data showed imaging artefacts reduced by up to 84% and 89% compared to polymer and gold fiducial markers, respectively. BioXmark® was shown to have no significant impact on tumour growth in control animals, but changes were observed in irradiated animals injected with BioXmark® due to alterations in dose calculations induced by the sharp contrast enhancement. BioXmark® is superior to solid fiducials with reduced imaging artefacts on CBCT. With minimal impact on the tumour growth delay, BioXmark® can be implemented in SAIGRT to improve target delineation and reduce set-up errors.
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15
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Tryggestad EJ, Liu W, Pepin MD, Hallemeier CL, Sio TT. Managing treatment-related uncertainties in proton beam radiotherapy for gastrointestinal cancers. J Gastrointest Oncol 2020; 11:212-224. [PMID: 32175124 DOI: 10.21037/jgo.2019.11.07] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
In recent years, there has been rapid adaption of proton beam radiotherapy (RT) for treatment of various malignancies in the gastrointestinal (GI) tract, with increasing number of institutions implementing intensity modulated proton therapy (IMPT). We review the progress and existing literature regarding the technical aspects of RT planning for IMPT, and the existing tools that can help with the management of uncertainties which may impact the daily delivery of proton therapy. We provide an in-depth discussion regarding range uncertainties, dose calculations, image guidance requirements, organ and body cavity filling consideration, implanted devices and hardware, use of fiducials, breathing motion evaluations and both active and passive motion management methods, interplay effect, general IMPT treatment planning considerations including robustness plan evaluation and optimization, and finally plan monitoring and adaptation. These advances have improved confidence in delivery of IMPT for patients with GI malignancies under various scenarios.
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Affiliation(s)
- Erik J Tryggestad
- Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Wei Liu
- Department of Radiation Oncology, Mayo Clinic Phoenix, Phoenix, AZ, USA
| | - Mark D Pepin
- Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, MN, USA
| | | | - Terence T Sio
- Department of Radiation Oncology, Mayo Clinic Phoenix, Phoenix, AZ, USA
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16
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Osman SOS, Russell E, King RB, Crowther K, Jain S, McGrath C, Hounsell AR, Prise KM, McGarry CK. Fiducial markers visibility and artefacts in prostate cancer radiotherapy multi-modality imaging. Radiat Oncol 2019; 14:237. [PMID: 31878967 PMCID: PMC6933910 DOI: 10.1186/s13014-019-1447-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 12/15/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In this study, a novel pelvic phantom was developed and used to assess the visibility and presence of artefacts from different types of commercial fiducial markers (FMs) on multi-modality imaging relevant to prostate cancer. METHODS AND MATERIALS The phantom was designed with 3D printed hollow cubes in the centre. These cubes were filled with gel to mimic the prostate gland and two parallel PVC rods were used to mimic bones in the pelvic region. Each cube was filled with gelatine and three unique FMs were positioned with a clinically-relevant spatial distribution. The FMs investigated were; Gold Marker (GM) CIVCO, GM RiverPoint, GM Gold Anchor (GA) line and ball shape, and polymer marker (PM) from CIVCO. The phantom was scanned using several imaging modalities typically used to image prostate cancer patients; MRI, CT, CBCT, planar kV-pair, ExacTrac, 6MV, 2.5MV and integrated EPID imaging. The visibility of the markers and any observed artefacts in the phantom were compared to in-vivo scans of prostate cancer patients with FMs. RESULTS All GMs were visible in volumetric scans, however, they also had the most visible artefacts on CT and CBCT scans, with the magnitude of artefacts increasing with FM size. PM FMs had the least visible artefacts in volumetric scans but they were not visible on portal images and had poor visibility on lateral kV images. The smallest diameter GMs (GA) were the most difficult GMs to identify on lateral kV images. CONCLUSION The choice between different FMs is also dependent on the adopted IGRT strategy. PM was found to be superior to investigated gold markers in the most commonly used modalities in the management of prostate cancer; CT, CBCT and MRI imaging.
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Affiliation(s)
- Sarah O. S. Osman
- Centre of Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, Northern Ireland BT7 1NN UK
- Radiotherapy Physics, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - Emily Russell
- Centre of Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, Northern Ireland BT7 1NN UK
| | - Raymond B. King
- Radiotherapy Physics, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - Karen Crowther
- Radiotherapy Department, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - Suneil Jain
- Centre of Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, Northern Ireland BT7 1NN UK
- Clinical Oncology, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - Cormac McGrath
- Radiological Sciences and Imaging, Belfast Health and Social Care Trust, Forster Green Hospital, Belfast, UK
| | - Alan R. Hounsell
- Centre of Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, Northern Ireland BT7 1NN UK
- Radiotherapy Physics, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - Kevin M. Prise
- Centre of Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, Northern Ireland BT7 1NN UK
| | - Conor K. McGarry
- Centre of Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, Northern Ireland BT7 1NN UK
- Radiotherapy Physics, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, UK
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17
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Quantitative evaluation of image recognition performance of fiducial markers in real-time tumor-tracking radiation therapy. Phys Med 2019; 65:33-39. [DOI: 10.1016/j.ejmp.2019.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 08/01/2019] [Accepted: 08/02/2019] [Indexed: 11/15/2022] Open
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18
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Schneider S, Aust DE, Brückner S, Welsch T, Hampe J, Troost EGC, Hoffmann AL. Detectability and structural stability of a liquid fiducial marker in fresh ex vivo pancreas tumour resection specimens on CT and 3T MRI. Strahlenther Onkol 2019; 195:756-763. [PMID: 31143995 DOI: 10.1007/s00066-019-01474-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/03/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE To test the detectability of a liquid fiducial marker injected into ex vivo pancreas tumour tissue on magnetic resonance imaging (MRI) and computed tomography (CT). Furthermore, its injection performance using different needle sizes and its structural stability after fixation in formaldehyde were investigated. METHODS Liquid fiducial markers with a volume of 20-100 µl were injected into freshly resected pancreas specimens of three patients with suspected adenocarcinoma. X‑ray guided injection was performed using different needle sizes (18 G, 22 G, 25 G). The specimens were scanned on MRI and CT with clinical protocols. The markers were segmented on CT by signal thresholding. Marker detectability in MRI was assessed in the registered segmentations. Marker volume on CT was compared to the injected volume as a measure of backflow. RESULTS Markers with a volume ≥20 µl were detected as hyperintensity on X‑ray and CT. On T1- and T2-weighted 3T MRI, marker sizes ranging from 20-100 µl were visible as hypointensity. Since most markers were non-spherical, MRI detectability was poor and their differentiation from hypointensities caused by air cavities or surgical clips was only feasible with a reference CT. Marker backflow was only observed when using an 18-G needle. A volume decrease of 6.6 ± 13.0% was observed after 24 h in formaldehyde and, with the exception of one instance, no wash-out occurred. CONCLUSIONS The liquid fiducial marker injected in ex vivo pancreatic resection specimen was visible as hyperintensity on kV X‑ray and CT and as hypointensity on MRI. The marker's size was stable in formaldehyde. A marker volume of ≥50 µL is recommended in clinically used MRI sequences. In vivo injection is expected to improve the markers sphericity due to persisting metabolism and thereby enhance detectability on MRI.
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Affiliation(s)
- Sergej Schneider
- Institute of Radiooncology-OncoRay, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany. .,OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstraße 74, PF 41, 01307, Dresden, Germany.
| | - Daniela E Aust
- Institute of Pathology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Stefan Brückner
- Medical Department 1, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Thilo Welsch
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Jochen Hampe
- Medical Department 1, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Esther G C Troost
- Institute of Radiooncology-OncoRay, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.,OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstraße 74, PF 41, 01307, Dresden, Germany.,Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,German Cancer Consortium (DKTK), partner site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), partner site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden; and Helmholtz Association/Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
| | - Aswin L Hoffmann
- Institute of Radiooncology-OncoRay, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.,OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstraße 74, PF 41, 01307, Dresden, Germany.,Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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19
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Bourillon L, Bourgier C, Gaborit N, Garambois V, Llès E, Zampieri A, Ogier C, Jarlier M, Radosevic-Robin N, Orsetti B, Delpech H, Theillet C, Colombo PE, Azria D, Pèlegrin A, Larbouret C, Chardès T. An auristatin-based antibody-drug conjugate targeting HER3 enhances the radiation response in pancreatic cancer. Int J Cancer 2019; 145:1838-1851. [PMID: 30882895 DOI: 10.1002/ijc.32273] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/20/2019] [Accepted: 03/01/2019] [Indexed: 12/17/2022]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is an aggressive cancer characterized by poor response to chemotherapy and radiotherapy due to the lack of efficient therapeutic tools and early diagnostic markers. We previously generated the nonligand competing anti-HER3 antibody 9F7-F11 that binds to pancreatic tumor cells and induces tumor regression in vivo in experimental models. Here, we asked whether coupling 9F7-F11 with a radiosensitizer, such as monomethylauristatin E (MMAE), by using the antibody-drug conjugate (ADC) technology could improve radiation therapy efficacy in PDAC. We found that the MMAE-based HER3 antibody-drug conjugate (HER3-ADC) was efficiently internalized in tumor cells, increased the fraction of cells arrested in G2/M, which is the most radiosensitive phase of the cell cycle, and promoted programmed cell death of irradiated HER3-positive pancreatic cancer cells (BxPC3 and HPAC cell lines). HER3-ADC decreased the clonogenic survival of irradiated cells by increasing DNA double-strand break formation (based on γH2AX level), and by modulating DNA damage repair. Tumor radiosensitization with HER3-ADC favored the inhibition of the AKT-induced survival pathway, together with more efficient caspase 3/PARP-mediated apoptosis. Incubation with HER3-ADC before irradiation synergistically reduced the phosphorylation of STAT3, which is involved in chemoradiation resistance. In vivo, the combination of HER3-ADC with radiation therapy increased the overall survival of mice harboring BxPC3, HPAC cell xenografts or patient-derived xenografts, and reduced proliferation (KI67-positive cells). Combining auristatin radiosensitizer delivery via an HER3-ADC with radiotherapy is a new promising therapeutic strategy in PDAC.
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Affiliation(s)
- Laura Bourillon
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier (ICM), 34298, Montpellier, France
| | - Céline Bourgier
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier (ICM), 34298, Montpellier, France.,Institut Régional du Cancer de Montpellier (ICM), 34298, Montpellier, France
| | - Nadège Gaborit
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier (ICM), 34298, Montpellier, France
| | - Véronique Garambois
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier (ICM), 34298, Montpellier, France
| | - Eva Llès
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier (ICM), 34298, Montpellier, France
| | - Alexandre Zampieri
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier (ICM), 34298, Montpellier, France
| | - Charline Ogier
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier (ICM), 34298, Montpellier, France
| | - Marta Jarlier
- Institut Régional du Cancer de Montpellier (ICM), 34298, Montpellier, France
| | - Nina Radosevic-Robin
- Department of Biopathology, Jean Perrin Comprehensive Cancer Center and INSERM/UCA UMR 1240, 63011, Clermont-Ferrand, France
| | - Béatrice Orsetti
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier (ICM), 34298, Montpellier, France
| | - Hélène Delpech
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier (ICM), 34298, Montpellier, France
| | - Charles Theillet
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier (ICM), 34298, Montpellier, France
| | - Pierre-Emmanuel Colombo
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier (ICM), 34298, Montpellier, France.,Institut Régional du Cancer de Montpellier (ICM), 34298, Montpellier, France
| | - David Azria
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier (ICM), 34298, Montpellier, France.,Institut Régional du Cancer de Montpellier (ICM), 34298, Montpellier, France
| | - André Pèlegrin
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier (ICM), 34298, Montpellier, France
| | - Christel Larbouret
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier (ICM), 34298, Montpellier, France
| | - Thierry Chardès
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier (ICM), 34298, Montpellier, France.,Centre National de la Recherche Scientifique (CNRS), Paris, France
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20
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van den Ende RPJ, Rigter LS, Kerkhof EM, van Persijn van Meerten EL, Rijkmans EC, Lambregts DMJ, van Triest B, van Leerdam ME, Staring M, Marijnen CAM, van der Heide UA. MRI visibility of gold fiducial markers for image-guided radiotherapy of rectal cancer. Radiother Oncol 2018; 132:93-99. [PMID: 30825976 DOI: 10.1016/j.radonc.2018.11.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/29/2018] [Accepted: 11/25/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND PURPOSE A GTV boost is suggested to result in higher complete response rates in rectal cancer patients, which is attractive for organ preservation. Fiducials may offer GTV position verification on (CB)CT, if the fiducial-GTV spatial relationship can be accurately defined on MRI. The study aim was to evaluate the MRI visibility of fiducials inserted in the rectum. MATERIALS AND METHODS We tested four fiducial types (two Visicoil types, Cook and Gold Anchor), inserted in five patients each. Four observers identified fiducial locations on two MRI exams per patient in two scenarios: without (scenario A) and with (scenario B) (CB)CT available. A fiducial was defined to be consistently identified if 3 out of 4 observers labeled that fiducial at the same position on MRI. Fiducial visibility was scored on an axial and sagittal T2-TSE sequence and a T1 3D GRE sequence. RESULTS Fiducial identification was poor in scenario A for all fiducial types. The Visicoil 0.75 and Gold Anchor were the most consistently identified fiducials in scenario B with 7 out of 9 and 8 out of 11 consistently identified fiducials in the first MRI exam and 2 out of 7 and 5 out of 10 in the second MRI exam, respectively. The consistently identified Visicoil 0.75 and Gold Anchor fiducials were best visible on the T1 3D GRE sequence. CONCLUSION The Visicoil 0.75 and Gold Anchor fiducials were the most visible fiducials on MRI as they were most consistently identified. The use of a registered (CB)CT and a T1 3D GRE MRI sequence is recommended.
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Affiliation(s)
- Roy P J van den Ende
- Department of Radiation Oncology, Leiden University Medical Center, the Netherlands.
| | - Lisanne S Rigter
- Department of Gastroenterology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ellen M Kerkhof
- Department of Radiation Oncology, Leiden University Medical Center, the Netherlands
| | | | - Eva C Rijkmans
- Department of Radiation Oncology, Leiden University Medical Center, the Netherlands
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Baukelien van Triest
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Monique E van Leerdam
- Department of Gastroenterology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Marius Staring
- Department of Radiation Oncology, Leiden University Medical Center, the Netherlands; Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Corrie A M Marijnen
- Department of Radiation Oncology, Leiden University Medical Center, the Netherlands
| | - Uulke A van der Heide
- Department of Radiation Oncology, Leiden University Medical Center, the Netherlands; Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
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21
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de Blanck SR, Scherman-Rydhög J, Siemsen M, Christensen M, Baeksgaard L, Irming Jølck R, Specht L, Andresen TL, Persson GF. Feasibility of a novel liquid fiducial marker for use in image guided radiotherapy of oesophageal cancer. Br J Radiol 2018; 91:20180236. [PMID: 29975152 DOI: 10.1259/bjr.20180236] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE: To evaluate the feasibility of a new liquid fiducial marker for use in image-guided radiotherapy for oesophageal cancer. METHODS: Liquid fiducial markers were implanted in patients with metastatic or inoperable locally advanced oesophageal or gastro-oesophageal junction cancer receiving radiotherapy. Markers were implanted using a conventional gastroscope equipped with a 22 G Wang needle. Marker visibility was evaluated on fluoroscopy, CT, MRI and cone beam CT scans. RESULTS: Liquid markers (n = 16) were injected in four patients. No Grade 2 or worse adverse events were observed in relation to the implantation procedure, during treatment or in the follow-up period. 12/16 (75%) markers were available at the planning CT-scan and throughout the treatment- and follow-up period. The implanted markers were adequately visible in CT and cone beam CT but were difficult to distinguish in fluoroscopy and MRI without information from the corresponding CT image. CONCLUSION: Liquid fiducial marker placement in the oesophagus proved safe and clinically feasible. ADVANCES IN KNOWLEDGE: This paper presents the first clinical use of a new liquid fiducial marker in patients with oesophageal cancer and demonstrates that marker implantation using standard gastroscopic equipment and subsequent use in three-dimensional image-guided radiation therapy is safe and clinically feasible.
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Affiliation(s)
- Steen Riisgaard de Blanck
- 1Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark
| | - Jonas Scherman-Rydhög
- 2Department of Physics, Niels Bohr Institute, University of Copenhagen , Copenhagen , Denmark.,3 Department of Radiation Physics, Skane University Hospital , Lund , Sweden
| | - Mette Siemsen
- 4 Department of Thoracic Surgery, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark
| | - Merete Christensen
- 4 Department of Thoracic Surgery, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark
| | - Lene Baeksgaard
- 1Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark
| | - Rasmus Irming Jølck
- 5 DTU Nanotech, Department of Micro-and Nanotechnology, Center for Nanomedicine and Theranostics, Technical University of Denmark , Kongens Lyngby , Denmark.,6 Nanovi A/S, DTU Scion , Kongens Lyngby , Denmark
| | - Lena Specht
- 1Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark
| | - Thomas Lars Andresen
- 5 DTU Nanotech, Department of Micro-and Nanotechnology, Center for Nanomedicine and Theranostics, Technical University of Denmark , Kongens Lyngby , Denmark
| | - Gitte Fredberg Persson
- 1Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark
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22
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De Roover R, Crijns W, Poels K, Peeters R, Draulans C, Haustermans K, Depuydt T. Characterization of a novel liquid fiducial marker for multimodal image guidance in stereotactic body radiotherapy of prostate cancer. Med Phys 2018. [PMID: 29537613 DOI: 10.1002/mp.12860] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Liquid fiducial markers have shown to be a promising alternative to solid gold markers in terms of imaging artifact reduction, patient comfort, and compatibility with different imaging modalities. This study aims to investigate the performance of the novel BioXmark® liquid marker for state-of-the-art multimodal imaging used in prostate cancer (PCa) radiotherapy, encompassing kV CT/CBCT, multiparametric MRI, and kV x-ray imaging. In addition, automatic detection of the liquid markers in x-ray imaging for prostate motion monitoring during treatment was investigated. METHODS A total of eight BioXmark® liquid markers with varying volumes (range 5-300 μL) were casted on a square grid into a gelatin phantom insert. A cylindrical gold marker (QLRAD, length = 7 mm, Ø = 1 mm) was inserted for reference. Liquid marker visibility and streaking artifacts in CT/CBCT imaging were evaluated by placing the gelatin phantom into a CIRS anthropomorphic phantom. Relevant MRI characteristics such as the T2 and T1 relaxation times, the ADC value, and the relative proton density (ρH) were quantified by placing the gelatin phantom insert next to a T1MES mapping phantom and a water-filled syringe for reference. Ex vivo multiparametric MRI images were acquired by placing the gelatin phantom next to a resected prostate specimen. Anterior-posterior x-ray projection images were obtained by placing the gelatin phantom insert on top of an anthropomorphic pelvic phantom with internal pelvic bony structures and were acquired for five positions relative to the bony anatomy and 24 clinically relevant x-ray exposure settings. To quantify individual automatic marker detection, single markers were artificially isolated in the x-ray images using postprocessing. RESULTS Markers of all sizes were clearly visible on CT and CBCT images with only the largest marker volumes (100-300 μL) displaying artifacts similar in size to the gold fiducial marker. Artifact size increased with increasing liquid marker volume. Liquid markers displayed good contrast in ex vivo T1-weighted and ρH-weighted images. The markers were not visible in the ex vivo T2-weighted image. The liquid markers induced a chemical shift artifact in the obtained ADC-map. Automated detection in x-ray imaging was feasible with high detection success (four of five positions) for marker volumes in the range of 25-200 μL. None of the liquid markers were detected successfully when superimposed on a bony edge, independent of their size. CONCLUSIONS This study is the first to show the compatibility of BioXmark® liquid markers with multimodal image-guided radiotherapy for PCa. Compared to a solid gold marker, they had favorable results in both visibility and induced imaging artifacts. Liquid marker visibility in MRI imaging of the prostate does not solely depend on the low ρH value (not visible on T2-weighted image) but is also influenced by its relaxation times. Automated marker detection in x-ray images was feasible but better adapted marker detection algorithms are necessary for marker localization in the presence of bony edges. Hence, the liquid marker provides a minimally invasive (fine needles) and highly applicable alternative to current solid gold markers for multimodal image-guided prostate radiotherapy treatments.
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Affiliation(s)
- Robin De Roover
- Laboratory of Experimental Radiotherapy, Department of Oncology, KU Leuven - University of Leuven, Herestraat 49, Leuven, B-3000, Belgium
| | - Wouter Crijns
- Department of Radiation Oncology, University Hospitals Leuven, Herestraat 49, Leuven, B-3000, Belgium
| | - Kenneth Poels
- Department of Radiation Oncology, University Hospitals Leuven, Herestraat 49, Leuven, B-3000, Belgium
| | - Ronald Peeters
- Department of Radiology, University Hospitals Leuven, Herestraat 49, Leuven, B-3000, Belgium
| | - Cédric Draulans
- Laboratory of Experimental Radiotherapy, Department of Oncology, KU Leuven - University of Leuven, Herestraat 49, Leuven, B-3000, Belgium.,Department of Radiation Oncology, University Hospitals Leuven, Herestraat 49, Leuven, B-3000, Belgium
| | - Karin Haustermans
- Laboratory of Experimental Radiotherapy, Department of Oncology, KU Leuven - University of Leuven, Herestraat 49, Leuven, B-3000, Belgium.,Department of Radiation Oncology, University Hospitals Leuven, Herestraat 49, Leuven, B-3000, Belgium
| | - Tom Depuydt
- Laboratory of Experimental Radiotherapy, Department of Oncology, KU Leuven - University of Leuven, Herestraat 49, Leuven, B-3000, Belgium.,Department of Radiation Oncology, University Hospitals Leuven, Herestraat 49, Leuven, B-3000, Belgium
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