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Metz MC, Ezhov I, Peeken JC, Buchner JA, Lipkova J, Kofler F, Waldmannstetter D, Delbridge C, Diehl C, Bernhardt D, Schmidt-Graf F, Gempt J, Combs SE, Zimmer C, Menze B, Wiestler B. Toward image-based personalization of glioblastoma therapy: A clinical and biological validation study of a novel, deep learning-driven tumor growth model. Neurooncol Adv 2024; 6:vdad171. [PMID: 38435962 PMCID: PMC10907005 DOI: 10.1093/noajnl/vdad171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Background The diffuse growth pattern of glioblastoma is one of the main challenges for accurate treatment. Computational tumor growth modeling has emerged as a promising tool to guide personalized therapy. Here, we performed clinical and biological validation of a novel growth model, aiming to close the gap between the experimental state and clinical implementation. Methods One hundred and twenty-four patients from The Cancer Genome Archive (TCGA) and 397 patients from the UCSF Glioma Dataset were assessed for significant correlations between clinical data, genetic pathway activation maps (generated with PARADIGM; TCGA only), and infiltration (Dw) as well as proliferation (ρ) parameters stemming from a Fisher-Kolmogorov growth model. To further evaluate clinical potential, we performed the same growth modeling on preoperative magnetic resonance imaging data from 30 patients of our institution and compared model-derived tumor volume and recurrence coverage with standard radiotherapy plans. Results The parameter ratio Dw/ρ (P < .05 in TCGA) as well as the simulated tumor volume (P < .05 in TCGA/UCSF) were significantly inversely correlated with overall survival. Interestingly, we found a significant correlation between 11 proliferation pathways and the estimated proliferation parameter. Depending on the cutoff value for tumor cell density, we observed a significant improvement in recurrence coverage without significantly increased radiation volume utilizing model-derived target volumes instead of standard radiation plans. Conclusions Identifying a significant correlation between computed growth parameters and clinical and biological data, we highlight the potential of tumor growth modeling for individualized therapy of glioblastoma. This might improve the accuracy of radiation planning in the near future.
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Affiliation(s)
- Marie-Christin Metz
- Department of Diagnostic and Interventional Neuroradiology, Technical University of Munich, Munich, Germany
| | - Ivan Ezhov
- Department of Informatics, Technical University of Munich, Munich, Germany
- TranslaTUM—Central Institute for Translational Cancer Research, Technical University of Munich, Munich, Germany
| | - Jan C Peeken
- Department of Radiation Oncology, Technical University of Munich, Munich, Germany
- Department of Radiation Sciences (DRS), Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Munich, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
| | - Josef A Buchner
- Department of Radiation Oncology, Technical University of Munich, Munich, Germany
| | - Jana Lipkova
- Department of Pathology and Molecular Medicine, University of California, Irvine, Irvine, CA, USA
| | - Florian Kofler
- Department of Diagnostic and Interventional Neuroradiology, Technical University of Munich, Munich, Germany
- Department of Informatics, Technical University of Munich, Munich, Germany
- Helmholtz Artificial Intelligence Cooperation Unit, Helmholtz Zentrum Munich, Munich, Germany
- TranslaTUM—Central Institute for Translational Cancer Research, Technical University of Munich, Munich, Germany
| | | | - Claire Delbridge
- Department of Neuropathology, Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Christian Diehl
- Department of Radiation Oncology, Technical University of Munich, Munich, Germany
| | - Denise Bernhardt
- Department of Radiation Oncology, Technical University of Munich, Munich, Germany
- Department of Radiation Sciences (DRS), Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Munich, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
| | | | - Jens Gempt
- Department of Neurosurgery, Technical University of Munich, Munich, Germany
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Technical University of Munich, Munich, Germany
- Department of Radiation Sciences (DRS), Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Munich, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Technical University of Munich, Munich, Germany
| | - Bjoern Menze
- Department of Informatics, Technical University of Munich, Munich, Germany
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
| | - Benedikt Wiestler
- Department of Diagnostic and Interventional Neuroradiology, Technical University of Munich, Munich, Germany
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Häger W, Toma-Dașu I, Astaraki M, Lazzeroni M. Overall survival prediction for high-grade glioma patients using mathematical modeling of tumor cell infiltration. Phys Med 2023; 113:102669. [PMID: 37603907 DOI: 10.1016/j.ejmp.2023.102669] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 08/08/2023] [Accepted: 08/14/2023] [Indexed: 08/23/2023] Open
Abstract
PURPOSE This study aimed at applying a mathematical framework for the prediction of high-grade gliomas (HGGs) cell invasion into normal tissues for guiding the clinical target delineation, and at investigating the possibility of using tumor infiltration maps for patient overall survival (OS) prediction. MATERIAL & METHODS A model describing tumor infiltration into normal tissue was applied to 93 HGG cases. Tumor infiltration maps and corresponding isocontours with different cell densities were produced. ROC curves were used to seek correlations between the patient OS and the volume encompassed by a particular isocontour. Area-Under-the-Curve (AUC) values were used to determine the isocontour having the highest predictive ability. The optimal cut-off volume, having the highest sensitivity and specificity, for each isocontour was used to divide the patients in two groups for a Kaplan-Meier survival analysis. RESULTS The highest AUC value was obtained for the isocontour of cell densities 1000 cells/mm3 and 2000 cells/mm3, equal to 0.77 (p < 0.05). Correlation with the GTV yielded an AUC of 0.73 (p < 0.05). The Kaplan-Meier survival analysis using the 1000 cells/mm3 isocontour and the ROC optimal cut-off volume for patient group selection rendered a hazard ratio (HR) of 2.7 (p < 0.05), while the GTV rendered a HR = 1.6 (p < 0.05). CONCLUSION The simulated tumor cell invasion is a stronger predictor of overall survival than the segmented GTV, indicating the importance of using mathematical models for cell invasion to assist in the definition of the target for HGG patients.
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Affiliation(s)
- Wille Häger
- Department of Physics, Stockholm University, Stockholm, Sweden; Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden.
| | - Iuliana Toma-Dașu
- Department of Physics, Stockholm University, Stockholm, Sweden; Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
| | - Mehdi Astaraki
- Department of Biomedical Engineering and Health Systems, Royal Institute of Technology, Huddinge, Sweden; Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
| | - Marta Lazzeroni
- Department of Physics, Stockholm University, Stockholm, Sweden; Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
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Bortfeld T, Buti G. Modeling the propagation of tumor fronts with shortest path and diffusion models—implications for the definition of the clinical target volume. Phys Med Biol 2022; 67. [PMID: 35817046 PMCID: PMC9388053 DOI: 10.1088/1361-6560/ac8043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 07/11/2022] [Indexed: 11/11/2022]
Abstract
Abstract
Objective. The overarching objective is to make the definition of the clinical target volume (CTV) in radiation oncology less subjective and more scientifically based. The specific objective of this study is to investigate similarities and differences between two methods that model tumor spread beyond the visible gross tumor volume (GTV): (1) the shortest path model, which is the standard method of adding a geometric GTV-CTV margin, and (2) the reaction-diffusion model. Approach. These two models to capture the invisible tumor ‘fire front’ are defined and compared in mathematical terms. The models are applied to example cases that represent tumor spread in non-uniform and anisotropic media with anatomical barriers. Main results. The two seemingly disparate models bring forth traveling waves that can be associated with the front of tumor growth outward from the GTV. The shape of the fronts is similar for both models. Differences are seen in cases where the diffusive flow is reduced due to anatomical barriers, and in complex spatially non-uniform cases. The diffusion model generally leads to smoother fronts. The smoothness can be controlled with a parameter defined by the ratio of the diffusion coefficient and the proliferation rate. Significance. Defining the CTV has been described as the weakest link of the radiotherapy chain. There are many similarities in the mathematical description and the behavior of the common geometric GTV-CTV expansion method, and the definition of the CTV tumor front via the reaction-diffusion model. Its mechanistic basis and the controllable smoothness make the diffusion model an attractive alternative to the standard GTV-CTV margin model.
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