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Oderinde OM, Narayanan M, Olcott P, Voronenko Y, Burns J, Xu S, Shao L, Feghali KAA, Shirvani SM, Surucu M, Kuduvalli G. Demonstration of real-time positron emission tomography biology-guided radiotherapy delivery to targets. Med Phys 2024; 51:5672-5681. [PMID: 38452277 DOI: 10.1002/mp.16999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 02/05/2024] [Accepted: 02/05/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Biology-guided radiotherapy (BgRT) is a novel technology that uses positron emission tomography (PET) data to direct radiotherapy delivery in real-time. BgRT enables the precise delivery of radiation doses based on the PET signals emanating from PET-avid tumors on the fly. In this way, BgRT uniquely utilizes radiotracer uptake as a biological beacon for controlling and adjusting dose delivery in real-time to account for target motion. PURPOSE To demonstrate using real-time PET for BgRT delivery on the RefleXion X1 radiotherapy machine. The X1 radiotherapy machine is a rotating ring-gantry radiotherapy system that generates a nominal 6MV photon beam, PET, and computed tomography (CT) components. The system utilizes emitted photons from PET-avid targets to deliver effective radiation beamlets or pulses to the tumor in real-time. METHODS This study demonstrated a real-time PET BgRT delivery experiment under three scenarios. These scenarios included BgRT delivering to (S1) a static target in a homogeneous and heterogeneous environment, (S2) a static target with a hot avoidance structure and partial PET-avid target, and (S3) a moving target. The first step was to create stereotactic body radiotherapy (SBRT) and BgRT plans (offline PET data supported) using RefleXion's custom-built treatment planning system (TPS). Additionally, to create a BgRT plan using PET-guided delivery, the targets were filled with 18F-Fluorodeoxyglucose (FDG), which represents a tumor/target, that is, PET-avid. The background materials were created in the insert with homogeneous water medium (for S1) and heterogeneous water with styrofoam mesh medium. A heterogeneous background medium simulated soft tissue surrounding the tumor. The treatment plan was then delivered to the experimental setups using a pre-commercial version of the X1 machine. As a final step, the dosimetric accuracy for S1 and S2 was assessed using the ArcCheck analysis tool-the gamma criteria of 3%/3 mm. For S3, the delivery dose was quantified using EBT-XD radiochromic film. The accuracy criteria were based on coverage, where 100% of the clinical target volume (CTV) receives at least 97% of the prescription dose, and the maximum dose in the CTV was ≤130% of the maximum planned dose (97 % ≤ CTV ≤ 130%). RESULTS For the S1, both SBRT and BgRT deliveries had gamma pass rates greater than 95% (SBRT range: 96.9%-100%, BgRT range: 95.2%-98.9%), while in S2, the gamma pass rate was 98% for SBRT and between 95.2% and 98.9% for BgRT plan delivering. For S3, both SBRT and BgRT motion deliveries met CTV dose coverage requirements, with BgRT plans delivering a very high dose to the target. The CTV dose ranges were (a) SBRT:100.4%-120.4%, and (b) BgRT: 121.3%-139.9%. CONCLUSIONS This phantom-based study demonstrated that PET signals from PET-avid tumors can be utilized to direct real-time dose delivery to the tumor accurately, which is comparable to the dosimetric accuracy of SBRT. Furthermore, BgRT delivered a PET-signal controlled dose to the moving target, equivalent to the dose distribution to the static target. A future study will compare the performance of BgRT with conventional image-guided radiotherapy.
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Affiliation(s)
- Oluwaseyi M Oderinde
- Advanced Molecular Imaging in Radiotherapy (AdMIRe) Research Laboratory, Purdue University, West Lafayette, Indiana, USA
- School of Health Sciences, Purdue University, West Lafayette, Indiana, USA
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Peter Olcott
- RefleXion Medical, Inc, Hayward, California, USA
| | | | - Jon Burns
- RefleXion Medical, Inc, Hayward, California, USA
| | - Shiyu Xu
- RefleXion Medical, Inc, Hayward, California, USA
| | - Ling Shao
- RefleXion Medical, Inc, Hayward, California, USA
| | | | | | - Murat Surucu
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, California, USA
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Xu X, Deng Z, Dehghani H, Iordachita I, Lim M, Wong JW, Wang KKH. Quantitative Bioluminescence Tomography-guided Conformal Irradiation for Preclinical Radiation Research. Int J Radiat Oncol Biol Phys 2021; 111:1310-1321. [PMID: 34411639 PMCID: PMC8602741 DOI: 10.1016/j.ijrobp.2021.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 07/16/2021] [Accepted: 08/05/2021] [Indexed: 10/31/2022]
Abstract
PURPOSE Widely used cone beam computed tomography (CBCT)-guided irradiators in preclinical radiation research are limited to localize soft tissue target because of low imaging contrast. Knowledge of target volume is a fundamental need for radiation therapy (RT). Without such information to guide radiation, normal tissue can be overirradiated, introducing experimental uncertainties. This led us to develop high-contrast quantitative bioluminescence tomography (QBLT) for guidance. The use of a 3-dimensional bioluminescence signal, related to cell viability, for preclinical radiation research is one step toward biology-guided RT. METHODS AND MATERIALS Our QBLT system enables multiprojection and multispectral bioluminescence imaging to maximize input data for the tomographic reconstruction. Accurate quantification of spectrum and dynamic change of in vivo signal were also accounted for the QBLT. A spectral-derivative method was implemented to eliminate the modeling of the light propagation from animal surface to detector. We demonstrated the QBLT capability of guiding conformal RT using a bioluminescent glioblastoma (GBM) model in vivo. A threshold was determined to delineate QBLT reconstructed gross target volume (GTVQBLT), which provides the best overlap between the GTVQBLT and CBCT contrast labeled GBM (GTV), used as the ground truth for GBM volume. To account for the uncertainty of GTVQBLT in target positioning and volume delineation, a margin was determined and added to the GTVQBLT to form a QBLT planning target volume (PTVQBLT) for guidance. RESULTS The QBLT can reconstruct in vivo GBM with localization accuracy within 1 mm. A 0.5-mm margin was determined and added to GTVQBLT to form PTVQBLT, largely improving tumor coverage from 75.0% (0 mm margin) to 97.9% in average, while minimizing normal tissue toxicity. With the goal of prescribed dose 5 Gy covering 95% of PTVQBLT, QBLT-guided 7-field conformal RT can effectively irradiate 99.4 ± 1.0% of GTV. CONCLUSIONS The QBLT provides a unique opportunity for investigators to use biologic information for target delineation, guiding conformal irradiation, and reducing normal tissue involvement, which is expected to increase reproducibility of scientific discovery.
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Affiliation(s)
- Xiangkun Xu
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland; Biomedical Imaging and Radiation Technology Laboratory, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Zijian Deng
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland; Biomedical Imaging and Radiation Technology Laboratory, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Hamid Dehghani
- School of Computer Science, University of Birmingham, Birmingham, West Midlands, United Kingdom
| | - Iulian Iordachita
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, Maryland
| | - Michael Lim
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland; Department of Neurosurgery, Stanford University, Stanford, California
| | - John W Wong
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Ken Kang-Hsin Wang
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland; Biomedical Imaging and Radiation Technology Laboratory, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.
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Silén J, Högel H, Kivinen K, Silvoniemi A, Forsback S, Löyttyniemi E, Solin O, Grénman R, Minn H, Jaakkola PM, Grönroos TJ. Uptake of [ 18F]EF5 as a Tracer for Hypoxic and Aggressive Phenotype in Experimental Head and Neck Squamous Cell Carcinoma. Transl Oncol 2014; 7:S1936-5233(14)00047-3. [PMID: 24862538 PMCID: PMC4145394 DOI: 10.1016/j.tranon.2014.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 03/17/2014] [Accepted: 03/19/2014] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This study aims to investigate whether the uptake of 2-(2-nitro-1H-imidazol-1-yl)-N-(2,2,3,3,3-pentafluoropropyl)-acetamide ([18F]EF5) and 2-deoxy-2-[18F]fluoro-d-glucose ([18F]FDG) is associated with a hypoxia-driven adverse phenotype in head and neck squamous cell carcinoma cell lines and tumor xenografts. METHODS Xenografts were imaged in vivo, and tumor sections were stained for hypoxia-inducible factor 1α (Hif-1α), carbonic anhydrase IX (CA IX), and glucose transporter 1 (Glut-1). Tracer uptakes and the expression of Hif-1α were determined in cell lines under 1% hypoxia. RESULTS High [18F]EF5 uptake was seen in xenografts expressing high levels of CA IX, Glut-1, and Hif-1α, whereas low [18F]EF5 uptake was detected in xenografts expressing low amounts of CA IX and Hif-1α. The uptake of [18F]EF5 between cell lines varied extensively under normoxic conditions. A clear correlation was found between the expression of Hif-1α and the uptake of [18F]FDG during hypoxia. CONCLUSIONS The UT-SCC cell lines studied differed with respect to their hypoxic phenotypes, and these variations were detectable with [18F]EF5. Acute hypoxia increases [18F]FDG uptake in vitro, whereas a high [18F]EF5 uptake reflects a more complex phenotype associated with hypoxia and an aggressive growth pattern.
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Affiliation(s)
- Jonna Silén
- MediCity Research Laboratory, Turku PET Centre, University of Turku, Turku, Finland; Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - Heidi Högel
- Turku Centre of Biotechnology, University of Turku, Turku, Finland
| | - Katri Kivinen
- Department of Pathology, University of Turku, Turku, Finland
| | - Antti Silvoniemi
- MediCity Research Laboratory, Turku PET Centre, University of Turku, Turku, Finland; Department of Otorhinolaryngology, Turku University Hospital, Turku, Finland
| | - Sarita Forsback
- MediCity Research Laboratory, Turku PET Centre, University of Turku, Turku, Finland
| | | | - Olof Solin
- MediCity Research Laboratory, Turku PET Centre, University of Turku, Turku, Finland
| | - Reidar Grénman
- Department of Otorhinolaryngology, Turku University Hospital, Turku, Finland
| | - Heikki Minn
- MediCity Research Laboratory, Turku PET Centre, University of Turku, Turku, Finland; Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - Panu M Jaakkola
- Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland; Turku Centre of Biotechnology, University of Turku, Turku, Finland
| | - Tove J Grönroos
- MediCity Research Laboratory, Turku PET Centre, University of Turku, Turku, Finland; Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland.
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Erlich F, Camisão C, Nogueira-Rodrigues A, Altino S, Ferreira C, Mamede M. 18F-FDG-PET-based tumor delineation in cervical cancer: Threshold contouring and lesion volumes. Rev Esp Med Nucl Imagen Mol 2013. [DOI: 10.1016/j.remnie.2013.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Walter F, la Fougère C, Belka C, Niyazi M. Technical Issues of [(18)F]FET-PET Imaging for Radiation Therapy Planning in Malignant Glioma Patients - A Review. Front Oncol 2012; 2:130. [PMID: 23061046 PMCID: PMC3463828 DOI: 10.3389/fonc.2012.00130] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 09/14/2012] [Indexed: 11/13/2022] Open
Affiliation(s)
- F Walter
- Department of Radiation Oncology, University of Munich Munich, Germany
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Chan DSY, Fielding P, Roberts SA, Reid TD, Ellis-Owen R, Lewis WG. Prognostic significance of 18-FDG PET/CT and EUS-defined tumour characteristics in patients with oesophageal cancer. Clin Radiol 2012; 68:352-7. [PMID: 22981727 DOI: 10.1016/j.crad.2012.08.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 08/01/2012] [Accepted: 08/06/2012] [Indexed: 12/25/2022]
Abstract
AIM To determine the correlation between 2-[(18)F]-fluoro-2-deoxy-d-glucose (FDG) positron-emission tomography/computed tomography (PET/CT) defined maximum standardized uptake value (SUVmax) and endoluminal ultrasound-defined tumour volume (EDTV) in patients with oesophageal cancer (OC) and their relative prognostic significance. MATERIALS AND METHODS One hundred and eighty-five consecutive patients with OC were staged using CT, endoscopic ultrasound (EUS), and PET/CT. The maximum potential EDTV was calculated (πr(2)L, where r = tumour thickness and L = total length of disease including proximal and distal lymph node metastases). Primary outcome measure was survival from diagnosis. RESULTS Ninety-one percent of patients (168/185) had FDG-avid tumours on PET/CT. SUVmax correlated positively and significantly with EDTV (Spearman's rho = 0.339, p = 0.001). On univariate analysis, survival was inversely related to the PET/CT lymph node metastasis count (LNMC, p = 0.015), EUS N stage (p = 0.002), EDTV (<48 cm(3), p = 0.001), EUS total length of disease (p = 0.001), SUVmax (p = 0.002), PET/CT N stage (p < 0.0001), and EUS LNMC (p < 0.0001). On multivariate analysis two factors were significantly and independently associated with survival: EDTV (HR, 3.118; 95% CI: 1.357-7.167; p = 0.007), and PET/CT N stage (HR, 0.496; 95% CI: 0.084-1.577; p = 0.022). CONCLUSION EDTV and PET/CT N stage were important predictors of survival and further research is needed to identify critical prognostic values.
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Affiliation(s)
- D S Y Chan
- Department of Surgery, University Hospital of Wales, Cardiff, UK.
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Erlich F, Camisão C, Nogueira-Rodrigues A, Altino S, Ferreira CG, Mamede M. 18F-FDG-PET-based tumor delineation in cervical cancer: threshold contouring and lesion volumes. Rev Esp Med Nucl Imagen Mol 2012; 32:162-6. [PMID: 22831777 DOI: 10.1016/j.remn.2012.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 06/05/2012] [Accepted: 06/11/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To evaluate a semi-automated PET-image tumor segmentation algorithm for gross tumor volume (GTV) delineation in patients with locally advanced cervical cancer. MATERIAL AND METHODS Thirty-two patients with locally advanced cervical cancer were retrospectively evaluated. Semi-automated PET-image-based GTV delineation was applied using a previous established algorithm (GTV2SD) and 2 fixed threshold-based methods (GTV40% and GTV50%). GTV2SD was determined as the pixel with the mean value plus 2-standard deviation of the liver intensity, and GTV40% and GTV50% with 40% and 50% of the maximum tumor intensity (Tmax), respectively. The derived volumes were then compared with the GTVs generated manually using MR (GTVMR). RESULTS The mean value of GTV2SD, GTV40% and GTV50% was 85.3cc, 16.2cc and 24.1cc, respectively. Good agreement was noticed between GTV2SD and GTVMR (ρ=0.88). GTV40% and GTV50% showed weaker correlation with GTVMR (ρ=0.68 and ρ=0.71, respectively). CONCLUSIONS This study provides preliminary evidence that metabolic tumor volume delineation is feasible using computer-generated measurements in (18)F-FDG PET images. Generation of PET-based tumor volumes is affected by the choice of threshold level used. Metabolic tumor bulk calculated using the pixel with the mean value plus 2-standard deviations of the liver intensity (GTV2SD) correlates better with the MR-derived tumor volumes. The method is a simple and clinically applicable approach to generate PET-derived GTV for radiation therapy planning of cervical cancer.
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Affiliation(s)
- F Erlich
- Radiation Oncology Service, National Cancer Institute of Brazil, Rio de Janeiro, Brazil
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Wang W, Lang J. Strategies to optimize radiotherapy based on biological responses of tumor and normal tissue. Exp Ther Med 2012; 4:175-180. [PMID: 22970024 DOI: 10.3892/etm.2012.593] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Accepted: 05/02/2012] [Indexed: 01/23/2023] Open
Abstract
Rapid developments in radiation oncology are currently taking place. Radiation-induced responses are being increasingly used for radiotherapy modification based on advancements in radiobiology. In the process of radiation treatment, radiobiological responses of tumor and normal tissue in patients are monitored non-invasively by a variety of techniques including imaging, biological methods and biochemical assays. Information collected using these methods and data on responses are further incorporated into radiotherapy optimization approaches, which not only include the optimization of radiation treatment planning, such as dose distributions in targets and treatment delivery, but also include radiation sensitivity modification and gene radiotherapy of the tumor and normal tissue. Hence, the highest tumor control rate is obtained with the utmost protection being afforded to normal tissue under this treatment modality.
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Affiliation(s)
- Weidong Wang
- Department of Radiation Oncology, Sichuan Cancer Hospital, Chengdu 610041, P.R. China
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Das SK, Ten Haken RK. Functional and molecular image guidance in radiotherapy treatment planning optimization. Semin Radiat Oncol 2011; 21:111-8. [PMID: 21356479 DOI: 10.1016/j.semradonc.2010.10.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Functional and molecular imaging techniques are increasingly being developed and used to quantitatively map the spatial distribution of parameters, such as metabolism, proliferation, hypoxia, perfusion, and ventilation, onto anatomically imaged normal organs and tumor. In radiotherapy optimization, these imaging modalities offer the promise of increased dose sparing to high-functioning subregions of normal organs or dose escalation to selected subregions of the tumor as well as the potential to adapt radiotherapy to functional changes that occur during the course of treatment. The practical use of functional/molecular imaging in radiotherapy optimization must take into cautious consideration several factors whose influences are still not clearly quantified or well understood including patient positioning differences between the planning computed tomography and functional/molecular imaging sessions, image reconstruction parameters and techniques, image registration, target/normal organ functional segmentation, the relationship governing the dose escalation/sparing warranted by the functional/molecular image intensity map, and radiotherapy-induced changes in the image intensity map over the course of treatment. The clinical benefit of functional/molecular image guidance in the form of improved local control or decreased normal organ toxicity has yet to be shown and awaits prospective clinical trials addressing this issue.
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Affiliation(s)
- Shiva K Das
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
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Price PM, Green MM. Positron emission tomography imaging approaches for external beam radiation therapies: current status and future developments. Br J Radiol 2011; 84 Spec No 1:S19-34. [PMID: 21427180 DOI: 10.1259/bjr/21263014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
In an era in which it is possible to deliver radiation with high precision, there is a heightened need for enhanced imaging capabilities to improve tumour localisation for diagnostic, planning and delivery purposes. This is necessary to increase the accuracy and overall efficacy of all types of external beam radiotherapy (RT), including particle therapies. Positron emission tomography (PET) has the potential to fulfil this need by imaging fundamental aspects of tumour biology. The key areas in which PET may support the RT process include improving disease diagnosis and staging; assisting tumour volume delineation; defining tumour phenotype or biological tumour volume; assessment of treatment response; and in-beam monitoring of radiation dosimetry. The role of PET and its current developmental status in these key areas are overviewed in this review, highlighting the advantages and drawbacks.
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Affiliation(s)
- P M Price
- Department of Academic Radiation Oncology, The University of Manchester, The Christie Hospital NHS Foundation Trust, Manchester, UK.
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Prognostic significance of endoluminal ultrasound-defined disease length and tumor volume (EDTV) for patients with the diagnosis of esophageal cancer. Surg Endosc 2010; 24:870-8. [PMID: 19730945 DOI: 10.1007/s00464-009-0681-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Accepted: 08/08/2009] [Indexed: 01/08/2023]
Abstract
BACKGROUND This study aimed to assess the prognostic significance of endoluminal ultrasound-defined total length of disease and endoluminal ultrasound defined tumor volume (EDTV) in esophageal cancer. The hypothesis was that endoscopic ultrasound (EUS)-defined total length of disease and EDTV are both significant prognostic indicators and better predictors of outcome than endoscopic tumor length. METHODS In this study, 174 consecutive patients (median age, 64 years and 128 months) underwent specialist EUS, and the maximum potential EDTV was calculated (pir(2) L, where r is the tumor thickness and L is the total length of disease) including proximal and distal lymph node metastases. Of the 174 patients, 104 underwent surgery (70 had neoadjuvant chemotherapy), 60 underwent definitive chemoradiotherapy, and 10 had palliative therapy. RESULTS Survival was related to EUS T stage (p = 0.013), EUS N stage (p = 0.001), EUS M1a stage (p = 0.004), EUS disease length (<8 cm; p = 0.001), and EDTV (all patients <25 cm(3), p = 0.001; surgical patients <40 cm(3), p = 0.036). Forward conditional multivariate analysis showed three factors to be associated with survival: EUS N stage (hazard ratio [HR], 1.646; 95% confidence interval [CI], 1.041-2.602; p = 0.033), EUS M1a stage (HR, 2.702; 95% CI, 1.069-6.830; p = 0.036), and EDTV (HR, 2.702; 95% CI, 1.069-6.830; p = 0.025). Median and 2-year survival for EDTV <25 cm(3) versus >25 cm(3) was 43.4 months and 56%, respectively, compared with 23.5 months and 35%. CONCLUSIONS In this study, EDTV based on total EUS-defined length of disease emerged as a new and important prognostic indicator for patients with esophageal cancer.
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Papathanassiou D, Bruna-Muraille C, Liehn JC, Nguyen TD, Curé H. Positron Emission Tomography in oncology: Present and future of PET and PET/CT. Crit Rev Oncol Hematol 2009; 72:239-54. [DOI: 10.1016/j.critrevonc.2008.10.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2008] [Revised: 09/30/2008] [Accepted: 10/14/2008] [Indexed: 01/01/2023] Open
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Simpson DR, Lawson JD, Nath SK, Rose BS, Mundt AJ, Mell LK. Utilization of advanced imaging technologies for target delineation in radiation oncology. J Am Coll Radiol 2009; 6:876-83. [PMID: 19945044 DOI: 10.1016/j.jacr.2009.08.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Accepted: 08/03/2009] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to evaluate the utilization of advanced imaging technologies for target delineation among radiation oncologists in the United States. METHODS A random sample of 1,600 radiation oncologists was contacted by Internet, e-mail, and fax and questioned regarding the use of advanced imaging technologies, clinical applications, and future plans for use. Advanced imaging technologies were defined as any of the following that were directly incorporated into radiation therapy planning: MRI, PET, single-photon emission CT, 4-D CT, functional MRI, and MR spectroscopy. RESULTS Of 1,089 contactable physicians, 394 (36%) responded. Of respondents, 65% were in private practice and 35% were in academic practice. The proportion using any advanced imaging technology for target delineation was 95%. However, the majority reported only rare (in <25% of their patients; 46.6%) or infrequent (in 25%-50% of their patients; 26.0%) utilization. The most commonly used technologies were 2-[(18)F]fluoro-2-deoxyglucose PET (76%), MRI (72%), and 4-D CT (44%). The most common cancers treated using image-guided target delineation were those of the lung (83%), central nervous system (79%), and head and neck (79%). Among users of advanced imaging technologies, 66% planned to increase use; 30% of nonusers planned to adopt these technologies in the future. CONCLUSIONS Advanced imaging technologies are widely used by US radiation oncologists for target delineation. Although the majority of respondents used them in <50% of their patients, the frequency of utilization is expected to increase. Studies determining the optimal application of these technologies in radiation therapy planning are needed.
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Affiliation(s)
- Daniel R Simpson
- Department of Radiation Oncology and Center for Advanced Radiotherapy Technologies, Rebecca and John Moores Comprehensive Cancer Center, University of California, San Diego, La Jolla, California 92093-0843, USA
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Chen GTY, Sharp GC, Mori S. A review of image-guided radiotherapy. Radiol Phys Technol 2009; 2:1-12. [DOI: 10.1007/s12194-008-0045-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Revised: 10/27/2008] [Accepted: 10/27/2008] [Indexed: 11/25/2022]
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