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Shouman MA, Fuchs F, Walter F, Corradini S, Westphalen CB, Vornhülz M, Beyer G, Andrade D, Belka C, Niyazi M, Rogowski P. Stereotactic body radiotherapy for pancreatic cancer - A systematic review of prospective data. Clin Transl Radiat Oncol 2024; 45:100738. [PMID: 38370495 PMCID: PMC10873666 DOI: 10.1016/j.ctro.2024.100738] [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: 10/01/2023] [Revised: 01/05/2024] [Accepted: 01/26/2024] [Indexed: 02/20/2024] Open
Abstract
Purpose This systematic review aims to comprehensively summarize the current prospective evidence regarding Stereotactic Body Radiotherapy (SBRT) in various clinical contexts for pancreatic cancer including its use as neoadjuvant therapy for borderline resectable pancreatic cancer (BRPC), induction therapy for locally advanced pancreatic cancer (LAPC), salvage therapy for isolated local recurrence (ILR), adjuvant therapy after radical resection, and as a palliative treatment. Special attention is given to the application of magnetic resonance-guided radiotherapy (MRgRT). Methods Following PRISMA guidelines, a systematic review of the Medline database via PubMed was conducted focusing on prospective studies published within the past decade. Data were extracted concerning study characteristics, outcome measures, toxicity profiles, SBRT dosage and fractionation regimens, as well as additional systemic therapies. Results and conclusion 31 studies with in total 1,571 patients were included in this review encompassing 14 studies for LAPC, 9 for neoadjuvant treatment, 2 for adjuvant treatment, 2 for ILR, with an additional 4 studies evaluating MRgRT. In LAPC, SBRT demonstrates encouraging results, characterized by favorable local control rates. Several studies even report conversion to resectable disease with substantial resection rates reaching 39%. The adoption of MRgRT may provide a solution to the challenge to deliver ablative doses while minimizing severe toxicities. In BRPC, select prospective studies combining preoperative ablative-dose SBRT with modern induction systemic therapies have achieved remarkable resection rates of up to 80%. MRgRT also holds potential in this context. Adjuvant SBRT does not appear to confer relevant advantages over chemotherapy. While prospective data for SBRT in ILR and for palliative pain relief are limited, they corroborate positive findings from retrospective studies.
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Affiliation(s)
- Mohamed A Shouman
- Department of Radiation Oncology, University Hospital LMU, Munich, Germany
- Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Frederik Fuchs
- Department of Radiation Oncology, University Hospital LMU, Munich, Germany
| | - Franziska Walter
- Department of Radiation Oncology, University Hospital LMU, Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital LMU, Munich, Germany
| | - C Benedikt Westphalen
- Department of Medicine III and Comprehensive Cancer Center (CCC Munich LMU), University Hospital LMU, Munich, Germany
| | - Marlies Vornhülz
- Bavarian Cancer Research Center (BZKF), Munich, Germany
- Department of Internal Medicine II, LMU University Hospital, Munich, Germany
| | - Georg Beyer
- Bavarian Cancer Research Center (BZKF), Munich, Germany
- Department of Internal Medicine II, LMU University Hospital, Munich, Germany
| | - Dorian Andrade
- Department of General, Visceral, and Transplant Surgery, University Hospital LMU, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital LMU, Munich, Germany
- Bavarian Cancer Research Center (BZKF), Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital LMU, Munich, Germany
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen, Germany
| | - Paul Rogowski
- Department of Radiation Oncology, University Hospital LMU, Munich, Germany
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Salas B, Ferrera-Alayón L, Espinosa-López A, Vera-Rosas A, Salcedo E, Kannemann A, Alayon A, Chicas-Sett R, LLoret M, Lara P. Dose-escalated SBRT for borderline and locally advanced pancreatic cancer. Feasibility, safety and preliminary clinical results of a multicenter study. Clin Transl Radiat Oncol 2024; 45:100753. [PMID: 38433951 PMCID: PMC10907515 DOI: 10.1016/j.ctro.2024.100753] [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: 09/02/2023] [Revised: 01/16/2024] [Accepted: 02/18/2024] [Indexed: 03/05/2024] Open
Abstract
Background Pancreatic Stereotactic Body Radiotherapy (SBRT) allows for the administration of a higher biologically effective doses (BED), that would be essential to achieve durable tumor control. Escalating treatment doses need a very accurate tumor positioning and motion control during radiotherapy.The aim of this study to assess the feasibility and safety of a Simultaneous Integrated Boost (SIB) dose-escalated protocol at 45 Gy, 50 Gy and 55 Gy in 5 consecutive daily fractions, in Border Line Resectable Pancreatic Cancer (BRCP) /Locally Advanced Pancreatic Cancer (LAPC) by means of a standard LINAC platform. Methods Patients diagnosed of BRPC/LAPC, candidates for neoadjuvant chemotherapy and SBRT, in four university hospitals of the province of Las Palmas (Canary Islands, Spain) were included in this prospective study. Radiotherapy was administered using standard technology (LINACS) with advanced positioning (Lipiodol® and metallic stent used as fiducial markers) and tumor motion control (4D, DBH, Calypso®). There were 3 planned dose-escalated SIB groups, 45 Gy/5f (9 patients) 50 Gy/5f (9 + 9 patients) and 55 Gy/5f (9 patients). The defined primary end points of the study were the safety and feasibility of the proposed treatment protocol. Secondary endpoints included radiological tumor response after SBRT, local control and survival. Results From June 2017 to December 2022, sixty-two patients were initially assessed for eligibility in the study in the four participating centers, and 49 were candidates for chemotherapy (CHT). Forty-one were referred to radiotherapy after CHT and 33 finally were treated by escalated-dose SIB, 45 Gy (9 patients) 50 Gy (16 patients), 55 Gy(8 patients). All patients completed the scheduled treatment and no acute or late severe (≥grade3) gastrointestinal toxicity was observed.Local response was analyzed by CT/MRI two months after the end of SBRT. Ten patients (31,25 %) achieved objective response (2/9:45 Gy, 5/15:50 Gy, 3/8:55 Gy). Follow-up was closed as July 2023. Freedom from local progression at 1-2y were 89,3% (95 %CI:83,4-95,2%) and 66 % (95 %CI:54,6-77,4%) respectively. The 1-2y survival rates were 95,7% (95 %CI:91,4-100 % and 48,6% (95 %CI:37,7-59,5%) respectively. Conclusion These promising results should be confirmed by further studies with larger sample size and extended follow-up period.
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Affiliation(s)
- B. Salas
- Department of Radiation Oncology University Hospital Dr Negrín Las Palmas de Gran Canaria, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain
| | - L. Ferrera-Alayón
- Department of Radiation Oncology University Hospital Dr Negrín Las Palmas de Gran Canaria, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain
- Las Palmas de Gran Canaria University (ULPGC) ,C. Juan de Quesada, 30, 35001 Las Palmas de Gran Canaria,Spain
| | - A. Espinosa-López
- Department of Radiation Oncology, University Hospital Virgen de la Arrixaca, Carretera Madrid-Cartagena, S/N, 30120 El Palmar (Murcia), Spain
| | - A. Vera-Rosas
- Department of Radiation Oncology University Hospital Dr Negrín Las Palmas de Gran Canaria, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain
| | - E. Salcedo
- Department of Radiation Oncology University Hospital Dr Negrín Las Palmas de Gran Canaria, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain
| | - A. Kannemann
- Department of Radiation Oncology University Hospital Dr Negrín Las Palmas de Gran Canaria, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain
| | - A. Alayon
- Department of Radiation Oncology University Hospital Dr Negrín Las Palmas de Gran Canaria, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain
| | - R. Chicas-Sett
- Department of Radiation Oncology, ASCIRES GRUPO BIOMEDICO, Valencia, Spain
| | - M. LLoret
- Department of Radiation Oncology University Hospital Dr Negrín Las Palmas de Gran Canaria, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain
- Las Palmas de Gran Canaria University (ULPGC) ,C. Juan de Quesada, 30, 35001 Las Palmas de Gran Canaria,Spain
- Instituto Canario de Investigacion del Cáncer ICIC
| | - P.C. Lara
- Instituto Canario de Investigacion del Cáncer ICIC
- Canarian Comprehensive Cancer Center, Department of Oncology University Hospital San Roque, C. Dolores de la Rocha, 5, 35001 Las Palmas de Gran Canaria, Spain
- Fernando Pessoa Canarias University, Calle la Juventud, s/n, 35450 Guía, Las Palmas de Gran Canaria, Spain
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Giacometti V, McLaughlin O, Comiskey P, Marshall H, Houlihan OA, Whitten G, Prise KM, Hounsell AR, Jain S, McGarry CK. Validation of a Quality Metric Score to Assess the Placement of Hydrogel Rectal Spacer in Patients Treated With Prostate Stereotactic Radiation Therapy. Adv Radiat Oncol 2024; 9:101396. [PMID: 38304109 PMCID: PMC10831189 DOI: 10.1016/j.adro.2023.101396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/11/2023] [Indexed: 02/03/2024] Open
Abstract
Purpose To evaluate the quality of the interspace between the prostate and rectum and assess the effect on the dose to the rectum by measuring the spacer quality score (SQS) before and after implanting a hydrogel rectal spacer. Methods and Materials Thirty patients with prostate cancer were treated with stereotactic ablative body radiation therapy as part of the SPORT clinical trial. Each patient had a 10 mL polyethylene glycol hydrogel spacer inserted transperineally. Computed tomography scans were acquired before and after spacer insertion, 10MV flattening filter free (FFF) stereotactic ablative body radiation therapy (SABR) treatment plans were generated using each image set. To calculate the SQS, the prostate-rectal interspace (PRI) was measured in the anterior-posterior orientation, parallel to the anatomic midline at the prostate base, apex, and midgland on the prespacer and postspacer computed tomography. Measurements were taken in 3 transverse positions between the prostate and the rectum, and PRI scores of 0, 1, and 2 were assigned if the interspace between prostate and rectum was <0.3, 0.3 to 0.9, or ≥1 cm, respectively. The overall SQS was the lowest of the PRI scores. Differences between prespacer and postspacer PRIs and SQS were investigated by performing Fisher's exact test and differences between doses to the rectum were investigated by performing the paired samples Wilcoxon rank-sum test and Student t test. Results Statistically significant differences between prespacer versus postspacer patients were found when grouping patients according to their overall SQS. The PRI summary score did not reach statistical significance between prespacer and postspacer at the base but was significantly higher for the prostate midline and apex. Statistically significant differences in some rectum dose-volume metrics were found when grouping patients according to their PRIs and SQS. Conclusions SQS before and after the spacer insertion was evaluated and was found to be correlated with pre- and postspacer rectal dosimetry. Sources of improvement of the SQS scoring metric and limitations are discussed.
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Affiliation(s)
- Valentina Giacometti
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
| | - Owen McLaughlin
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
| | - Patrick Comiskey
- Department of Radiotherapy Physics, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Hannah Marshall
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
| | - Orla A. Houlihan
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
- Department of Clinical Oncology, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Glenn Whitten
- Department of Radiotherapy Physics, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Kevin M. Prise
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
| | - Alan R. Hounsell
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
- Department of Radiotherapy Physics, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Suneil Jain
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
- Department of Clinical Oncology, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Conor K. McGarry
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
- Department of Radiotherapy Physics, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
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Laprie A, Noel G, Chaltiel L, Truc G, Sunyach MP, Charissoux M, Magne N, Auberdiac P, Biau J, Ken S, Tensaouti F, Khalifa J, Sidibe I, Roux FE, Vieillevigne L, Catalaa I, Boetto S, Uro-Coste E, Supiot S, Bernier V, Filleron T, Mounier M, Poublanc M, Olivier P, Delord JP, Cohen-Jonathan-Moyal E. Randomized phase III trial of metabolic imaging-guided dose escalation of radio-chemotherapy in patients with newly diagnosed glioblastoma (SPECTRO GLIO trial). Neuro Oncol 2024; 26:153-163. [PMID: 37417948 PMCID: PMC10768994 DOI: 10.1093/neuonc/noad119] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Glioblastoma (GBM) systematically recurs after a standard 60 Gy radio-chemotherapy regimen. Since magnetic resonance spectroscopic imaging (MRSI) has been shown to predict the site of relapse, we analyzed the effect of MRSI-guided dose escalation on overall survival (OS) of patients with newly diagnosed GBM. METHODS In this multicentric prospective phase III trial, patients who had undergone biopsy or surgery for a GBM were randomly assigned to a standard dose (SD) of 60 Gy or a high dose (HD) of 60 Gy with an additional simultaneous integrated boost totaling 72 Gy to MRSI metabolic abnormalities, the tumor bed and residual contrast enhancements. Temozolomide was administered concomitantly and maintained for 6 months thereafter. RESULTS One hundred and eighty patients were included in the study between March 2011 and March 2018. After a median follow-up of 43.9 months (95% CI [42.5; 45.5]), median OS was 22.6 months (95% CI [18.9; 25.4]) versus 22.2 months (95% CI [18.3; 27.8]) for HD, and median progression-free survival was 8.6 (95% CI [6.8; 10.8]) versus 7.8 months (95% CI [6.3; 8.6]), in SD versus HD, respectively. No increase in toxicity rate was observed in the study arm. The pseudoprogression rate was similar across the SD (14.4%) and HD (16.7%) groups. For O(6)-methylguanine-DNA methyltransferase (MGMT) methylated patients, the median OS was 38 months (95% CI [23.2; NR]) for HD patients versus 28.5 months (95% CI [21.1; 35.7]) for SD patients. CONCLUSION The additional MRSI-guided irradiation dose totaling 72 Gy was well tolerated but did not improve OS in newly diagnosed GBM. TRIAL REGISTRATION NCT01507506; registration date: December 20, 2011. https://clinicaltrials.gov/ct2/show/NCT01507506?cond=NCT01507506&rank=1.
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Affiliation(s)
- Anne Laprie
- Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | | | - Leonor Chaltiel
- Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Gilles Truc
- Centre Georges-François Leclerc, Dijon, France
| | | | | | - Nicolas Magne
- Institut de Cancérologie de la Loire, Saint-Priest en Jarez, France
| | | | - Julian Biau
- Centre Jean-Perrin, Clermont-Ferrand, France
| | - Soléakhéna Ken
- Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, RadOpt-CRCT-INSERM, Toulouse, France
| | - Fatima Tensaouti
- Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole & ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Jonathan Khalifa
- Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | | | - Franck-Emmanuel Roux
- Centre Hospitalier Universitaire de Toulouse, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Laure Vieillevigne
- Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | | | - Sergio Boetto
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Emmanuelle Uro-Coste
- Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole, RadOpt-CRCT-INSERM, Toulouse, France
| | - Stéphane Supiot
- Institut de Cancerologie de l’Ouest, Nantes st Herblain, France
| | - Valérie Bernier
- Institut de Cancérologie de Lorraine Centre Alexis Vautrin, Nancy, France
| | - Thomas Filleron
- Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Muriel Mounier
- Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Muriel Poublanc
- Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Pascale Olivier
- Service de Pharmacologie Médicale et Clinique, Centre Régional de Pharmacovigilance, de Pharmacoépidémiologie et d’Information sur le Médicament CHU de Toulouse, Toulouse, France
| | - Jean-Pierre Delord
- Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
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Christ SM, Youssef G, Tanguturi SK, Cagney D, Shi D, McFaline-Figueroa JR, Chukwueke U, Lee EQ, Hertler C, Andratschke N, Weller M, Reardon DA, Haas-Kogan D, Guckenberger M, Wen PY, Rahman R. Re-irradiation of recurrent IDH-wildtype glioblastoma in the bevacizumab and immunotherapy era: Target delineation, outcomes and patterns of recurrence. Clin Transl Radiat Oncol 2024; 44:100697. [PMID: 38046107 PMCID: PMC10689476 DOI: 10.1016/j.ctro.2023.100697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/12/2023] [Accepted: 10/28/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction and background While recurrent glioblastoma patients are often treated with re-irradiation, there is limited data on the use of re-irradiation in the setting of bevacizumab (BEV), temozolomide (TMZ) re-challenge, or immune checkpoint inhibition (ICI). We describe target delineation in patients with prior anti-angiogenic therapy, assess safety and efficacy of re-irradiation, and evaluate patterns of recurrence. Materials and methods Patients with a histologically confirmed diagnosis of glioblastoma treated at a single institution between 2013 and 2021 with re-irradiation were included. Tumor, treatment and clinical data were collected. Logistic and Cox regression analysis were used for statistical analysis. Results One hundred and seventeen recurrent glioblastoma patients were identified, receiving 129 courses of re-irradiation. In 66 % (85/129) of cases, patients had prior BEV. In the 80 patients (62 %) with available re-irradiation plans, 20 (25 %) had all T2/FLAIR abnormality included in the gross tumor volume (GTV). Median overall survival (OS) for the cohort was 7.3 months, and median progression-free survival (PFS) was 3.6 months. Acute CTCAE grade ≥ 3 toxicity occurred in 8 % of cases. Concurrent use of TMZ or ICI was not associated with improved OS nor PFS. On multivariable analysis, higher KPS was significantly associated with longer OS (p < 0.01). On subgroup analysis, patients with prior BEV had significantly more marginal recurrences than those without (26 % vs. 13 %, p < 0.01). Conclusion Re-irradiation can be safely employed in recurrent glioblastoma patients. Marginal recurrence was more frequent in patients with prior BEV, suggesting a need to consider more inclusive treatment volumes incorporating T2/FLAIR abnormality.
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Affiliation(s)
- Sebastian M. Christ
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, MA, USA
- Department of Radiation Oncology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Gilbert Youssef
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Shyam K. Tanguturi
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Daniel Cagney
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Diana Shi
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, MA, USA
| | | | - Ugonma Chukwueke
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Eudocia Q. Lee
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Caroline Hertler
- Competence Center Palliative Care, University Hospital and University of Zurich, Zurich, Switzerland
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - David A. Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Daphne Haas-Kogan
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Patrick Y. Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Rifaquat Rahman
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, MA, USA
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Waters M, Price A, Laugeman E, Henke L, Hugo G, Stowe H, Andruska N, Brenneman R, Hao Y, Green O, Robinson C, Gay H, Michalski J, Baumann BC. CT-based online adaptive radiotherapy improves target coverage and organ at risk (OAR) avoidance in stereotactic body radiation therapy (SBRT) for prostate cancer. Clin Transl Radiat Oncol 2024; 44:100693. [PMID: 38021093 PMCID: PMC10663731 DOI: 10.1016/j.ctro.2023.100693] [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: 01/04/2023] [Revised: 10/02/2023] [Accepted: 10/22/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Stereotactic body radiation therapy (SBRT) is an emerging treatment modality for clinically localized prostate cancer (PCa). Online daily adaptive radiotherapy (ART) could potentially improve the therapeutic ratio of prostate SBRT by accounting for inter-fraction variation in target and OAR volumes. To our knowledge, no group has evaluated the clinical utility of a novel AI-augmented CT-based ART system for prostate SBRT. In this study we hypothesized that adaptive prostate SBRT plans would result in improved target coverage and lower dose to OARs in comparison to unadapted treatment plans. Methods Seven patients with favorable intermediate to oligometastatic PCa treated with 5-fx prostate adaptive SBRT were retrospectively reviewed. Patients were treated with 3625 cGy to the prostate and seminal vesicles. 6 patients additionally received 2500 cGy to the pelvic nodes, 5 patients underwent a boost to 4000 cGy to the prostate. For each fraction, a CBCT was acquired and OARs (rectum, bladder, bowel, sigmoid, femurs) were segmented/deformed using AI. CTVs were rigidly registered. Volumes were adjusted manually and PTV expansions added. Adaptive treatment plans were developed based on the contoured targets and OARs and dose to these volumes for the adapted vs. initial plans were compared for each fraction. V100 and the D0.03 cc between scheduled and adapted treatment plans were compared using a Student's t-test, with significance threshold of P < 0.05. Results Seven patients completed 35 Fx's of adaptive RT. Daily adaptation resulted in a statistically significant mean improvement in PTV V100 for all targets: [21.4 % ± 4.3 % for PTV 4000 (p < 0.0001); 8.7 % ± 1.1 % for PTV 3625 (p < 0.0001); and 11.5 % ± 3.1 % for PTV 2500 (p = 0.0013)]. Mean rectal D0.03 was significantly reduced by 38.8 cGy ± 5.95 cGy (p < 0.0001) per fraction (194 cGy/5 fractions) compared to the initial plans. There was a modest increase in bladder dose of 10.9 cGy ± 4.93 cGy per fraction (p = 0.0424) for the adaptive plans. The adaptive plans met bladder constraints for every fraction. There were no statistically significant differences between sigmoid or bowel dose for adapted vs. initial plans. No patients experienced acute CTCAE grade ≥ 3 GI/GU adverse events (median F/U 9.5 months). All statistically significant differences were maintained in the presence and absence of rectal hydrogel spacer (p < 0.05). Conclusions CT-based online adaptive SBRT resulted in statistically significant and clinically meaningful improvements in PTV coverage and D0.03 cc dose to the rectum. A trial evaluating CT adaptive whole-pelvis prostate SBRT is underway.
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Affiliation(s)
- Michael Waters
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Alex Price
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Eric Laugeman
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Lauren Henke
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Geoff Hugo
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Hayley Stowe
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Neal Andruska
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Randall Brenneman
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Yao Hao
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Olga Green
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Clifford Robinson
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Hiram Gay
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Jeff Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Brian C. Baumann
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, USA
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Davey A, Pan S, Bryce-Atkinson A, Mandeville H, Janssens GO, Kelly SM, Hol M, Tang V, Davies LSC, SIOP-Europe Radiation Oncology Working Group, Aznar M. The need for consensus on delineation and dose constraints of dentofacial structures in paediatric radiotherapy: Outcomes of a SIOP Europe survey. Clin Transl Radiat Oncol 2023; 43:100681. [PMID: 37790584 PMCID: PMC10543782 DOI: 10.1016/j.ctro.2023.100681] [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: 09/14/2023] [Accepted: 09/21/2023] [Indexed: 10/05/2023] Open
Abstract
Background and purpose Children receiving radiotherapy for head-and-neck tumours often experience severe dentofacial side effects. Despite this, recommendations for contouring and dose constraints to dentofacial structures are lacking in clinical practice. We report on a survey aiming to understand current practice in contouring and dose assessment to dentofacial structures. Methods A digital survey was distributed to European Society for Paediatric Oncology members of the Radiation Oncology Working Group, and member-affiliated centres in Europe, Australia, and New Zealand. The questions focused on clinical practice and aimed to establish areas for future development. Results Results from 52 paediatric radiotherapy centres across 27 countries are reported. Only 29/52 centres routinely delineated some dentofacial structures, with the most common being the mandible (25 centres), temporo-mandibular joint (22), dentition (13), orbit (10) and maxillary bone (eight). For most bones contoured, an 'As Low As Reasonably Achievable' dose objective was implemented. Only four centres reported age-adapted dose constraints.The largest barrier to clinical implementation of dose constraints was firstly, the lack of contouring guidance (49/52, 94%) and secondly, that delineation is time-consuming (33/52, 63%). Most respondents who routinely contour dentofacial structures (25/27, 90%) agreed a contouring atlas would aid delineation. Conclusion Routine delineation of dentofacial structures is infrequent in paediatric radiotherapy. Based on survey findings, we aim to 1) define a consensus-contouring atlas for dentofacial structures, 2) develop auto-contouring solutions for dentofacial structures to aid clinical implementation, and 3) carry out treatment planning studies to investigate the importance of delineation of these structures for planning optimisation.
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Affiliation(s)
- Angela Davey
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Shermaine Pan
- Department of Proton Therapy, The Christie NHS Foundation Trust, Manchester, UK
| | - Abigail Bryce-Atkinson
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | | | - Geert O. Janssens
- Princess Maxima Center for Paediatric Oncology, Utrecht, The Netherlands
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sarah M. Kelly
- European Society for Paediatric Oncology (SIOP Europe), Clos Chapelle-aux-Champs 30, Brussels, Belgium
- The European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Avenue E. Mounier 83, Brussels, Belgium
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Marinka Hol
- Princess Maxima Center for Paediatric Oncology, Utrecht, The Netherlands
- Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Vivian Tang
- Paediatric Radiology, Royal Manchester Children’s Hospital, Manchester, UK
| | | | | | - Marianne Aznar
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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8
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Aldawsari AM, Al-Qaisieh B, Broadbent DA, Bird D, Murray L, Speight R. The role and potential of using quantitative MRI biomarkers for imaging guidance in brain cancer radiotherapy treatment planning: A systematic review. Phys Imaging Radiat Oncol 2023; 27:100476. [PMID: 37565088 PMCID: PMC10410581 DOI: 10.1016/j.phro.2023.100476] [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: 03/24/2023] [Revised: 07/15/2023] [Accepted: 07/19/2023] [Indexed: 08/12/2023] Open
Abstract
Background and purpose Improving the accuracy of brain tumour radiotherapy (RT) treatment planning is important to optimise patient outcomes. This systematic review investigates primary studies providing clinical evidence for the integration of quantitative magnetic resonance imaging (qMRI) biomarkers and MRI radiomics to optimise brain tumour RT planning. Materials and methods PubMed, Scopus, Embase and Web of Science databases were searched for all years until June 21, 2022. The search identified original articles demonstrating clinical evidence for the use of qMRI biomarkers and MRI radiomics for the optimization of brain cancer RT planning. Relevant information was extracted and tabulated, including qMRI metrics and techniques, impact on RT plan optimization and changes in target and normal tissue contouring and dose distribution. Results Nineteen articles met the inclusion criteria. Studies were grouped according to the qMRI biomarkers into: 1) diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI; five studies); 2) diffusion tensor imaging (DTI; seven studies); and 3) MR spectroscopic imaging (MRSI; seven studies). No relevant MRI-based radiomics studies were identified. Integration of DTI maps offers the potential for improved organs at risk (OAR) sparing. MRSI metabolic maps are a promising technique for improving delineation accuracy in terms of heterogeneity and infiltration, with OAR sparing. No firm conclusions could be drawn regarding the integration of DWI metrics and PWI maps. Conclusions Integration of qMRI metrics into RT planning offers the potential to improve delineation and OAR sparing. Clinical trials and consensus guidelines are required to demonstrate the clinical benefits of such approaches.
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Affiliation(s)
- Abeer M. Aldawsari
- Leeds Institute of Cardiovascular & Metabolic Medicine (LICAMM), University of Leeds, Woodhouse, Leeds LS2 9JT, United Kingdom
- Radiological Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh 12371, Saudi Arabia
| | - Bashar Al-Qaisieh
- Department of Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, United Kingdom
| | - David A. Broadbent
- Leeds Institute of Cardiovascular & Metabolic Medicine (LICAMM), University of Leeds, Woodhouse, Leeds LS2 9JT, United Kingdom
- Department of Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, United Kingdom
| | - David Bird
- Department of Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, United Kingdom
| | - Louise Murray
- Department of Clinical Oncology, Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds LS9 7LP, United Kingdom
- Leeds Institute of Medical Research, University of Leeds, Leeds LS2 9JT, United Kingdom
| | - Richard Speight
- Department of Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, United Kingdom
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Sarkar B, Pradhan A. Planning System-dependent Recommendations of Intensity-modulated Technique for Breast Radiotherapy: A Literature Review-based Adaptation and Institutional Dosimetric Experience from a Large-volume Tertiary Cancer Care Hospital. J Med Phys 2023; 48:221-229. [PMID: 37969141 PMCID: PMC10642598 DOI: 10.4103/jmp.jmp_51_23] [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: 04/20/2023] [Revised: 06/27/2023] [Accepted: 08/08/2023] [Indexed: 11/17/2023] Open
Abstract
This article aims to identify, through a literature review, the best intensity-modulated technique (IMRT)/volumetric-modulated arc therapy (VMAT) for the breast/chest wall (Br/CW) as a function of the treatment planning system (TPS) and present the institutional dosimetric data for the same. A PubMed search was conducted following intensity-modulated irradiation techniques (IMRT) presented in the study: field-in-field (FiF), tangential IMRT (t-IMRT), multi-field IMRT, tangential VMAT (t-VMAT), half-arc VMAT (HA-VMAT), and large arc VMAT (LA-VMAT). The literature with at least one arm VMAT is included in this study. A total of 370 articles were identified between 2010 and 2022, out of which 19 articles were found to be unique. These articles were classified in terms of the TPS used: Eclipse (9), Monaco (6), RayStation (2), Pinnacle (1), and one unidentified TPS. Based on the literature review, dosimetric attributes, and second cancer risk analysis (SCRA), t-IMRT was found to be the most preferable technique in Eclipse, Pinnacle, and RayStation TPS. However, for Monaco TPS, t-VMAT (approximately 30° tangential arc) offers better dose coverage with lower organ-at-risk (OAR) doses. In terms of OAR doses and SCRA, LA-VMAT (≥210°) and HA-VMAT (180°) are avoidable techniques in any TPS, and FiF should be preferred over these two techniques. In our present institution, which uses the Eclipse TPS, data for 300 patients treated with t-IMRT were collected. The data included beam angle, monitor unit [MU], target coverage (D95% and V105% [cc]), and analysis of the maximum (%), and mean dose (%) of the OAR. t-IMRT utilizes two medial and three lateral tangential beams placed at a spread of approximately 10° and 20°, respectively. The results showed a D95% of 96.3 ± 1.2% and a V105% of 4.9 ± 7.0 cc. The mean doses to the heart and ipsilateral lung were 10.1 ± 20.9% and 11.4 ± 10.2%, respectively. The mean MU was 1282.7 ± 453.4. Based on the findings, the most preferred intensity-modulated technique for Eclipse, Pinnacle, and RayStation is t-IMRT, while for Monaco, it is t-VMAT. The data from the Eclipse planning system demonstrate a satisfactory dosimetric outcome for t-IMRT. However, the use of VMAT techniques employing an arc angle between 180° and 210° or higher is strongly discouraged.
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Affiliation(s)
- Biplab Sarkar
- Department of Radiation Oncology, Apollo Multispeciality Hospitals, Kolkata, West Bengal, India
- Department of Physics, GLA University, Mathura, Uttar Pradesh, India
| | - Anirudh Pradhan
- Director, Centre for Cosmology, Astrophysics and Space Science (CCASS), GLA University, Mathura, Uttar Pradesh, India
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Pang Y, Kosmin M, Li Z, Deng X, Li Z, Li X, Zhang Y, Royle G, Manolopoulos S. Isotoxic dose escalated radiotherapy for glioblastoma based on diffusion-weighted MRI and tumor control probability-an in-silico study. Br J Radiol 2023; 96:20220384. [PMID: 37102792 PMCID: PMC10230387 DOI: 10.1259/bjr.20220384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 02/19/2023] [Accepted: 03/03/2023] [Indexed: 04/28/2023] Open
Abstract
OBJECTIVES Glioblastoma (GBM) is the most common malignant primary brain tumor with local recurrence after radiotherapy (RT), the most common mode of failure. Standard RT practice applies the prescription dose uniformly across tumor volume disregarding radiological tumor heterogeneity. We present a novel strategy using diffusion-weighted (DW-) MRI to calculate the cellular density within the gross tumor volume (GTV) in order to facilitate dose escalation to a biological target volume (BTV) to improve tumor control probability (TCP). METHODS The pre-treatment apparent diffusion coefficient (ADC) maps derived from DW-MRI of ten GBM patients treated with radical chemoradiotherapy were used to calculate the local cellular density based on published data. Then, a TCP model was used to calculate TCP maps from the derived cell density values. The dose was escalated using a simultaneous integrated boost (SIB) to the BTV, defined as the voxels for which the expected pre-boost TCP was in the lowest quartile of the TCP range for each patient. The SIB dose was chosen so that the TCP in the BTV increased to match the average TCP of the whole tumor. RESULTS By applying a SIB of between 3.60 Gy and 16.80 Gy isotoxically to the BTV, the cohort's calculated TCP increased by a mean of 8.44% (ranging from 7.19 to 16.84%). The radiation dose to organ at risk is still under their tolerance. CONCLUSIONS Our findings indicate that TCPs of GBM patients could be increased by escalating radiation doses to intratumoral locations guided by the patient's biology (i.e., cellularity), moreover offering the possibility for personalized RT GBM treatments. ADVANCES IN KNOWLEDGE A personalized and voxel level SIB radiotherapy method for GBM is proposed using DW-MRI, which can increase the tumor control probability and maintain organ at risk dose constraints.
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Affiliation(s)
- Yaru Pang
- Department of Medical Physics and Biomedical Engineering, University College London, Gower Street, London, United Kingdom
| | | | - Zhuangling Li
- Department of Radiation Oncology, Shenzhen People's Hospital, Shenzhen, China
| | - Xiaonian Deng
- Department of Radiation Oncology, Shenzhen People's Hospital, Shenzhen, China
| | - Zihuang Li
- Department of Radiation Oncology, Shenzhen People's Hospital, Shenzhen, China
| | - Xianming Li
- Department of Radiation Oncology, Shenzhen People's Hospital, Shenzhen, China
| | - Ying Zhang
- Department of Medical Physics and Biomedical Engineering, University College London, Gower Street, London, United Kingdom
| | - Gary Royle
- Department of Medical Physics and Biomedical Engineering, University College London, Gower Street, London, United Kingdom
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11
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Tensaouti F, Desmoulin F, Gilhodes J, Roques M, Ken S, Lotterie JA, Noël G, Truc G, Sunyach MP, Charissoux M, Magné N, Lubrano V, Péran P, Cohen-Jonathan Moyal E, Laprie A. Is pre-radiotherapy metabolic heterogeneity of glioblastoma predictive of progression-free survival? Radiother Oncol 2023; 183:109665. [PMID: 37024057 DOI: 10.1016/j.radonc.2023.109665] [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: 08/12/2022] [Revised: 03/25/2023] [Accepted: 03/28/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND AND PURPOSE All glioblastoma subtypes share the hallmark of aggressive invasion, meaning that it is crucial to identify their different components if we are to ensure effective treatment and improve survival. Proton MR spectroscopic imaging (MRSI) is a noninvasive technique that yields metabolic information and is able to identify pathological tissue with high accuracy. The aim of the present study was to identify clusters of metabolic heterogeneity, using a large MRSI dataset, and determine which of these clusters are predictive of progression-free survival (PFS). MATERIALS AND METHODS MRSI data of 180 patients acquired in a pre-radiotherapy examination were included in the prospective SPECTRO-GLIO trial. Eight features were extracted for each spectrum: Cho/NAA, NAA/Cr, Cho/Cr, Lac/NAA, and the ratio of each metabolite to the sum of all the metabolites. Clustering of data was performed using a mini-batch k-means algorithm. The Cox model and logrank test were used for PFS analysis. RESULTS Five clusters were identified as sharing similar metabolic information and being predictive of PFS. Two clusters revealed metabolic abnormalities. PFS was lower when Cluster 2 was the dominant cluster in patients' MRSI data. Among the metabolites, lactate (present in this cluster and in Cluster 5) was the most statistically significant predictor of poor outcome. CONCLUSION Results showed that pre-radiotherapy MRSI can be used to reveal tumor heterogeneity. Groups of spectra, which have the same metabolic information, reflect the different tissue components representative of tumor burden proliferation and hypoxia. Clusters with metabolic abnormalities and high lactate are predictive of PFS.
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Affiliation(s)
- Fatima Tensaouti
- Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse - Oncopôle, Radiation oncology, Toulouse, France; ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France.
| | - Franck Desmoulin
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
| | - Julia Gilhodes
- Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse - Oncopôle, Biostatistics, Toulouse, France
| | - Margaux Roques
- CHU Toulouse, Neuroradiology, Toulouse, France; ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
| | - Soleakhena Ken
- Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse - Oncopôle, Engineering and Medical Physics, Toulouse, France; Inserm U1037- Centre de Recherches contre le Cancer de Toulouse, Radiation oncology, Toulouse, France
| | - Jean-Albert Lotterie
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France; CHU Toulouse, Nuclear Medicine, Toulouse, France
| | | | - Gilles Truc
- Centre Georges-François Leclerc, Radiation Oncology, Dijon, France
| | | | - Marie Charissoux
- Institut du Cancer de Montpellier, Radiation Oncology, Montpellier, France
| | - Nicolas Magné
- Institut de Cancérologie de la Loire Lucien Neuwirth, Radiation Oncology, Saint-Priest-en-Jarez, France
| | - Vincent Lubrano
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
| | - Patrice Péran
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
| | - Elizabeth Cohen-Jonathan Moyal
- Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse - Oncopôle, Radiation oncology, Toulouse, France; Inserm U1037- Centre de Recherches contre le Cancer de Toulouse, Radiation oncology, Toulouse, France
| | - Anne Laprie
- Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse - Oncopôle, Radiation oncology, Toulouse, France; ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
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12
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Bahrami Asl F, Islami-seginsara M, Ebrahimi Kalan M, Hemmatjo R, Hesam M, Shafiei-Irannejad V. Exposure to ionizing radiations and changes in blood cells and interleukin-6 in radiation workers. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:35757-35768. [PMID: 36538225 PMCID: PMC9764314 DOI: 10.1007/s11356-022-24652-8] [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: 06/04/2022] [Accepted: 12/05/2022] [Indexed: 06/17/2023]
Abstract
Long-term exposure to ionizing radiation (IR) can cause dire health consequences even less than the dose limits. Previous biomonitoring studies have focused more on complete blood counts (CBCs), with non-coherent results. In this study, we aimed to investigate the association between exposure to IR and cytokine interleukin-6 (IL-6) along with hematological parameters in Tabriz megacity's radiation workers. In this hospital-based study, blood samples were taken from 33 radiation workers (exposed group) and 34 non-radiation workers (control group) in 4 hospitals. Absorbed radiation dose was measured by a personal film badge dosimeter in radiation workers. The studied biomarkers and all of the selected covariates were measured and analyzed using adjusted multiple linear regression models. The exposed doses for all radiation workers were under the dose limits (overall mean = 1.18 mSv/year). However, there was a significant association between exposure to ionizing radiation and IL-6 (49.78 vs 36.17; t = 2.4; p = 0.02) and eosinophils (0.17 vs 0.14; t = 2.02; p = 0.049). The difference between the mean of the other biomarkers in radiation workers was not statistically significant compared to the control group. This study demonstrated that long-term exposure to ionizing radiation, even under the dose limits, is related to a significantly increased level of some blood biomarkers (Il-6 and eosinophil) that, in turn, can cause subsequent health effects such as cancer.
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Affiliation(s)
- Farshad Bahrami Asl
- Department of Environmental Health Engineering, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran
| | - Mahdi Islami-seginsara
- Department of Environmental Health Engineering, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran
| | - Mohammad Ebrahimi Kalan
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Rasoul Hemmatjo
- Department of Occupational Health, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran
| | - Mousa Hesam
- Radiation Health Unit, Department of Environmental Health Engineering, Health Vice-Chancellor, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahid Shafiei-Irannejad
- Cellular and Molecular Research Center, Cellular and Molecular Medicine Institute, Urmia University of Medical Sciences, Urmia, Iran
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13
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Luan S, Xue X, Wei C, Ding Y, Zhu B, Wei W. Machine Learning-Based Quality Assurance for Automatic Segmentation of Head-and-Neck Organs-at-Risk in Radiotherapy. Technol Cancer Res Treat 2023; 22:15330338231157936. [PMID: 36788411 PMCID: PMC9932790 DOI: 10.1177/15330338231157936] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
Purpose/Objective(s): With the development of deep learning, more convolutional neural networks (CNNs) are being introduced in automatic segmentation to reduce oncologists' labor requirement. However, it is still challenging for oncologists to spend considerable time evaluating the quality of the contours generated by the CNNs. Besides, all the evaluation criteria, such as Dice Similarity Coefficient (DSC), need a gold standard to assess the quality of the contours. To address these problems, we propose an automatic quality assurance (QA) method using isotropic and anisotropic methods to automatically analyze contour quality without a gold standard. Materials/Methods: We used 196 individuals with 18 different head-and-neck organs-at-risk. The overall process has the following 4 main steps. (1) Use CNN segmentation network to generate a series of contours, then use these contours as organ masks to erode and dilate to generate inner/outer shells for each 2D slice. (2) Thirty-eight radiomics features were extracted from these 2 shells, using the inner/outer shells' radiomics features ratios and DSCs as the input for 12 machine learning models. (3) Using the DSC threshold adaptively classified the passing/un-passing slices. (4) Through 2 different threshold analysis methods quantitatively evaluated the un-passing slices and obtained a series of location information of poor contours. Parts 1-3 were isotropic experiments, and part 4 was the anisotropic method. Result: From the isotropic experiments, almost all the predicted values were close to the labels. Through the anisotropic method, we obtained the contours' location information by assessing the thresholds of the peak-to-peak and area-to-area ratios. Conclusion: The proposed automatic segmentation QA method could predict the segmentation quality qualitatively. Moreover, the method can analyze the location information for un-passing slices.
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Affiliation(s)
- Shunyao Luan
- Department of Radiation Oncology, Hubei Cancer
Hospital, Tongji Medical College, Huazhong
University of Science and Technology, Wuhan, China,School of Optical and Electronic Information,
Huazhong
University of Science and Technology,
Wuhan, China
| | - Xudong Xue
- Department of Radiation Oncology, Hubei Cancer
Hospital, Tongji Medical College, Huazhong
University of Science and Technology, Wuhan, China
| | - Changchao Wei
- Department of Radiation Oncology, Hubei Cancer
Hospital, Tongji Medical College, Huazhong
University of Science and Technology, Wuhan, China,Key Laboratory of Artificial Micro and Nano-structures of Ministry
of Education, Center for Theoretical Physics, School of Physics and Technology,
Wuhan
University, Wuhan, China
| | - Yi Ding
- Department of Radiation Oncology, Hubei Cancer
Hospital, Tongji Medical College, Huazhong
University of Science and Technology, Wuhan, China
| | - Benpeng Zhu
- School of Optical and Electronic Information,
Huazhong
University of Science and Technology,
Wuhan, China,Benpeng Zhu, School of Optical and
Electronic Information, Huazhong University of Science and Technology, Wuhan,
430000, China.
| | - Wei Wei
- Department of Radiation Oncology, Hubei Cancer
Hospital, Tongji Medical College, Huazhong
University of Science and Technology, Wuhan, China,Wei Wei, Department of Radiation Oncology,
Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science
and Technology, Wuhan, 430079, China.
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14
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Qubala A, Schwahofer A, Jersemann S, Eskandarian S, Harrabi S, Naumann P, Winter M, Ellerbrock M, Shafee J, Abtehi S, Herfarth K, Debus J, Jäkel O. Optimizing the Patient Positioning Workflow of Patients with Pelvis, Limb, and Chest/Spine Tumors at an Ion-Beam Gantry based on Optical Surface Guidance. Adv Radiat Oncol 2022; 8:101105. [PMID: 36624871 PMCID: PMC9822948 DOI: 10.1016/j.adro.2022.101105] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/01/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose Surface-guided radiation therapy (SGRT) has been investigated intensively to ensure correct patient positioning during a radiation therapy course. Although the implementation is well defined for photon-beam facilities, only a few analyses have been published for ion-beam therapy centers. To investigate the accuracy, reliability, and efficiency of SGRT used in ion-beam treatments against the conventional skin marks, a retrospective study of a unique SGRT installation in an ion gantry treatment room was conducted, where the environment is quite different to conventional radiation therapy. Methods and Materials There were 32 patients, divided into 3 cohorts-pelvis, limb, and chest/spine tumors-and treated with ion-beams. Two patient positioning workflows based on 300 fractions were compared: workflow with skin marks and workflow with SGRT. Position verification was followed by planar kilo voltage imaging. After image matching, 6 degrees of freedom corrections were recorded to assess interfraction positioning errors. In addition, the time required for patient positioning, image matching, and the number of repeated kilo voltage imaging also were gathered. Results SGRT decreased the translational magnitude shifts significantly (P < .05) by 0.5 ± 1.4 mm for pelvis and 1.9 ± 0.5 mm for limb, whereas for chest/spine, it increased by 0.7 ± 0.3 mm. Rotational corrections were predominantly lowered with SGRT for all cohorts with significant differences in pitch for pelvis (P = .002) and chest/spine (P = .009). The patient positioning time decreased by 18%, 9%, and 15% for pelvis, limb, and chest/spine, respectively, compared with skin marks. By using SGRT, 53% of all studied patients had faster positioning time, and 87.5% had faster matching time. Repositioning and consequent reimaging decreased from about 7% to 2% with a statistically significant difference of .042. Conclusions The quality of patient positioning before ion-beam treatments has been optimized by using SGRT without additional imaging dose. SGRT clearly reduced inefficiencies in the patient positioning workflow.
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Affiliation(s)
- Abdallah Qubala
- Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany,Faculty of Medicine, University of Heidelberg, Heidelberg, Germany,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany,Corresponding author: Abdallah Qubala, MSc
| | - Andrea Schwahofer
- National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany,Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stefan Jersemann
- Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
| | - Saleh Eskandarian
- Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
| | - Semi Harrabi
- Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany,Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany,National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Patrick Naumann
- Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany,Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany,National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Marcus Winter
- Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
| | - Malte Ellerbrock
- Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
| | - Jehad Shafee
- Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany,Saarland University of Applied Sciences, Saarbruecken, Germany
| | - Samira Abtehi
- Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
| | - Klaus Herfarth
- Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany,Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany,National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Jürgen Debus
- Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany,Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany,National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Oliver Jäkel
- Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany,Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany,National Center for Tumor Diseases (NCT), Heidelberg, Germany
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15
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Hou C, Yin H, Gong G, Wang L, Su Y, Lu J, Yin Y. A novel approach for dose painting radiotherapy of brain metastases guided by mr perfusion images. Front Oncol 2022; 12:828312. [DOI: 10.3389/fonc.2022.828312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 11/15/2022] [Indexed: 12/05/2022] Open
Abstract
PurposeTo investigate the feasibility and dosimetric index features of dose painting guided by perfusion heterogeneity for brain metastasis (BMs) patients.MethodsA total of 50 patients with single BMs were selected for this study. CT and MR simulation images were obtained, including contrast-enhanced T1-weighted images (T1WI+C) and cerebral blood flow (CBF) maps from 3D-arterial spin labeling (ASL). The gross tumor volume (GTV) was determined by fusion of CT and T1WI+C images. Hypoperfused subvolumes (GTVH) with less than 25% of the maximum CBF value were defined as the dose escalation region. The planning target volume (PTV) and PTVH were calculated from GTV and GTVH respectively. The PTVN was obtained by subtracting PTVH from PTV, and conventional dose was given. Three kinds of radiotherapy plans were designed based on the CBF values. Plan 1 was defined as the conventional plan with an arbitrary prescription dose of 60 Gy for PTV. For dose painting, Plan 2 and Plan 3 escalated the prescription dose for PTVH to 72 Gy based on Plan 1, but Plan 3 removed the maximum dose constraint. Dosimetric indices were compared among the three plans.ResultsThe mean GTV volume was 34.5 (8.4-118.0) cm3, and mean GTVH volume was 17.0 (4.5-58.3) cm3, accounting for 49.3% of GTV. Both conventional plan and dose painting plans achieved 98% target coverage. The conformity index of PTVH were 0.44 (Plan1), 0.64 and 0.72 (Plan 2 and Plan 3, P<0.05). Compared to Plan 1, the D2%, D98% and Dmean values of the PTVH escalated by 20.50%, 19.32%, and 19.60% in Plan 2 and by 24.88%, 17.22% and 19.22% in Plan 3 respectively (P<0.05). In the three plans, the index of achievement value for PTVH was between 1.01 and 1.03 (P<0.05). The dose increment rates of Plan 2 and Plan 3 for each organs at risk (OARs) was controlled at 2.19% - 5.61% compared with Plan 1. The doses received by OARs did not significantly differ among the three plans (P >0.05).ConclusionsBMs are associated with significant heterogeneity, and effective escalation of the dose delivered to target subvolumes can be achieved with dose painting guided by 3D-ASL without extra doses to OARs.
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Laprie A, Tensaouti F, Cohen-Jonathan Moyal E. [Radiation dose intensification for glioblastoma]. Cancer Radiother 2022; 26:894-898. [PMID: 36085279 DOI: 10.1016/j.canrad.2022.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/07/2022] [Accepted: 07/07/2022] [Indexed: 10/14/2022]
Abstract
Glioblastoma is the most common brain tumor in adults; its treatment includes surgical excision or biopsy followed by radio-chemotherapy. Even if radiotherapy increases the survival of all patients regardless of their age or their general condition, there are always sources of radioresistance, where relapses occur and therefore treatment fails. Indeed, these foci result in a local relapse, which is observed in 95% of cases in the irradiation fields. We will describe here the current approaches to overcome this radioresistance by dose escalation, without or with guidance by metabolic and functional imaging (dose-painting). We will detail several prospective trials including the French phase III trial, SPECTRO-GLIO, randomizing the use of an integrated boost guided by spectrometric magnetic resonance imaging and similar trials developed across the Atlantic. We will also discuss approaches using different PET markers as well as diffusion or perfusion magnetic resonance imaging.
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Affiliation(s)
- A Laprie
- Département d'oncologie radiothérapie, institut universitaire du cancer de Toulouse-Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex, France; Inserm Toulouse neuroimaging center (Tonic), place Baylac, 31000 Toulouse, France.
| | - F Tensaouti
- Département d'oncologie radiothérapie, institut universitaire du cancer de Toulouse-Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex, France; Inserm Toulouse neuroimaging center (Tonic), place Baylac, 31000 Toulouse, France
| | - E Cohen-Jonathan Moyal
- Département d'oncologie radiothérapie, institut universitaire du cancer de Toulouse-Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex, France; Inserm Radopt, CRCT, Centre de recherche en cancérologie de Toulouse, 2, avenue Hubert-Curien, 31100 Toulouse, France
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17
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Kis D, Szivos L, Rekecki M, Shukir BS, Mate A, Hideghety K, Barzo P. Predicting the true extent of glioblastoma based on probabilistic tractography. Front Neurosci 2022; 16:886465. [PMID: 36213748 PMCID: PMC9533086 DOI: 10.3389/fnins.2022.886465] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 08/16/2022] [Indexed: 11/25/2022] Open
Abstract
Glioblastoma is the most frequent type of primary brain tumors. Despite the advanced therapy, most of the patients die within 2 years after the diagnosis. The tumor has a typical appearance on MRI: a central hypointensity surrounded by an inhomogeneous, ring-shaped contrast enhancement along its border. Too small to be recognized by MRI, detached individual tumor cells migrate along white matter fiber tracts several centimeters away from the edge of the tumor. Usually these cells are the source of tumor recurrence. If the infiltrated brain areas could be identified, longer survival time could be achieved through supratotal resection and individually planned radiation therapy. Probabilistic tractography is an advanced imaging method that can potentially be used to identify infiltrated pathways, thus the real extent of the glioblastoma. Our study consisted of twenty high grade glioma patients. Probabilistic tractography was started from the tumor. The location of tumor recurrence on follow-up MRI was considered as the primary infiltrated white matter tracts. The results of probabilistic tractography were evaluated at thirteen different thresholds. The overlap with the tumor recurrence of each threshold level was then defined to calculate the sensitivity and specificity. In the group level, sensitivity (81%) and specificity (90%) were the most reliable at 5% threshold level. There were two outliers in the study group, both with high specificity and very low sensitivity. According to our results, probabilistic tractography can help to define the true extent of the glioblastoma at the time of diagnosis with high sensitivity and specificity. Individually planned surgery and irradiation could provide a better chance of survival in these patients.
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Affiliation(s)
- David Kis
- Department of Neurosurgery, Faculty of Medicine, University of Szeged, Szeged, Hungary
- *Correspondence: David Kis,
| | - Laszlo Szivos
- Department of Neurosurgery, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Mark Rekecki
- Department of Neurosurgery, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Bayan Salam Shukir
- Department of Neurosurgery, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Adrienn Mate
- Department of Neurosurgery, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Katalin Hideghety
- Department of Oncology, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Pal Barzo
- Department of Neurosurgery, Faculty of Medicine, University of Szeged, Szeged, Hungary
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18
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Abstract
Cardiac remodelling is characterized by abnormal changes in the function and morphological properties such as diameter, mass, normal diameter of cavities, heart shape, fibrosis, thickening of vessels and heart layers, cardiomyopathy, infiltration of inflammatory cells, and some others. These damages are associated with damage to systolic and diastolic abnormalities, damage to ventricular function, and vascular remodelling, which may lead to heart failure and death. Exposure of the heart to radiation or anti-cancer drugs including chemotherapy drugs such as doxorubicin, receptor tyrosine kinase inhibitors (RTKIs) such as imatinib, and immune checkpoint inhibitors (ICIs) can induce several abnormal changes in the heart structure and function through the induction of inflammation and fibrosis, vascular remodelling, hypertrophy, and some others. This review aims to explain the basic mechanisms behind cardiac remodelling following cancer therapy by different anti-cancer modalities.
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19
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Pang Y, Wang H, Li H. Medical Imaging Biomarker Discovery and Integration Towards AI-Based Personalized Radiotherapy. Front Oncol 2022; 11:764665. [PMID: 35111666 PMCID: PMC8801459 DOI: 10.3389/fonc.2021.764665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/29/2021] [Indexed: 12/22/2022] Open
Abstract
Intensity-modulated radiation therapy (IMRT) has been used for high-accurate physical dose distribution sculpture and employed to modulate different dose levels into Gross Tumor Volume (GTV), Clinical Target Volume (CTV) and Planning Target Volume (PTV). GTV, CTV and PTV can be prescribed at different dose levels, however, there is an emphasis that their dose distributions need to be uniform, despite the fact that most types of tumour are heterogeneous. With traditional radiomics and artificial intelligence (AI) techniques, we can identify biological target volume from functional images against conventional GTV derived from anatomical imaging. Functional imaging, such as multi parameter MRI and PET can be used to implement dose painting, which allows us to achieve dose escalation by increasing doses in certain areas that are therapy-resistant in the GTV and reducing doses in less aggressive areas. In this review, we firstly discuss several quantitative functional imaging techniques including PET-CT and multi-parameter MRI. Furthermore, theoretical and experimental comparisons for dose painting by contours (DPBC) and dose painting by numbers (DPBN), along with outcome analysis after dose painting are provided. The state-of-the-art AI-based biomarker diagnosis techniques is reviewed. Finally, we conclude major challenges and future directions in AI-based biomarkers to improve cancer diagnosis and radiotherapy treatment.
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Affiliation(s)
- Yaru Pang
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Hui Wang
- Department of Chemical Engineering, University College London, London, United Kingdom
| | - He Li
- Department of Engineering, University of Cambridge, Cambridge, United Kingdom
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20
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Ramesh K, Mellon EA, Gurbani SS, Weinberg BD, Schreibmann E, Sheriff SA, Goryawala M, de le Fuente M, Eaton BR, Zhong J, Voloschin AD, Sengupta S, Dunbar EM, Holdhoff M, Barker PB, Maudsley AA, Kleinberg LR, Shim H, Shu HKG. A multi-institutional pilot clinical trial of spectroscopic MRI-guided radiation dose escalation for newly diagnosed glioblastoma. Neurooncol Adv 2022; 4:vdac006. [PMID: 35382436 PMCID: PMC8976280 DOI: 10.1093/noajnl/vdac006] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Glioblastomas (GBMs) are aggressive brain tumors despite radiation therapy (RT) to 60 Gy and temozolomide (TMZ). Spectroscopic magnetic resonance imaging (sMRI), which measures levels of specific brain metabolites, can delineate regions at high risk for GBM recurrence not visualized on contrast-enhanced (CE) MRI. We conducted a clinical trial to assess the feasibility, safety, and efficacy of sMRI-guided RT dose escalation to 75 Gy for newly diagnosed GBMs. Methods Our pilot trial (NCT03137888) enrolled patients at 3 institutions (Emory University, University of Miami, Johns Hopkins University) from September 2017 to June 2019. For RT, standard tumor volumes based on T2-FLAIR and T1w-CE MRIs with margins were treated in 30 fractions to 50.1 and 60 Gy, respectively. An additional high-risk volume based on residual CE tumor and Cho/NAA (on sMRI) ≥2× normal was treated to 75 Gy. Survival curves were generated by the Kaplan-Meier method. Toxicities were assessed according to CTCAE v4.0. Results Thirty patients were treated in the study. The median age was 59 years. 30% were MGMT promoter hypermethylated; 7% harbored IDH1 mutation. With a median follow-up of 21.4 months for censored patients, median overall survival (OS) and progression-free survival were 23.0 and 16.6 months, respectively. This regimen appeared well-tolerated with 70% of grade 3 or greater toxicity ascribed to TMZ and 23% occurring at least 1 year after RT. Conclusion Dose-escalated RT to 75 Gy guided by sMRI appears feasible and safe for patients with newly diagnosed GBMs. OS outcome is promising and warrants additional testing. Based on these results, a randomized phase II trial is in development.
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Affiliation(s)
- Karthik Ramesh
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia, USA,Department of Biomedical Engineering, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Eric A Mellon
- Department of Radiation Oncology, University of Miami, Miami, Florida, USA
| | - Saumya S Gurbani
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia, USA,Department of Biomedical Engineering, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Brent D Weinberg
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA,Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Eduard Schreibmann
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | | | | | - Bree R Eaton
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jim Zhong
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Alfredo D Voloschin
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Soma Sengupta
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA,Present affiliation: Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | | | - Matthias Holdhoff
- Department of Oncology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Peter B Barker
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Lawrence R Kleinberg
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Hyunsuk Shim
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia, USA,Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA,Department of Biomedical Engineering, Emory University School of Medicine, Atlanta, Georgia, USA,Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, USA,Corresponding Authors: Hyunsuk Shim, PhD and Hui-Kuo G. Shu, MD, PhD, Department of Radiation Oncology, Winship Cancer Institute of Emory University, 1701 Uppergate Drive, Atlanta, GA 30322, USA (. )
| | - Hui-Kuo G Shu
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia, USA,Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, USA
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21
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Tensaouti F, Desmoulin F, Gilhodes J, Martin E, Ken S, Lotterie JA, Noël G, Truc G, Sunyach MP, Charissoux M, Magné N, Lubrano V, Péran P, Cohen-Jonathan Moyal E, Laprie A. Quality control of 3D MRSI data in glioblastoma: Can we do without the experts? Magn Reson Med 2021; 87:1688-1699. [PMID: 34825724 DOI: 10.1002/mrm.29098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 11/05/2021] [Accepted: 11/05/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE Proton magnetic resonance spectroscopic imaging (1H MRSI) is a noninvasive technique for assessing tumor metabolism. Manual inspection is still the gold standard for quality control (QC) of spectra, but it is both time-consuming and subjective. The aim of the present study was to assess automatic QC of glioblastoma MRSI data using random forest analysis. METHODS Data for 25 patients, acquired prospectively in a preradiotherapy examination, were submitted to postprocessing with syngo.MR Spectro (VB40A; Siemens) or Java-based magnetic resonance user interface (jMRUI) software. A total of 28 features were extracted from each spectrum for the automatic QC. Three spectroscopists also performed manual inspections, labeling each spectrum as good or poor quality. All statistical analyses, with addressing unbalanced data, were conducted with R 3.6.1 (R Foundation for Statistical Computing; https://www.r-project.org). RESULTS The random forest method classified the spectra with an area under the curve of 95.5%, sensitivity of 95.8%, and specificity of 81.7%. The most important feature for the classification was Residuum_Lipids_Versus_Fit, obtained with syngo.MR Spectro. CONCLUSION The automatic QC method was able to distinguish between good- and poor-quality spectra, and can be used by radiation oncologists who are not spectroscopy experts. This study revealed a novel set of MRSI signal features that are closely correlated with spectral quality.
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Affiliation(s)
- Fatima Tensaouti
- Department of Radiation Oncology, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse-Oncopôle, Toulouse, France.,ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Franck Desmoulin
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Julia Gilhodes
- Department of Biostatistics, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse-Oncopôle, Toulouse, France
| | - Elodie Martin
- Department of Biostatistics, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse-Oncopôle, Toulouse, France
| | - Soleakhena Ken
- Department of Engineering and Medical Physics, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse-Oncopôle, Toulouse, France
| | - Jean-Albert Lotterie
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France.,Department of Nuclear Medicine, CHU Toulouse, Toulouse, France
| | - Georges Noël
- ICANS-Radiation Oncology Strasbourg, Strasbourg, France
| | - Gilles Truc
- Department of Radiation Oncology, Centre Georges-François Leclerc, Dijon, France
| | | | - Marie Charissoux
- Department of Radiation Oncology, Institut du Cancer de Montpellier, Montpellier, France
| | - Nicolas Magné
- Department of Radiation Oncology, Institut de Cancérologie de la Loire Lucien Neuwirth, Saint-Priest-en-Jarez, France
| | - Vincent Lubrano
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Patrice Péran
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Elizabeth Cohen-Jonathan Moyal
- Department of Radiation Oncology, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse-Oncopôle, Toulouse, France.,Inserm U1037-Centre de Recherches Contre le Cancer de Toulouse, Toulouse, France
| | - Anne Laprie
- Department of Radiation Oncology, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse-Oncopôle, Toulouse, France.,ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
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22
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Bolcaen J, Kleynhans J, Nair S, Verhoeven J, Goethals I, Sathekge M, Vandevoorde C, Ebenhan T. A perspective on the radiopharmaceutical requirements for imaging and therapy of glioblastoma. Theranostics 2021; 11:7911-7947. [PMID: 34335972 PMCID: PMC8315062 DOI: 10.7150/thno.56639] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/29/2021] [Indexed: 11/26/2022] Open
Abstract
Despite numerous clinical trials and pre-clinical developments, the treatment of glioblastoma (GB) remains a challenge. The current survival rate of GB averages one year, even with an optimal standard of care. However, the future promises efficient patient-tailored treatments, including targeted radionuclide therapy (TRT). Advances in radiopharmaceutical development have unlocked the possibility to assess disease at the molecular level allowing individual diagnosis. This leads to the possibility of choosing a tailored, targeted approach for therapeutic modalities. Therapeutic modalities based on radiopharmaceuticals are an exciting development with great potential to promote a personalised approach to medicine. However, an effective targeted radionuclide therapy (TRT) for the treatment of GB entails caveats and requisites. This review provides an overview of existing nuclear imaging and TRT strategies for GB. A critical discussion of the optimal characteristics for new GB targeting therapeutic radiopharmaceuticals and clinical indications are provided. Considerations for target selection are discussed, i.e. specific presence of the target, expression level and pharmacological access to the target, with particular attention to blood-brain barrier crossing. An overview of the most promising radionuclides is given along with a validation of the relevant radiopharmaceuticals and theranostic agents (based on small molecules, peptides and monoclonal antibodies). Moreover, toxicity issues and safety pharmacology aspects will be presented, both in general and for the brain in particular.
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Affiliation(s)
- Julie Bolcaen
- Radiobiology, Radiation Biophysics Division, Nuclear Medicine Department, iThemba LABS, Cape Town, South Africa
| | - Janke Kleynhans
- Nuclear Medicine Research Infrastructure NPC, Pretoria, South Africa
- Nuclear Medicine Department, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
| | - Shankari Nair
- Radiobiology, Radiation Biophysics Division, Nuclear Medicine Department, iThemba LABS, Cape Town, South Africa
| | | | - Ingeborg Goethals
- Ghent University Hospital, Department of Nuclear Medicine, Ghent, Belgium
| | - Mike Sathekge
- Nuclear Medicine Research Infrastructure NPC, Pretoria, South Africa
- Nuclear Medicine Department, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
| | - Charlot Vandevoorde
- Radiobiology, Radiation Biophysics Division, Nuclear Medicine Department, iThemba LABS, Cape Town, South Africa
| | - Thomas Ebenhan
- Nuclear Medicine Research Infrastructure NPC, Pretoria, South Africa
- Nuclear Medicine Department, University of Pretoria, Pretoria, South Africa
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23
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Zhong J, Huang V, Gurbani SS, Ramesh K, Scott Cordova J, Schreibmann E, Shu HKG, Olson J, Han H, Giuffrida A, Shim H, Weinberg BD. 3D whole-brain metabolite imaging to improve characterization of low-to-intermediate grade gliomas. J Neurooncol 2021; 153:303-311. [PMID: 33983570 PMCID: PMC8237861 DOI: 10.1007/s11060-021-03770-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/03/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE MRI is the standard imaging modality used for diagnosis, treatment planning, and post-treatment management of gliomas. Contrast-enhanced T1-weighted (CE-T1w) MRI is used to plan biopsy and radiation for grade IV gliomas but is less effective for grade II and III gliomas (i.e., low-to-intermediate grade gliomas) which may have minimal or no enhancement. Magnetic resonance spectroscopic imaging (MRSI) is an advanced MRI technique that has been shown, to improve diagnostic yield of biopsy and target delineation for grade IV glioma. The purpose of this study is to determine if MRSI can improve characterization and tissue sampling of low-to-intermediate grade gliomas. METHODS Prospective grade II and grade III glioma patients were enrolled to undergo whole brain high-resolution MRSI prior to tissue sampling. Choline/N-acetyl-aspartate (Cho/NAA) maps were overlaid on anatomic imaging and imported into stereotactic biopsy software. Patients were treated with standard-of-care surgery and radiation. Volumes of spectroscopically abnormal tissue were generated and compared with anatomic imaging and areas of enhancing recurrence on follow-up imaging. RESULTS Ten patients had pathologic diagnosis of grade II (n = 4) or grade III (n = 6) with a median follow-up of 27.3 months. Five patients had recurrence, and regions of recurrence were found to overlap with metabolically abnormal regions on MRSI at the time of diagnosis. CONCLUSION MRSI in low-to-intermediate grade glioma patients is predictive of areas of subsequent recurrence. Larger studies are needed to determine if MRSI can be used to guide surgical and radiation treatment planning in these patients.
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Affiliation(s)
- Jim Zhong
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Emory University School of Medicine, 1701 Uppergate Drive, C5018, Atlanta, GA, 30322, USA
| | - Vicki Huang
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Emory University School of Medicine, 1701 Uppergate Drive, C5018, Atlanta, GA, 30322, USA
| | - Saumya S Gurbani
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Emory University School of Medicine, 1701 Uppergate Drive, C5018, Atlanta, GA, 30322, USA
| | - Karthik Ramesh
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Emory University School of Medicine, 1701 Uppergate Drive, C5018, Atlanta, GA, 30322, USA
| | - J Scott Cordova
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Emory University School of Medicine, 1701 Uppergate Drive, C5018, Atlanta, GA, 30322, USA
| | - Eduard Schreibmann
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Emory University School of Medicine, 1701 Uppergate Drive, C5018, Atlanta, GA, 30322, USA
| | - Hui-Kuo G Shu
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Emory University School of Medicine, 1701 Uppergate Drive, C5018, Atlanta, GA, 30322, USA
| | - Jeffrey Olson
- Department of Neurosurgery, Winship Cancer Institute of Emory University, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Hui Han
- Biomedical Sciences and Biomedical Imaging Research Institute, Cedars Sinai, Los Angeles, CA, 90048, USA
| | - Alexander Giuffrida
- Department of Biomedical Engineering, Winship Cancer Institute of Emory University, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Hyunsuk Shim
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Emory University School of Medicine, 1701 Uppergate Drive, C5018, Atlanta, GA, 30322, USA.
| | - Brent D Weinberg
- Department of Radiology and Imaging Sciences, Winship Cancer Institute of Emory University, Emory University School of Medicine, 1701 Uppergate Drive, C5018, Atlanta, GA, 30322, USA.
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24
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McGee KP, Hwang KP, Sullivan DC, Kurhanewicz J, Hu Y, Wang J, Li W, Debbins J, Paulson E, Olsen JR, Hua CH, Warner L, Ma D, Moros E, Tyagi N, Chung C. Magnetic resonance biomarkers in radiation oncology: The report of AAPM Task Group 294. Med Phys 2021; 48:e697-e732. [PMID: 33864283 PMCID: PMC8361924 DOI: 10.1002/mp.14884] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/24/2021] [Accepted: 03/28/2021] [Indexed: 12/16/2022] Open
Abstract
A magnetic resonance (MR) biologic marker (biomarker) is a measurable quantitative characteristic that is an indicator of normal biological and pathogenetic processes or a response to therapeutic intervention derived from the MR imaging process. There is significant potential for MR biomarkers to facilitate personalized approaches to cancer care through more precise disease targeting by quantifying normal versus pathologic tissue function as well as toxicity to both radiation and chemotherapy. Both of which have the potential to increase the therapeutic ratio and provide earlier, more accurate monitoring of treatment response. The ongoing integration of MR into routine clinical radiation therapy (RT) planning and the development of MR guided radiation therapy systems is providing new opportunities for MR biomarkers to personalize and improve clinical outcomes. Their appropriate use, however, must be based on knowledge of the physical origin of the biomarker signal, the relationship to the underlying biological processes, and their strengths and limitations. The purpose of this report is to provide an educational resource describing MR biomarkers, the techniques used to quantify them, their strengths and weakness within the context of their application to radiation oncology so as to ensure their appropriate use and application within this field.
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Affiliation(s)
- Kiaran P McGee
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ken-Pin Hwang
- Department of Imaging Physics, Division of Diagnostic Imaging, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Daniel C Sullivan
- Department of Radiology, Duke University, Durham, North Carolina, USA
| | - John Kurhanewicz
- Department of Radiology, University of California, San Francisco, California, USA
| | - Yanle Hu
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Jihong Wang
- Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Wen Li
- Department of Radiation Oncology, University of Arizona, Tucson, Arizona, USA
| | - Josef Debbins
- Department of Radiology, Barrow Neurologic Institute, Phoenix, Arizona, USA
| | - Eric Paulson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jeffrey R Olsen
- Department of Radiation Oncology, University of Colorado Denver - Anschutz Medical Campus, Denver, Colorado, USA
| | - Chia-Ho Hua
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | | | - Daniel Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eduardo Moros
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Neelam Tyagi
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Caroline Chung
- Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
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25
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Weinberg BD, Kuruva M, Shim H, Mullins ME. Clinical Applications of Magnetic Resonance Spectroscopy in Brain Tumors: From Diagnosis to Treatment. Radiol Clin North Am 2021; 59:349-362. [PMID: 33926682 PMCID: PMC8272438 DOI: 10.1016/j.rcl.2021.01.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Magnetic resonance spectroscopy (MRS) is a valuable tool for imaging brain tumors, primarily as an adjunct to conventional imaging and clinical presentation. MRS is useful in initial diagnosis of brain tumors, helping differentiate tumors from possible mimics such as metastatic disease, lymphoma, demyelination, and infection, as well as in the subsequent follow-up of patients after resection and chemoradiation. Unfortunately, the spectroscopic appearance of many pathologies can overlap, and ultimately follow-up or biopsy may be required to make a definitive diagnosis. Future developments may continue to increase the value of MRS for initial diagnosis, treatment planning, and early detection of recurrence.
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Affiliation(s)
- Brent D Weinberg
- Radiology and Imaging Sciences, Emory University, 1364 Clifton Road Northeast BG20, Atlanta, GA 30322, USA.
| | - Manohar Kuruva
- Radiology and Imaging Sciences, Emory University, 1364 Clifton Road Northeast BG20, Atlanta, GA 30322, USA
| | - Hyunsuk Shim
- Radiation Oncology, Emory University, 1365 Clifton Road Northeast, Atlanta, GA 30322, USA
| | - Mark E Mullins
- Radiology and Imaging Sciences, Emory University, 1364 Clifton Road Northeast BG20, Atlanta, GA 30322, USA
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26
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Maudsley AA, Andronesi OC, Barker PB, Bizzi A, Bogner W, Henning A, Nelson SJ, Posse S, Shungu DC, Soher BJ. Advanced magnetic resonance spectroscopic neuroimaging: Experts' consensus recommendations. NMR IN BIOMEDICINE 2021; 34:e4309. [PMID: 32350978 PMCID: PMC7606742 DOI: 10.1002/nbm.4309] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 02/01/2020] [Accepted: 03/10/2020] [Indexed: 05/04/2023]
Abstract
Magnetic resonance spectroscopic imaging (MRSI) offers considerable promise for monitoring metabolic alterations associated with disease or injury; however, to date, these methods have not had a significant impact on clinical care, and their use remains largely confined to the research community and a limited number of clinical sites. The MRSI methods currently implemented on clinical MRI instruments have remained essentially unchanged for two decades, with only incremental improvements in sequence implementation. During this time, a number of technological developments have taken place that have already greatly benefited the quality of MRSI measurements within the research community and which promise to bring advanced MRSI studies to the point where the technique becomes a true imaging modality, while making the traditional review of individual spectra a secondary requirement. Furthermore, the increasing use of biomedical MR spectroscopy studies has indicated clinical areas where advanced MRSI methods can provide valuable information for clinical care. In light of this rapidly changing technological environment and growing understanding of the value of MRSI studies for biomedical studies, this article presents a consensus from a group of experts in the field that reviews the state-of-the-art for clinical proton MRSI studies of the human brain, recommends minimal standards for further development of vendor-provided MRSI implementations, and identifies areas which need further technical development.
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Affiliation(s)
- Andrew A Maudsley
- Department of Radiology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Ovidiu C Andronesi
- Department of Radiology, Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, Massachusetts
| | - Peter B Barker
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, and the Kennedy Krieger Institute, F.M. Kirby Center for Functional Brain Imaging, Baltimore, Maryland
| | - Alberto Bizzi
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Wolfgang Bogner
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Vienna, Austria
| | - Anke Henning
- Max Planck Institute for Biological Cybernetics, Tübingen, Germany
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sarah J Nelson
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Stefan Posse
- Department of Neurology, University of New Mexico, Albuquerque, New Mexico
| | - Dikoma C Shungu
- Department of Neuroradiology, Weill Cornell Medical College, New York, New York
| | - Brian J Soher
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
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27
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Rico M, Martínez M, Rodríguez M, Rosas L, Barco A, Martínez E. Hypofractionation and Stereotactic Body Radiation Therapy in Inoperable Locally Advanced Non-small Cell Lung Cancer. J Clin Transl Res 2021; 7:199-208. [PMID: 34104822 PMCID: PMC8177839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/24/2021] [Accepted: 03/29/2021] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND AND AIM Radiotherapy (RT) plays a key role in the control of locally advanced non-small cell lung cancer (LA-NSCLC). Throughout the years, different doses and fractionations of RT have been used in an attempt to optimize the results. Recently, special interest has been given to hypofractionation (hypoRT) and stereotactic body radiation therapy (SBRT). HypoRT is a relatively widespread treatment, although the accompanying level of evidence is limited. For its part, SBRT has been used specially to overdose specific areas of the disease as a boost after radiochemotherapy. In both cases, the study of how to integrate these RT tools with chemotherapy and immunotherapy is fundamental. In addition, the 2020 COVID-19 pandemic situation has sparked increased interest in hypofractionated treatments. In this review, we analyze the role of SBRT and hypoRT in the management of LA-NSCLC in accordance with current scientific evidence. RELEVANCE FOR PATIENTS The objective of this article is to introduce professionals to the role that hypoRT and SBRT can play in the treatment of LA-NSCLC to offer the best treatment to their patients.
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Affiliation(s)
- Mikel Rico
- 1Department of Radiation Oncology, Complejo Hospitalario de Navarra, Pamplona 31008, Navarra, Spain,2Health Research Institute of Navarre (IdiSNA), Navarra Biomed, Pamplona 31008, Navarra, Spain,
Corresponding author Mikel Rico Department of Radiation Oncology, Complejo Hospitalario de Navarra, Pamplona 31008, Navarra, Spain/Health Research Institute of Navarre (IdiSNA), Navarra Biomed, Pamplona 31008, Navarra, Spain E-mail:
| | - Maribel Martínez
- 1Department of Radiation Oncology, Complejo Hospitalario de Navarra, Pamplona 31008, Navarra, Spain
| | - Maitane Rodríguez
- 1Department of Radiation Oncology, Complejo Hospitalario de Navarra, Pamplona 31008, Navarra, Spain
| | - Lombardo Rosas
- 1Department of Radiation Oncology, Complejo Hospitalario de Navarra, Pamplona 31008, Navarra, Spain
| | - Andrea Barco
- 1Department of Radiation Oncology, Complejo Hospitalario de Navarra, Pamplona 31008, Navarra, Spain
| | - Enrique Martínez
- 1Department of Radiation Oncology, Complejo Hospitalario de Navarra, Pamplona 31008, Navarra, Spain
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Dong YL, Vadla GP, Lu JYJ, Ahmad V, Klein TJ, Liu LF, Glazer PM, Xu T, Chabu CY. Cooperation between oncogenic Ras and wild-type p53 stimulates STAT non-cell autonomously to promote tumor radioresistance. Commun Biol 2021; 4:374. [PMID: 33742110 PMCID: PMC7979758 DOI: 10.1038/s42003-021-01898-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 02/23/2021] [Indexed: 12/27/2022] Open
Abstract
Oncogenic RAS mutations are associated with tumor resistance to radiation therapy. Cell-cell interactions in the tumor microenvironment (TME) profoundly influence therapy outcomes. However, the nature of these interactions and their role in Ras tumor radioresistance remain unclear. Here we use Drosophila oncogenic Ras tissues and human Ras cancer cell radiation models to address these questions. We discover that cellular response to genotoxic stress cooperates with oncogenic Ras to activate JAK/STAT non-cell autonomously in the TME. Specifically, p53 is heterogeneously activated in Ras tumor tissues in response to irradiation. This mosaicism allows high p53-expressing Ras clones to stimulate JAK/STAT cytokines, which activate JAK/STAT in the nearby low p53-expressing surviving Ras clones, leading to robust tumor re-establishment. Blocking any part of this cell-cell communication loop re-sensitizes Ras tumor cells to irradiation. These findings suggest that coupling STAT inhibitors to radiotherapy might improve clinical outcomes for Ras cancer patients.
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Affiliation(s)
- Yong-Li Dong
- Howard Hughes Medical Institute, Department of Genetics, Yale University School of Medicine, Boyer Center for Molecular Medicine, New Haven, CT, USA
- State Key Laboratory of Genetic Engineering and National Center for International Research, Fudan-Yale Biomedical Research Center, Institute of Developmental Biology and Molecular Medicine, School of Life Sciences, Fudan University, Shanghai, China
| | - Gangadhara P Vadla
- Division of Biological Sciences, College of Veterinary Medicine, Department of Surgery, University of Missouri, Columbia, MO, USA
| | - Jin-Yu Jim Lu
- Howard Hughes Medical Institute, Department of Genetics, Yale University School of Medicine, Boyer Center for Molecular Medicine, New Haven, CT, USA
- Yale-Waterbury Internal Medicine Residency Program, Waterbury, CT, USA
| | - Vakil Ahmad
- Division of Biological Sciences, College of Veterinary Medicine, Department of Surgery, University of Missouri, Columbia, MO, USA
| | - Thomas J Klein
- Howard Hughes Medical Institute, Department of Genetics, Yale University School of Medicine, Boyer Center for Molecular Medicine, New Haven, CT, USA
- South Florida Radiation Oncology, West Palm Beach, FL, USA
| | - Lu-Fang Liu
- Howard Hughes Medical Institute, Department of Genetics, Yale University School of Medicine, Boyer Center for Molecular Medicine, New Haven, CT, USA
| | - Peter M Glazer
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Tian Xu
- Howard Hughes Medical Institute, Department of Genetics, Yale University School of Medicine, Boyer Center for Molecular Medicine, New Haven, CT, USA.
- Key Laboratory of Growth Regulation and Translation Research of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, Zhejiang Province, China.
| | - Chiswili-Yves Chabu
- Division of Biological Sciences, College of Veterinary Medicine, Department of Surgery, University of Missouri, Columbia, MO, USA.
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Castellano A, Bailo M, Cicone F, Carideo L, Quartuccio N, Mortini P, Falini A, Cascini GL, Minniti G. Advanced Imaging Techniques for Radiotherapy Planning of Gliomas. Cancers (Basel) 2021; 13:cancers13051063. [PMID: 33802292 PMCID: PMC7959155 DOI: 10.3390/cancers13051063] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 02/07/2023] Open
Abstract
The accuracy of target delineation in radiation treatment (RT) planning of cerebral gliomas is crucial to achieve high tumor control, while minimizing treatment-related toxicity. Conventional magnetic resonance imaging (MRI), including contrast-enhanced T1-weighted and fluid-attenuated inversion recovery (FLAIR) sequences, represents the current standard imaging modality for target volume delineation of gliomas. However, conventional sequences have limited capability to discriminate treatment-related changes from viable tumors, owing to the low specificity of increased blood-brain barrier permeability and peritumoral edema. Advanced physiology-based MRI techniques, such as MR spectroscopy, diffusion MRI and perfusion MRI, have been developed for the biological characterization of gliomas and may circumvent these limitations, providing additional metabolic, structural, and hemodynamic information for treatment planning and monitoring. Radionuclide imaging techniques, such as positron emission tomography (PET) with amino acid radiopharmaceuticals, are also increasingly used in the workup of primary brain tumors, and their integration in RT planning is being evaluated in specialized centers. This review focuses on the basic principles and clinical results of advanced MRI and PET imaging techniques that have promise as a complement to RT planning of gliomas.
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Affiliation(s)
- Antonella Castellano
- Neuroradiology Unit, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.C.); (A.F.)
| | - Michele Bailo
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, 20132 Milan, Italy; (M.B.); (P.M.)
| | - Francesco Cicone
- Department of Experimental and Clinical Medicine, “Magna Graecia” University of Catanzaro, and Nuclear Medicine Unit, University Hospital “Mater Domini”, 88100 Catanzaro, Italy;
- Correspondence: ; Tel.: +39-0-961-369-4155
| | - Luciano Carideo
- National Cancer Institute, G. Pascale Foundation, 80131 Naples, Italy;
| | - Natale Quartuccio
- A.R.N.A.S. Ospedale Civico Di Cristina Benfratelli, 90144 Palermo, Italy;
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, 20132 Milan, Italy; (M.B.); (P.M.)
| | - Andrea Falini
- Neuroradiology Unit, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.C.); (A.F.)
| | - Giuseppe Lucio Cascini
- Department of Experimental and Clinical Medicine, “Magna Graecia” University of Catanzaro, and Nuclear Medicine Unit, University Hospital “Mater Domini”, 88100 Catanzaro, Italy;
| | - Giuseppe Minniti
- Radiation Oncology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, 53100 Siena, Italy;
- IRCCS Neuromed, 86077 Pozzilli (IS), Italy
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31
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Laino ME, Young R, Beal K, Haque S, Mazaheri Y, Corrias G, Bitencourt AG, Karimi S, Thakur SB. Magnetic resonance spectroscopic imaging in gliomas: clinical diagnosis and radiotherapy planning. BJR Open 2020; 2:20190026. [PMID: 33178960 PMCID: PMC7594883 DOI: 10.1259/bjro.20190026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 01/13/2020] [Accepted: 03/18/2020] [Indexed: 12/23/2022] Open
Abstract
The reprogramming of cellular metabolism is a hallmark of cancer diagnosis and prognosis. Proton magnetic resonance spectroscopic imaging (MRSI) is a non-invasive diagnostic technique for investigating brain metabolism to establish cancer diagnosis and IDH gene mutation diagnosis as well as facilitate pre-operative planning and treatment response monitoring. By allowing tissue metabolism to be quantified, MRSI provides added value to conventional MRI. MRSI can generate metabolite maps from a single volume or multiple volume elements within the whole brain. Metabolites such as NAA, Cho and Cr, as well as their ratios Cho:NAA ratio and Cho:Cr ratio, have been used to provide tumor diagnosis and aid in radiation therapy planning as well as treatment assessment. In addition to these common metabolites, 2-hydroxygluterate (2HG) has also been quantified using MRSI following the recent discovery of IDH mutations in gliomas. This has opened up targeted drug development to inhibit the mutant IDH pathway. This review provides guidance on MRSI in brain gliomas, including its acquisition, analysis methods, and evolving clinical applications.
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Affiliation(s)
| | - Robert Young
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA
| | - Kathryn Beal
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA
| | - Sofia Haque
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA
| | | | - Giuseppe Corrias
- Department of Radiology, University of Cagliari, 40 Via Università, 09124 Cagliari, Italy
| | | | - Sasan Karimi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA
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32
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Baker S, Logie N, Paulson K, Duimering A, Murtha A. Radiotherapy for Brain Tumors: Current Practice and Future Directions. CURRENT CANCER THERAPY REVIEWS 2020. [DOI: 10.2174/1573394715666181129105542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Radiotherapy is an important component of the treatment for primary and metastatic
brain tumors. Due to the close proximity of critical structures and normal brain parenchyma, Central
Nervous System (CNS) radiotherapy is associated with adverse effects such as neurocognitive
deficits, which must be weighed against the benefit of improved tumor control. Advanced radiotherapy
technology may help to mitigate toxicity risks, although there is a paucity of high-level
evidence to support its use. Recent advances have been made in the treatment for gliomas, meningiomas,
benign tumors, and metastases, although outcomes remain poor for many high grade
tumors. This review highlights recent developments in CNS radiotherapy, discusses common
treatment toxicities, critically reviews advanced radiotherapy technologies, and highlights promising
treatment strategies to improve clinical outcomes in the future.
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Affiliation(s)
- Sarah Baker
- Department of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada
| | - Natalie Logie
- University of Florida Proton Therapy Institute, Jacksonville, FL, United States
| | - Kim Paulson
- Department of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada
| | - Adele Duimering
- Department of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada
| | - Albert Murtha
- Department of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada
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Tang B, Ma J, Xu J, Li J, Kang S, Wang P, Wu F, Orlandini LC. Feasibility of using calibrated cone-beam computed tomography scans to validate the heart dose in left breast post-mastectomy radiotherapy. J Int Med Res 2020; 48:300060520929168. [PMID: 32567427 PMCID: PMC7309397 DOI: 10.1177/0300060520929168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objective In post-mastectomy radiotherapy, high-conformal techniques are a valid method for determining the dose distribution around a target. However, the proximity of critical structures is a reason for concern. This study aims to evaluate the feasibility of using calibrated cone-beam computed tomography (CBCT) scans as a valid tool for a timely heart dose evaluation. Methods A retrospective analysis was conducted on 170 retrospective CBCT scans of 17 patients who underwent high-conformal post-mastectomy irradiation. The delivered doses that were calculated using personalized calibrated CBCT were compared with the doses planned, using the dose–volume histogram dosimetric parameters. Results The heart volume that was evaluated using CBCT presented a mean increase of 6%; this discrepancy impacted the heart dose in 4 of 17 patients, with an absolute increase of V25 Gy (range, 2.5%–7.6%) and an increase in the mean dose (range, 1.1–3.4 Gy). The dose for the target, ipsilateral lung, and contralateral breast remained unchanged. Conclusion Using CBCT to monitor the dose that is delivered to the heart is feasible, allowing for a timely shift to an adaptive plan if clinically necessary.
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Affiliation(s)
- Bin Tang
- Key Laboratory of Radiation Physics, Institute of Nuclear Science and Technology, Sichuan University, No. 24, South Section 1, Yihuar, Chengdu, 610065, China.,Department of Radiation Oncology, Sichuan Cancer Hospital & Research Institute, No. 55, the 4th Section, Renmin South Road, Chengdu, 610041, China
| | - Jiabao Ma
- Department of Radiation Oncology, Sichuan Cancer Hospital & Research Institute, No. 55, the 4th Section, Renmin South Road, Chengdu, 610041, China
| | - Jinghui Xu
- Department of Radiation Oncology, Sichuan Cancer Hospital & Research Institute, No. 55, the 4th Section, Renmin South Road, Chengdu, 610041, China
| | - Jie Li
- Department of Radiation Oncology, Sichuan Cancer Hospital & Research Institute, No. 55, the 4th Section, Renmin South Road, Chengdu, 610041, China
| | - Shengwei Kang
- Key Laboratory of Radiation Physics, Institute of Nuclear Science and Technology, Sichuan University, No. 24, South Section 1, Yihuar, Chengdu, 610065, China.,Department of Radiation Oncology, Sichuan Cancer Hospital & Research Institute, No. 55, the 4th Section, Renmin South Road, Chengdu, 610041, China
| | - Pei Wang
- Department of Radiation Oncology, Sichuan Cancer Hospital & Research Institute, No. 55, the 4th Section, Renmin South Road, Chengdu, 610041, China
| | - Fan Wu
- Department of Radiation Oncology, Sichuan Cancer Hospital & Research Institute, No. 55, the 4th Section, Renmin South Road, Chengdu, 610041, China
| | - Lucia Clara Orlandini
- Department of Radiation Oncology, Sichuan Cancer Hospital & Research Institute, No. 55, the 4th Section, Renmin South Road, Chengdu, 610041, China
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34
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Fennell JT, Gkika E, Grosu AL. Molecular Imaging in Photon Radiotherapy. Recent Results Cancer Res 2020; 216:845-863. [PMID: 32594409 DOI: 10.1007/978-3-030-42618-7_27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Nowadays, more than ever before, the treatment of cancer patients requires an interdisciplinary approach more than ever. Radiation therapy (RT) has become an indispensable pillar of cancer treatment early on, offering a local, curative treatment option and symptom control in palliative cases.
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Affiliation(s)
| | - Eleni Gkika
- Department of Radiation Oncology, University of Freiburg, Freiburg, Germany
| | - Anca L Grosu
- Department of Radiation Oncology, University of Freiburg, Freiburg, Germany.
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Li JY, Huang WX, Chen J, Zhao SP, Tang YY. Targeted Inhibitory Effect of Nasopharyngeal Carcinoma Cells by Hre 2.Grp78 Chimeric Promoter Regulating Fusion Gene TK/VP3. Technol Cancer Res Treat 2019; 18:1533033819875166. [PMID: 31769345 PMCID: PMC6880038 DOI: 10.1177/1533033819875166] [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] [Indexed: 11/19/2022] Open
Abstract
Objective: To construct plasmids with Hre2.Grp78 chimeric promoter regulating fusion
gene TK/VP3 and elaborate the effects of overexpressed
TK/VP3 on nasopharyngeal carcinoma cells. Methods: Four plasmids were constructed, including pcDNA3.1-CMV-TK/VP3,
pcDNA3.1-Hre2.TK/VP3, pcDNA3.1-Grp78.TK/VP3, and
pcDNA3.1-Hre2.Grp78.TK/VP3. The human nasopharyngeal carcinoma cell line HNE1
cells were transfected with the 4 plasmids, respectively. Cell viabilities were
evaluated using 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT)
assay, and apoptosis was conducted using flow cytometry analysis. The expression of TK,
VP3, Grp78, and hypoxia-inducible factor 1α and apoptosis-related proteins was
determined by real-time quantitative polymerase chain reaction and Western blotting. Results: The recombinant plasmids that could steadily overexpress TK and VP3 were successfully
constructed. Expression of TK and VP3 in cells transfected with
pcDNA3.1-Hre2.TK/VP3 and pcDNA3.1-Grp78.TK/VP3 was significantly higher than
pcDNA3.1-CMV-TK/VP3, and expression in cells transfected with
pcDNA3.1-Hre2.Grp78.TK/VP3 was the highest. Under glucose deprivation or
hypoxia condition, Grp78 or hypoxia-inducible factor 1α was overexpressed so that
expression of TK and VP3 was significantly upregulated, which could further inhibit cell
proliferation and enhance cell apoptosis. Conclusion: We successfully constructed 4 plasmids with Hre2.Grp78 chimeric promoter
regulating fusion gene TK/VP3, which could significantly inhibit the
proliferation as well as enhance the apoptosis of nasopharyngeal carcinoma cells under
glucose deprivation or hypoxia condition.
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Affiliation(s)
- Jin-Yun Li
- Xiangya Hospital, Central South University, Changsha, China
| | - Wen-Xiao Huang
- Xiangya Hospital, Central South University, Changsha, China
| | - Jie Chen
- Xiangya Hospital, Central South University, Changsha, China
| | - Su-Ping Zhao
- Xiangya Hospital, Central South University, Changsha, China
| | - Yao-Yun Tang
- Xiangya Hospital, Central South University, Changsha, China
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Zeinali-Rafsanjani B, Mosleh-Shirazi MA, Faghihi R, Saeedi-Moghadam M, Lotfi M, Jalli R. A method for cranial target delineation in radiotherapy treatment planning aided by single-voxel magnetic resonance spectroscopy: evaluation using a custom-designed gel-based phantom and simulations. Br J Radiol 2019; 92:20190216. [PMID: 31556332 DOI: 10.1259/bjr.20190216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Magnetic resonance spectroscopy (MRS) has been useful in radiotherapy treatment planning (RTP) especially in tumor delineation. Routinely, 2D/3D MRSI data are used for this application. However, not all centers have access to 2D/3D MRSI. The objective of this study was to introduce a method of using single-voxel spectroscopy (SVS) data in target delineation and assess its reliability. METHODS A gel-based phantom containing Creatine (Cr), N-acetyl-l-aspartic-acid (NAA), and Choline (Cho) was designed and built. The metabolite ratios simulate the normal and tumoral part of the brain. The jMRUI software (v. 6.0) was used to simulate a 1.5 T GE MRI scanner. The metabolite spectra provided by different time of echos (TE)s of the Point-RESolved Spectroscopy pulse-sequence (PRESS), different data-points, and post-processings were quantized by jMRUI. PseudoMRSI maps of Cho/Cr, NAA/Cr, and Cho + Cr/NAA were created. A conformity index (CI) was used to determine which metabolite-ratio isolines are more appropriate for tumor delineation. RESULTS The simulation accuracy was verified. There were no differences > 4% between the measured and simulated spectra in peak regions. The pseudoMRSI map of Cho + Cr/NAA smoothly followed the complicated geometry of the tumor inside the gel-based phantom. The results showed that the single-voxel spectra produced by the PRESS pulse sequence with the TE of 144 ms, 512 data-points, and minimum post-processings of water suppression, eddy current correction, and baseline correction can be used for target delineation. CONCLUSION This study suggests that SVS data can be used to aid target delineation by using a mathematical approach. This can enable a wider use of MR-derived information in radiotherapy. ADVANCES IN KNOWLEDGE To the best of our knowledge, until now, 2D or 3D MRSI data provided from 3T MRI scanners have been used for MRS-based radiotherapy treatment planning. However, there are a lot of centers that are equipped to 1.5 T MRI scanners and some of them just equipped to SVS. This study introduces a mathematical approach to help these centers to take the benefits of MRS-based treatment planning.
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Affiliation(s)
- Banafsheh Zeinali-Rafsanjani
- Medical imaging research center, Shiraz University of medical sciences, Shiraz, Iran.,Department of Nuclear Engineering, School of Mechanical Engineering, Shiraz University, Shiraz, Iran
| | - Mohammad Amin Mosleh-Shirazi
- Ionizing and Nonionizing Radiation Protection Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.,Radiotherapy and Oncology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Faghihi
- Department of Nuclear Engineering, School of Mechanical Engineering, Shiraz University, Shiraz, Iran.,Radiation research center, School of Mechanical Engineering, Shiraz University, Shiraz, Iran
| | - Mahdi Saeedi-Moghadam
- Medical imaging research center, Shiraz University of medical sciences, Shiraz, Iran
| | - Mehrzad Lotfi
- Medical imaging research center, Shiraz University of medical sciences, Shiraz, Iran
| | - Reza Jalli
- Medical imaging research center, Shiraz University of medical sciences, Shiraz, Iran
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Li Y, Zhu J, Liu Z, Teng J, Xie Q, Zhang L, Liu X, Shi J, Chen L. A preliminary study of using a deep convolution neural network to generate synthesized CT images based on CBCT for adaptive radiotherapy of nasopharyngeal carcinoma. Phys Med Biol 2019; 64:145010. [PMID: 31170699 DOI: 10.1088/1361-6560/ab2770] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This study aims to utilize a deep convolutional neural network (DCNN) for synthesized CT image generation based on cone-beam CT (CBCT) and to apply the images to dose calculations for nasopharyngeal carcinoma (NPC). An encoder-decoder 2D U-Net neural network was produced. A total of 70 CBCT/CT paired images of NPC cancer patients were used for training (50), validation (10) and testing (10) datasets. The testing datasets were treated with the same prescription dose (70 Gy to PTVnx70, 68 Gy to PTVnd68, 62 Gy to the PTV62 and 54 Gy to the PTV54). The mean error (ME) and mean absolute error (MAE) for the true CT images were calculated for image quality evaluation of the synthesized CT. The dose-volume histogram (DVH) dose metric difference and 3D gamma pass rate for the true CT images were calculated for dose analysis, and the results were compared with those for the CBCT images (original CBCT images without any correction) and a patient-specific calibration (PSC) method. Compared with CBCT, the range of the MAE for synthesized CT images improved from (60, 120) to (6, 27) Hounsfield units (HU), and the ME improved from (-74, 51) to (-26, 4) HU. Compared with the true CT method, the average DVH dose metric differences for the CBCT, PSC and synthesized CT methods were 0.8% ± 1.9%, 0.4% ± 0.7% and 0.2% ± 0.6%, respectively. The 1%/1 mm gamma pass rates within the body for the CBCT, PSC and synthesized CT methods were 90.8% ± 6.2%, 94.1% ± 4.4% and 95.5% ± 1.6%, respectively, and the rates within the PTVnx70 were 80.3% ± 16.6%, 87.9% ± 19.7%, 98.6% ± 2.9%, respectively. The DCNN model can generate high-quality synthesized CT images from CBCT images and be used for accurate dose calculations for NPC patients. This finding has great significance for the clinical application of adaptive radiotherapy for NPC.
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Affiliation(s)
- Yinghui Li
- School of Physics, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China. Physics Department of the Radiotherapy Department, The First People's Hospital of FoShan (Affiliated FoShan Hospital of Sun Yat-sen University), Foshan, Guangdong, People's Republic of China. State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Sun Yat-Sen University of Medical Sciences, Guangzhou, Guangdong, People's Republic of China
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Kauweloa KI, Bergamo A, Gutierrez AN, Stathakis S, Papanikolaou N, Mavroidis P. Use of 3D biological effective dose (BED) for optimizing multi-target liver cancer treatments. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2019; 42:711-718. [PMID: 31297729 DOI: 10.1007/s13246-019-00771-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 05/24/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022]
Abstract
The purpose is to calculate the composite 3D biological effective dose (BED) distribution in healthy liver, when multiple lesions are treated concurrently with different hypo-fractionated schemes and stereotactic body radiation therapy, and to investigate the potential of biological based plan optimization. Two patients, each having two tumors that were treated sequentially with different treatment plans, were selected. The treatment information of both treatment plans of the patients was used and their dose matrices were exported to an in-house MATLAB software, which was used to calculate the composite BED distribution. The composite BED distributions were used to determine if the healthy liver received BED beyond tolerance. When the dose to the minimum critical volume was less than tolerance, an optimization code was used to derive the scaling factors (ScF) that should be applied to the dose matrix of each plan until the minimum critical volume of healthy liver reaches a BED close to tolerance. It was shown that for each patient, there is a margin for dose escalation regarding the doses to the individual targets. More specifically, the ScFs of the doses range between 5.6 and 99 in the first patient, whereas for the second patient, the ScFs of the optimal doses range between 12.7 and 35.6. The present study indicates that there is a significant margin for dose escalation without increasing the radiation toxicity to the healthy liver. Also, the calculation of the composite BED distribution can provide additional information that may lead to a better assessment of the liver's tolerance to different fractionation schemes and prescribed doses as well as more clinically relevant treatment plan optimization.
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Affiliation(s)
- Kevin I Kauweloa
- Department of Radiation Oncology, University of Texas Health Sciences Center At San Antonio, San Antonio, TX, USA
| | - Angelo Bergamo
- Department of Radiation Oncology, University of Texas Health Sciences Center At San Antonio, San Antonio, TX, USA
| | - Alonso N Gutierrez
- Department of Radiation Oncology, University of Texas Health Sciences Center At San Antonio, San Antonio, TX, USA
| | - Sotiris Stathakis
- Department of Radiation Oncology, University of Texas Health Sciences Center At San Antonio, San Antonio, TX, USA
| | - Nikos Papanikolaou
- Department of Radiation Oncology, University of Texas Health Sciences Center At San Antonio, San Antonio, TX, USA
| | - Panayiotis Mavroidis
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC, USA.
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Tensaouti F, Ducassou A, Chaltiel L, Bolle S, Habrand JL, Alapetite C, Coche-Dequeant B, Bernier V, Claude L, Carrie C, Padovani L, Muracciole X, Supiot S, Huchet A, Leseur J, Kerr C, Hangard G, Lisbona A, Goudjil F, Ferrand R, Laprie A. Feasibility of Dose Escalation in Patients With Intracranial Pediatric Ependymoma. Front Oncol 2019; 9:531. [PMID: 31293971 PMCID: PMC6598548 DOI: 10.3389/fonc.2019.00531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 05/31/2019] [Indexed: 12/25/2022] Open
Abstract
Background and purpose: Pediatric ependymoma carries a dismal prognosis, mainly owing to local relapse within RT fields. The current prospective European approach is to increase the radiation dose with a sequential hypofractionated stereotactic boost. In this study, we assessed the possibility of using a simultaneous integrated boost (SIB), comparing VMAT vs. IMPT dose delivery. Material and methods: The cohort included 101 patients. The dose to planning target volume (PTV59.4) was 59.4/1.8 Gy, and the dose to SIB volume (PTV67.6) was 67.6/2.05 Gy. Gross tumor volume (GTV) was defined as the tumor bed plus residual tumor, clinical target volume (CTV59.4) was GTV + 5 mm, and PTV59.4 was CTV59.4 + 3 mm. PTV67.6 was GTV+ 3 mm. After treatment plan optimization, quality indices and doses to target volume and organs at risk (OARs) were extracted and compared with the standard radiation doses that were actually delivered (median = 59.4 Gy [50.4 59.4]). Results: In most cases, the proton treatment resulted in higher quality indices (p < 0.001). Compared with the doses that were initially delivered, mean, and maximum doses to some OARs were no higher with SIB VMAT, and significantly lower with protons (p < 0.001). In the case of posterior fossa tumor, there was a lower dose to the brainstem with protons, in terms of V59 Gy, mean, and near-maximum (D2%) doses. Conclusion: Dose escalation with intensity-modulated proton or photon SIB is feasible in some patients. This approach could be considered for children with unresectable residue or post-operative FLAIR abnormalities, particularly if they have supratentorial tumors. It should not be considered for infratentorial tumors encasing the brainstem or extending to the medulla.
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Affiliation(s)
- Fatima Tensaouti
- ToNIC, Toulouse NeuroImaging Center, Universite de Toulouse, Inserm, Toulouse, France
- Department of Radiation Oncology, Institut Claudius Regaud, Institut Universitaire du, Cancer de Toulouse-Oncopole, Toulouse, France
| | - Anne Ducassou
- Department of Radiation Oncology, Institut Claudius Regaud, Institut Universitaire du, Cancer de Toulouse-Oncopole, Toulouse, France
| | - Léonor Chaltiel
- Department of Biostatistics, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Stéphanie Bolle
- Department of Radiotherapy Oncology, Institut Gustave Roussy, Villejuif, France
| | - Jean Louis Habrand
- Department of Radiation Oncology, Centre Francois Baclesse, Caen, France
| | | | | | - Valérie Bernier
- Department of Radiation Oncology, Centre Alexis Vautrin, Vandœuvre-lès-Nancy, France
| | - Line Claude
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
| | - Christian Carrie
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
| | | | | | - Stéphane Supiot
- Department of Radiation Oncology, Institut de Cancerologie de l'Ouest, Nantes, France
| | - Aymeri Huchet
- Department of Radiation Oncology, Centre Hospitalier et Universitaire, Bordeaux, France
| | - Julie Leseur
- Department of Radiation Oncology, Centre Eugéne Marquis, Rennes, France
| | - Christine Kerr
- Department of Radiation Oncology, Institut Regional du Cancer Montpellier, Val d'Aurelle, Montpellier, France
| | - Grégorie Hangard
- Department of Engineering and Medical Physics, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Albert Lisbona
- Department of Radiation Oncology, Institut de Cancerologie de l'Ouest, Nantes, France
| | - Farid Goudjil
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Régis Ferrand
- Department of Engineering and Medical Physics, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Anne Laprie
- ToNIC, Toulouse NeuroImaging Center, Universite de Toulouse, Inserm, Toulouse, France
- Department of Radiation Oncology, Institut Claudius Regaud, Institut Universitaire du, Cancer de Toulouse-Oncopole, Toulouse, France
- Université Toulouse III Paul Sabatier, Toulouse, France
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Gurbani SS, Sheriff S, Maudsley AA, Shim H, Cooper LAD. Incorporation of a spectral model in a convolutional neural network for accelerated spectral fitting. Magn Reson Med 2019; 81:3346-3357. [PMID: 30666698 PMCID: PMC6414236 DOI: 10.1002/mrm.27641] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/09/2018] [Accepted: 11/29/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE MRSI has shown great promise in the detection and monitoring of neurologic pathologies such as tumor. A necessary component of data processing includes the quantitation of each metabolite, typically done through fitting a model of the spectrum to the data. For high-resolution volumetric MRSI of the brain, which may have ~10,000 spectra, significant processing time is required for spectral analysis and generation of metabolite maps. METHODS A novel unsupervised deep learning architecture that combines a convolutional neural network with a priori models of the spectrum is presented. This architecture, a convolutional encoder-model decoder (CEMD), combines the strengths of adaptive and unbiased convolutional networks with models of magnetic resonance and is readily interpretable. RESULTS The CEMD architecture performs accurate spectral fitting for volumetric MRSI in patients with glioblastoma, provides whole-brain fitting in 1 min on a standard computer, and handles a variety of spectral artifacts. CONCLUSION A new architecture combining physics domain knowledge with convolutional neural networks has been developed and is able to perform rapid spectral fitting of whole-brain data. Rapid processing is a critical step toward routine clinical practice.
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Affiliation(s)
- Saumya S. Gurbani
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA, USA
| | - Sulaiman Sheriff
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Andrew A. Maudsley
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hyunsuk Shim
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA, USA
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Lee A. D. Cooper
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA, USA
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA
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Laprie A, Ken S, Filleron T, Lubrano V, Vieillevigne L, Tensaouti F, Catalaa I, Boetto S, Khalifa J, Attal J, Peyraga G, Gomez-Roca C, Uro-Coste E, Noel G, Truc G, Sunyach MP, Magné N, Charissoux M, Supiot S, Bernier V, Mounier M, Poublanc M, Fabre A, Delord JP, Cohen-Jonathan Moyal E. Dose-painting multicenter phase III trial in newly diagnosed glioblastoma: the SPECTRO-GLIO trial comparing arm A standard radiochemotherapy to arm B radiochemotherapy with simultaneous integrated boost guided by MR spectroscopic imaging. BMC Cancer 2019; 19:167. [PMID: 30791889 PMCID: PMC6385401 DOI: 10.1186/s12885-019-5317-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 01/24/2019] [Indexed: 02/05/2023] Open
Abstract
Background Glioblastoma, a high-grade glial infiltrating tumor, is the most frequent malignant brain tumor in adults and carries a dismal prognosis. External beam radiotherapy (EBRT) increases overall survival but this is still low due to local relapses, mostly occurring in the irradiation field. As the ratio of spectra of choline/N acetyl aspartate> 2 (CNR2) on MR spectroscopic imaging has been described as predictive for the site of local relapse, we hypothesized that dose escalation on these regions would increase local control and hence global survival. Methods/design In this multicenter prospective phase III trial for newly diagnosed glioblastoma, 220 patients having undergone biopsy or surgery are planned for randomization to two arms. Arm A is the Stupp protocol (EBRT 60 Gy on contrast enhancement + 2 cm margin with concomitant temozolomide (TMZ) and 6 months of TMZ maintenance); Arm B is the same treatment with an additional simultaneous integrated boost of intensity-modulated radiotherapy (IMRT) of 72Gy/2.4Gy delivered on the MR spectroscopic imaging metabolic volumes of CHO/NAA > 2 and contrast-enhancing lesions or resection cavity. Stratification is performed on surgical and MGMT status. Discussion This is a dose-painting trial, i.e. delivery of heterogeneous dose guided by metabolic imaging. The principal endpoint is overall survival. An online prospective quality control of volumes and dose is performed in the experimental arm. The study will yield a large amount of longitudinal multimodal MR imaging data including planning CT, radiotherapy dosimetry, MR spectroscopic, diffusion and perfusion imaging. Trial registration NCT01507506, registration date December 20, 2011.
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Affiliation(s)
- Anne Laprie
- Radiation Oncology Department, Institut Claudius Regaud- Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France. .,ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, INSERM, UPS, Toulouse, France.
| | - Soléakhéna Ken
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, INSERM, UPS, Toulouse, France.,Department of Engineering and Medical Physics, Institut Claudius Regaud- Institut Universitaire du Cancer de Toulouse-OncopoleCancer de Toulouse-Oncopole, Toulouse, France
| | - Thomas Filleron
- Biostatistics Unit, Institut Claudius Regaud- Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Vincent Lubrano
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, INSERM, UPS, Toulouse, France.,Neurosurgery Department, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Laure Vieillevigne
- Department of Engineering and Medical Physics, Institut Claudius Regaud- Institut Universitaire du Cancer de Toulouse-OncopoleCancer de Toulouse-Oncopole, Toulouse, France
| | - Fatima Tensaouti
- Radiation Oncology Department, Institut Claudius Regaud- Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France.,ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, INSERM, UPS, Toulouse, France
| | - Isabelle Catalaa
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, INSERM, UPS, Toulouse, France.,Neuroimaging Department, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Sergio Boetto
- Neurosurgery Department, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Jonathan Khalifa
- Radiation Oncology Department, Institut Claudius Regaud- Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Justine Attal
- Radiation Oncology Department, Institut Claudius Regaud- Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Guillaume Peyraga
- Radiation Oncology Department, Institut Claudius Regaud- Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Carlos Gomez-Roca
- Medical Oncology Department, Institut Claudius Regaud- Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Emmanuelle Uro-Coste
- Pathology department, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Georges Noel
- Radiation Oncology Department, Centre Paul Strauss, Strasbourg, France
| | - Gilles Truc
- Radiation Oncology Department Centre Georges-François Leclerc, Dijon, France
| | | | - Nicolas Magné
- Radiation Oncology Department, Institut de Cancérologie de la Loire, Saint-Priest en Jarez, France
| | - Marie Charissoux
- Radiation Oncology Department - Centre Val d'aurelle, Montpellier, France
| | - Stéphane Supiot
- Radiation Oncology Department, Institut de Cancerologie de l'Ouest, Nantes st Herblain, France
| | - Valérie Bernier
- Radiation Oncology Department, Institut de cancérologie de Lorraine centre Alexis Vautrin, Nancy, France
| | - Muriel Mounier
- Clinical Research Department, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Muriel Poublanc
- Clinical Research Department, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Amandine Fabre
- Clinical Research Department, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Jean-Pierre Delord
- Medical Oncology Department, Institut Claudius Regaud- Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Elizabeth Cohen-Jonathan Moyal
- Radiation Oncology Department, Institut Claudius Regaud- Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France.,INSERM UMR1037, Cancer Research Center of Toulouse, Oncopole, Toulouse, France
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Sarkaria JN, Hu LS, Parney IF, Pafundi DH, Brinkmann DH, Laack NN, Giannini C, Burns TC, Kizilbash SH, Laramy JK, Swanson KR, Kaufmann TJ, Brown PD, Agar NYR, Galanis E, Buckner JC, Elmquist WF. Is the blood-brain barrier really disrupted in all glioblastomas? A critical assessment of existing clinical data. Neuro Oncol 2019; 20:184-191. [PMID: 29016900 DOI: 10.1093/neuonc/nox175] [Citation(s) in RCA: 408] [Impact Index Per Article: 81.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The blood-brain barrier (BBB) excludes the vast majority of cancer therapeutics from normal brain. However, the importance of the BBB in limiting drug delivery and efficacy is controversial in high-grade brain tumors, such as glioblastoma (GBM). The accumulation of normally brain impenetrant radiographic contrast material in essentially all GBM has popularized a belief that the BBB is uniformly disrupted in all GBM patients so that consideration of drug distribution across the BBB is not relevant in designing therapies for GBM. However, contrary to this view, overwhelming clinical evidence demonstrates that there is also a clinically significant tumor burden with an intact BBB in all GBM, and there is little doubt that drugs with poor BBB permeability do not provide therapeutically effective drug exposures to this fraction of tumor cells. This review provides an overview of the clinical literature to support a central hypothesis: that all GBM patients have tumor regions with an intact BBB, and cure for GBM will only be possible if these regions of tumor are adequately treated.
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Affiliation(s)
- Jann N Sarkaria
- Mayo Clinic, Rochester, Minnesota (J.N.S., I.F.P., D.H.P., D.H.B., N.N.L., C.G., T.C.B., S.H.K., T.J.K., P.D.B., E.G., J.C.B.)
| | - Leland S Hu
- Mayo Clinic, Scottsdale, Arizona (L.S.H., K.R.S.)
| | - Ian F Parney
- Mayo Clinic, Rochester, Minnesota (J.N.S., I.F.P., D.H.P., D.H.B., N.N.L., C.G., T.C.B., S.H.K., T.J.K., P.D.B., E.G., J.C.B.)
| | - Deanna H Pafundi
- Mayo Clinic, Rochester, Minnesota (J.N.S., I.F.P., D.H.P., D.H.B., N.N.L., C.G., T.C.B., S.H.K., T.J.K., P.D.B., E.G., J.C.B.)
| | - Debra H Brinkmann
- Mayo Clinic, Rochester, Minnesota (J.N.S., I.F.P., D.H.P., D.H.B., N.N.L., C.G., T.C.B., S.H.K., T.J.K., P.D.B., E.G., J.C.B.)
| | - Nadia N Laack
- Mayo Clinic, Rochester, Minnesota (J.N.S., I.F.P., D.H.P., D.H.B., N.N.L., C.G., T.C.B., S.H.K., T.J.K., P.D.B., E.G., J.C.B.)
| | - Caterina Giannini
- Mayo Clinic, Rochester, Minnesota (J.N.S., I.F.P., D.H.P., D.H.B., N.N.L., C.G., T.C.B., S.H.K., T.J.K., P.D.B., E.G., J.C.B.)
| | - Terence C Burns
- Mayo Clinic, Rochester, Minnesota (J.N.S., I.F.P., D.H.P., D.H.B., N.N.L., C.G., T.C.B., S.H.K., T.J.K., P.D.B., E.G., J.C.B.)
| | - Sani H Kizilbash
- Mayo Clinic, Rochester, Minnesota (J.N.S., I.F.P., D.H.P., D.H.B., N.N.L., C.G., T.C.B., S.H.K., T.J.K., P.D.B., E.G., J.C.B.)
| | - Janice K Laramy
- University of Minnesota, Minneapolis, Minnesota (J.K.L., W.F.E.)
| | | | - Timothy J Kaufmann
- Mayo Clinic, Rochester, Minnesota (J.N.S., I.F.P., D.H.P., D.H.B., N.N.L., C.G., T.C.B., S.H.K., T.J.K., P.D.B., E.G., J.C.B.)
| | - Paul D Brown
- Mayo Clinic, Rochester, Minnesota (J.N.S., I.F.P., D.H.P., D.H.B., N.N.L., C.G., T.C.B., S.H.K., T.J.K., P.D.B., E.G., J.C.B.)
| | | | - Evanthia Galanis
- Mayo Clinic, Rochester, Minnesota (J.N.S., I.F.P., D.H.P., D.H.B., N.N.L., C.G., T.C.B., S.H.K., T.J.K., P.D.B., E.G., J.C.B.)
| | - Jan C Buckner
- Mayo Clinic, Rochester, Minnesota (J.N.S., I.F.P., D.H.P., D.H.B., N.N.L., C.G., T.C.B., S.H.K., T.J.K., P.D.B., E.G., J.C.B.)
| | - William F Elmquist
- Mayo Clinic, Rochester, Minnesota (J.N.S., I.F.P., D.H.P., D.H.B., N.N.L., C.G., T.C.B., S.H.K., T.J.K., P.D.B., E.G., J.C.B.)
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Tissue-type mapping of gliomas. NEUROIMAGE-CLINICAL 2018; 21:101648. [PMID: 30630760 PMCID: PMC6411966 DOI: 10.1016/j.nicl.2018.101648] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/05/2018] [Accepted: 12/22/2018] [Indexed: 11/24/2022]
Abstract
Purpose To develop a statistical method of combining multimodal MRI (mMRI) of adult glial brain tumours to generate tissue heterogeneity maps that indicate tumour grade and infiltration margins. Materials and methods We performed a retrospective analysis of mMRI from patients with histological diagnosis of glioma (n = 25). 1H Magnetic Resonance Spectroscopic Imaging (MRSI) was used to label regions of “pure” low- or high-grade tumour across image types. Normal brain and oedema characteristics were defined from healthy controls (n = 10) and brain metastasis patients (n = 10) respectively. Probability density distributions (PDD) for each tissue type were extracted from intensity normalised proton density and T2-weighted images, and p and q diffusion maps. Superpixel segmentation and Bayesian inference was used to produce whole-brain tissue-type maps. Results Total lesion volumes derived automatically from tissue-type maps correlated with those from manual delineation (p < 0.001, r = 0.87). Large high-grade volumes were determined in all grade III & IV (n = 16) tumours, in grade II gemistocytic rich astrocytomas (n = 3) and one astrocytoma with a histological diagnosis of grade II. For patients with known outcome (n = 20), patients with survival time < 2 years (3 grade II, 2 grade III and 10 grade IV) had a high-grade volume significantly greater than zero (Wilcoxon signed rank p < 0.0001) and also significantly greater high grade volume than the 5 grade II patients with survival >2 years (Mann Witney p = 0.0001). Regions classified from mMRI as oedema had non-tumour-like 1H MRS characteristics. Conclusions 1H MRSI can label tumour tissue types to enable development of a mMRI tissue type mapping algorithm, with potential to aid management of patients with glial tumours. Non-Gaussian multimodal MRI characteristics of high and low grade glioma tissue. Bayesian inference of multimodal MRI derives whole brain tumour tissue-type maps. Automated segmentation of normal and tumour tissue volumes. Visualisation of glioma heterogeneity, infiltration, necrosis and vasogenic oedema.
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Vanhove C, Goethals I. Magnetic resonance imaging-guided radiation therapy using animal models of glioblastoma. Br J Radiol 2018; 92:20180713. [PMID: 30563357 DOI: 10.1259/bjr.20180713] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Glioblastoma is the most aggressive and most common malignant primary brain tumour in adults and has a high mortality and morbidity. Because local tumour control in glioblastoma patients is still elusive in the majority of patients, there is an urgent need for alternative treatment strategies. However, to implement changes to the existing clinical standard of care, research must be conducted to develop alternative treatment strategies. A novel approach in radiotherapy is the introduction of pre-clinical precision image-guided radiation research platforms. The aim of this review is to give a brief overview of the efforts that have been made in the field of radiation research using animal models of glioblastoma. Because MRI has become the reference imaging technique for treatment planning and assessment of therapeutic responses in glioblastoma patients, we will focus in this review on small animal radiotherapy combined with MRI.
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Affiliation(s)
- Christian Vanhove
- 1 Department of Electronics and Information Systems, Institute Biomedical Technology (IBiTech), Ghent University , Ghent , Belgium
| | - Ingeborg Goethals
- 2 Department of Nuclear Medicine, Ghent University Hospital , Ghent , Belgium
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Press RH, Zhong J, Gurbani SS, Weinberg BD, Eaton BR, Shim H, Shu HKG. The Role of Standard and Advanced Imaging for the Management of Brain Malignancies From a Radiation Oncology Standpoint. Neurosurgery 2018; 85:165-179. [DOI: 10.1093/neuros/nyy461] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 08/30/2018] [Indexed: 01/20/2023] Open
Abstract
Abstract
Radiation therapy (RT) plays a critical role in the overall management of many central nervous system (CNS) tumors. Advances in RT treatment planning, with techniques such as intensity modulated radiation therapy, volumetric modulated arc therapy, and stereotactic radiosurgery, now allow the delivery of highly conformal dose with great precision. These techniques rely on high-resolution 3-dimensional anatomical imaging modalities such as computed tomography or magnetic resonance imaging (MRI) scans to accurately and reliably define CNS targets and normal tissue avoidance structures. The integration of cross-sectional imaging into radiation oncology has directly translated into improvements in the therapeutic window of RT, and the union between radiation oncology and imaging is only expected to grow stronger. In addition, advanced imaging modalities including diffusion, perfusion, and spectroscopic MRIs as well as positron emission tomography (PET) scans with novel tracers are being utilized to provide additional insight into tumor biology and behavior beyond anatomy. Together, these standard and advanced imaging modalities hold significant potential to improve future RT delivery and response assessment. In this review, we will discuss the current utilization of standard/advanced imaging for CNS tumors from a radiation oncology perspective as well as the implications of novel MRI and PET modalities currently under investigation.
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Affiliation(s)
- Robert H Press
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Jim Zhong
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Saumya S Gurbani
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | - Brent D Weinberg
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Bree R Eaton
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Hyunsuk Shim
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | - Hui-Kuo G Shu
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
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Peyraga G, Robaine N, Khalifa J, Cohen-Jonathan-Moyal E, Payoux P, Laprie A. Molecular PET imaging in adaptive radiotherapy: brain. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2018; 62:337-348. [PMID: 30497232 DOI: 10.23736/s1824-4785.18.03116-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Owing to their heterogeneity and radioresistance, the prognosis of primitive brain tumors, which are mainly glial tumors, remains poor. Dose escalation in radioresistant areas is a potential issue for improving local control and overall survival. This review focuses on advances in biological and metabolic imaging of brain tumors that are proving to be essential for defining tumor target volumes in radiation therapy (RT) and for increasing the use of DPRT (dose painting RT) and ART (adaptative RT), to optimize dose in radio-resistant areas. EVIDENCE ACQUISITION Various biological imaging modalities such as PET (hypoxia, glucidic metabolism, protidic metabolism, cellular proliferation, inflammation, cellular membrane synthesis) and MRI (spectroscopy) may be used to identify these areas of radioresistance. The integration of these biological imaging modalities improves the diagnosis, prognosis and treatment of brain tumors. EVIDENCE SYNTHESIS Technological improvements (PET and MRI), the development of research, and intensive cooperation between different departments are necessary before using daily metabolic imaging (PET and MRI) to treat patients with brain tumors. CONCLUSIONS The adaptation of treatment volumes during RT (ART) seems promising, but its development requires improvements in several areas and an interdisciplinary approach involving radiology, nuclear medicine and radiotherapy. We review the literature on biological imaging to outline the perspectives for using DPRT and ART in brain tumors.
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Affiliation(s)
- Guillaume Peyraga
- Department of Radiation Therapy, Claudius Regaud Institute, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - Nesrine Robaine
- Department of Nuclear Medicine, Claudius Regaud Institute, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - Jonathan Khalifa
- Department of Radiation Therapy, Claudius Regaud Institute, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France.,Paul Sabatier University, Toulouse III, Toulouse, France
| | - Elizabeth Cohen-Jonathan-Moyal
- Department of Radiation Therapy, Claudius Regaud Institute, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France.,Paul Sabatier University, Toulouse III, Toulouse, France
| | - Pierre Payoux
- Department of Nuclear Medicine, Purpan University Hospital Center, Toulouse, France
| | - Anne Laprie
- Department of Radiation Therapy, Claudius Regaud Institute, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France - .,Paul Sabatier University, Toulouse III, Toulouse, France
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Press RH, Shu HKG, Shim H, Mountz JM, Kurland BF, Wahl RL, Jones EF, Hylton NM, Gerstner ER, Nordstrom RJ, Henderson L, Kurdziel KA, Vikram B, Jacobs MA, Holdhoff M, Taylor E, Jaffray DA, Schwartz LH, Mankoff DA, Kinahan PE, Linden HM, Lambin P, Dilling TJ, Rubin DL, Hadjiiski L, Buatti JM. The Use of Quantitative Imaging in Radiation Oncology: A Quantitative Imaging Network (QIN) Perspective. Int J Radiat Oncol Biol Phys 2018; 102:1219-1235. [PMID: 29966725 PMCID: PMC6348006 DOI: 10.1016/j.ijrobp.2018.06.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 05/25/2018] [Accepted: 06/14/2018] [Indexed: 02/07/2023]
Abstract
Modern radiation therapy is delivered with great precision, in part by relying on high-resolution multidimensional anatomic imaging to define targets in space and time. The development of quantitative imaging (QI) modalities capable of monitoring biologic parameters could provide deeper insight into tumor biology and facilitate more personalized clinical decision-making. The Quantitative Imaging Network (QIN) was established by the National Cancer Institute to advance and validate these QI modalities in the context of oncology clinical trials. In particular, the QIN has significant interest in the application of QI to widen the therapeutic window of radiation therapy. QI modalities have great promise in radiation oncology and will help address significant clinical needs, including finer prognostication, more specific target delineation, reduction of normal tissue toxicity, identification of radioresistant disease, and clearer interpretation of treatment response. Patient-specific QI is being incorporated into radiation treatment design in ways such as dose escalation and adaptive replanning, with the intent of improving outcomes while lessening treatment morbidities. This review discusses the current vision of the QIN, current areas of investigation, and how the QIN hopes to enhance the integration of QI into the practice of radiation oncology.
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Affiliation(s)
- Robert H. Press
- Dept. of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Hui-Kuo G. Shu
- Dept. of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Hyunsuk Shim
- Dept. of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - James M. Mountz
- Dept. of Radiology, University of Pittsburgh, Pittsburgh, PA
| | | | | | - Ella F. Jones
- Dept. of Radiology, University of California, San Francisco, San Francisco, CA
| | - Nola M. Hylton
- Dept. of Radiology, University of California, San Francisco, San Francisco, CA
| | - Elizabeth R. Gerstner
- Dept. of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | | | - Lori Henderson
- Cancer Imaging Program, National Cancer Institute, Bethesda, MD
| | | | - Bhadrasain Vikram
- Radiation Research Program/Division of Cancer Treatment & Diagnosis, National Cancer Institute, Bethesda, MD
| | - Michael A. Jacobs
- Dept. of Radiology and Radiological Science, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore MD
| | - Matthias Holdhoff
- Brain Cancer Program, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore MD
| | - Edward Taylor
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - David A. Jaffray
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | | | - David A. Mankoff
- Dept. of Radiology, University of Pennsylvania, Philadelphia, PA
| | | | | | - Philippe Lambin
- Dept. of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Thomas J. Dilling
- Dept. of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | | | - John M. Buatti
- Dept. of Radiation Oncology, University of Iowa, Iowa City, IA
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Cardenas CE, Anderson BM, Aristophanous M, Yang J, Rhee DJ, McCarroll RE, Mohamed ASR, Kamal M, Elgohari BA, Elhalawani HM, Fuller CD, Rao A, Garden AS, Court LE. Auto-delineation of oropharyngeal clinical target volumes using 3D convolutional neural networks. ACTA ACUST UNITED AC 2018; 63:215026. [DOI: 10.1088/1361-6560/aae8a9] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Maudsley AA. Lesion segmentation for MR spectroscopic imaging using the convolution difference method. Magn Reson Med 2018; 81:1499-1510. [PMID: 30303564 DOI: 10.1002/mrm.27500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/18/2018] [Accepted: 08/01/2018] [Indexed: 11/05/2022]
Abstract
PURPOSE Delineation of lesion boundaries from volumetric MRSI metabolite ratio maps using a method that accounts for the spatial response function of the acquisition and variable spectral quality and is robust to signal heterogeneity within the lesion. METHODS A novel method for lesion segmentation, termed convolution difference, has been developed that is robust to signal heterogeneity within the lesion and to differences in the spatial response function. Procedures are described for processing metabolite ratio maps and to exclude regions of inadequate spectral quality. This method was evaluated using computer simulations, and the results were compared with an iterative thresholding technique that determines an optimal amplitude threshold, and with the use of a fixed amplitude threshold. These methods were evaluated for segmentation of volumetric MRSI studies of gliomas using maps of the choline to N-acetylaspartate ratio, and a qualitative comparison of lesion volumes carried out. RESULTS Simulation studies indicated improved performance for the convolution difference method when applied to ratio maps. Variations in tumor volume were observed for the in vivo studies between the convolution difference and the iterative thresholding methods; however, visual analysis indicates that both showed improved accuracy in comparison to using a fixed amplitude threshold. CONCLUSION This study reinforces previous reports indicating that the use of fixed threshold values for segmentation of maps with broad spatial response functions can result in errors in lesion volume definition. A novel segmentation method, termed the convolution difference, has been introduced and demonstrated to be robust for segmentation of volumetric MRSI metabolite data.
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Affiliation(s)
- Andrew A Maudsley
- Department of Radiology, University of Miami School of Medicine, Miami, Florida
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Wang P, Tang S, Taylor PA, Cummings DE, Janson M, Traneus E, Sturgeon JD, Lee AK, Chang C. Clinical examination of proton pencil beam scanning on a moving anthropomorphic lung phantom. Med Dosim 2018; 44:122-129. [PMID: 29759487 DOI: 10.1016/j.meddos.2018.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 02/26/2018] [Accepted: 04/05/2018] [Indexed: 10/16/2022]
Abstract
The objective of this study was to examine the use of proton pencil beam scanning for the treatment of moving lung tumors. A single-field uniform dose proton pencil beam scanning (PBS) plan was generated for the standard thorax phantom designed by the Imaging and Radiation Oncology Core (IROC) Houston QA Center. Robust optimization, including range and setup uncertainties as well as volumetric repainting, was used for the plan. Patient-specific quality assurance (QA) measurements were performed using both a water tank and a custom heterogeneous QA phantom. A custom moving phantom was used to find the optimal number of volumetric repainting. Both analytical and Monte Carlo (MC) algorithms were used for dose calculation and their accuracies were compared with actual measurements. A single ionization chamber, a 2-dimensional ionization chamber array, thermoluminescent dosimeters (TLDs), and films were used for dose measurements. The optimal number of volumetric repainting was found to be 4 times in our system. The mean dose overestimations on a moving target by analytical and MC algorithms based on a time-averaged computed tomography (CT) image of the phantom were found to be 4.8% and 2.4%, respectively. The mean gamma indexes for analytical and MC algorithms were 91% and 96%, respectively. The MC dose algorithm calculation was found to have a better agreement with measurements compared with the analytical algorithm. When treating moving lung tumors using proton PBS, the techniques of robust optimization, volumetric repainting, and MC dose calculation were found effective. Extra care needs to be taken when an analytical dose calculation algorithm is used.
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Affiliation(s)
- Peng Wang
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD.
| | | | - Paige A Taylor
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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