1
|
Yao W, Farr JB, Mossahebi S, Yi B, Chen S. Technical note: Determination of proton linear energy transfer from the integral depth dose. Med Phys 2024; 51:5148-5153. [PMID: 38043083 DOI: 10.1002/mp.16866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Proton linear energy transfer (LET) is associated with the relative biological effectiveness of radiation on tissues. Monte Carlo (MC) simulations have been known to be the preferred method to calculate LET. Detectors have also been built to measure LET, but they need to be calibrated with MC simulations. PURPOSE To propose and test a MC-free method for determining LET from the measured integral depth dose (LFI) of the protons of interest. METHOD AND MATERIALS LFI consists of three steps: (1) IDD measurements, (2) extraction of energy spectrum (ES) from the IDD, and (3) LET determination from the extracted ES and the stopping power of each energy. To validate the accuracy of the extraction of ES, we use Gaussian ES to synthesize IDD, extract ES from the synthesized IDD, and then compare the original (ground truth) and extracted ES. LETs calculated from the original and extracted ES are also compared. To obtain the LET of protons of interest, we measure IDDs by a large-area plane-parallel ionization chamber in water. Finally, TOPAS MC is employed to simulate IDDs, ES, and LETs. From the simulated IDD, the extracted ES and LET are compared with the simulations from TOPAS MC. RESULTS From the synthesized IDDs, the LETs agreed excellently when the peak energies ≥10 and 1.25 MeV with depth resolutions 0.1 and 0.01 mm, respectively. For energy <1.25 MeV, even higher depth resolution than 0.01 mm is required. From the MC simulated IDDs, our track-averaged LET excellently agreed with MC simulation, but not the LETd. Our LETd was smaller than MC simulated LETd in the shallow region but larger in the distal Bragg peak region. CONCLUSION LET can be accurately determined from the IDD. This method can be used in the clinic to commission or validate LETs from other measurement methods or a treatment planning system.
Collapse
Affiliation(s)
- Weiguang Yao
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jonathan B Farr
- Department of Medical Physics, Applications of Detectors and Accelerators to Medicine, Meyrin, Switzerland
| | - Sina Mossahebi
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Byongyong Yi
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Shifeng Chen
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
2
|
Niyazi M, Andratschke N, Bendszus M, Chalmers AJ, Erridge SC, Galldiks N, Lagerwaard FJ, Navarria P, Munck Af Rosenschöld P, Ricardi U, van den Bent MJ, Weller M, Belka C, Minniti G. ESTRO-EANO guideline on target delineation and radiotherapy details for glioblastoma. Radiother Oncol 2023; 184:109663. [PMID: 37059335 DOI: 10.1016/j.radonc.2023.109663] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/23/2023] [Accepted: 03/29/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND AND PURPOSE Target delineation in glioblastoma is still a matter of extensive research and debate. This guideline aims to update the existing joint European consensus on delineation of the clinical target volume (CTV) in adult glioblastoma patients. MATERIAL AND METHODS The ESTRO Guidelines Committee identified 14 European experts in close interaction with the ESTRO clinical committee and EANO who discussed and analysed the body of evidence concerning contemporary glioblastoma target delineation, then took part in a two-step modified Delphi process to address open questions. RESULTS Several key issues were identified and are discussed including i) pre-treatment steps and immobilisation, ii) target delineation and the use of standard and novel imaging techniques, and iii) technical aspects of treatment including planning techniques and fractionation. Based on the EORTC recommendation focusing on the resection cavity and residual enhancing regions on T1-sequences with the addition of a reduced 15 mm margin, special situations are presented with corresponding potential adaptations depending on the specific clinical situation. CONCLUSIONS The EORTC consensus recommends a single clinical target volume definition based on postoperative contrast-enhanced T1 abnormalities, using isotropic margins without the need to cone down. A PTV margin based on the individual mask system and IGRT procedures available is advised; this should usually be no greater than 3 mm when using IGRT.
Collapse
Affiliation(s)
- Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany; German Cancer Consortium (DKTK), partner site Munich, Munich, Germany; Bavarian Cancer Research Center (BZKF), Munich, Germany.
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Martin Bendszus
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Sara C Erridge
- Edinburgh Centre for Neuro-Oncology, University of Edinburgh, Western General Hospital, Edinburgh, EH4 1EU, UK
| | - Norbert Galldiks
- Department of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany; Institute of Neuroscience and Medicine (INM-3), Research Center Juelich, Juelich, Germany; Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
| | - Frank J Lagerwaard
- Department of Radiation Oncology, Amsterdam UMC location Vrije Universiteit Amsterdam, The Netherlands
| | - Pierina Navarria
- Radiotherapy and Radiosurgery Department, IRCCS, Humanitas Research Hospital, Rozzano (MI), Italy
| | - Per Munck Af Rosenschöld
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, and Lund University, Lund, Sweden
| | | | | | - Michael Weller
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany; German Cancer Consortium (DKTK), partner site Munich, Munich, Germany; Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Giuseppe Minniti
- Dept. of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy; IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
| |
Collapse
|
3
|
Wang Y, Liu R, Zhang Q, Dong M, Wang D, Chen J, Ou Y, Luo H, Yang K, Wang X. Charged particle therapy for high-grade gliomas in adults: a systematic review. Radiat Oncol 2023; 18:29. [PMID: 36755321 PMCID: PMC9906872 DOI: 10.1186/s13014-022-02187-z] [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: 10/14/2022] [Accepted: 12/20/2022] [Indexed: 02/10/2023] Open
Abstract
High-grade gliomas are the most common intracranial malignancies, and their current prognosis remains poor despite standard aggressive therapy. Charged particle beams have unique physical and biological properties, especially high relative biological effectiveness (RBE) of carbon ion beam might improve the clinical treatment outcomes of malignant gliomas. We systematically reviewed the safety, efficacy, and dosimetry of carbon-ion or proton radiotherapy to treat high-grade gliomas. The protocol is detailed in the online PROSPERO database, registration No. CRD42021258495. PubMed, EMBASE, Web of Science, and The Cochrane Library databases were collected for data analysis on charged particle radiotherapy for high-grade gliomas. Until July 2022, two independent reviewers extracted data based on inclusion and exclusion criteria. Eleven articles were eligible for further analysis. Overall survival rates were marginally higher in patients with the current standard of care than those receiving concurrent intensity-modulated radiotherapy plus temozolomide. The most common side effects of carbon-ion-related therapy were grade 1-2 (such as dermatitis, headache, and alopecia). Long-term toxicities (more than three to six months) usually present as radiation necrosis; however, toxicities higher than grade 3 were not observed. Similarly, dermatitis, headache, and alopecia are among the most common acute side effects of proton therapy treatment. Despite improvement in survival rates, the method of dose-escalation using proton boost is associated with severe brain necrosis which should not be clinically underestimated. Regarding dosimetry, two studies compared proton therapy and intensity-modulated radiation therapy plans. Proton therapy plans aimed to minimize dose exposure to non-target tissues while maintaining target coverage. The use of charged-particle radiotherapy seems to be effective with acceptable adverse effects when used either alone or as a boost. The tendency of survival outcome shows that carbon ion boost is seemingly superior to proton boost. The proton beam could provide good target coverage, and it seems to reduce dose exposure to contralateral organs at risk significantly. This can potentially reduce the treatment-related dose- and volume-related side effects in long-term survivors, such as neurocognitive impairment. High-quality randomized control trials should be conducted in the future. Moreover, Systemic therapeutic options that can be paired with charged particles are necessary.
Collapse
Affiliation(s)
- Yuhang Wang
- grid.9227.e0000000119573309Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, China ,grid.32566.340000 0000 8571 0482The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Ruifeng Liu
- grid.9227.e0000000119573309Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, China ,grid.410726.60000 0004 1797 8419Department of Postgraduate, University of Chinese Academy of Sciences, Beijing, China ,Heavy Ion Therapy Center, Lanzhou Heavy Ions Hospital, Lanzhou, China
| | - Qiuning Zhang
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, China. .,Department of Postgraduate, University of Chinese Academy of Sciences, Beijing, China. .,Heavy Ion Therapy Center, Lanzhou Heavy Ions Hospital, Lanzhou, China.
| | - Meng Dong
- grid.9227.e0000000119573309Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, China ,grid.32566.340000 0000 8571 0482The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Dandan Wang
- grid.9227.e0000000119573309Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, China ,grid.32566.340000 0000 8571 0482The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Junru Chen
- grid.9227.e0000000119573309Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, China ,grid.32566.340000 0000 8571 0482The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Yuhong Ou
- grid.9227.e0000000119573309Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, China ,grid.32566.340000 0000 8571 0482The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Hongtao Luo
- grid.9227.e0000000119573309Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, China ,grid.410726.60000 0004 1797 8419Department of Postgraduate, University of Chinese Academy of Sciences, Beijing, China ,Heavy Ion Therapy Center, Lanzhou Heavy Ions Hospital, Lanzhou, China
| | - Kehu Yang
- grid.32566.340000 0000 8571 0482Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Xiaohu Wang
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, China. .,The First School of Clinical Medicine, Lanzhou University, Lanzhou, China. .,Department of Postgraduate, University of Chinese Academy of Sciences, Beijing, China. .,Heavy Ion Therapy Center, Lanzhou Heavy Ions Hospital, Lanzhou, China.
| |
Collapse
|
4
|
Wu YY, Fan KH. Proton therapy for prostate cancer: current state and future perspectives. Br J Radiol 2022; 95:20210670. [PMID: 34558308 PMCID: PMC8978248 DOI: 10.1259/bjr.20210670] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Localized prostate cancer can be treated with several radiotherapeutic approaches. Proton therapy (PT) can precisely target tumors, thus sparing normal tissues and reducing side-effects without sacrificing cancer control. However, PT is a costly treatment compared with conventional photon radiotherapy, which may undermine its overall efficacy. In this review, we summarize current data on the dosimetric rationale, clinical benefits, and cost of PT for prostate cancer. METHODS An extensive literature review of PT for prostate cancer was performed with emphasis on studies investigating dosimetric advantage, clinical outcomes, cost-effective strategies, and novel technology trends. RESULTS PT is safe, and its efficacy is comparable to that of standard photon-based therapy or brachytherapy. Data on gastrointestinal, genitourinary, and sexual function toxicity profiles are conflicting; however, PT is associated with a low risk of second cancer and has no effects on testosterone levels. Regarding cost-effectiveness, PT is suboptimal, although evolving trends in radiation delivery and construction of PT centers may help reduce the cost. CONCLUSION PT has several advantages over conventional photon radiotherapy, and novel approaches may increase its efficacy and safety. Large prospective randomized trials comparing photon therapy with proton-based treatments are ongoing and may provide data on the differences in efficacy, toxicity profile, and quality of life between proton- and photon-based treatments for prostate cancer in the modern era. ADVANCES IN KNOWLEDGE PT provides excellent physical advantages and has a superior dose profile compared with X-ray radiotherapy. Further evidence from clinical trials and research studies will clarify the role of PT in the treatment of prostate cancer, and facilitate the implementation of PT in a more accessible, affordable, efficient, and safe way.
Collapse
Affiliation(s)
- Yao-Yu Wu
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Kang-Hsing Fan
- Department of Radiation Oncology, New Taipei Municipal TuCheng Hospital, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
5
|
Application of Deep Learning Technology in Glioma. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:8507773. [PMID: 35222894 PMCID: PMC8881132 DOI: 10.1155/2022/8507773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/09/2022] [Accepted: 01/28/2022] [Indexed: 01/10/2023]
Abstract
A common and most basic brain tumor is glioma that is exceptionally dangerous to health of various patients. A glioma segmentation, which is primarily magnetic resonance imaging (MRI) oriented, is considered as one of common tools developed for doctors. These doctors use this system to examine, analyse, and diagnose appearance of the glioma's outward for both patients, i.e., indoor and outdoor. In the literature, a widely utilized approach for the segmentation of glioma is the deep learning-oriented method. To cope with this issue, a segmentation of glioma approach, i.e., primarily on the convolution neural networks, is developed in this manuscript. A DM-DA-enabled cascading approach for the segmentation of glioma, which is 2DResUnet-enabled model, is reported to resolve the problem of spatial data acquisition of insufficient 3D specifically in the 2D full CNN along with the core issue of memory consumption of 3D full CNN. For gliomas segmentation at various stages, we have utilized multiscale fusion approach, attention, segmentation, and DenseBlock. Moreover, for reducing three dimensionalities of the Unet model, a sampling of fixed region is used along with multisequence data of the glioma image. Finally, the CNN model has the ability of producing a better segmentation of tumor preferably with minimum possible memory. The proposed model has used BraTS18 and BraTS17 benchmark data sets for fivefold cross-validation (local) and online evaluation preferably official, respectively. Evaluation results have verified that edema's Dice Score preferable average, enhancement, and core areas of the segmentation of the glioma with DM-DA-Unet perform exceptionally well on the validation set of BraTS17. Finally, average sensitivity was observed to be high as well, which is approximately closer to the best segmentation model and its effect on the validation set of BraTS1 and has segmented gliomas accurately.
Collapse
|
6
|
Brown PD, Chung C, Liu DD, McAvoy S, Grosshans D, Al Feghali K, Mahajan A, Li J, McGovern SL, McAleer MF, Ghia AJ, Sulman EP, Penas-Prado M, de Groot JF, Heimberger AB, Wang J, Armstrong TS, Gilbert MR, Guha-Thakurta N, Wefel JS. A prospective phase II randomized trial of proton radiotherapy vs intensity-modulated radiotherapy for patients with newly diagnosed glioblastoma. Neuro Oncol 2021; 23:1337-1347. [PMID: 33647972 DOI: 10.1093/neuonc/noab040] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND To determine if proton radiotherapy (PT), compared to intensity-modulated radiotherapy (IMRT), delayed time to cognitive failure in patients with newly diagnosed glioblastoma (GBM). METHODS Eligible patients were randomized unblinded to PT vs IMRT. The primary endpoint was time to cognitive failure. Secondary endpoints included overall survival (OS), intracranial progression-free survival (PFS), toxicity, and patient-reported outcomes (PROs). RESULTS A total of 90 patients were enrolled and 67 were evaluable with median follow-up of 48.7 months (range 7.1-66.7). There was no significant difference in time to cognitive failure between treatment arms (HR, 0.88; 95% CI, 0.45-1.75; P = .74). PT was associated with a lower rate of fatigue (24% vs 58%, P = .05), but otherwise, there were no significant differences in PROs at 6 months. There was no difference in PFS (HR, 0.74; 95% CI, 0.44-1.23; P = .24) or OS (HR, 0.86; 95% CI, 0.49-1.50; P = .60). However, PT significantly reduced the radiation dose for nearly all structures analyzed. The average number of grade 2 or higher toxicities was significantly higher in patients who received IMRT (mean 1.15, range 0-6) compared to PT (mean 0.35, range 0-3; P = .02). CONCLUSIONS In this signal-seeking phase II trial, PT was not associated with a delay in time to cognitive failure but did reduce toxicity and patient-reported fatigue. Larger randomized trials are needed to determine the potential of PT such as dose escalation for GBM and cognitive preservation in patients with lower-grade gliomas with a longer survival time.
Collapse
Affiliation(s)
- Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Caroline Chung
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Diane D Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sarah McAvoy
- Department of Radiation Oncology, University of Maryland, Baltimore, Maryland, USA
| | - David Grosshans
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Karine Al Feghali
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jing Li
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Susan L McGovern
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mary-Fran McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Amol J Ghia
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Erik P Sulman
- Department of Radiation Oncology, NYU Grossman School of Medicine, New York, New York, USA
| | - Marta Penas-Prado
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - John F de Groot
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Amy B Heimberger
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jihong Wang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Terri S Armstrong
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Mark R Gilbert
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Nandita Guha-Thakurta
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
7
|
Jin MC, Shi S, Wu A, Sandhu N, Xiang M, Soltys SG, Hiniker S, Li G, Pollom EL. Impact of proton radiotherapy on treatment timing in pediatric and adult patients with CNS tumors. Neurooncol Pract 2020; 7:626-635. [PMID: 33312677 PMCID: PMC7716142 DOI: 10.1093/nop/npaa034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Despite putative benefits associated with proton radiotherapy in the setting of CNS tumors, numerous barriers limit treatment accessibility. Given these challenges, we explored the association of proton use with variations in treatment timing. METHODS Pediatric and adult patients with histologically confirmed CNS tumors were identified from the National Cancer Database (2004-2015). Univariable and multivariable regression models were constructed to assess factors impacting radiation timing. Multivariable Cox regression was used to evaluate the effect of treatment delay on survival. RESULTS A total of 76 157 patients received photon or proton radiotherapy. Compared to photons, time to proton administration was longer in multiple pediatric (embryonal, ependymal, nonependymal glial, and other) and adult (ependymal, nonependymal glial, meningeal, other) tumor histologies. On adjusted analysis, proton radiotherapy was associated with longer delays in radiotherapy administration in pediatric embryonal tumors (+3.00 weeks, P = .024) and in all adult tumors (embryonal [+1.36 weeks, P = .018], ependymal [+3.15 weeks, P < .001], germ cell [+2.65 weeks, P = .024], glial [+2.15 weeks, P < .001], meningeal [+5.05 weeks, P < .001], and other [+3.06 weeks, P < .001]). In patients with high-risk tumors receiving protons, delays in adjuvant radiotherapy were independently associated with poorer survival (continuous [weeks], adjusted hazard ratio = 1.09, 95% CI = 1.02-1.16). CONCLUSIONS Proton radiotherapy is associated with later radiation initiation in pediatric and adult patients with CNS tumors. In patients with high-risk CNS malignancies receiving protons, delayed adjuvant radiotherapy is associated with poorer survival. Further studies are needed to understand this discrepancy to maximize the potential of proton radiotherapy for CNS malignancies.
Collapse
Affiliation(s)
- Michael C Jin
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Siyu Shi
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Adela Wu
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Navjot Sandhu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Michael Xiang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Scott G Soltys
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Susan Hiniker
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Gordon Li
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Erqi L Pollom
- Palo Alto Veterans Affairs Health Care System, Palo Alto, California
| |
Collapse
|
8
|
Wang M, Zheng J, Song Y, Li M, Zeng X. Evaluation of the effect of mechanical deformation on beam isocenter properties of the SC200 scanning beam delivery system. NUCLEAR ENGINEERING AND TECHNOLOGY 2020. [DOI: 10.1016/j.net.2020.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
9
|
Vogel J, Carmona R, Ainsley CG, Lustig RA. The Promise of Proton Therapy for Central Nervous System Malignancies. Neurosurgery 2020; 84:1000-1010. [PMID: 30476191 DOI: 10.1093/neuros/nyy454] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 08/28/2018] [Indexed: 11/15/2022] Open
Abstract
Radiation therapy plays a significant role in management of benign and malignant diseases of the central nervous system. Patients may be at risk of acute and late toxicity from radiation therapy due to dose deposition in critical normal structures. In contrast to conventional photon delivery techniques, proton therapy is characterized by Bragg peak dose deposition which results in decreased exit dose beyond the target and greater sparing of normal structure which may reduce the rate of late toxicities from treatment. Dosimetric studies have demonstrated reduced dose to normal structures using proton therapy as compared to photon therapy. In addition, clinical studies are being reported demonstrating safety, feasibility, and low rates of acute toxicity. Technical challenges in proton therapy remain, including full understanding of depth of proton penetration and the biological activity in the distal Bragg peak. In addition, longer clinical follow-up is required to demonstrate reduction in late toxicities as compared to conventional photon-based radiation techniques. In this review, we summarize the current clinical literature and areas of active investigation in proton therapy for adult central nervous system malignancies.
Collapse
Affiliation(s)
- Jennifer Vogel
- Department of Rad-iation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ruben Carmona
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania
| | - Christopher G Ainsley
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania
| | - Robert A Lustig
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania
| |
Collapse
|
10
|
Abstract
Impaired neurocognitive function is an increasingly recognized morbidity in patients who have cancer. Cancer treatments, psychosocial stressors, and the malignancy itself can alter brain function. The mechanisms by which this occurs are under active investigation. Although there is a growing appreciation of its prevalence and causes, there remain limited therapeutic options for the treatment of neurocognitive dysfunction in this population. A persistent scientific and clinical effort to understand its mechanisms and impact is critical to the care of oncology patients.
Collapse
Affiliation(s)
- Rebecca A Harrison
- Department of Neuro-Oncology, The University of Texas M.D. Anderson Cancer Center, 1400 Holcombe Boulevard, Unit 0431, Houston, TX 77030, USA.
| | - Jeffrey S Wefel
- Section of Neuropsychology, Department of Neuro-Oncology, The University of Texas M.D. Anderson Cancer Center, 1400 Holcombe Boulevard, Unit 0431, Houston, TX 77030, USA
| |
Collapse
|
11
|
Abstract
CLINICAL ISSUE Successful radiotherapy requires precise localization of the tumor and requires high-quality imaging for developing a treatment plan. STANDARD TREATMENT Irradiation of the tumor region, including a safety margin. TREATMENT INNOVATIONS The target volume consists of the gross tumor volume (GTV) containing visible parts of the tumor, the clinical target volume (CTV) covering the GTV plus invisible tumor extensions, and the planning target volume (PTV) to account for uncertainties. The non-GTV parts of the CTV are based on historical patient data. The PTV margins are based on a calculation of possible uncertainties during planning, setup, or treatment. Normal tissue deserves the identical care in contouring, since its tolerance may limit the tumor dose, taking into account the contours of organs at risk. Serial risk organs benefit from defining a planning organ of risk volume (PRV) to better limit the dose delivered to them. DIAGNOSTIC WORK-UP The better the imaging, the more reliable the definition of the GTV and treatment success will be. Multiple imaging sequences are desirable to support the delineation of the tumor. They may result in different CTVs that, depending on their tumor burden, may require different doses. PERFORMANCE The definition of standardized target volumes according to the ICRU reports 50, 62, and 83 forms the basis for an individualized radiation treatment planning according to unified criteria on a high-quality level. ACHIEVEMENTS Radio-oncology is by nature interdisciplinary, the diagnostic radiologist being an indispensable team partner. A regular dialogue between the disciplines is pivotal for target volume definition and treatment success. PRACTICAL RECOMMENDATIONS Imaging for target volume definition requires highest quality imaging, the use of functional imaging methods and close cooperation with a diagnostic radiologist experienced in this field.
Collapse
|
12
|
Agn M, Munck Af Rosenschöld P, Puonti O, Lundemann MJ, Mancini L, Papadaki A, Thust S, Ashburner J, Law I, Van Leemput K. A modality-adaptive method for segmenting brain tumors and organs-at-risk in radiation therapy planning. Med Image Anal 2019; 54:220-237. [PMID: 30952038 PMCID: PMC6554451 DOI: 10.1016/j.media.2019.03.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 03/14/2019] [Accepted: 03/21/2019] [Indexed: 12/25/2022]
Abstract
In this paper we present a method for simultaneously segmenting brain tumors and an extensive set of organs-at-risk for radiation therapy planning of glioblastomas. The method combines a contrast-adaptive generative model for whole-brain segmentation with a new spatial regularization model of tumor shape using convolutional restricted Boltzmann machines. We demonstrate experimentally that the method is able to adapt to image acquisitions that differ substantially from any available training data, ensuring its applicability across treatment sites; that its tumor segmentation accuracy is comparable to that of the current state of the art; and that it captures most organs-at-risk sufficiently well for radiation therapy planning purposes. The proposed method may be a valuable step towards automating the delineation of brain tumors and organs-at-risk in glioblastoma patients undergoing radiation therapy.
Collapse
Affiliation(s)
- Mikael Agn
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Denmark.
| | - Per Munck Af Rosenschöld
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Oula Puonti
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Denmark
| | - Michael J Lundemann
- Department of Oncology, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Laura Mancini
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, UK; Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, UK
| | - Anastasia Papadaki
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, UK; Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, UK
| | - Steffi Thust
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, UK; Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, UK
| | - John Ashburner
- Wellcome Centre for Human Neuroimaging, UCL Institute of Neurology, University College London, UK
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Koen Van Leemput
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Denmark; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, USA
| |
Collapse
|
13
|
Influence of volumetric modulated arc therapy and FET-PET scanning on treatment outcomes for glioblastoma patients. Radiother Oncol 2018; 130:149-155. [PMID: 30446316 DOI: 10.1016/j.radonc.2018.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 08/26/2018] [Accepted: 10/01/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND We sought to assess the influence of the clinical introduction of new radiotherapy technologies on glioblastoma patients' outcomes. METHODS Newly diagnosed glioblastoma patients treated with 60 Gy and temozolomide (2005-2014) were analyzed. The patients' GTV and CTV were defined based on MR (n = 521) or FET-PET/MR (n = 190), and were treated using conformal radiotherapy (CRT, n = 159) or image-guided volumetric modulated arc therapy with hippocampal sparing (IG-VMAT, n = 362). Progression-free survival (PFS) was assessed using the McDonald criteria. Associations between clinical data, dosimetry data, treatment technology, for PFS and overall survival (OS) were explored. RESULTS The PFS (7 months) and OS (15 months) were unaffected by CRT, IG-VMAT and FET-PET technology. Mean brain dose was correlated with tumor volume, and was lower for IG-VMAT vs. CRT (p < 0.001). Larger mean brain dose was associated with inferior PFS (univariate/multivariate Cox models, p < 0.001) and OS (univariate, p < 0.001). Multivariate Cox models revealed association of larger mean brainstem dose (p < 0.001), BTV (p = 0.045), steroid use at baseline (p = 0.003), age (p = 0.019) and MGMT status (p = 0.022) with lower OS. CONCLUSIONS Introduction of hippocampal-sparing IG-VMAT technology appeared to be safe, and may have reduced toxicity and cognitive impairment. Larger mean brain dose was strongly associated with inferior PFS and OS.
Collapse
|
14
|
Li Y, Zhang W. Quantitative evaluation of diffusion tensor imaging for clinical management of glioma. Neurosurg Rev 2018; 43:881-891. [PMID: 30417213 DOI: 10.1007/s10143-018-1050-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/26/2018] [Accepted: 11/01/2018] [Indexed: 11/26/2022]
Abstract
Diffusion tensor imaging (DTI), assessing physiological motion of water in vivo, provides macroscopic view of microstructures of white matter in the central nervous system, and such imaging technique had been extensively used for the clinical treatment and research of glioma. This review mainly focuses on illuminating the merits of quantitative evaluation of DTI for glioma management. The content of the article includes DTI's application on tissue characterization, white matter tracts mapping, radiotherapy delineation, post-therapy outcome assessment, and multimodal imaging. At last, we elucidate a synoptic presentation of DTI limitation, which is critical for physicians making DTI-based clinical decisions in glioma management.
Collapse
Affiliation(s)
- Ye Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100853, China.
| | - Wenyao Zhang
- Beijing Key Laboratory of Intelligent Information Technology, School of Computer Science, Beijing Institute of Technology, Beijing, 100081, China
| |
Collapse
|
15
|
Lundemann M, Munck Af Rosenschöld P, Muhic A, Larsen VA, Poulsen HS, Engelholm SA, Andersen FL, Kjær A, Larsson HBW, Law I, Hansen AE. Feasibility of multi-parametric PET and MRI for prediction of tumour recurrence in patients with glioblastoma. Eur J Nucl Med Mol Imaging 2018; 46:603-613. [PMID: 30276440 DOI: 10.1007/s00259-018-4180-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 09/21/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Recurrence in glioblastoma patients often occur close to the original tumour and indicates that the current treatment is inadequate for local tumour control. In this study, we explored the feasibility of using multi-modality imaging at the time of radiotherapy planning. Specifically, we aimed to identify parameters from pre-treatment PET and MRI with potential to predict tumour recurrence. MATERIALS AND METHODS Sixteen patients were prospectively recruited and treated according to established guidelines. Multi-parametric imaging with 18F-FET PET/CT and 18F-FDG PET/MR including diffusion and dynamic contrast enhanced perfusion MRI were performed before radiotherapy. Correlations between imaging parameters were calculated. Imaging was related to the voxel-wise outcome at the time of tumour recurrence. Within the radiotherapy target, median differences of imaging parameters in recurring and non-recurring voxels were calculated for contrast-enhancing lesion (CEL), non-enhancing lesion (NEL), and normal appearing grey and white matter. Logistic regression models were created to predict the patient-specific probability of recurrence. The most important parameters were identified using standardized model coefficients. RESULTS Significant median differences between recurring and non-recurring voxels were observed for FDG, FET, fractional anisotropy, mean diffusivity, mean transit time, extra-vascular, extra-cellular blood volume and permeability derived from scans prior to chemo-radiotherapy. Tissue-specific patterns of voxel-wise correlations were observed. The most pronounced correlations were observed for 18F-FDG- and 18F-FET-uptake in CEL and NEL. Voxel-wise modelling of recurrence probability resulted in area under the receiver operating characteristic curve of 0.77 from scans prior to therapy. Overall, FET proved to be the most important parameter for recurrence prediction. CONCLUSION Multi-parametric imaging before radiotherapy is feasible and significant differences in imaging parameters between recurring and non-recurring voxels were observed. Combining parameters in a logistic regression model enabled patient-specific maps of recurrence probability, where 18F-FET proved to be most important. This strategy could enable risk-adapted radiotherapy planning.
Collapse
Affiliation(s)
- Michael Lundemann
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. .,Department of Oncology, Section for Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. .,Niels Bohr Institute, Department of Science, University of Copenhagen, Copenhagen, Denmark.
| | - Per Munck Af Rosenschöld
- Niels Bohr Institute, Department of Science, University of Copenhagen, Copenhagen, Denmark.,Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Scania, Sweden
| | - Aida Muhic
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Vibeke A Larsen
- Department of Radiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Hans S Poulsen
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Svend-Aage Engelholm
- Department of Oncology, Section for Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Flemming L Andersen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Kjær
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Cluster for Molecular Imaging, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Henrik B W Larsson
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Adam E Hansen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
16
|
Padilla-Cabal F, Georg D, Fuchs H. A pencil beam algorithm for magnetic resonance image-guided proton therapy. Med Phys 2018. [PMID: 29532490 PMCID: PMC5969113 DOI: 10.1002/mp.12854] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Purpose The feasibility of magnetic resonance image (MRI)‐based proton therapy is based, among several other factors, on the implementation of appropriate extensions on current dose calculation methods. This work aims to develop a pencil beam algorithm (PBA) for dose calculation of proton beams within magnetic field regions of up to 3 T. Methods Monte Carlo (MC) simulations using the GATE 7.1/GEANT4.9.4p02 toolkit were performed to generate calibration and benchmarking data for the PBA. Dose distributions from proton beams in the clinical required energy range 60–250 MeV impinging on a 400 × 400 × 400 mm3 water phantom and transverse magnetic fields ranging from 0 to 3 T were considered. Energy depositions in homogeneous and heterogeneous phantoms filled with water, adipose, bone, and air were evaluated for proton energies of 80, 150, and 240 MeV, combining a trajectory calculation method and look‐up tables (LUT). A novel parametrization model, using independent tailed Gauss fitting functions, was employed to describe the nonsymmetric shape of lateral beam profiles. Integrated depth‐dose curves (IDD), lateral dose profiles, and two‐dimensional dose distributions calculated with the PBA were compared with results from MC simulations to assess the performance of the algorithm. A gamma index criterion of 2%/2 mm was used for analysis. Results A close to perfect agreement was observed for PB‐based dose calculations in water in magnetic fields of 0.5, 1.5, and 3 T. IDD functions showed differences between the PBA and MC of less than 0.1% before the Bragg peak, and deviations of 2–8% in the distal energy falloff region. Gamma index pass rates higher than 99% and mean values lower than 0.1 were encountered for all analyzed configurations. For homogeneous phantoms, only the full bone configuration offered deviations in the Bragg peak position of up to 1.7% and overestimations of the lateral beam spot width for high‐energy protons and magnetic field intensities. An excellent agreement between PBA and MC dose calculation was also achieved using slab‐like and lateral heterogeneous phantoms, with gamma index passing rates above 98% and mean values between 0.1 and 0.2. As expected, agreement reduced for high‐energy protons and high‐intensity magnetic fields, although results remained good enough to be considered for future implementation in clinical practice. Conclusions The proposed pencil beam algorithm for protons can accurately account for dose distortion effects induced by external magnetic fields. The application of an analytical model for dose estimation and corrections reduces the calculation times considerably, making the presented PBA a suitable candidate for integration in a treatment planning system.
Collapse
Affiliation(s)
- Fatima Padilla-Cabal
- Department of Radiotherapy, Medical University of Vienna/AKH, Vienna, Austria.,Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Dietmar Georg
- Department of Radiotherapy, Medical University of Vienna/AKH, Vienna, Austria.,Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Hermann Fuchs
- Department of Radiotherapy, Medical University of Vienna/AKH, Vienna, Austria.,Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
17
|
Voets NL, Bartsch A, Plaha P. Brain white matter fibre tracts: a review of functional neuro-oncological relevance. J Neurol Neurosurg Psychiatry 2017; 88:1017-1025. [PMID: 28710324 DOI: 10.1136/jnnp-2017-316170] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/03/2017] [Accepted: 06/20/2017] [Indexed: 01/18/2023]
Abstract
State-of-the-art glioma treatment aims to maximise neuro-oncological benefit while minimising losses in quality of life. Optimising this balance remains hindered by our still limited understanding of information processing in the human brain. To help understand individual differences in functional outcomes following neuro-oncological treatment, we review mounting evidence demonstrating the fundamental role that white matter connections play in complex human behaviour. We focus on selected fibre tracts whose destruction is recognised to elicit predictable behavioural deficits and consider specific indications for non-invasive diffusion MRI tractography, the only existing method to map these fibre tracts in vivo, in the selection and planning of neuro-oncological treatments. Despite remaining challenges, longitudinal tract imaging, in combination with intraoperative testing and neuropsychological evaluation, offers unique opportunities to refine our understanding of human brain organisation in the quest to predict and ultimately reduce the quality of life burden of both surgical and non-surgical first-line neuro-oncological therapies.
Collapse
Affiliation(s)
- Natalie L Voets
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK.,Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Andreas Bartsch
- Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany
| | - Puneet Plaha
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK.,Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| |
Collapse
|
18
|
Buthut M, Haussmann R, Seidlitz A, Krause M, Donix M. [Cognitive deficits following brain tumor radiation therapy]. DER NERVENARZT 2017; 89:423-430. [PMID: 28932944 DOI: 10.1007/s00115-017-0423-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Brain radiation is an important treatment option for malignant and benign brain diseases. The possible acute or chronic impact of radiation therapy on cognitive performance is important for daily functioning and quality of life. A detailed evaluation of cognitive impairment is important in the context of how to control disease progression. The susceptibility of the hippocampus to radiation-induced neuronal damage and its important role in memory highlight that therapeutic strategies require precision medicine.
Collapse
Affiliation(s)
- M Buthut
- Neurologische Klinik (Neustadt/Trachau), Städtisches Klinikum Dresden, Industriestr. 40, 01129, Dresden, Deutschland
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - R Haussmann
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - A Seidlitz
- Klinik und Poliklinik für Strahlentherapie und Radioonkologie, OncoRay - Nationales Zentrum für Strahlenforschung in der Onkologie, Medizinische Fakultät und Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - M Krause
- Klinik und Poliklinik für Strahlentherapie und Radioonkologie, OncoRay - Nationales Zentrum für Strahlenforschung in der Onkologie, Medizinische Fakultät und Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Dresden, Deutschland
- Nationales Centrum für Tumorerkrankungen (NCT), Dresden, Deutschland
- Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland
- Institut für Radioonkologie - OncoRay, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Deutschland
| | - M Donix
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Standort Dresden, Arnoldstr. 18, 01307, Dresden, Deutschland.
| |
Collapse
|
19
|
Holm AIS, Petersen JBB, Muren LP, Seiersen K, Borghammer P, Lukacova S. Functional image-guided dose escalation in gliomas using of state-of-the-art photon vs. proton therapy. Acta Oncol 2017; 56:826-831. [PMID: 28464742 DOI: 10.1080/0284186x.2017.1285498] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Recurrences of glioma are usually local, suggesting the need for higher tumor dose. We investigated the boundaries for dose escalation of an 18F-fluoro-ethyl-tyrosine positron emission tomography defined target by intensity-modulated photon therapy (IMRT), volumetric modulated arc therapy (VMAT) and intensity-modulated proton therapy (IMPT). MATERIALS AND METHODS Standard dose (60 Gy) and dose-escalated plans were calculated for seven patients using IMRT, VMAT and IMPT. The achieved boost dose, the dose to the organs at risk (OAR), the dose homogeneity (defined as overdose volume, ODV) and the ratio of the 30 Gy isodose curve and the boost volume (R30) were compared. The risk of radionecrosis was estimated using the ratio of the dose volume histograms of the brain (range 30-60 Gy). RESULTS The mean boost dose was 77.1 Gy for IMRT, 79.2 Gy for VMAT and 85.1 GyE for IMPT. Compared with the standard plan, the ODV was unchanged and the R30 increased (17%) for IMRT. For VMAT, the ODV decreased (7%) and the R30 was unchanged whereas IMPT substantially decreased ODV (61%), R30 (22%), OAR doses as well as the risk of radionecrosis. CONCLUSIONS Dose escalation can be achieved with IMRT, VMAT and IMPT while respecting normal tissue constraints, yet with IMPT being most favorable.
Collapse
Affiliation(s)
| | | | - Ludvig Paul Muren
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - Klaus Seiersen
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - Per Borghammer
- Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Slávka Lukacova
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
20
|
Poulsen SH, Urup T, Grunnet K, Christensen IJ, Larsen VA, Jensen ML, Af Rosenschöld PM, Poulsen HS, Law I. The prognostic value of FET PET at radiotherapy planning in newly diagnosed glioblastoma. Eur J Nucl Med Mol Imaging 2017; 44:373-381. [PMID: 27554774 PMCID: PMC5281673 DOI: 10.1007/s00259-016-3494-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 08/10/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Glioblastoma patients show a great variability in progression free survival (PFS) and overall survival (OS). To gain additional pretherapeutic information, we explored the potential of O-(2-18F-fluoroethyl)-L-tyrosine (FET) PET as an independent prognostic biomarker. METHODS We retrospectively analyzed 146 consecutively treated, newly diagnosed glioblastoma patients. All patients were treated with temozolomide and radiation therapy (RT). CT/MR and FET PET scans were obtained postoperatively for RT planning. We used Cox proportional hazards models with OS and PFS as endpoints, to test the prognostic value of FET PET biological tumor volume (BTV). RESULTS Median follow-up time was 14 months, and median OS and PFS were 16.5 and 6.5 months, respectively. In the multivariate analysis, increasing BTV (HR = 1.17, P < 0.001), poor performance status (HR = 2.35, P < 0.001), O(6)-methylguanine-DNA methyltransferase protein status (HR = 1.61, P = 0.024) and higher age (HR = 1.32, P = 0.013) were independent prognostic factors of poor OS. For poor PFS, only increasing BTV (HR = 1.18; P = 0.002) was prognostic. A prognostic index for OS was created based on the identified prognostic factors. CONCLUSION Large BTV on FET PET is an independent prognostic factor of poor OS and PFS in glioblastoma patients. With the introduction of FET PET, we obtain a prognostic index that can help in glioblastoma treatment planning.
Collapse
Affiliation(s)
- Sidsel Højklint Poulsen
- Department of Radiation Biology, The Finsen Center, Rigshospitalet, Section 6321, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
- Department of Clinical Physiology, Nuclear Medicine and PET, Center of Diagnostic Investigation, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
| | - Thomas Urup
- Department of Radiation Biology, The Finsen Center, Rigshospitalet, Section 6321, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
- Department of Oncology, The Finsen Center, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Kirsten Grunnet
- Department of Radiation Biology, The Finsen Center, Rigshospitalet, Section 6321, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
- Department of Oncology, The Finsen Center, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Ib Jarle Christensen
- Laboratory of Gastroenterology, University of Copenhagen, Hvidovre Hospital, Kettegård Allé 30, DK-2650, Copenhagen, Denmark
| | - Vibeke Andrée Larsen
- Department of Radiology, Center of Diagnostic Investigation, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Michael Lundemann Jensen
- Department of Oncology, The Finsen Center, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
- Section of Radiotherapy, The Finsen Center, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Per Munck Af Rosenschöld
- Department of Oncology, The Finsen Center, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
- Section of Radiotherapy, The Finsen Center, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Hans Skovgaard Poulsen
- Department of Radiation Biology, The Finsen Center, Rigshospitalet, Section 6321, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
- Department of Oncology, The Finsen Center, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Center of Diagnostic Investigation, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| |
Collapse
|
21
|
Lundemann M, Costa JC, Law I, Engelholm SA, Muhic A, Poulsen HS, Munck Af Rosenschold P. Patterns of failure for patients with glioblastoma following O-(2-[ 18F]fluoroethyl)-L-tyrosine PET- and MRI-guided radiotherapy. Radiother Oncol 2017; 122:380-386. [PMID: 28110959 DOI: 10.1016/j.radonc.2017.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 11/29/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND PURPOSE To evaluate the patterns of failure following clinical introduction of amino-acid O-(2-[18F]fluoroethyl)-L-tyrosine (FET)-PET-guided target definition for radiotherapy (RT) of glioblastoma patients. MATERIALS AND METHODS The first 66 consecutive patients with confirmed histology, scanned using FET-PET/CT and MRI were selected for evaluation. Chemo-radiotherapy was delivered to a volume based on both MRI and FET-PET (PETvol). The volume of recurrence (RV) was defined on MRI data collected at the time of progression according to RANO criteria. RESULTS Fifty patients were evaluable, with median follow-up of 45months. Central, in-field, marginal and distant recurrences were observed for 82%, 10%, 2%, and 6% of the patients, respectively. We found a volumetric overlap of 26%, 31% and 39% of the RV with the contrast-enhancing MR volume, PETvol and the composite MRPETvol, respectively. MGMT-methylation (p=0.03), larger PETvol (p<0.001), and less extensive surgery (p<0.001), were associated with larger PETvol overlap. CONCLUSION The combined MRPETvol had a stronger association with the recurrence volume than either of the modalities alone. Larger overlap of PETvol and RV was observed for patients with MGMT-methylation, less extensive surgery, and large PETvol on the RT-planning scans.
Collapse
Affiliation(s)
- Michael Lundemann
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen University Hospital, København Ø, Denmark; Niels Bohr Institute, Department of Science, University of Copenhagen, København Ø, Denmark.
| | - Junia Cardoso Costa
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen University Hospital, København Ø, Denmark; Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, København Ø, Denmark
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, København Ø, Denmark
| | - Svend Aage Engelholm
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen University Hospital, København Ø, Denmark
| | - Aida Muhic
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, København Ø, Denmark
| | - Hans Skovgaard Poulsen
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, København Ø, Denmark
| | - Per Munck Af Rosenschold
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen University Hospital, København Ø, Denmark; Niels Bohr Institute, Department of Science, University of Copenhagen, København Ø, Denmark
| |
Collapse
|
22
|
Yuan J, Lei M, Yang Z, Fu J, Huo L, Hong J. Dosimetric comparison between intensity-modulated radiotherapy and RapidArc with single arc and dual arc for malignant glioma involving the parietal lobe. Mol Clin Oncol 2016; 5:181-188. [PMID: 27330795 DOI: 10.3892/mco.2016.872] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/11/2016] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to evaluate the difference in treatment plan quality, monitor units (MUs) per fraction and dosimetric parameters between IMRT (intensity-modulated radiotherapy) and RapidArc with single arc (RA1) and dual arc (RA2) for malignant glioma involving the parietal lobe. Treatment plans for IMRT and RA1 and RA2 were prepared for 10 patients with malignant gliomas involving the parietal lobe. The Wilcoxon matched-pair signed-rank test was used to compare the plan quality, monitor units and dosimetric parameters between IMRT and RA1 and RA2 through dose-volume histograms. Dnear-max (D2%) to the left lens, right lens and left optical nerve in RA1 were less compared with those in IMRT; D2% to the right lens and right optic nerve in RA2 were less compared with those in IMRT. D2% to the optic chiasma in RA2 was small compared with that in RA1. The median dose (D50%) to the right lens and right optic nerve in RA1 and RA2 was less compared with the identical parameters in IMRT, and D50% to the brain stem in RA2 was less compared with that in RA1. The volume receiving at least 45 Gy (V45) or V50 in normal brain tissue (whole brain minus the planning target volume 2; B-P) in RA1 was less compared with that in IMRT. V30, V35, V40, V45, or V50 in B-P in RA2 was less compared with that in IMRT. The MUs per fraction in RA1 and RA2 were significantly less compared with those in IMRT. All differences with a P-value<0.05 were considered to be significantly different. In conclusion, RA1 and RA2 markedly reduced the MUs per fraction, and spared partial organs at risk and B-P compared with IMRT.
Collapse
Affiliation(s)
- Jun Yuan
- Department of Radiation Oncology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Mingjun Lei
- Department of Radiation Oncology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Zhen Yang
- Department of Radiation Oncology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Jun Fu
- Department of Radiation Oncology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Lei Huo
- The Institute of Skull Base Surgery and Neuro-Oncology at Hunan, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Jidong Hong
- Department of Radiation Oncology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| |
Collapse
|
23
|
Christensen AN, Rydhög JS, Søndergaard RV, Andresen TL, Holm S, Munck Af Rosenschöld P, Conradsen K, Jølck RI. Injectable silver nanosensors: in vivo dosimetry for external beam radiotherapy using positron emission tomography. NANOSCALE 2016; 8:11002-11011. [PMID: 27174233 DOI: 10.1039/c6nr00201c] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Development of safe and efficient radiotherapy routines requires quantification of the delivered absorbed dose to the cancer tissue in individual patients. In vivo dosimetry can provide accurate information about the absorbed dose delivered during treatment. In the current study, a novel silver-nanosensor formulation based on poly(vinylpyrrolidinone)-coated silver nanoparticles formulated in a gelation matrix composed of sucrose acetate isobutyrate has been developed for use as an in vivo dosimeter for external beam radiotherapy. In situ photonuclear reactions trigger the formation of radioactive (106)Ag, which enables post treatment verification of the delivered dose using positron emission tomography imaging. The silver-nanosensor was investigated in a tissue equivalent thorax phantom using clinical settings and workflow for both standard fractionated radiotherapy (2 Gy) and stereotactic radiotherapy (10- and 22 Gy) in a high-energy beam setting (18 MV). The developed silver-nanosensor provided high radiopacity on the planning CT-scans sufficient for patient positioning in image-guided radiotherapy and provided dosimetric information about the absorbed dose with a 10% and 8% standard deviation for the stereotactic regimens, 10 and 22 Gy, respectively.
Collapse
Affiliation(s)
- A N Christensen
- DTU Compute, Department of Applied Mathematics and Computer Science, Technical University of Denmark, Building 321/324, Matematiktorvet, 2800 Kgs. Lyngby, Denmark
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Abstract
Radiotherapy (RT) of the brain is associated with significant stigma in the neuro-oncology community. This is primarily because of the potentially severe complications with which it may be associated. These complications, especially in subacute and latent settings, are often unpredictable, potentially progressive, and irreversible. The onset of complications may start from the first fraction of 2 Gy, continuing over several months after end of RT with persistent drowsiness and apathy. It may also extend over many years with progressive onset of neurocognitive impairments such as memory decline, and diminished focus/attention. For long-term survivors, such as young patients irradiated for a favorable low-grade glioma, quality of life can be seriously impacted by RT. It is essential, as in the pediatric field, to propose patient-specific regimens from the very outset of therapy. The use of molecular biomarkers to better predict survival, control of comorbidities along with judicious use of medications such as steroids and antiepileptics, improved targeting with the help of modern imaging and RT techniques, modulation of the dose, and fractionation aimed at limiting integral dose to the healthy brain all have the potential to minimize treatment-related complications while maintaining the therapeutic efficacy for which RT is known. Sparing "radiosensitive" areas such as hippocampi could have a modest but measurable impact with regard to cognitive preservation, an effect that can possibly be enhanced when used in conjunction with memantine and/or donepezil.
Collapse
|
25
|
Munck Af Rosenschold P, Costa J, Engelholm SA, Lundemann MJ, Law I, Ohlhues L, Engelholm S. Impact of [18F]-fluoro-ethyl-tyrosine PET imaging on target definition for radiation therapy of high-grade glioma. Neuro Oncol 2014; 17:757-63. [PMID: 25537018 DOI: 10.1093/neuonc/nou316] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 10/20/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We sought to assess the impact of amino-acid (18)F-fluoro-ethyl-tyrosine (FET) positron emission tomography (PET) on the volumetric target definition for radiation therapy of high-grade glioma versus the current standard using MRI alone. Specifically, we investigated the influence of tumor grade, MR-defined tumor volume, and the extent of surgical resection on PET positivity. METHODS Fifty-four consecutive high-grade glioma patients (World Health Organization grades III-IV) with confirmed histology were scanned using FET-PET/CT and T1 and T2/fluid attenuated inversion recovery MRI. Gross tumor volume and clinical target volumes (CTVs) were defined in a blinded fashion based on MRI and subsequently PET, and volumetric analysis was performed. The extent of the surgical resection was reviewed using postoperative MRI. RESULTS Overall, for ∼ 90% of the patients, the PET-positive volumes were encompassed by T1 MRI with contrast-defined tumor plus a 20-mm margin. The tumor volume defined by PET was larger for glioma grade IV (P < .001) and smaller for patients with more extensive surgical resection (P = .004). The margin required to be added to the MRI-defined tumor in order to fully encompass the FET-PET positive volume tended to be larger for grade IV tumors (P = .018). CONCLUSION With an unchanged CTV margin and by including FET-PET for gross tumor volume definition, the CTV will increase moderately for most patients, and quite substantially for a minority of patients. Patients with grade IV glioma were found to be the primary candidates for PET-guided radiation therapy planning.
Collapse
Affiliation(s)
- Per Munck Af Rosenschold
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark (P.M.a.R., J.C., S.A.E., M.J.L., L.O.); Niels Bohr Institute, University of Copenhagen, Copenhagen, Denmark (P.M.a.R., M.J.L.); Department of Clinical Physiology, Nuclear Medicine, and PET, Rigshospitalet, Copenhagen, Denmark (I.L., J.C.); Section of Radiation Oncology, Skåne University Hospital, Lund, Sweden (S.E.)
| | - Junia Costa
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark (P.M.a.R., J.C., S.A.E., M.J.L., L.O.); Niels Bohr Institute, University of Copenhagen, Copenhagen, Denmark (P.M.a.R., M.J.L.); Department of Clinical Physiology, Nuclear Medicine, and PET, Rigshospitalet, Copenhagen, Denmark (I.L., J.C.); Section of Radiation Oncology, Skåne University Hospital, Lund, Sweden (S.E.)
| | - Svend Aage Engelholm
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark (P.M.a.R., J.C., S.A.E., M.J.L., L.O.); Niels Bohr Institute, University of Copenhagen, Copenhagen, Denmark (P.M.a.R., M.J.L.); Department of Clinical Physiology, Nuclear Medicine, and PET, Rigshospitalet, Copenhagen, Denmark (I.L., J.C.); Section of Radiation Oncology, Skåne University Hospital, Lund, Sweden (S.E.)
| | - Michael J Lundemann
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark (P.M.a.R., J.C., S.A.E., M.J.L., L.O.); Niels Bohr Institute, University of Copenhagen, Copenhagen, Denmark (P.M.a.R., M.J.L.); Department of Clinical Physiology, Nuclear Medicine, and PET, Rigshospitalet, Copenhagen, Denmark (I.L., J.C.); Section of Radiation Oncology, Skåne University Hospital, Lund, Sweden (S.E.)
| | - Ian Law
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark (P.M.a.R., J.C., S.A.E., M.J.L., L.O.); Niels Bohr Institute, University of Copenhagen, Copenhagen, Denmark (P.M.a.R., M.J.L.); Department of Clinical Physiology, Nuclear Medicine, and PET, Rigshospitalet, Copenhagen, Denmark (I.L., J.C.); Section of Radiation Oncology, Skåne University Hospital, Lund, Sweden (S.E.)
| | - Lars Ohlhues
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark (P.M.a.R., J.C., S.A.E., M.J.L., L.O.); Niels Bohr Institute, University of Copenhagen, Copenhagen, Denmark (P.M.a.R., M.J.L.); Department of Clinical Physiology, Nuclear Medicine, and PET, Rigshospitalet, Copenhagen, Denmark (I.L., J.C.); Section of Radiation Oncology, Skåne University Hospital, Lund, Sweden (S.E.)
| | - Silke Engelholm
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark (P.M.a.R., J.C., S.A.E., M.J.L., L.O.); Niels Bohr Institute, University of Copenhagen, Copenhagen, Denmark (P.M.a.R., M.J.L.); Department of Clinical Physiology, Nuclear Medicine, and PET, Rigshospitalet, Copenhagen, Denmark (I.L., J.C.); Section of Radiation Oncology, Skåne University Hospital, Lund, Sweden (S.E.)
| |
Collapse
|
26
|
Munley MT, Kagadis GC, McGee KP, Kirov AS, Jang S, Mutic S, Jeraj R, Xing L, Bourland JD. An introduction to molecular imaging in radiation oncology: a report by the AAPM Working Group on Molecular Imaging in Radiation Oncology (WGMIR). Med Phys 2014; 40:101501. [PMID: 24089890 DOI: 10.1118/1.4819818] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Molecular imaging is the direct or indirect noninvasive monitoring and recording of the spatial and temporal distribution of in vivo molecular, genetic, and/or cellular processes for biochemical, biological, diagnostic, or therapeutic applications. Molecular images that indicate the presence of malignancy can be acquired using optical, ultrasonic, radiologic, radionuclide, and magnetic resonance techniques. For the radiation oncology physicist in particular, these methods and their roles in molecular imaging of oncologic processes are reviewed with respect to their physical bases and imaging characteristics, including signal intensity, spatial scale, and spatial resolution. Relevant molecular terminology is defined as an educational assist. Current and future clinical applications in oncologic diagnosis and treatment are discussed. National initiatives for the development of basic science and clinical molecular imaging techniques and expertise are reviewed, illustrating research opportunities in as well as the importance of this growing field.
Collapse
Affiliation(s)
- Michael T Munley
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
| | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Grau C, Høyer M, Alber M, Overgaard J, Lindegaard JC, Muren LP. Biology-guided adaptive radiotherapy (BiGART)--more than a vision? Acta Oncol 2013; 52:1243-7. [PMID: 23984809 DOI: 10.3109/0284186x.2013.829245] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Cai Grau
- Department of Oncology, Aarhus University Hospital , Aarhus , Denmark
| | | | | | | | | | | |
Collapse
|
28
|
Diagnostic accuracy of F-18-fluoroethyltyrosine PET and PET/CT in patients with brain tumor. Clin Transl Imaging 2013. [DOI: 10.1007/s40336-013-0017-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
29
|
Abstract
Imaging is a key component in the management of brain tumours, with MRI being the preferred modality for most clinical scenarios. However, although conventional MRI provides mainly structural information, such as tumour size and location, it leaves many important clinical questions, such as tumour type, aggressiveness and prognosis, unanswered. An increasing number of studies have shown that additional information can be obtained using functional imaging methods (which probe tissue properties), and that these techniques can give key information of clinical importance. These techniques include diffusion imaging, which can assess tissue structure, and perfusion imaging and magnetic resonance spectroscopy, which measures tissue metabolite profiles. Tumour metabolism can also be investigated using PET, with 18F-deoxyglucose being the most readily available tracer. This Review discusses these methods and the studies that have investigated their clinical use. A strong emphasis is placed on the measurement of quantitative parameters, which is a move away from the qualitative nature of conventional radiological reporting and presents major challenges, particularly for multicentre studies.
Collapse
|
30
|
Greene-Schloesser D, Robbins ME, Peiffer AM, Shaw EG, Wheeler KT, Chan MD. Radiation-induced brain injury: A review. Front Oncol 2012; 2:73. [PMID: 22833841 PMCID: PMC3400082 DOI: 10.3389/fonc.2012.00073] [Citation(s) in RCA: 430] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 06/26/2012] [Indexed: 12/03/2022] Open
Abstract
Approximately 100,000 primary and metastatic brain tumor patients/year in the US survive long enough (>6 months) to experience radiation-induced brain injury. Prior to 1970, the human brain was thought to be highly radioresistant; the acute CNS syndrome occurs after single doses >30 Gy; white matter necrosis occurs at fractionated doses >60 Gy. Although white matter necrosis is uncommon with modern techniques, functional deficits, including progressive impairments in memory, attention, and executive function have become important, because they have profound effects on quality of life. Preclinical studies have provided valuable insights into the pathogenesis of radiation-induced cognitive impairment. Given its central role in memory and neurogenesis, the majority of these studies have focused on the hippocampus. Irradiating pediatric and young adult rodent brains leads to several hippocampal changes including neuroinflammation and a marked reduction in neurogenesis. These data have been interpreted to suggest that shielding the hippocampus will prevent clinical radiation-induced cognitive impairment. However, this interpretation may be overly simplistic. Studies using older rodents, that more closely match the adult human brain tumor population, indicate that, unlike pediatric and young adult rats, older rats fail to show a radiation-induced decrease in neurogenesis or a loss of mature neurons. Nevertheless, older rats still exhibit cognitive impairment. This occurs in the absence of demyelination and/or white matter necrosis similar to what is observed clinically, suggesting that more subtle molecular, cellular and/or microanatomic modifications are involved in this radiation-induced brain injury. Given that radiation-induced cognitive impairment likely reflects damage to both hippocampal- and non-hippocampal-dependent domains, there is a critical need to investigate the microanatomic and functional effects of radiation in various brain regions as well as their integration at clinically relevant doses and schedules. Recently developed techniques in neuroscience and neuroimaging provide not only an opportunity to accomplish this, but they also offer the opportunity to identify new biomarkers and new targets for interventions to prevent or ameliorate these late effects.
Collapse
Affiliation(s)
- Dana Greene-Schloesser
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | | | | | | | | |
Collapse
|
31
|
Ermoian R, Ladra M, Patel S. Children's Oncology Group L991 final study report: Establishing an important benchmark for assessing late effects of trimodality care of pediatric patients treated for high grade gliomas. Transl Pediatr 2012; 1:3-5. [PMID: 26835257 PMCID: PMC4728847 DOI: 10.3978/j.issn.2224-4336.2012.04.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ralph Ermoian
- University of Washington, Department of Radiation Oncology, UWMC Cancer Center, Box 356043, 1959 Pacific Street, Seattle, WA 98195-6043, USA
| | - Matthew Ladra
- University of Washington, Department of Radiation Oncology, UWMC Cancer Center, Box 356043, 1959 Pacific Street, Seattle, WA 98195-6043, USA
| | - Shilpen Patel
- University of Washington, Department of Radiation Oncology, UWMC Cancer Center, Box 356043, 1959 Pacific Street, Seattle, WA 98195-6043, USA
| |
Collapse
|
32
|
Dunet V, Rossier C, Buck A, Stupp R, Prior JO. Performance of 18F-fluoro-ethyl-tyrosine (18F-FET) PET for the differential diagnosis of primary brain tumor: a systematic review and Metaanalysis. J Nucl Med 2012; 53:207-14. [PMID: 22302961 DOI: 10.2967/jnumed.111.096859] [Citation(s) in RCA: 182] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED For the past decade, PET with (18)F-fluoro-ethyl-tyrosine ((18)F-FET) has been used in the evaluation of patients with primary brain tumors (PBTs), but so far series have reported only a limited number of patients. The purpose of this systematic review and metaanalysis was to assess the diagnostic performance of (18)F-FET PET in patients with suspicion of PBT. METHODS We examined studies published in the literature using MEDLINE and EMBASE databases. Inclusion criteria were use of (18)F-FET PET for initial assessment of patients with a newly diagnosed brain lesion; patients who had no radiotherapy, surgery, or chemotherapy before (18)F-FET PET; and use of histology as a gold standard. Metaanalysis was performed on a per-patient basis. We secondarily performed receiver-operating-characteristic analysis of pooled patients to determine tumor-to-background ratio (TBR) of (18)F-FET uptake and best diagnostic value. RESULTS Thirteen studies totaling 462 patients were included. For the diagnosis of PBT, (18)F-FET PET demonstrated a pooled sensitivity of 0.82 (95% confidence interval [CI], 0.74-0.88), specificity of 0.76 (95% CI, 0.44-0.92), area under the curve of 0.84 (95% CI, 0.80-0.87), positive likelihood ratio of 3.4 (95% CI, 1.2-9.5), and negative likelihood ratio of 0.24 (95% CI, 0.14-0.39). Receiver-operating-characteristic analysis indicated that a mean TBR threshold of at least 1.6 and a maximum TBR of at least 2.1 had the best diagnostic value for differentiating PBTs from nontumoral lesions. CONCLUSION (18)F-FET PET demonstrated excellent performance for diagnosing PBTs. Strict standardization of PET acquisition protocols and prospective, multicenter studies investigating the added value over current MRI are now needed to establish (18)F-FET PET as a highly relevant tool for patient management.
Collapse
Affiliation(s)
- Vincent Dunet
- Department of Nuclear Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | | | | | | | | |
Collapse
|
33
|
Weksberg DC, Bilton SD, Chang EL. Use of a deformable atlas to identify cryptic critical structures in the treatment of glioblastoma multiforme. PLoS One 2012; 7:e32098. [PMID: 22461883 PMCID: PMC3312881 DOI: 10.1371/journal.pone.0032098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 01/19/2012] [Indexed: 01/03/2023] Open
Abstract
Dose constraints for traditional neural critical structures (e.g. optic chiasm, brain stem) are a standard component of planning radiation therapy to the central nervous system. Increasingly, investigators are becoming interested in accounting for the dose delivered to other non-target neural structures (e.g. hippocampi), which are not easily identified on axial imaging. In this pilot study, a commercially available digital atlas was used to identify cryptic neural structures (hippocampus, optic radiations, and visual cortices) in 6 patients who received intensity modulated radiation therapy (IMRT) as part of multimodal management of glioblastoma multiforme (GBM). The patient's original IMRT plans were re-optimized, with avoidance parameters for the newly identified critical structures. Re-optimization was able to reduce both mean and maximum dose to the volumes of interest, with a more pronounced effect for contralateral structures. Mean dose was reduced by 11% and 3% to contralateral and ipsilateral structures, respectively, with comparable reduction in maximum dose of 10% and 2%, respectively. Importantly, target coverage was not compromised, with an average change in coverage of 0.2%. Overall, our results demonstrate the feasibility of incorporating tools for cryptic critical structure identification into the treatment planning process for GBM.
Collapse
Affiliation(s)
- David C. Weksberg
- MD Anderson Cancer Center, Department of Radiation Oncology, University of Texas, Houston, Texas, United States of America
| | - Stephen D. Bilton
- MD Anderson Cancer Center, Department of Radiation Oncology, University of Texas, Houston, Texas, United States of America
| | - Eric L. Chang
- Department of Radiation Oncology, University of Southern California Keck School of Medicine, Norris Cancer Hospital, Los Angeles, California, United States of America
- * E-mail:
| |
Collapse
|