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Adapting Biological Feedback in Radiotherapy Eirik Malinen - PowerPoint PPT Presentation

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Adapting Biological Feedback in Radiotherapy Eirik Malinen Introduction Tumor and normal tissue function is not spatially homogenous Tissue characteristics change during fractionated radiotherapy Quantitative volumetric imaging for

  1. Adapting Biological Feedback in Radiotherapy Eirik Malinen

  2. Introduction • Tumor and normal tissue function is not spatially homogenous • Tissue characteristics change during fractionated radiotherapy • Quantitative volumetric imaging for monitoring functional changes • Adapt treatment to spatial changes

  3. Tumors

  4. FDG-PET, H&N, pre and post RT Annals of Oncology 21, 1078–1082

  5. FDG-PET, H&N, patterns of failure Recurrent volume on IMRT CT scan original PET scan • 9/9 of failures were in-field, 8/9 were inside pretreatment PET-BTV. Radiother Oncol 89, 13–18

  6. FDG-PET-based adaptive dose painting Int J Radiat Oncol Biol Phys 80, 1045-1055

  7. FDG-PET, NSCLC, time trends Radiother Oncol 82, 145–152 Int J Radiat Oncol Biol Phys 71, 1402-1407

  8. FDG-PET, NSCLC, residual uptake post RT Radiotherapy and Oncology 91, 386–392

  9. Reproducibility J Nucl Med 51, 1368–1376

  10. DWI, H&N Pre Tx Wk1 Tx Post Tx Am J Roentgen 32, 1904–1910 Clin Cancer Res 15, 986-994

  11. MRSI and fMRI, gliomas Br J Radiol 80, 347–354

  12. DCEMRI, cancers of the uterine cervix See talks by E. Andersen, Thursday 16:20 C. Halle, Friday 12:30 Int J Radiat Oncol Biol Phys 77, 502–508

  13. DCEMRI monitoring, spontaneous canine tumors Acta Oncol 47, 1249-1256 Radiother Oncol 93, 618-624

  14. Contrast-enhanced cone beam CT Radiother Oncol 97, 521-524 Acta Oncol 49, 972-977

  15. Serial imaging and prescription Int J Radiat Oncol Biol Phys 68, 1496-1504

  16. Normal tissue

  17. Lung perfusion – SPECT Base plan SPECT plan Int J Radiat Oncol Biol Phys 66, 1543-1552

  18. Lung inflammation and RILT – FDG-PET • Intense pre-RT uptake in lung associated with RILT • Intense uptake + dose > 2-5 Gy most significant Radiother Oncol 93, 618-624

  19. 4D-CT assessment of lung function Pre-RT Post-RT Difference Dose distribution Med Phys 37, 1261-1273

  20. Cardiac perfusion – SPECT Int J Radiat Oncol Biol Phys 63, 214-223

  21. DCECT – liver • Perfusion correlated with liver function • Doses > 45 Gy gave perfusion shut-down Int J Radiat Oncol Biol Phys 70, 154-160

  22. Adaptive strategies A. Compare images B. Compare plans Semin Radiat Oncol 20, 138-146

  23. Costs • Imaging session: CT - 1 u, MR - 3 u, PET - 9 u • Planning session: 3 u • Fractionated treatment (35 fr): 70 u

  24. Acknowledgements Dag Rune Olsen & Åste Søvik

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