Adapting Biological Feedback in Radiotherapy Eirik Malinen - - PowerPoint PPT Presentation

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Adapting Biological Feedback in Radiotherapy Eirik Malinen - - PowerPoint PPT Presentation

Sep 06, 2022 125 likes •372 views

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

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Adapting Biological Feedback in Radiotherapy

Eirik Malinen

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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
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Tumors

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FDG-PET, H&N, pre and post RT

Annals of Oncology 21, 1078–1082

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FDG-PET, H&N, patterns of failure

Recurrent volume on

  • riginal PET scan

Radiother Oncol 89, 13–18

IMRT CT scan

  • 9/9 of failures were in-field, 8/9 were inside

pretreatment PET-BTV.

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FDG-PET-based adaptive dose painting

Int J Radiat Oncol Biol Phys 80, 1045-1055

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FDG-PET, NSCLC, time trends

Radiother Oncol 82, 145–152 Int J Radiat Oncol Biol Phys 71, 1402-1407

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FDG-PET, NSCLC, residual uptake post RT

Radiotherapy and Oncology 91, 386–392

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Reproducibility

J Nucl Med 51, 1368–1376

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DWI, H&N

Am J Roentgen 32, 1904–1910 Clin Cancer Res 15, 986-994

Pre Tx Wk1 Tx Post Tx

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MRSI and fMRI, gliomas

Br J Radiol 80, 347–354

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DCEMRI, cancers of the uterine cervix

Int J Radiat Oncol Biol Phys 77, 502–508

See talks by

  • E. Andersen, Thursday 16:20
  • C. Halle, Friday 12:30
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DCEMRI monitoring, spontaneous canine tumors

Acta Oncol 47, 1249-1256 Radiother Oncol 93, 618-624

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Contrast-enhanced cone beam CT

Radiother Oncol 97, 521-524 Acta Oncol 49, 972-977

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Serial imaging and prescription

Int J Radiat Oncol Biol Phys 68, 1496-1504

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Normal tissue

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Lung perfusion – SPECT

Int J Radiat Oncol Biol Phys 66, 1543-1552

Base plan SPECT plan

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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

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4D-CT assessment of lung function

Pre-RT Post-RT Difference Dose distribution

Med Phys 37, 1261-1273

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Cardiac perfusion – SPECT

Int J Radiat Oncol Biol Phys 63, 214-223

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DCECT – liver

Int J Radiat Oncol Biol Phys 70, 154-160

  • Perfusion correlated with liver function
  • Doses > 45 Gy gave perfusion shut-down
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Adaptive strategies

Semin Radiat Oncol 20, 138-146

  • A. Compare images
  • B. Compare plans
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Costs

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

Dag Rune Olsen & Åste Søvik