Dose prescription and treatment planning based on FMISO-PET hypoxia

Toma-Daşu, Iuliana; Uhrdin, J.; Antonovic, Laura; Daşu, Alexandru; Nuyts, Sandra; Dirix, Piet; Haustermans, Karin; Brahme, Anders

doi:10.3109/0284186x.2011.599815

Cited by 85 publications

(68 citation statements)

References 46 publications

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“…In a separate study in 10 H&NC patients, IMRT planning and dose escalations using 18 F-FMISO PET imaging data was shown to increase tumor control probability by an average of 17% as a result of the modeled dose increases (119). Dose painting by numbers (DPBN), which escalates radiation doses based on the intensity of the 18 F-FMISO PET imaging data, enabled additional precision in therapy planning over uniform dose estimates (uniDE) derived from 18 F-FDG (265,266). In this model, the average increase in tumor-control probability (TCP) in 13 patients was *15% for 18 F-FMISO DPBN, which was higher than the 2% increase in tumor control probability for the 18 F-FDG uniDE protocol based on modeled dose increases to the hypoxic regions of the tumor.…”

Section: A Use Of Hypoxia Information In Radiation Therapy Planningmentioning

confidence: 99%

The Clinical Importance of Assessing Tumor Hypoxia: Relationship of Tumor Hypoxia to Prognosis and Therapeutic Opportunities

Walsh

Lebedev

Aten³

et al. 2014

Antioxidants & Redox Signaling

323

264

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Tumor hypoxia is a well-established biological phenomenon that affects the curability of solid tumors, regardless of treatment modality. Especially for head and neck cancer patients, tumor hypoxia is linked to poor patient outcomes. Given the biological problems associated with tumor hypoxia, the goal for clinicians has been to identify moderately to severely hypoxic tumors for differential treatment strategies. The ''gold standard'' for detecting and characterizing of tumor hypoxia are the invasive polarographic electrodes. Several less invasive hypoxia assessment techniques have also shown promise for hypoxia assessment. The widespread incorporation of hypoxia information in clinical tumor assessment is severely impeded by several factors, including regulatory hurdles and unclear correlation with potential treatment decisions. There is now an acute need for approved diagnostic technologies for determining the hypoxia status of cancer lesions, as it would enable clinical development of personalized, hypoxia-based therapies, which will ultimately improve outcomes. A number of different techniques for assessing tumor hypoxia have evolved to replace polarographic pO 2 measurements for assessing tumor hypoxia. Several of these modalities, either individually or in combination with other imaging techniques, provide functional and physiological information of tumor hypoxia that can significantly improve the course of treatment. The assessment of tumor hypoxia will be valuable to radiation oncologists, surgeons, and biotechnology and pharmaceutical companies who are engaged in developing hypoxia-based therapies or treatment strategies. Antioxid. Redox Signal. 21, 1516-1554.

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Section: A Use Of Hypoxia Information In Radiation Therapy Planningmentioning

confidence: 99%

The Clinical Importance of Assessing Tumor Hypoxia: Relationship of Tumor Hypoxia to Prognosis and Therapeutic Opportunities

Walsh

Lebedev

Aten³

et al. 2014

Antioxidants & Redox Signaling

323

264

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“…In contrast, 'thick strokes' would apparently provide the best results for tumours with highly dynamic oxygenation and may also avoid problems with radiation delivery to the intended target. Furthermore, correcting the simpler dose distributions to account for the underlying heterogeneity of hypoxia, the desired levels of control may be easier reached [6]. In fact, the clinical success of hypoxia targeting strategies in the absence of adaptive approaches might be explained by changes in tumour radiation resistance though reoxygenation.…”

Section: Discussionmentioning

confidence: 99%

“…Variations of the hypoxic distribution during the course of the treatment were simulated by generating several local oxygenations according to the calculation algorithm and the input distributions [6]. The resulting oxygen maps were subsequently used to simulate images that could be obtained with the PET tracer fluoromisonidazole (FMISO) using a previously determined relationship between marker uptake and local oxygen tension [6]. The finite resolution in imaging the tracer uptake was simulated by convoluting the resulting maps with averaging masks with variable widths (Figure 2).…”

Section: Methodsmentioning

confidence: 99%

“…Most efforts have been put into imaging tumour hypoxia with positron emission tomography (PET) [4] and the subsequent inclusion of this type of imaging information into treatment planning [5][6], although other factors could also be imaged and targeted [1]. The potential of the proposed methods has mainly been investigated through planning studies, but their clinical implementation has been delayed due to several concerns.…”

Section: Introductionmentioning

confidence: 99%

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Dose painting by numbers - do the practical limitations of the technique decrease or increase the probability of controlling tumours?

Daşu

Toma-Daşu

2013

IFMBE Proceedings

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Abstract-One of the important questions regarding the feasibility of dose-painting-by-numbers approaches for treatment planning concerns the influence of the averaging of the imaging techniques used and the resolution of the planned and achieved dose distributions. This study investigates the impact of these aspects on the probability of controlling dynamic tumours. The effectiveness of dose painting approaches to target tumour hypoxia has been investigated in terms of the predicted tumour control probabilities (TCP) for tumours with dynamic oxygenations. Several levels of resolution for the resistance of the tumour or the planned dose distributions have been investigated. A very fine heterogeneous dose distribution ideally calculated at voxel level for a high target TCP would fail to control a tumour with dynamic oxygenation during the course of fractionated radiotherapy as mismatches between hotspots in the dose distribution and resistant hypoxic foci would lead to a significant loss in TCP. Only adaptive treatment would lead to reasonably high TCP. A coarse resolution for imaging or for dose distributions might compensate microscale mismatches in dynamic tumours, but the resulting tumour control could still be below the target levels. These results indicate that there is a complex relationship between the resolution of the dose-painting-by-numbers approaches and the dynamics of tumour oxygenation. Furthermore, the clinical success of hypoxia targeting strategies in the absence of adaptive approaches might be explained by changes in tumour radiation resistance through reoxygenation.

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“…Several strategies for dose-painting approaches based on hypoxia in head and neck tumours have been proposed and they are under various stages of validation. Among them one could mention the planning study by Thorwarth et al [71] on dose escalation to head and neck hypoxic subvolumes based on PET imaging which was followed by a still ongoing clinical trial and the dose prescription and treatment planning method based on hypoxia PET imaging proposed by Toma-Dasu et al [72] which is currently under clinical validation.…”

Section: Reoxygenationmentioning

confidence: 99%