Robust treatment planning of dose painting for prostate cancer based on ADC-to-Gleason score mappings – what is the potential to increase the tumor control probability?

Grönlund, Eric; Almhagen, Erik; Johansson, Silvia; Traneus, E.; Nyholm, Tufve; Thellenberg, Camilla; Ahnesjö, Anders

doi:10.1080/0284186x.2020.1817547

Cited by 7 publications

(26 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We optimized a set of homogeneous plans with a range of target dose levels to study the relationship between target dose, rectum load, and tumor control, and to set the DPBN plans in a clinical context. Our study design differs from that of Grönlund et al (11) who kept the mean dose to the prostate equal between the homogeneous and dose painted plans; moreover, they only simulated conventional treatment flows. The resulting TCP and rectum DVH metrics were calculated based on the accumulated dose from simulated full treatment courses; these metrics were used to compare the four study arms.…”

Section: Overview Of Study Designmentioning

confidence: 99%

“…The present work aims to investigate if the reduced geometric uncertainties obtained by adaptive RT (ART) can increase the potential of dose painting compared to conventional, non-adaptive, treatment workflows. To this end, we present a treatment simulation study where the DPBN formalism for PCa by Grönlund et al (7,11) is combined with adaptive workflow features provided by the Elekta Unity MRL system (13). For reference we also included study arms with homogeneous dose escalation.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Adaptive dose painting for prostate cancer

2022

Self Cite

View full text Add to dashboard Cite

PurposeDose painting (DP) is a radiation therapy (RT) strategy for patients with heterogeneous tumors delivering higher dose to radiation resistant regions and less to sensitive ones, thus aiming to maximize tumor control with limited side effects. The success of DP treatments is influenced by the spatial accuracy in dose delivery. Adaptive RT (ART) workflows can reduce the overall geometric dose delivery uncertainty. The purpose of this study is to dosimetrically compare ART and non-adaptive conventional RT workflows for delivery of DP prescriptions in the treatment of prostate cancer (PCa).Materials and methodsWe performed a planning and treatment simulation study of four study arms. Adaptive and conventional workflows were tested in combination with DP and Homogeneous dose. We used image data from 5 PCa patients that had been treated on the Elekta Unity MR linac; the patients had been imaged in treatment position before each treatment fraction (7 in total). The local radiation sensitivity from apparent diffusion coefficient maps of 15 high-risk PCa patients was modelled in a previous study. these maps were used as input for optimization of DP plans aiming for maximization of tumor control probability (TCP) under rectum dose constraints. A range of prostate doses were planned for the homogeneous arms. Adaptive plans were replanned based on the anatomy-of-the-day, whereas conventional plans were planned using a pre-treatment image and subsequently recalculated on the anatomy-of-the-day. The dose from 7 fractions was accumulated using dose mapping. The endpoints studied were the TCP and dose-volume histogram metrics for organs at risk.ResultsAccumulated DP doses (adaptive and conventional) resulted in high TCP, between 96-99%. The largest difference between adaptive and conventional DP was 2.6 percentage points (in favor of adaptive DP). An analysis of the dose per fraction revealed substantial target misses for one patient in the conventional workflow that—if systematic—could jeopardize the TCP. Compared to homogeneous prescriptions with equal mean prostate dose, DP resulted in slightly higher TCP.ConclusionCompared to homogeneous dose, DP maintains or marginally increases the TCP. Adaptive DP workflows could avoid target misses compared to conventional workflows.

show abstract

Section: Overview Of Study Designmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Adaptive dose painting for prostate cancer

2022

Self Cite

View full text Add to dashboard Cite

show abstract

“…This result is consistent with other studies that show that DWI examination can assess the tumor treatment effect. [ 20 , 21 ] Quantification of imaging findings can be performed by observing changes in WB-DWI signal intensity and ADC values. To a certain extent, the trend of ADC value change can predict the prognosis of the patients.…”

Section: Discussionmentioning

confidence: 99%

Role of whole-body diffusion-weighted imaging in evaluation of multiple myeloma

Wang

Zhang

et al. 2021

Medicine

View full text Add to dashboard Cite

The evaluation of bone disease in multiple myeloma (MM) is an important topic in imaging. This study retrospectively investigated whole-body diffusion-weighted imaging (WB-DWI) in the evaluation of bone marrow infiltration and treatment response in MM. A total of 126 patients with MM who underwent WB-DWI between January 2016 and December 2020 were enrolled. All the patients received 4-course induction chemotherapy. WB-DWI was performed before and after chemotherapy to measure the apparent diffusion coefficient (ADC) values. According to gender and Revised International Staging System (RISS) staging groups, the relationship between ADC value and bone marrow plasma cell infiltration ratio before treatment were explored using Spearman and Pearson correlation coefficients. Comparison of ADC values before and after treatment according to different chemotherapy regimens and treatment response was performed by 2-independent samples non-parametric tests and t test. There was a negative correlation between the ADC value and the degree of bone marrow infiltration and this was statistically significant (r = –0.843, P < .001). In different gender and RISS groups, ADC value before treatment was negatively correlated with the proportion of plasma cell infiltration (male, r = –0.849; female, r = –0.836; Stage I, r = –0.659; Stage II, r = –0.870; Stage III, r = –0.745; all P < .001). The ADC values of all subjects increased to varying degrees after 4-course induction chemotherapy, including different chemotherapy regimens and treatment responses (all P < .05 except for progressive disease group). The ADC value was negatively correlated with the degree of bone marrow infiltration in different gender and RISS stages. The ADC value increased after treatment, but it was not consistent with progressive disease group. The increase of ADC value may indicate the disease burden and outcome of MM induced chemotherapy.

show abstract

“…Current quantitative imaging approaches have larger voxels and worse signal-to-noise-ratio (SNR) compared to other clinical imaging techniques, since quantitative imaging requires one or multiple quantitative parameters for each voxel ( 92 ). For dynamic contrast-enhanced MRI/CT, the acquisition of multiple images is required ( 1 ).…”

Section: Challenges and Future Prospectmentioning

confidence: 99%

“…For DPBC, the uncertainties of registration can be reduced by adding margins to the high-risk area. However, DPBN features the voxel-level analysis and is more sensitive to uncertainty arising in image registration ( 92 ). Most treatment planning systems support image registration and fusion to allow the use of multimodality and time-series image data and even anatomical atlases to assist in target volume and normal tissue delineation.…”

Section: Challenges and Future Prospectmentioning

confidence: 99%

Medical Imaging Biomarker Discovery and Integration Towards AI-Based Personalized Radiotherapy

Pang

Wang

2022

Front. Oncol.

View full text Add to dashboard Cite

Intensity-modulated radiation therapy (IMRT) has been used for high-accurate physical dose distribution sculpture and employed to modulate different dose levels into Gross Tumor Volume (GTV), Clinical Target Volume (CTV) and Planning Target Volume (PTV). GTV, CTV and PTV can be prescribed at different dose levels, however, there is an emphasis that their dose distributions need to be uniform, despite the fact that most types of tumour are heterogeneous. With traditional radiomics and artificial intelligence (AI) techniques, we can identify biological target volume from functional images against conventional GTV derived from anatomical imaging. Functional imaging, such as multi parameter MRI and PET can be used to implement dose painting, which allows us to achieve dose escalation by increasing doses in certain areas that are therapy-resistant in the GTV and reducing doses in less aggressive areas. In this review, we firstly discuss several quantitative functional imaging techniques including PET-CT and multi-parameter MRI. Furthermore, theoretical and experimental comparisons for dose painting by contours (DPBC) and dose painting by numbers (DPBN), along with outcome analysis after dose painting are provided. The state-of-the-art AI-based biomarker diagnosis techniques is reviewed. Finally, we conclude major challenges and future directions in AI-based biomarkers to improve cancer diagnosis and radiotherapy treatment.

show abstract

Robust treatment planning of dose painting for prostate cancer based on ADC-to-Gleason score mappings – what is the potential to increase the tumor control probability?

Abstract: Ahnesjö (2020): Robust treatment planning of dose painting for prostate cancer based on ADC-to-Gleason score mappings-what is the potential to increase the tumor control probability?, Acta Oncologica,

Cited by 7 publications

References 36 publications

Adaptive dose painting for prostate cancer

Adaptive dose painting for prostate cancer

Role of whole-body diffusion-weighted imaging in evaluation of multiple myeloma

Medical Imaging Biomarker Discovery and Integration Towards AI-Based Personalized Radiotherapy

Contact Info

Product

Resources

About