Safety margin in irradiation of colorectal liver metastases: assessment of the control dose of micrometastases

Seidensticker, Max; Wust, Peter; Rühl, Ricarda; Mohnike, Konrad; Pech, Maciej; Wieners, Gero; Gademann, G.; Ricke, Jens

doi:10.1186/1748-717x-5-24

Cited by 16 publications

(8 citation statements)

References 32 publications

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“…The methodology they proposed does not account for the inter-sample variability. In radiation oncology applications, tolerance and prediction intervals were used to summarize dose uncertainties and organ motion for optimized treatment delivery [33] and for dose planning [34]. We do not know of any previous application of tolerance limits to summarize experimental evaluation of image registration.…”

Section: Discussionmentioning

confidence: 99%

Application of Tolerance Limits to the Characterization of Image Registration Performance

Fedorov

Wells

Kikinis

et al. 2014

IEEE Trans. Med. Imaging

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Deformable image registration is used increasingly in image-guided interventions and other applications. However, validation and characterization of registration performance remain areas that require further study. We propose an analysis methodology for deriving tolerance limits on the initial conditions for deformable registration that reliably lead to a successful registration. This approach results in a concise summary of the probability of registration failure, while accounting for the variability in the test data. The (β, γ) tolerance limit can be interpreted as a value of the input parameter that leads to successful registration outcome in at least 100β% of cases with the 100γ% confidence. The utility of the methodology is illustrated by summarizing the performance of a deformable registration algorithm evaluated in three different experimental setups of increasing complexity. Our examples are based on clinical data collected during MRI-guided prostate biopsy registered using publicly available deformable registration tool. The results indicate that the proposed methodology can be used to generate concise graphical summaries of the experiments, as well as a probabilistic estimate of the registration outcome for a future sample. Its use may facilitate improved objective assessment, comparison and retrospective stress-testing of deformable.

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Section: Discussionmentioning

confidence: 99%

Application of Tolerance Limits to the Characterization of Image Registration Performance

Fedorov

Wells

Kikinis

et al. 2014

IEEE Trans. Med. Imaging

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“…Image-guided single-fraction 192 Ir-high-dose-rate brachytherapy (HDR-BT) is a high precision percutaneous ablation technique which has been shown to yield promising results with regards to safety and efficacy in the treatment of unresectable colorectal liver metastases [ 6 - 8 ]. Precise application of high irradiation doses to tumor tissue with steep dose gradients resulting in sparing of adjacent liver parenchyma allows this technique to be applied repeatedly for treatment of recurrent hepatic metastases [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Value of diffusion weighted MR imaging as an early surrogate parameter for evaluation of tumor response to high-dose-rate brachytherapy of colorectal liver metastases

et al. 2011

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BackgroundTo assess the value of diffusion weighted imaging (DWI) as an early surrogate parameter for treatment response of colorectal liver metastases to image-guided single-fraction 192Ir-high-dose-rate brachytherapy (HDR-BT).MethodsThirty patients with a total of 43 metastases underwent CT- or MRI-guided HDR-BT. In 13 of these patients a total of 15 additional lesions were identified, which were not treated at the initial session and served for comparison. Magnetic resonance imaging (MRI) including breathhold echoplanar DWI sequences was performed prior to therapy (baseline MRI), 2 days after HDR-BT (early MRI) as well as after 3 months (follow-up MRI). Tumor volume (TV) and intratumoral apparent diffusion coefficient (ADC) were measured independently by two radiologists. Statistical analysis was performed using univariate comparison, ANOVA and paired t test as well as Pearson's correlation.ResultsAt early MRI no changes of TV and ADC were found for non-treated colorectal liver metastases. In contrast, mean TV of liver lesions treated with HDR-BT increased by 8.8% (p = 0.054) while mean tumor ADC decreased significantly by 11.4% (p < 0.001). At follow-up MRI mean TV of non-treated metastases increased by 50.8% (p = 0.027) without significant change of mean ADC values. In contrast, mean TV of treated lesions decreased by 47.0% (p = 0.026) while the mean ADC increased inversely by 28.6% compared to baseline values (p < 0.001; Pearson's correlation coefficient of r = -0.257; p < 0.001).ConclusionsDWI is a promising imaging biomarker for early prediction of tumor response in patients with colorectal liver metastases treated with HDR-BT, yet the optimal interval between therapy and early follow-up needs to be elucidated.

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“…We hypothesize: the key to these divergent findings is full coverage of the CTV that is more challenging to achieve outright for larger compared to smaller lesions. Moreover, comparable to surgery also for local treatment, the margin status is vitally important and related to LTC and prognosis after treatment (36,37). Hence, some possible but remediable pitfalls need to be discussed.…”

Section: Discussionmentioning

confidence: 99%

Interstitial Brachytherapy for Limited (<4 cm) and Large (≥4 cm) Hepatic Metastases from Rare and Less Common Cancers

et al. 2020

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Background/Aim: Interstitial brachytherapy (iBT) seems to achieve higher local tumor control rates for lesions limited in size. The objective was to evaluate the efficacy and safety of iBT in the treatment of limited and large liver metastases from rare or less common cancers (RLCC). Patients and Methods: A total of 194 unresectable liver metastases categorized as limited (<4 cm, n=153, subgroup A) and large lesions (≥4 cm, n=41, subgroup B) were treated. Clinical and image-based follow-up was conducted every 3 months after iBT. Results: Cumulative local recurrence (CLR) rate was 9.8% (19 recurrences; A: n=16; B: n=3). No significant difference in CLR was noted between subgroup A and B (A:10.5%, B:7.3%, p=0.339). Median follow-up was 6.2 months (range=2.2-92.9 months). Complication assessment revealed 5 severe adverse events (grade 3: 4.3%, grade 4 and 5: 0%) with 4 events in A and 1 event in B. Conclusion: IBT is a feasible, effective, and safe minimally invasive treatment for small and large liver metastases from RLCC.According to the RARECAREnet project, rare cancers belong to a defined group of diseases with an incidence rate of <6/100,000, whereas less common cancers could be defined by an incidence of ≥6/1,000,000 outside the common or frequent cancers, such as breast, colorectal, lung and prostate (1, 2). Taken together, these two groups of neoplasms add up to 47% of all newly diagnosed malignancies (2). Since treatment experience is limited even in major cancer centers, rare or less common cancers (RLCC) are a significant challenge to clinical practice with varying survival rates among European countries (3). In particular, developing adequately powered clinical trials for advanced-stage cancer is demanding due to the low number of patients; therefore, evidence for effectiveness of new therapeutic methods is difficult to provide, leading to limited therapy options. Hence, for advanced/metastasized RLCC, research is frequently confined to case reports or small retrospective series.From a theoretical oncological perspective, metastases limited in number and distribution (i.e. oligometastases) are increasingly considered suitable for localized therapy aiming for disease control and prolongation of life in selected patients, as shown for colorectal cancer (CRC). In fact, for CRC patients with oligometastatic disease (OMD) confined to one organ, i.e. most commonly the liver, 5-year survival rates of 25-40% are reported after complete metastasectomy, furthermore, after a survival of 10 years post-surgery, patients are even considered cured (4-6). However, effective surgical resection is applicable to a limited number of cases, as the ability to perform complete macro-and microscopic resection of multiple liver metastases relies on the capacity of the future liver remnant to minimize the risk of posthepatectomy liver failure. Resectability is limited by the distribution and accessibility of metastases, consequently, curative resection of liver metastases is not possible in up to 80% of CRC patients (7).However, ...

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Safety margin in irradiation of colorectal liver metastases: assessment of the control dose of micrometastases

Cited by 16 publications

References 32 publications

Application of Tolerance Limits to the Characterization of Image Registration Performance

Application of Tolerance Limits to the Characterization of Image Registration Performance

Value of diffusion weighted MR imaging as an early surrogate parameter for evaluation of tumor response to high-dose-rate brachytherapy of colorectal liver metastases

Interstitial Brachytherapy for Limited (<4 cm) and Large (≥4 cm) Hepatic Metastases from Rare and Less Common Cancers

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