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What is dose painting?. Barbara Vanderstraeten Ghent University Hospital 19 January 2008. Outline. Introduction Technical solution Planning studies Conclusions. I. Introduction. Imaging for RT. From V Grégoire. Anatomical imaging. CT MRI. Biological imaging. PET SPECT fMRI MRSI.
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What is dose painting? Barbara Vanderstraeten Ghent University Hospital 19 January 2008
Outline • Introduction • Technical solution • Planning studies • Conclusions
Imaging for RT From V Grégoire
Anatomical imaging • CT • MRI
Biological imaging • PET • SPECT • fMRI • MRSI Brain Tumor
Tumor biology characterization S Apisarnthanarax and KSC Chao. Radiat Res 2005;163:1-25.
Biological imaging for RT • Improvement of diagnostic and staging accuracy • Guidance of target volume definition and dose prescription • Evaluation of therapeutic response
Target volume definition • Gross tumor volume (GTV) • Clinical target volume (CTV) • Planning target volume (PTV)
Biological target volume (BTV) CC Ling, J Humm, S Larson et al. Int J Radiat Oncol Biol Phys 2000;47:551-60.
Dose painting by contours KSC Chao, WR Bosch, S Mutic et al. Int J Radiat Oncol Biol Phys 2001;49:1171-82.
Dose painting by contours KSC Chao, WR Bosch, S Mutic et al. Int J Radiat Oncol Biol Phys 2001;49:1171-82.
Dose painting by contours 18F-FDG-PET-guided dose painting in head and neck cancer: phase I clinical trial (41 patients) I Madani, W Duthoy, C Derie et al. Int J Radiat Oncol Biol Phys 2007;68:126-35.
Dose painting by numbers Biologically Conformal Radiation Therapy
Dose Dhigh Dlow Signal intensity Ilow Ihigh Relationship between signal intensity and radiation dose
Treatment plan optimization B Vanderstraeten et al. Phys Med Biol 2006;51:N277-86
III. Planning studies • Feasibility of BCRT • 18F-FDG-PET-guided BCRT for head and neck cancer B Vanderstraeten et al. Radiother Oncol 2006;79:249-58 • 18F-FMISO-guided BCRT for head and neck cancer D Thorwarth et al. Int J Radiat Oncol Biol Phys 2007;68:291-300
Feasibility of BCRT • 18F-FMISO-PET-guided BCRT for a base-of-tongue cancer case M Alber et al. Phys Med Biol 2003;48:N31-5 • 18F-FDG-PET- and 99mTc-MAA-SPECT-guided BCRT for 2 lung cancer cases DK Das et al. Med Phys 2004;31:1452-61 • 18F-FDG-PET- guided BCRT for an oropharyngeal cancer case B Vanderstraeten et al. Phys Med Biol 2006;51:N277-86
Set-up • 15 head and neck cancer patients • 18F-FDG-PET imaging of tumor metabolism • Dose painting by contours (“contour-based IMRT”) versus dose painting by numbers (“voxel intensity-based IMRT”) • Comparison of clinically relevant dose-volume characteristics • Between “cb250” and “vib216-250” • Between “vib216-250” and “vib216-300” • DVHs
18F-FMISO-guided BCRT for head and neck cancer • 13 head and neck cancer patients • 18F-FMISO-PET hypoxia imaging • Comparison of • Conventional IMRT • 18F-FDG-PET-guided dose painting by contours • 18F-FMISO-PET-guided dose painting by numbers • DVHs, TCP
18F-FMISO-guided BCRT for head and neck cancer D Thorwarth, SM Eschmann, F Paulsen and M Alber Int J Radiat Oncol Biol Phys 2007;68:291-300.
IV. Conclusions • The rationale for dose painting is clear • Dose painting is technically feasible • By contours • By numbers • Current issues? See Discussion at 12:30
Fundamental research in vitro, animal studies Radiobiology • Biological imaging • Tracers • Acquisition, reconstruction, quantification • Treatment planning and delivery • Biological optimisation • Adaptive RT Treatment outcome Nuclear medicine Radiotherapy physics Radiotherapy Clinical investigations