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What is dose painting?

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?

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  1. What is dose painting? Barbara Vanderstraeten Ghent University Hospital 19 January 2008

  2. Outline • Introduction • Technical solution • Planning studies • Conclusions

  3. I. Introduction

  4. Imaging for RT From V Grégoire

  5. Anatomical imaging • CT • MRI

  6. Biological imaging • PET • SPECT • fMRI • MRSI Brain Tumor

  7. Tumor biology characterization S Apisarnthanarax and KSC Chao. Radiat Res 2005;163:1-25.

  8. Biological imaging for RT • Improvement of diagnostic and staging accuracy • Guidance of target volume definition and dose prescription • Evaluation of therapeutic response

  9. Target volume definition • Gross tumor volume (GTV) • Clinical target volume (CTV) • Planning target volume (PTV)

  10. Biological target volume (BTV) CC Ling, J Humm, S Larson et al. Int J Radiat Oncol Biol Phys 2000;47:551-60.

  11. Dose painting

  12. Dose painting by contours

  13. Dose painting by contours KSC Chao, WR Bosch, S Mutic et al. Int J Radiat Oncol Biol Phys 2001;49:1171-82.

  14. Dose painting by contours KSC Chao, WR Bosch, S Mutic et al. Int J Radiat Oncol Biol Phys 2001;49:1171-82.

  15. 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.

  16. Dose painting by numbers

  17. Dose painting by numbers Biologically Conformal Radiation Therapy

  18. II. Technical solution

  19. Dose Dhigh Dlow Signal intensity Ilow Ihigh Relationship between signal intensity and radiation dose

  20. Treatment plan optimization B Vanderstraeten et al. Phys Med Biol 2006;51:N277-86

  21. Treatment plan evaluation QVH

  22. Example: 18F-FDG-PET-guided BCRT for oropharyngeal cancer

  23. Example: 18F-FDG-PET-guided BCRT for oropharyngeal cancer

  24. 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

  25. 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

  26. 18F-FDG-PET-guided BCRT for head and neck cancer

  27. 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

  28. Target dose prescription

  29. “cb250” (blue) versus “vib216-250” (green)

  30. “vib216-250” (green) versus “vib216-300” (orange)

  31. Example

  32. Treatment plan evaluation

  33. 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

  34. 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.

  35. 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

  36. 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

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