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

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Presentation on theme: "What is dose painting? Barbara Vanderstraeten Ghent University Hospital 19 January 2008."— Presentation transcript:

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

2 Outline I.Introduction II.Technical solution III.Planning studies IV.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 RadiotracerCharacterization 18 F-FDGGlucose metabolism 18 F-FLTDNA synthesis 11 C-METProtein synthesis 60 Cu-ATSM, 18 F-FMISOHypoxia Radiolabeled Annexin VApoptosis Radiolabeled V 3 integrin antagonists Angiogenesis S Apisarnthanarax and KSC Chao. Radiat Res 2005;163:1-25.

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

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 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 18 F-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 Biologically Conformal Radiation Therapy

18 II. Technical solution

19 Relationship between signal intensity and radiation dose Dose I low I high D low D high Signal intensity

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

21 Treatment plan evaluation QVH

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

23

24 III. Planning studies Feasibility of BCRT 18 F-FDG-PET-guided BCRT for head and neck cancer B Vanderstraeten et al. Radiother Oncol 2006;79:249-58 18 F-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 18 F-FMISO-PET-guided BCRT for a base-of- tongue cancer case M Alber et al. Phys Med Biol 2003;48:N31-5 18 F-FDG-PET- and 99m Tc-MAA-SPECT-guided BCRT for 2 lung cancer cases DK Das et al. Med Phys 2004;31:1452-61 18 F-FDG-PET- guided BCRT for an oropharyngeal cancer case B Vanderstraeten et al. Phys Med Biol 2006;51:N277-86

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

27 Set-up 15 head and neck cancer patients 18 F-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 cb 250 and vib 216-250 –Between vib 216-250 and vib 216-300 DVHs

28 Target dose prescription cb 250 (cGy/fx) vib 216-250 (cGy/fx) vib 216-300 (cGy/fx) PTV PET 250 PTV 69+PET 216 - 250216 - 300 PTV 69 216 PTV 66 206 PTV 62 194 PTV 56 175

29 cb 250 (blue) versus vib 216-250 (green)

30 vib 216-250 (green) versus vib 216-300 (orange)

31 Example

32 Treatment plan evaluation

33 18 F-FMISO-guided BCRT for head and neck cancer 13 head and neck cancer patients 18 F-FMISO-PET hypoxia imaging Comparison of –Conventional IMRT – 18 F-FDG-PET-guided dose painting by contours – 18 F-FMISO-PET-guided dose painting by numbers DVHs, TCP

34 18 F-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

37 Treatment planning and delivery Biological optimisation Adaptive RT Biological imaging Tracers Acquisition, reconstruction, quantification Clinical investigations Fundamental research in vitro, animal studies Treatment outcome


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