Diffusion-Weighted Magnetic Resonance Imaging-Guided Dose Painting in Patients With Locoregionally Advanced Nasopharyngeal Carcinoma Treated With Induction Chemotherapy Plus Concurrent Chemoradiotherapy: A Randomized, Controlled Clinical Trial

Fu, Shengnan; Li, Yanxian; Han, Yang; Wang, Hui; Chen, Yanzhu; Yan, Ouying; He, Qing-Yu; Lin, Liang-In; Liu, Feng

doi:10.1016/j.ijrobp.2021.12.175

Cited by 25 publications

(13 citation statements)

References 45 publications

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“…Implementing an MR-planning program is the first step in the shift from CT-guided to fully MR-guided radiation therapy, and advantages could include integrating functional MR images and artificial intelligence (AI) to use image texture analysis and develop biomarkers to predict response before and during treatment [33,34]. It is hypothesized that these types of MR data could be utilized, for example, to adapt radiation dose during treatment depending on tumour response, for example, delivering higher doses to radioresistant regions and lower doses to the radiosensitive segments, an approach known as dose painting [35][36][37].…”

Section: Discussionmentioning

confidence: 99%

Clinical implementation of magnetic resonance imaging simulation for radiation oncology planning: 5 year experience

Palhares

Lü

et al. 2023

Radiat Oncol

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Purpose Integrating magnetic resonance (MR) into radiotherapy planning has several advantages. This report details the clinical implementation of an MR simulation (MR-planning) program for external beam radiotherapy (EBRT) in one of North America's largest radiotherapy programs. Methods and materials An MR radiotherapy planning program was developed and implemented at Sunnybrook Health Sciences Center in 2016 with two dedicated wide-bore MR platforms (1.5 and 3.0 Tesla). Planning MR was sequentially implemented every 3 months for separate treatment sites, including the central nervous system (CNS), gynecologic (GYN), head and neck (HN), genitourinary (GU), gastrointestinal (GI), breast, and brachial plexus. Essential protocols and processes were detailed in this report, including clinical workflow, optimized MR-image acquisition protocols, MR-adapted patient setup, strategies to overcome risks and challenges, and an MR-planning quality assurance program. This study retrospectively reviewed simulation site data for all MR-planning sessions performed for EBRT over the past 5 years. Results From July 2016 to December 2021, 8798 MR-planning sessions were carried out, which corresponds to 25% of all computer tomography (CT) simulations (CT-planning) performed during the same period at our institution. There was a progressive rise from 80 MR-planning sessions in 2016 to 1126 in 2017, 1492 in 2018, 1824 in 2019, 2040 in 2020, and 2236 in 2021. As a result, the relative number of planning MR/CT increased from 3% of all planning sessions in 2016 to 36% in 2021. The most common site of MR-planning was CNS (49%), HN (13%), GYN (12%), GU (12%), and others (8%). Conclusion Detailed clinical processes and protocols of our MR-planning program were presented, which have been improved over more than 5 years of robust experience. Strategies to overcome risks and challenges in the implementation process are highlighted. Our work provides details that can be used by institutions interested in implementing an MR-planning program.

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Section: Discussionmentioning

confidence: 99%

Clinical implementation of magnetic resonance imaging simulation for radiation oncology planning: 5 year experience

Palhares

Lü

et al. 2023

Radiat Oncol

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“…The reliable segmentations of NPC areas and subregions provide evidence to guide the dose-painting for radiation therapy ( 49 ). The diffusion-weighted MRI-guided dose-painting intensity-modulated radiation therapy was proven to be associated with improved local tumor control and survival in NPC ( 50 ). The voxelwise TIR assessment describes the risk of NPC invasion to each voxel in the coordinate system.…”

Section: Discussionmentioning

confidence: 99%

Prognostic potential of a voxelwise invasion risk map of nasopharyngeal carcinoma based on a coordinate system of the nasopharynx

Chen¹,

Li²,

Yang³

et al. 2023

Quant Imaging Med Surg

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Background: Tumor invasion risk (TIR) is an important prognostic factor in nasopharyngeal carcinoma (NPC). We propose a novel prognostic analytic method for NPC based on a voxelwise analysis of TIR in a coordinate system of the nasopharynx.Methods: A stable nasopharynx coordinate system was constructed based on anatomical landmarks to obtain an accurate TIR profile for NPC. The coordinate system was validated by image registration of the lateral pterygoid muscle (LPM). The tumors were registered to the coordinate system through shift, scale, and rotation transformations. The voxelwise TIR map for NPC was obtained by superposition of all registered and mirrored tumor regions of interest. The minimum risk (MinR) point of the tumor region was used as an independent prognostic factor for NPC. The cutoff value was calculated with density plot and validated with restricted cubic splines (RCSs), and then the patients were divided into 2 groups for overall survival (OS) analysis. Results:The first voxelwise TIR map of NPC was obtained based on 778 patients. The OS of patients with a low TIR was 76.8% and was 92.6% for patients with a high TIR [P<0.001; hazard ratio (HR) =1/0.45; 95% CI: 0.27-0.77; adjusted P=0.004]. Thus, patients with a low TIR had a poor prognosis, whereas patients with a high TIR had a good prognosis. The MinR may be better at grading the prognosis of patients compared to the American Joint Committee on Cancer (AJCC) staging or tumor/node (T/N) classification systems. Conclusions:The voxelwise TIR map provides a new method for the prognostic analysis of NPC.Potential clinical applications of voxelwise TIR mapping are clinical target volume (CTV) delineation and dose-painting for NPC.

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“…A low apparent diffusion coefficient (ADC) value in DW-MRI is associated with adverse treatment outcomes independent of clinical stage and other known prognostic factors [ 42 ]. A recent randomized controlled trial of 260 patients reported improved disease-free survival with DW-MRI-guided dose-painting IMRT in loco-regionally advanced NPC compared with that of standard IMRT [ 43 ]. Following induction chemotherapy, patients in the experimental arm of this trial received 70.4–72.6 Gy in 32–33 fractions to GTV with an additional concomitant boost of 75.2–77.6 Gy to tumor areas with ADC below the mean value in the pre-induction images.…”

Section: Optimizing Prescription Dosesmentioning

confidence: 99%

Current Radiotherapy Considerations for Nasopharyngeal Carcinoma

Chow

Beitler³

et al. 2022

Cancers

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Radiotherapy is the primary treatment modality for nasopharyngeal carcinoma (NPC). Successful curative treatment requires optimal radiotherapy planning and precise beam delivery that maximizes locoregional control while minimizing treatment-related side effects. In this article, we highlight considerations in target delineation, radiation dose, and the adoption of technological advances with the aim of optimizing the benefits of radiotherapy in NPC patients.

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Diffusion-Weighted Magnetic Resonance Imaging-Guided Dose Painting in Patients With Locoregionally Advanced Nasopharyngeal Carcinoma Treated With Induction Chemotherapy Plus Concurrent Chemoradiotherapy: A Randomized, Controlled Clinical Trial

Cited by 25 publications

References 45 publications

Clinical implementation of magnetic resonance imaging simulation for radiation oncology planning: 5 year experience

Clinical implementation of magnetic resonance imaging simulation for radiation oncology planning: 5 year experience

Prognostic potential of a voxelwise invasion risk map of nasopharyngeal carcinoma based on a coordinate system of the nasopharynx

Current Radiotherapy Considerations for Nasopharyngeal Carcinoma

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