Incorporation of SPECT bone marrow imaging into intensity modulated whole-pelvic radiation therapy treatment planning for gynecologic malignancies

Roeske, John C.; Lujan, Anthony E.; Reba, Richard C.; Penney, Bill C.; Yamada, S. Diane; Mundt, Arno J.

doi:10.1016/j.radonc.2005.06.017

Cited by 81 publications

(59 citation statements)

References 26 publications

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“…The mean volume of bowel receiving an excess of 30 Gy (V 30 ) and 45 Gy (V 45 ) was 522 cm 3 and 154 cm 3 , respectively. The mean V 10 , V 20 , V 30 , and V 40 of the pelvic bone marrow was 83.7%, 65.2%, 42.4%, and 20.3%, respectively, with an overall mean dose 26.3 Gy. For patients undergoing IG-IMRT, the mean V 10 , V 20 , V 30 , and V 40 of active bone marrow was 82.6%, 63.5%, 45.7%, and 22.2%, respectively, with an overall mean dose of 26.4 Gy.…”

Section: Resultsmentioning

confidence: 96%

“…A key unanswered question is whether reducing the pelvic bone marrow radiation dose can reduce hematologic toxicity and permit better chemotherapy delivery in patients undergoing CRT. This hypothesis was posited in early studies investigating IMRT and techniques to image the bone marrow (13,21,30). Retrospective studies subsequently correlated lower rates of hematologic toxicity with a reduced radiation dose to the pelvic bone marrow and metabolically active bone marrow, lending support to this hypothesis (17)(18)(19)26).…”

Section: Discussionmentioning

confidence: 93%

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Phase 2 Multicenter Clinical Trial of Bone Marrow–Sparing Intensity Modulated Radiation Therapy With Concurrent Cisplatin for Stage IB-IVA Cervical Cancer

Mell

Sirák

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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SummaryWe performed an international phase II trial to test the Purpose: To test the hypothesis that intensity modulated radiation therapy (IMRT) reduces acute hematologic and gastrointestinal (GI) toxicity for patients with locoregionally advanced cervical cancer. hypothesis that intensity modulated radiation therapy (IMRT) would reduce the acute toxicity for locoregionally advanced cervical cancer. For the 83 patients enrolled, acute gastrointestinal toxicity was significantly reduced with both IMRT and positron emission tomography-guided bone marrow sparing IMRT (IG-IMRT) compared with historical controls. The incidence of neutropenia was significantly reduced in patients who underwent IG-IMRT. We conclude that IMRT reduces acute toxicity compared with standard treatment in this population and that IG-IMRT warrants testing in randomized trials.Methods and Materials: We enrolled patients with stage IB-IVA cervical carcinoma in a single-arm phase II trial involving 8 centers internationally. All patients received weekly cisplatin concurrently with once-daily IMRT, followed by intracavitary brachytherapy, as indicated. The primary endpoint was the occurrence of either acute grade !3 neutropenia or clinically significant GI toxicity within 30 days of completing chemoradiation therapy. A preplanned subgroup analysis tested the hypothesis that positron emission tomography-based image-guided IMRT (IG-IMRT) would lower the risk of acute neutropenia. We also longitudinally assessed patients' changes in quality of life. Results: From October 2011 to April 2015, 83 patients met the eligibility criteria and initiated protocol therapy. The median follow-up was 26.0 months. The incidence of any primary event was 26.5% (95% confidence interval [CI] 18.2%-36.9%), significantly lower than the 40% incidence hypothesized a priori from historical data (PZ.012). The incidence of grade !3 neutropenia and clinically significant GI toxicity was 19.3% (95% CI 12.2%-29.0%) and 12.0% (95% CI 6.7%-20.8%), respectively. Compared with patients treated without IG-IMRT (nZ48), those treated with IG-IMRT (nZ35) had a significantly lower incidence of grade !3 neutropenia (8.6% vs 27.1%; 2-sided c 2 PZ.035) and nonsignificantly lower incidence of grade !3 leukopenia (25.7% vs 41.7%; PZ.13) and any grade !3 hematologic toxicity (31.4% vs 43.8%; PZ.25). Conclusions: IMRT reduces acute hematologic and GI toxicity compared with standard treatment, with promising therapeutic outcomes. Positron emission tomography IG-IMRT reduces the incidence of acute neutropenia. Ó

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Section: Resultsmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 93%

Phase 2 Multicenter Clinical Trial of Bone Marrow–Sparing Intensity Modulated Radiation Therapy With Concurrent Cisplatin for Stage IB-IVA Cervical Cancer

Mell

Sirák

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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“…These subregions cannot be distinguished on computed tomography(37-39), however, studies using functional imaging such as magnetic resonance imaging, positron emission tomography (PET), and single photon emission computed tomography (SPECT) have revealed that active BM tends to be concentrated in specific subregions in the pelvis, namely the iliac crests, medial ilium, sacrum and lumbar spine (39)(40)(41). Previous studies have found that HT increases with increasing volume of lumbar/sacral BM irradiated (16,17).…”

Section: Discussionmentioning

confidence: 99%

Normal Tissue Complication Probability Modeling of Acute Hematologic Toxicity in Cervical Cancer Patients Treated With Chemoradiotherapy

Rose

Aydogan

Yeginer

et al. 2009

International Journal of Radiation Oncology*Biology*Physics

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PURPOSE-To test the hypothesis that increased pelvic bone marrow (BM) irradiation is associated with increased hematologic toxicity (HT) in cervical cancer patients undergoing chemoradiotherapy (CRT), and to develop a normal tissue complication probability (NTCP) model for HT.METHODS AND MATERIALS-We tested associations between hematologic nadirs during CRT and the volume of BM receiving ≥ 10 and 20 Gy (V 10 and V 20 ) using a previously developed linear regression model. The validation cohort consisted of 44 cervical cancer patients treated with concurrent cisplatin and pelvic radiotherapy. Subsequently, these data were pooled with 37 identically treated patients from a prior study, forming a cohort of 81 patients for NTCP analysis. Generalized linear modeling was used to test associations between hematologic nadirs and dosimetric parameters, adjusting for body mass index. Receiver operating characteristic curves were used to derive optimal dosimetric planning constraints.RESULTS-In the validation cohort, significant negative correlations were observed between white blood cell count (WBC) nadir and V 10 (regression coefficient (β)=−0.060, p=0.009) and V 20 (β=−0.044, p=0.010). In the combined cohort, the (adjusted) β estimates for log(WBC) vs. V 10 and V 20 were: −0.022 (p=0.025) and −0.021 (p=0.002), respectively. Patients with V 10 ≥ 95% were more likely to experience grade ≥ 3 leukopenia (68.8% vs. 24.6%, p<0.001) as were patients with V 20 > 76% (57.7% vs. 21.8%, p=0.001). Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conflicts of Interests:NonePresented at the 51st meeting of the American Society of Radiation Oncology, Chicago, IL, 2009 NIH Public Access CONCLUSIONS-These findings support the hypothesis that HT increases with increasing pelvic BM volume irradiated. Efforts to maintain V 10 < 95% and V 20 < 76% may reduce HT.

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“…Recently, SPECT has also been gaining importance in oncological diagnosis 1,2 and radiotherapy planning 3 . SPECT functional images, however, often lack anatomical information, which is necessary to localize disease sites 4 .…”

Section: Introductionmentioning

confidence: 99%

Dual-isotope Acquisition for CT–SPECT Registration of Infection Studies

2009

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The registration of CT and NM images can enhance patient diagnosis since it allows for the fusion of anatomical and functional information as well as attenuation correction of NM images. However, irrespective of the methods used, registration accuracy depends heavily on the characteristics of the input images and the degree of similarity between them. This poses a challenge for registering CT and NM images as they may have very different characteristics. To address the particular problem of CT and In-111 SPECT registration, we propose to perform a dual-isotope study which involves an additional injection of Tc-99m MDP to generate two inherently registered images: In-111 SPECT and Tc-99m SPECT. As skeletal structures are visible in both CT and Tc-99m SPECT, performing registration of these images may be much more effective. The very same spatial transformation derived can be immediately applied to complete the registration of CT and the corresponding In-111 SPECT. Accordingly, we hypothesize that the registration of CT and Tc-99m SPECT can be more accurately performed than the registration of CT and In-111 SPECT and seek to compare the accuracies between the aforementioned registrations. In this paper, we have collected three clinical datasets, with the ground-truth transformations known, and tested the proposed approach by using a mutual information-based algorithm to solve for the rigid/non-rigid misalignments introduced to them. Based on the results of our experiments, we conclude that registration using Tc-99m SPECT can achieve 100% success rate, and is thus much more superior to the registration using In-111 SPECT, which at best, achieves only 38% success rate. Clearly, the introduction of a dual-isotope acquisition can substantially improve the registration of SPECT and CT images.

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Incorporation of SPECT bone marrow imaging into intensity modulated whole-pelvic radiation therapy treatment planning for gynecologic malignancies

Cited by 81 publications

References 26 publications

Phase 2 Multicenter Clinical Trial of Bone Marrow–Sparing Intensity Modulated Radiation Therapy With Concurrent Cisplatin for Stage IB-IVA Cervical Cancer

Phase 2 Multicenter Clinical Trial of Bone Marrow–Sparing Intensity Modulated Radiation Therapy With Concurrent Cisplatin for Stage IB-IVA Cervical Cancer

Normal Tissue Complication Probability Modeling of Acute Hematologic Toxicity in Cervical Cancer Patients Treated With Chemoradiotherapy

Dual-isotope Acquisition for CT–SPECT Registration of Infection Studies

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