Quantification of Tumor Oxygenation Based on FMISO PET: Influence of Location and Oxygen Level of the Well-Oxygenated Reference Region

Lazzeroni, M.; Toma-Daşu, Iuliana; Ureba, Ana; Schiavo, Filippo; Wiedenmann, Nicole; Bunea, Hatice; Thomann, B.; Baltas, Dimos; Mix, Michael; Stoykow, C.; Sörensen, A; Grosu, Anca L.

doi:10.1007/978-3-030-34461-0_22

Cited by 8 publications

(6 citation statements)

References 10 publications

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“…Indeed, Electron Paramagnetic Resonance images may direct the location of radiation tumor boosts to enhance tumor cures [16]. On the other hand, some PET imaging has already been verified to be effective in guiding oxygen-based radiotherapy [17][18][19] and to transform the radiotracer uptake into oxygen partial pressure maps, determining the volume of the hypoxic target (HTV).…”

Section: Introductionmentioning

confidence: 99%

Non-Homogeneous Tumor Growth and Its Implications for Radiotherapy: A Phenomenological Approach

Castorina

Castorina²,

Ferini³

2021

JPM

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Tumor regrowth and heterogeneity are important clinical parameters during radiotherapy, and the probability of treatment benefit critically depends on the tumor progression pattern in the interval between the fractional irradiation treatments. We propose an analytic, easy-to-use method to take into account clonal subpopulations with different specific growth rates and radiation resistances. The different strain regrowth effects, as described by Gompertz law, require a dose-boost to reproduce the survival probability of the corresponding homogeneous system and for uniform irradiation. However, the estimate of the survival fraction for a tumor with a hypoxic subpopulation is more reliable when there is a slow specific regrowth rate and when the dependence on the oxygen enhancement ratio of radiotherapy is consistently taken into account. The approach is discussed for non-linear two-population dynamics for breast cancer and can be easily generalized to a larger number of components and different tumor phenotypes.

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Section: Introductionmentioning

confidence: 99%

Non-Homogeneous Tumor Growth and Its Implications for Radiotherapy: A Phenomenological Approach

Castorina

Castorina²,

Ferini³

2021

JPM

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“…The curve fitting to roughly determine A, B, and C is based on points including the hypoxic threshold and reported pO 2 values of 29.2 mmHg in the muscle and 33.8 mmHg in the normal brain 47 . Detailed [ 18 F]‐FMISO uptake data may be used in the future to provide this conversion, 48 but here, we focus the study on the mathematical approach detailed below.…”

Section: Methodsmentioning

confidence: 99%

“…7 end for this conversion, 48 but here, we focus the study on the mathematical approach detailed below.…”

Section: Calculation Of Rbe Using [ 18 F]-fmiso-pet Imagesmentioning

confidence: 99%

Hypoxia‐informed RBE‐weighted beam orientation optimization for intensity modulated proton therapy

Ramesh,

Ruan,

Liu

et al. 2024

Medical Physics

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BackgroundVariable relative biological effectiveness (RBE) models in treatment planning have been proposed to optimize the therapeutic ratio of proton therapy. It has been reported that proton RBE decreases with increasing tumor oxygen level, offering an opportunity to address hypoxia‐related radioresistance with RBE‐weighted optimization.PurposeHere, we obtain a voxel‐level estimation of partial oxygen pressure to weigh RBE values in a single biologically informed beam orientation optimization (BOO) algorithm.MethodsThree glioblastoma patients with [18F]‐fluoromisonidazole (FMISO)‐PET/CT images were selected from the institutional database. Oxygen values were derived from tracer uptake using a nonlinear least squares curve fitting. McNamara RBE, calculated from proton dose, was then weighed using oxygen enhancement ratios (OER) for each voxel and incorporated into the dose fidelity term of the BOO algorithm. The nonlinear optimization problem was solved using a split‐Bregman approach, with FISTA as the solver. The proposed hypoxia informed RBE‐weighted method (HypRBE) was compared to dose fidelity terms using the constant RBE of 1.1 (cRBE) and the normoxic McNamara RBE model (RegRBE). Tumor homogeneity index (HI), maximum biological dose (Dmax), and D95%, as well as OAR therapeutic index (TI = gEUDCTV/gEUDOAR) were evaluated along with worst‐case statistics after normalization to normal tissue isotoxicity.ResultsCompared to [cRBE, RegRBE], HypRBE increased tumor HI, Dmax, and D95% across all plans by on average [31.3%, 31.8%], [48.6%, 27.1%], and [50.4%, 23.8%], respectively. In the worst‐case scenario, the parameters increase on average by [12.5%, 14.7%], [7.3%,−8.9%], and [22.3%, 2.1%]. Despite increased OAR Dmean and Dmax by [8.0%, 3.0%] and [13.1%, −0.1%], HypRBE increased average TI by [22.0%, 21.1%]. Worst‐case OAR Dmean, Dmax, and TI worsened by [17.9%, 4.3%], [24.5%, −1.2%], and [9.6%, 10.5%], but in the best cases, HypRBE escalates tumor coverage significantly without compromising OAR dose, increasing the therapeutic ratio.ConclusionsWe have developed an optimization algorithm whose dose fidelity term accounts for hypoxia‐informed RBE values. We have shown that HypRBE selects bE:\Alok\aaeams better suited to deliver high physical dose to low RBE, hypoxic tumor regions while sparing the radiosensitive normal tissue.

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“…Lastly, its ability to dynamically distinguish responsive regions (well-oxygenated) and unresponsive ones (hypoxic) early during the radiotherapy course could enable a progressive modulation of dose-painting for a better chance of cure [38]. On the other hand, some PET imaging has already proved to be effective in guiding oxygen-based radiotherapy [39][40][41].…”

Section: Clinical Use Of Lattice Radiotherapymentioning

confidence: 99%

Lattice or Oxygen-Guided Radiotherapy: What If They Converge? Possible Future Directions in the Era of Immunotherapy

Ferini¹,

Valenti²,

Tripoli³

et al. 2021

Cancers

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Palliative radiotherapy has a great role in the treatment of large tumor masses. However, treating a bulky disease could be difficult, especially in critical anatomical areas. In daily clinical practice, short course hypofractionated radiotherapy is delivered in order to control the symptomatic disease. Radiation fields generally encompass the entire tumor mass, which is homogeneously irradiated. Recent technological advances enable delivering a higher radiation dose in small areas within a large mass. This goal, previously achieved thanks to the GRID approach, is now achievable using the newest concept of LATTICE radiotherapy (LT-RT). This kind of treatment allows exploiting various radiation effects, such as bystander and abscopal effects. These events may be enhanced by the concomitant use of immunotherapy, with the latter being ever more successfully delivered in cancer patients. Moreover, a critical issue in the treatment of large masses is the inhomogeneous intratumoral distribution of well-oxygenated and hypo-oxygenated areas. It is well known that hypoxic areas are more resistant to the killing effect of radiation, hence the need to target them with higher aggressive doses. This concept introduces the “oxygen-guided radiation therapy” (OGRT), which means looking for suitable hypoxic markers to implement in PET/CT and Magnetic Resonance Imaging. Future treatment strategies are likely to involve combinations of LT-RT, OGRT, and immunotherapy. In this paper, we review the radiobiological rationale behind a potential benefit of LT-RT and OGRT, and we summarize the results reported in the few clinical trials published so far regarding these issues. Lastly, we suggest what future perspectives may emerge by combining immunotherapy with LT-RT/OGRT.

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Quantification of Tumor Oxygenation Based on FMISO PET: Influence of Location and Oxygen Level of the Well-Oxygenated Reference Region

Cited by 8 publications

References 10 publications

Non-Homogeneous Tumor Growth and Its Implications for Radiotherapy: A Phenomenological Approach

Non-Homogeneous Tumor Growth and Its Implications for Radiotherapy: A Phenomenological Approach

Hypoxia‐informed RBE‐weighted beam orientation optimization for intensity modulated proton therapy

Lattice or Oxygen-Guided Radiotherapy: What If They Converge? Possible Future Directions in the Era of Immunotherapy

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