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Mao Q, Gu M, Hong C, Wang H, Ruan X, Liu Z, Yuan B, Xu M, Dong C, Mou L, Gao X, Tang G, Chen T, Wu A, Pan Y. A Contrast-Enhanced Tri-Modal MRI Technique for High-Performance Hypoxia Imaging of Breast Cancer. Small 2024:e2308850. [PMID: 38366271 DOI: 10.1002/smll.202308850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/19/2024] [Indexed: 02/18/2024]
Abstract
Personalized radiotherapy strategies enabled by the construction of hypoxia-guided biological target volumes (BTVs) can overcome hypoxia-induced radioresistance by delivering high-dose radiotherapy to targeted hypoxic areas of the tumor. However, the construction of hypoxia-guided BTVs is difficult owing to lack of precise visualization of hypoxic areas. This study synthesizes a hypoxia-responsive T1 , T2 , T2 mapping tri-modal MRI molecular nanoprobe (SPION@ND) and provides precise imaging of hypoxic tumor areas by utilizing the advantageous features of tri-modal magnetic resonance imaging (MRI). SPION@ND exhibits hypoxia-triggered dispersion-aggregation structural transformation. Dispersed SPION@ND can be used for routine clinical BTV construction using T1 -contrast MRI. Conversely, aggregated SPION@ND can be used for tumor hypoxia imaging assessment using T2 -contrast MRI. Moreover, by introducing T2 mapping, this work designs a novel method (adjustable threshold-based hypoxia assessment) for the precise assessment of tumor hypoxia confidence area and hypoxia level. Eventually this work successfully obtains hypoxia tumor target and accurates hypoxia tumor target, and achieves a one-stop hypoxia-guided BTV construction. Compared to the positron emission tomography-based hypoxia assessment, SPION@ND provides a new method that allows safe and convenient imaging of hypoxic tumor areas in clinical settings.
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Affiliation(s)
- Quanliang Mao
- Department of Radiology, First Affiliated Hospital of Ningbo University, 59 Liuting Street, Ningbo, 315010, P. R. China
| | - Mengyin Gu
- Department of Radiology, First Affiliated Hospital of Ningbo University, 59 Liuting Street, Ningbo, 315010, P. R. China
| | - Chengyuan Hong
- Cixi Institute of Biomedical Engineering, International Cooperation Base of Biomedical Materials Technology and Application, CAS Key Laboratory of Magnetic Materials and Devices and Zhejiang Engineering Research Center for Biomedical Materials, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences (CAS), Ningbo Key Laboratory of Biomedical Imaging Probe Materials and Technology, Ningbo, Zhejiang Province, 315201, P. R. China
| | - Huiying Wang
- Department of Radiology, First Affiliated Hospital of Ningbo University, 59 Liuting Street, Ningbo, 315010, P. R. China
| | - Xinzhong Ruan
- Department of Radiology, First Affiliated Hospital of Ningbo University, 59 Liuting Street, Ningbo, 315010, P. R. China
| | - Zhusheng Liu
- Cixi Institute of Biomedical Engineering, International Cooperation Base of Biomedical Materials Technology and Application, CAS Key Laboratory of Magnetic Materials and Devices and Zhejiang Engineering Research Center for Biomedical Materials, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences (CAS), Ningbo Key Laboratory of Biomedical Imaging Probe Materials and Technology, Ningbo, Zhejiang Province, 315201, P. R. China
| | - Bo Yuan
- Cixi Institute of Biomedical Engineering, International Cooperation Base of Biomedical Materials Technology and Application, CAS Key Laboratory of Magnetic Materials and Devices and Zhejiang Engineering Research Center for Biomedical Materials, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences (CAS), Ningbo Key Laboratory of Biomedical Imaging Probe Materials and Technology, Ningbo, Zhejiang Province, 315201, P. R. China
| | - Mengting Xu
- Cixi Institute of Biomedical Engineering, International Cooperation Base of Biomedical Materials Technology and Application, CAS Key Laboratory of Magnetic Materials and Devices and Zhejiang Engineering Research Center for Biomedical Materials, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences (CAS), Ningbo Key Laboratory of Biomedical Imaging Probe Materials and Technology, Ningbo, Zhejiang Province, 315201, P. R. China
| | - Chen Dong
- Cixi Institute of Biomedical Engineering, International Cooperation Base of Biomedical Materials Technology and Application, CAS Key Laboratory of Magnetic Materials and Devices and Zhejiang Engineering Research Center for Biomedical Materials, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences (CAS), Ningbo Key Laboratory of Biomedical Imaging Probe Materials and Technology, Ningbo, Zhejiang Province, 315201, P. R. China
| | - Lei Mou
- Cixi Institute of Biomedical Engineering, International Cooperation Base of Biomedical Materials Technology and Application, CAS Key Laboratory of Magnetic Materials and Devices and Zhejiang Engineering Research Center for Biomedical Materials, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences (CAS), Ningbo Key Laboratory of Biomedical Imaging Probe Materials and Technology, Ningbo, Zhejiang Province, 315201, P. R. China
| | - Xiang Gao
- Department of Neurosurgery, First Affiliated Hospital of Ningbo University, Ningbo, 315010, P. R. China
| | - Guangyu Tang
- Department of Radiology, Shanghai Tenth People's Hospital of Tongji University, Shanghai, 200072, P. R. China
| | - Tianxiang Chen
- Cixi Institute of Biomedical Engineering, International Cooperation Base of Biomedical Materials Technology and Application, CAS Key Laboratory of Magnetic Materials and Devices and Zhejiang Engineering Research Center for Biomedical Materials, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences (CAS), Ningbo Key Laboratory of Biomedical Imaging Probe Materials and Technology, Ningbo, Zhejiang Province, 315201, P. R. China
- Ningbo Clinical Research Center for Medical Imaging, Ningbo, 315010, P. R. China
| | - Aiguo Wu
- Cixi Institute of Biomedical Engineering, International Cooperation Base of Biomedical Materials Technology and Application, CAS Key Laboratory of Magnetic Materials and Devices and Zhejiang Engineering Research Center for Biomedical Materials, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences (CAS), Ningbo Key Laboratory of Biomedical Imaging Probe Materials and Technology, Ningbo, Zhejiang Province, 315201, P. R. China
| | - Yuning Pan
- Department of Radiology, First Affiliated Hospital of Ningbo University, 59 Liuting Street, Ningbo, 315010, P. R. China
- Department of Radiology, Shanghai Tenth People's Hospital of Tongji University, Shanghai, 200072, P. R. China
- Ningbo Clinical Research Center for Medical Imaging, Ningbo, 315010, P. R. China
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Miljanic M, Nwachukwu C, Rahimi A. Definitive ablative stereotactic partial breast irradiation in early stage inoperable breast cancer. J Cancer Res Clin Oncol 2023; 149:15553-15559. [PMID: 37648809 DOI: 10.1007/s00432-023-05053-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/28/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE This case series and literature review aims to investigate the efficacy and safety of definitive ablative radiation therapy as a treatment modality for non-operable patients with early stage breast cancer. We present two cases demonstrating the potential of this approach to achieve durable responses. METHODS We assessed the long-term response of two non-operable patients diagnosed with Stage II (cT2N0M) and Stage IA (T1bN0M0) invasive ductal carcinoma (IDC), who were deemed unfit for surgery due to significant co-morbid conditions. Definitive ablative radiation therapy was administered using stereotactic partial breast irradiation with ablative doses delivered in either a single fraction or two fractions. Serial imaging was conducted to assess treatment response and monitor adverse events. RESULTS Both patients exhibited notable treatment responses following definitive ablative radiation therapy. The first patient, an 84-year-old woman, experienced a 69% reduction in tumor size over a follow-up period exceeding 2 years. The second patient, an 87-year-old woman, achieved complete resolution of disease on imaging, with no signs of progression even 26 month post-treatment. Both patients tolerated the treatment well, without significant treatment-related adverse events. CONCLUSIONS Our case series suggests that definitive ablative radiation therapy may serve as a safe and effective treatment option for non-operable patients with early stage breast cancer. The observed durable treatment responses and minimal toxicity support the potential of this approach. Furthermore, a longer interval between ablative radiation therapy and surgery may enhance treatment response, potentially leading to increased complete pathologic response rates.
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Affiliation(s)
- Mihailo Miljanic
- Department of Radiation Oncology at University of Texas Southwestern Medical Center, 2280 Inwood Road, Dallas, TX, USA.
| | - Chika Nwachukwu
- Department of Radiation Oncology at University of Texas Southwestern Medical Center, 2280 Inwood Road, Dallas, TX, USA
| | - Assal Rahimi
- Department of Radiation Oncology at University of Texas Southwestern Medical Center, 2280 Inwood Road, Dallas, TX, USA
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Lattery G, Kaulfers T, Cheng C, Zhao X, Selvaraj B, Lin H, Simone CB, Choi JI, Chang J, Kang M. Pencil Beam Scanning Bragg Peak FLASH Technique for Ultra-High Dose Rate Intensity-Modulated Proton Therapy in Early-Stage Breast Cancer Treatment. Cancers (Basel) 2023; 15:4560. [PMID: 37760528 PMCID: PMC10527307 DOI: 10.3390/cancers15184560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Bragg peak FLASH-RT can deliver highly conformal treatment and potentially offer improved normal tissue protection for radiotherapy patients. This study focused on developing ultra-high dose rate (≥40 Gy × RBE/s) intensity-modulated proton therapy (IMPT) for hypofractionated treatment of early-stage breast cancer. A novel tracking technique was developed to enable pencil beaming scanning (PBS) of single-energy protons to adapt the Bragg peak (BP) to the target distally. Standard-of-care PBS treatment plans of consecutively treated early-stage breast cancer patients using multiple energy layers were reoptimized using this technique, and dose metrics were compared between single-energy layer BP FLASH and conventional IMPT plans. FLASH dose rate coverage by volume (V40Gy/s) was also evaluated for the FLASH sparing effect. Distal tracking can precisely stop BP at the target distal edge. All plans (n = 10) achieved conformal IMPT-like dose distributions under clinical machine parameters. No statistically significant differences were observed in any dose metrics for heart, ipsilateral lung, most ipsilateral breast, and CTV metrics (p > 0.05 for all). Conventional plans yielded slightly superior target and skin dose uniformities with 4.5% and 12.9% lower dose maxes, respectively. FLASH-RT plans reached 46.7% and 61.9% average-dose rate FLASH coverage for tissues receiving more than 1 and 5 Gy plan dose total under the 250 minimum MU condition. Bragg peak FLASH-RT techniques achieved comparable plan quality to conventional IMPT while reaching adequate dose rate ratios, demonstrating the feasibility of early-stage breast cancer clinical applications.
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Affiliation(s)
- Grant Lattery
- Department of Physics and Astronomy, Hofstra University, 1000 Hempstead Turnpike, Hempstead, NY 11549, USA; (G.L.); (T.K.)
| | - Tyler Kaulfers
- Department of Physics and Astronomy, Hofstra University, 1000 Hempstead Turnpike, Hempstead, NY 11549, USA; (G.L.); (T.K.)
| | - Chingyun Cheng
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08901, USA;
| | - Xingyi Zhao
- Beijing Key Laboratory of Medical Physics and Engineering, Peking University, Beijing 100871, China;
- New York Proton Center, 225 E 126th Street, New York, NY 10035, USA; (B.S.); (H.L.); (C.B.S.II); (J.I.C.)
| | - Balaji Selvaraj
- New York Proton Center, 225 E 126th Street, New York, NY 10035, USA; (B.S.); (H.L.); (C.B.S.II); (J.I.C.)
| | - Haibo Lin
- New York Proton Center, 225 E 126th Street, New York, NY 10035, USA; (B.S.); (H.L.); (C.B.S.II); (J.I.C.)
| | - Charles B. Simone
- New York Proton Center, 225 E 126th Street, New York, NY 10035, USA; (B.S.); (H.L.); (C.B.S.II); (J.I.C.)
| | - J. Isabelle Choi
- New York Proton Center, 225 E 126th Street, New York, NY 10035, USA; (B.S.); (H.L.); (C.B.S.II); (J.I.C.)
| | - Jenghwa Chang
- Department of Physics and Astronomy, Hofstra University, 1000 Hempstead Turnpike, Hempstead, NY 11549, USA; (G.L.); (T.K.)
- Radiation Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 450 Lakeville Road, Lake Success, NY 11042, USA
| | - Minglei Kang
- New York Proton Center, 225 E 126th Street, New York, NY 10035, USA; (B.S.); (H.L.); (C.B.S.II); (J.I.C.)
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Meattini I, de Oliveira Franco R, Salvestrini V, Hijal T. Special issue. De-escalation of loco-regional treatment in breast cancer: Time to find the balance? Partial breast irradiation. Breast 2023; 69:401-409. [PMID: 37116401 PMCID: PMC10163674 DOI: 10.1016/j.breast.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/15/2023] [Accepted: 04/23/2023] [Indexed: 04/30/2023] Open
Abstract
Breast cancer is the most common cancer in women worldwide. Over the past few decades, remarkable progress has been made in understanding the biology and pathology of breast cancer. A personalized conservative approach has been currently adopted addressing the patient's individual risk of relapse. After postoperative whole breast irradiation for early-stage breast cancer, a rate of recurrences outside the initial tumour bed lower than 4% was observed. Thus, the highest benefits of breast irradiation seem to result from the dose delivered to the tissue neighbouring the tumour bed. Nonetheless, reducing treatment morbidity while maintaining radiation therapy's ability to decrease local recurrences is an important challenge in treating patients with radiation therapy. In this regard, strategies such as partial-breast irradiation have been developed to reduce toxicity without compromising oncologic outcomes. According to the national and international published guidelines, clinical oncologists can refer to specific dose/fractionation schedules and eligible criteria. However, there are still some areas of open questions. Breast cancer represents a multidisciplinary paradigm; it should be considered a heterogeneous disease where a "one-treatment-fits-all" approach cannot be considered an appropriate option. This is a wide overview on the main partial breast irradiation advantages, risks, timings, techniques, and available recommendations. We aim to provide practical findings to support clinical decision-making, exploring future perspectives, towards a balance for optimisation of breast cancer.
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Affiliation(s)
- Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
| | - Rejane de Oliveira Franco
- Department of Oncology, McGill University, Montreal, Canada; Division of Radiation Oncology, McGill University Health Centre, Montreal, Canada
| | - Viola Salvestrini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Tarek Hijal
- Department of Oncology, McGill University, Montreal, Canada; Division of Radiation Oncology, McGill University Health Centre, Montreal, Canada
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