1
|
Barnafi Wittwer E, Rippker C, Caprile P, Torres DE, El Far R, Gago-Arias A, Merino T. Dosimetric Evaluation of Cardiac Structures on Left Breast Cancer Radiotherapy: Impact of Movement, Dose Calculation Algorithm and Treatment Technique. Cardiol Res 2023; 14:279-290. [PMID: 37559707 PMCID: PMC10409545 DOI: 10.14740/cr1486] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/05/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Breast cancer is the most frequently diagnosed and leading cause of cancer-related deaths among females. The treatment of breast cancer with radiotherapy, albeit effective, has been shown to be toxic to the heart, resulting in an elevated risk of cardiovascular disease and associated fatalities. METHODS In this study, we evaluated the impact of respiratory movement, treatment plans and dose calculation algorithm on the dose delivered to the heart and its substructures during left breast radiotherapy over a cohort of 10 patients. We did this through three image sets, four different treatment plans and the employment of three algorithms on the same treatment plan. The dose parameters were then employed to estimate the impact on the 9-year excess cumulative risk for acute cardiac events by applying the model proposed by Darby. RESULTS The left ventricle was the structure most irradiated. Due to the lack of four-dimensional computed tomography (4DCT), we used a set of images called phase-average CT that correspond to the average of the images from the respiratory cycle (exhale, exhale 50%, inhale, inhale 50%). When considering these images, nearly 10% of the heart received more than 5 Gy and doses were on average 27% higher when compared to free breathing images. Deep inspiration breath-hold plans reduced cardiac dose for nine out of 10 patients and reduced mean heart dose in about 50% when compared to reference plans. We also found that the implementation of deep inspiration breath-hold would reduce the relative lifetime risk of ischemic heart disease to 10%, in comparison to 21% from the reference plan. CONCLUSION Our findings illustrate the importance of a more accurate determination of the dose and its consideration in cardiologists' consultation, a factor often overlooked during clinical examination. They also motivate the evaluation of the dose to the heart substructures to derive new heart dose constraints, and a more mindful and individualized clinical practice depending on the treatment employed.
Collapse
Affiliation(s)
- Esteban Barnafi Wittwer
- Medicine Faculty, Pontificia Universidad Catolica de Chile, Santiago, Chile
- These authors contributed equally to this work
| | - Carolin Rippker
- Physics Faculty, Heidelberg University, Heidelberg, Germany
- These authors contributed equally to this work
| | - Paola Caprile
- Physics Institute, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | | | - Rodrigo El Far
- Cancer Center UC, Red de Salud Christus-UC, Santiago, Chile
| | - Araceli Gago-Arias
- Physics Institute, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Group of Medical Physics and Biomathematics, Instituto de Investigacion Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain
| | - Tomas Merino
- Medicine Faculty, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Cancer Center UC, Red de Salud Christus-UC, Santiago, Chile
| |
Collapse
|
2
|
Pardo-Montero J, González-Crespo I, Gómez-Caamaño A, Gago-Arias A. Radiobiological Meta-Analysis of the Response of Prostate Cancer to Different Fractionations: Evaluation of the Linear-Quadratic Response at Large Doses and the Effect of Risk and ADT. Cancers (Basel) 2023; 15:3659. [PMID: 37509320 PMCID: PMC10377316 DOI: 10.3390/cancers15143659] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/04/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
The purpose of this work was to investigate the response of prostate cancer to different radiotherapy schedules, including hypofractionation, to evaluate potential departures from the linear-quadratic (LQ) response, to obtain the best-fitting parameters for low-(LR), intermediate-(IR), and high-risk (HR) prostate cancer and to investigate the effect of ADT on the radiobiological response. We constructed a dataset of the dose-response containing 87 entries/16,536 patients (35/5181 LR, 32/8146 IR, 20/3209 HR), with doses per fraction ranging from 1.8 to 10 Gy. These data were fit to tumour control probability models based on the LQ model, linear-quadratic-linear (LQL) model, and a modification of the LQ (LQmod) model accounting for increasing radiosensitivity at large doses. Fits were performed with the maximum likelihood expectation methodology, and the Akaike information criterion (AIC) was used to compare the models. The AIC showed that the LQ model was superior to the LQL and LQmod models for all risks, except for IR, where the LQL model outperformed the other models. The analysis showed a low α/β for all risks: 2.0 Gy for LR (95% confidence interval: 1.7-2.3), 3.4 Gy for IR (3.0-4.0), and 2.8 Gy for HR (1.4-4.2). The best fits did not show proliferation for LR and showed moderate proliferation for IR/HR. The addition of ADT was consistent with a suppression of proliferation. In conclusion, the LQ model described the response of prostate cancer better than the alternative models. Only for IR, the LQL model outperformed the LQ model, pointing out a possible saturation of radiation damage with increasing dose. This study confirmed a low α/β for all risks.
Collapse
Affiliation(s)
- Juan Pardo-Montero
- Group of Medical Physics and Biomathematics, Instituto de Investigación Sanitaria de Santiago (IDIS), 15706 Santiago de Compostela, Spain
- Department of Medical Physics, Complexo Hospitalario Universitario de Santiago de Compostela, 15706 Santiago de Compostela, Spain
| | - Isabel González-Crespo
- Group of Medical Physics and Biomathematics, Instituto de Investigación Sanitaria de Santiago (IDIS), 15706 Santiago de Compostela, Spain
- Department of Applied Mathematics, Universidade de Santiago de Compostela, 15705 Santiago de Compostela, Spain
| | - Antonio Gómez-Caamaño
- Department of Radiation Oncology, Complexo Hospitalario Universitario de Santiago de Compostela, 15706 Santiago de Compostela, Spain
| | - Araceli Gago-Arias
- Group of Medical Physics and Biomathematics, Instituto de Investigación Sanitaria de Santiago (IDIS), 15706 Santiago de Compostela, Spain
- Department of Medical Physics, Complexo Hospitalario Universitario de Santiago de Compostela, 15706 Santiago de Compostela, Spain
- Institute of Physics, Pontificia Universidad Católica de Chile, Santiago de Chile 7820436, Chile
| |
Collapse
|
3
|
Neira S, Guiu-Souto J, Pais P, Rodríguez Martínez de Llano S, Fernández C, Pubul V, Ruibal Á, Pombar M, Gago-Arias A, Pardo-Montero J. Quantification of internal dosimetry in PET patients II: Individualized Monte Carlo-based dosimetry for [18F]fluorocholine PET. Med Phys 2021; 48:5448-5458. [PMID: 34260065 PMCID: PMC9291792 DOI: 10.1002/mp.15090] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/04/2021] [Accepted: 06/28/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose To obtain individualized internal doses with a Monte Carlo (MC) method in patients undergoing diagnostic [18F]FCH‐PET studies and to compare such doses with the MIRD method calculations. Methods A patient cohort of 17 males were imaged after intravenous administration of a mean [18F]FCH activity of 244.3 MBq. The resulting PET/CT images were processed in order to generate individualized input source and geometry files for dose computation with the MC tool GATE. The resulting dose estimates were studied and compared to the MIRD method with two different computational phantoms. Mass correction of the S‐factors was applied when possible. Potential sources of uncertainty were closely examined: the effect of partial body images, urinary bladder emptying, and biokinetic modeling. Results Large differences in doses between our methodology and the MIRD method were found, generally in the range ±25%, and up to ±120% for some cases. The mass scaling showed improvements, especially for non‐walled and high‐uptake tissues. Simulations of the urinary bladder emptying showed negligible effects on doses to other organs, with the exception of the prostate. Dosimetry based on partial PET/CT images (excluding the legs) resulted in an overestimation of mean doses to bone, skin, and remaining tissues, and minor differences in other organs/tissues. Estimated uncertainties associated with the biokinetics of FCH introduce variations of cumulated activities in the range of ±10% in the high‐uptake organs. Conclusions The MC methodology allows for a higher degree of dosimetry individualization than the MIRD methodology, which in some cases leads to important differences in dose values. Dosimetry of FCH‐PET based on a single partial PET study seems viable due to the particular biokinetics of FCH, even though some correction factors may need to be applied to estimate mean skin/bone doses.
Collapse
Affiliation(s)
- Sara Neira
- Group of Medical Physics and Biomathematics, Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Spain
| | - Jacobo Guiu-Souto
- Department of Medical Physics, Centro Oncolóxico de Galicia, A Coruña, Spain
| | - Paulino Pais
- Department of Nuclear Medicine, Centro Oncolóxico de Galicia, A Coruña, Spain
| | | | - Carlos Fernández
- Department of Medical Physics, Centro Oncolóxico de Galicia, A Coruña, Spain
| | - Virginia Pubul
- Department of Nuclear Medicine, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Álvaro Ruibal
- Department of Nuclear Medicine, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain.,Group of Molecular Imaging and Oncology, Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Spain.,Molecular Imaging Group, Department of Radiology, Faculty of Medicine, Universidade de Santiago de Compostela, Santiago de Compostela, Spain.,Fundación Tejerina, Madrid, Spain
| | - Miguel Pombar
- Group of Molecular Imaging and Oncology, Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Spain.,Department of Medical Physics, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Araceli Gago-Arias
- Group of Medical Physics and Biomathematics, Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Spain.,Department of Medical Physics, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain.,Institute of Physics, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Pardo-Montero
- Group of Medical Physics and Biomathematics, Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Spain.,Department of Medical Physics, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| |
Collapse
|
4
|
Gago-Arias A, Neira S, Pombar M, Gómez-Caamaño A, Pardo-Montero J. Evaluation of indirect damage and damage saturation effects in dose-response curves of hypofractionated radiotherapy of early-stage NSCLC and brain metastases. Radiother Oncol 2021; 161:1-8. [PMID: 34015386 DOI: 10.1016/j.radonc.2021.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/28/2020] [Revised: 05/11/2021] [Accepted: 05/11/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE To investigate the possible contribution of indirect damage and damage saturation to tumour control obtained with SBRT/SRS treatments for early-stage NSCLC and brain metastases. METHODS AND MATERIALS We have constructed a dataset of early-stage NSCLC and brain metastases dose-response. These data were fitted to models based on the linear-quadratic (LQ), the linear-quadratic-linear (LQL), and phenomenological modifications of the LQ-model to account for indirect cell damage. We use the Akaike-Information-Criterion formalism to compare performance, and studied the stability of the results with changes in fitting parameters and perturbations on dose/TCP values. RESULTS In NSCLC, a modified LQ-model with a beta-term increasing with dose yields the best-fits for α/β = 10 Gy. Only the inclusion of very fast accelerated proliferation or low α/β values can eliminate such superiority. In brain, the LQL model yields the best-fits, and the ranking is not affected by variations of fitting parameters or dose/TCP perturbations. CONCLUSIONS For α/β = 10 Gy, a modified LQ-model with a beta-term increasing with dose provides better fits to NSCLC dose-response curves. For brain metastases, the LQL provides the best fit. This might be interpreted as a hint of indirect damage in NSCLC, and damage saturation in brain metastases. The results for NSCLC are strongly dependent on the value of α/β and may require further investigation, while those for brain seem to be clearly significant. Our results can assist in the design of improved radiotherapy for NSCLC and brain metastases, aiming at avoiding over/under-treatment.
Collapse
Affiliation(s)
- Araceli Gago-Arias
- Group of Medical Physics and Biomathematics, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain; Department of Medical Physics, Complexo Hospitalario Universitario de Santiago de Compostela, Spain; Institute of Physics, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile.
| | - Sara Neira
- Group of Medical Physics and Biomathematics, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain
| | - Miguel Pombar
- Department of Medical Physics, Complexo Hospitalario Universitario de Santiago de Compostela, Spain; Group of Molecular Imaging and Oncology, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain
| | - Antonio Gómez-Caamaño
- Group of Molecular Imaging and Oncology, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain; Department of Radiotherapy, Complexo Hospitalario Universitario de Santiago de Compostela, Spain
| | - Juan Pardo-Montero
- Group of Medical Physics and Biomathematics, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain; Department of Medical Physics, Complexo Hospitalario Universitario de Santiago de Compostela, Spain.
| |
Collapse
|
5
|
Neira S, Gago-Arias A, Guiu-Souto J, Pardo-Montero J. A kinetic model of continuous radiation damage to populations of cells: comparison to the LQ model and application to molecular radiotherapy. Phys Med Biol 2020; 65:245015. [PMID: 32615551 DOI: 10.1088/1361-6560/aba21d] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The linear-quadratic (LQ) model to describe the survival of irradiated cells may be the most frequently used biomathematical model in radiotherapy. There has been an intense debate on the mechanistic origin of the LQ model. An interesting approach is that of obtaining LQ-like behavior from kinetic models, systems of differential equations that model the induction and repair of damage. Development of such kinetic models is particularly interesting for application to continuous dose rate therapies, such as molecular radiotherapy or brachytherapy. In this work, we present a simple kinetic model that describes the kinetics of populations of tumor cells, rather than lethal/sub-lethal lesions, which may be especially useful for application to continuous dose rate therapies, as in molecular radiotherapy. The multi-compartment model consists of a set of three differential equations. The model incorporates in an easy way different cross-interacting compartments of cells forming a tumor, and may be of especial interest for studying dynamics of treated tumors. In the fast dose delivery limit, the model can be analytically solved, obtaining a simple closed-form expression. Fitting of several surviving curves with both this solution and the LQ model shows that they produce similar fits, despite being functionally different. We have also investigated the operation of the model in the continuous dose rate scenario, firstly by fitting pre-clinical data of tumor response to 131I-CLR1404 therapy, and secondly by showing how damage repair and proliferation rates can cause a treatment to achieve control or not. Kinetic models like the one presented in this work may be of special interest when modeling response to molecular radiotherapy.
Collapse
Affiliation(s)
- Sara Neira
- Group of Medical Physics and Biomathematics, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain. Equal contribution
| | | | | | | |
Collapse
|
6
|
Paredes-Cisneros I, Karger CP, Caprile P, Nolte D, Espinoza I, Gago-Arias A. Simulation of hypoxia PET-tracer uptake in tumours: Dependence of clinical uptake-values on transport parameters and arterial input function. Phys Med 2020; 70:109-117. [PMID: 32006939 DOI: 10.1016/j.ejmp.2020.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/10/2020] [Accepted: 01/11/2020] [Indexed: 11/27/2022] Open
Abstract
Poor radiotherapy outcome is in many cases related to hypoxia, due to the increased radioresistance of hypoxic tumour cells. Positron emission tomography may be used to non-invasively assess the oxygenation status of the tumour using hypoxia-specific radiotracers. Quantification and interpretation of these images remains challenging, since radiotracer binding and oxygen tension are not uniquely related. Computer simulation is a useful tool to improve the understanding of tracer dynamics and its relation to clinical uptake parameters currently used to quantify hypoxia. In this study, a model for simulating oxygen and radiotracer distribution in tumours was implemented to analyse the impact of physiological transport parameters and of the arterial input function (AIF) on: oxygenation histograms, time-activity curves, tracer binding and clinical uptake-values (tissue-to-blood ratio, TBR, and a composed hypoxia-perfusion metric, FHP). Results were obtained for parallel and orthogonal vessel architectures and for vascular fractions (VFs) of 1% and 3%. The most sensitive parameters were the AIF and the maximum binding rate (Kmax). TBR allowed discriminating VF for different AIF, and FHP for different Kmax, but neither TBR nor FHP were unbiased in all cases. Biases may especially occur in the comparison of TBR- or FHP-values between different tumours, where the relation between measured and actual AIF may vary. Thus, these parameters represent only surrogates rather than absolute measurements of hypoxia in tumours.
Collapse
Affiliation(s)
- Isabela Paredes-Cisneros
- German Cancer Research Center (DKFZ), Department of Medical Physics in Radiation Oncology, Heidelberg, Germany; Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany; Heidelberg University, Faculty of Physics and Astronomy, Heidelberg, Germany.
| | - Christian P Karger
- German Cancer Research Center (DKFZ), Department of Medical Physics in Radiation Oncology, Heidelberg, Germany; Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
| | - Paola Caprile
- Pontificia Universidad Católica de Chile, Institute of Physics, Santiago, Chile
| | - David Nolte
- Universidad de Chile, Center for Mathematical Modeling, Santiago, Chile; University of Groningen, Johann Bernoulli Institute, Groningen, The Netherlands
| | - Ignacio Espinoza
- Pontificia Universidad Católica de Chile, Institute of Physics, Santiago, Chile
| | - Araceli Gago-Arias
- Pontificia Universidad Católica de Chile, Institute of Physics, Santiago, Chile; Instituto de Investigación Sanitaria de Santiago (IDIS), Group of Medical Physics and Biomathematics, Santiago de Compostela, Spain
| |
Collapse
|
7
|
Rodríguez-Barbeito P, Díaz-Botana P, Gago-Arias A, Feijoo M, Neira S, Guiu-Souto J, López-Pouso Ó, Gómez-Caamaño A, Pardo-Montero J. A Model of Indirect Cell Death Caused by Tumor Vascular Damage after High-Dose Radiotherapy. Cancer Res 2019; 79:6044-6053. [PMID: 31641030 DOI: 10.1158/0008-5472.can-19-0181] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 07/02/2019] [Accepted: 10/16/2019] [Indexed: 11/16/2022]
Abstract
There is increasing evidence that high doses of radiotherapy, like those delivered in stereotactic body radiotherapy (SBRT), trigger indirect mechanisms of cell death. Such effect seems to be two-fold. High doses may trigger an immune response and may cause vascular damage, leading to cell starvation and death. Development of mathematical response models, including indirect death, may help clinicians to design SBRT optimal schedules. Despite increasing experimental literature on indirect tumor cell death caused by vascular damage, efforts on modeling this effect have been limited. In this work, we present a biomathematical model of this effect. In our model, tumor oxygenation is obtained by solving the reaction-diffusion equation; radiotherapy kills tumor cells according to the linear-quadratic model, and also endothelial cells (EC), which can trigger loss of functionality of capillaries. Capillary death will affect tumor oxygenation, driving nearby tumor cells into severe hypoxia. Capillaries can recover functionality due to EC proliferation. Tumor cells entering a predetermined severe hypoxia status die according to a hypoxia-death model. This model fits recently published experimental data showing the effect of vascular damage on surviving fractions. It fits surviving fraction curves and qualitatively reproduces experimental values of percentages of functional capillaries 48 hours postirradiation, and hypoxic cells pre- and 48 hours postirradiation. This model is useful for exploring aspects of tumor and EC response to radiotherapy and constitutes a stepping stone toward modeling indirect tumor cell death caused by vascular damage and accounting for this effect during SBRT planning. SIGNIFICANCE: A novel biomathematical model of indirect tumor cell death caused by vascular radiation damage could potentially help clinicians interpret experimental data and design better radiotherapy schedules.
Collapse
Affiliation(s)
- Pedro Rodríguez-Barbeito
- Group of Medical Physics and Biomathematics, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain.,Department of Applied Mathematics, Universidade de Santiago de Compostela, Spain
| | - Pablo Díaz-Botana
- Group of Medical Physics and Biomathematics, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain.,Galician Supercomputation Center (CESGA), Santiago de Compostela, Spain
| | - Araceli Gago-Arias
- Group of Medical Physics and Biomathematics, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain.,Institute of Physics, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - Manuel Feijoo
- Department of Particle Physics, Universidade de Santiago de Compostela, Spain
| | - Sara Neira
- Group of Medical Physics and Biomathematics, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain
| | - Jacobo Guiu-Souto
- Department of Medical Physics, Complexo Hospitalario Universitario de Santiago de Compostela, Spain.,Department of Medical Physics, Fundación Centro Oncolóxico de Galicia, A Coruña, Spain
| | - Óscar López-Pouso
- Group of Medical Physics and Biomathematics, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain.,Department of Applied Mathematics, Universidade de Santiago de Compostela, Spain
| | - Antonio Gómez-Caamaño
- Department of Radiotherapy, Complexo Hospitalario Universitario de Santiago de Compostela, Spain
| | - Juan Pardo-Montero
- Group of Medical Physics and Biomathematics, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain. .,Department of Medical Physics, Complexo Hospitalario Universitario de Santiago de Compostela, Spain
| |
Collapse
|
8
|
Gago-Arias A, Sánchez-Nieto B, Espinoza I, Karger CP, Pardo-Montero J. Impact of different biologically-adapted radiotherapy strategies on tumor control evaluated with a tumor response model. PLoS One 2018; 13:e0196310. [PMID: 29698534 PMCID: PMC5919644 DOI: 10.1371/journal.pone.0196310] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 04/10/2018] [Indexed: 11/26/2022] Open
Abstract
Motivated by the capabilities of modern radiotherapy techniques and by the recent developments of functional imaging techniques, dose painting by numbers (DPBN) was proposed to treat tumors with heterogeneous biological characteristics. This work studies different DPBN optimization techniques for virtual head and neck tumors assessing tumor response in terms of cell survival and tumor control probability with a previously published tumor response model (TRM). Uniform doses of 2 Gy are redistributed according to the microscopic oxygen distribution and the density distribution of tumor cells in four virtual tumors with different biological characteristics. In addition, two different optimization objective functions are investigated, which: i) minimize tumor cell survival (OFsurv) or; ii) maximize the homogeneity of the density of surviving tumor cells (OFstd). Several adaptive schemes, ranging from single to daily dose optimization, are studied and the treatment response is compared to that of the uniform dose. The results show that the benefit of DPBN treatments depends on the tumor reoxygenation capability, which strongly differed among the set of virtual tumors investigated. The difference between daily (fraction by fraction) and three weekly optimizations (at the beginning of weeks 1, 3 and 4) was found to be small, and higher benefit was observed for the treatments optimized using OFsurv. This in silico study corroborates the hypothesis that DPBN may be beneficial for treatments of tumors which show reoxygenation during treatment, and that a few optimizations may be sufficient to achieve this therapeutic benefit.
Collapse
Affiliation(s)
- Araceli Gago-Arias
- Instituto de Física, Pontificia Universidad Católica de Chile, Santiago, Chile
- * E-mail:
| | | | - Ignacio Espinoza
- Instituto de Física, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Christian P. Karger
- National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - Juan Pardo-Montero
- Grupo de Imaxe Molecular, Instituto de Investigación Sanitaria (IDIS), Santiago de Compostela, Spain
- Servizo de Radiofísica e Protección Radiolóxica, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| |
Collapse
|
9
|
Gago-Arias A, Espinoza I, Sánchez-Nieto B, Pardo-Montero J. EP-1717: Impact of radiation induced cell death kinetics on reoxygenation and tumour response. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32968-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
10
|
Gago-Arias A, Aguiar P, Espinoza I, Sánchez-Nieto B, Pardo-Montero J. Modelling radiation-induced cell death and tumour re-oxygenation: local versus global and instant versus delayed cell death. Phys Med Biol 2016; 61:1204-16. [DOI: 10.1088/0031-9155/61/3/1204] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
11
|
Gago-Arias A, Antolín E, Fayos-Ferrer F, Simón R, González-Castaño DM, Palmans H, Sharpe P, Gómez F, Pardo-Montero J. Erratum: “Correction factors for ionization chamber dosimetry in CyberKnife: Machine-specific, plan-class, and clinical fields” [Med. Phys. 40, 011721 (10pp.) (2013)]. Med Phys 2013. [DOI: 10.1118/1.4801896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
12
|
Gago-Arias A, Antolín E, Fayos-Ferrer F, Simón R, González-Castaño DM, Palmans H, Sharpe P, Gómez F, Pardo-Montero J. Correction factors for ionization chamber dosimetry in CyberKnife: Machine-specific, plan-class, and clinical fields. Med Phys 2013; 40:011721. [DOI: 10.1118/1.4773047] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
13
|
Brualla-González L, Gómez F, Vicedo A, González-Castaño DM, Gago-Arias A, Pazos A, Zapata M, Roselló JV, Pardo-Montero J. A two-dimensional liquid-filled ionization chamber array prototype for small-field verification: characterization and first clinical tests. Phys Med Biol 2012; 57:5221-34. [DOI: 10.1088/0031-9155/57/16/5221] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
14
|
Brualla-Gonzalez L, Pardo-Montero J, García-Hernández T, González-Castaño D, Gonzalez AV, Pazos A, Granero D, Zapata M, Gago-Arias A, Ferrando JR, Gomez F. SU-E-T-63: Small Field Verification with a New 2D Liquid Ionization Array. Med Phys 2012. [DOI: 10.1118/1.4735119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
15
|
Gago-Arias A, Pardo-Montero J, Rodríguez-Romero R, Sánchez-Rubio P, Núñez L, Palmans H, Sharpe P, Fayos F, Antolín E, Simón R. OC-0515 IONIZATION CHAMBER CORRECTION FACTORS IN YOMOTHERAPY AND CYBERKNIFE. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70854-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
16
|
Gago-Arias A, Brualla-González L, González-Castaño DM, Gómez F, García MS, Vega VL, Sueiro JM, Pardo-Montero J. Evaluation of chamber response function influence on IMRT verification using 2D commercial detector arrays. Phys Med Biol 2012; 57:2005-20. [DOI: 10.1088/0031-9155/57/7/2005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
17
|
Gago-Arias A, Rodríguez-Romero R, Sánchez-Rubio P, Miguel González-Castaño D, Gómez F, Núñez L, Palmans H, Sharpe P, Pardo-Montero J. Correction factors for A1SL ionization chamber dosimetry in TomoTherapy: Machine-specific, plan-class, and clinical fields. Med Phys 2012; 39:1964-70. [DOI: 10.1118/1.3692181] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
18
|
Gago-Arias A, Pardo-Montero J, Rodriguez-Romero R, Sanchez-Rubio P, Gonzalez-Castano D, Palmans H, Sharpe P, Fayos F, Antolin E, Simon R, Gomez F. 254 CORRECTION FACTORS FOR IONIZATION CHAMBER DOSIMETRY IN TOMOTHERAPY AND CYBERKNIFE. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70221-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
19
|
Pena J, González-Castaño DM, Gómez F, Gago-Arias A, González-Castaño FJ, Rodríguez-Silva D, Gómez A, Mouriño C, Pombar M, Sánchez M. eIMRT: a web platform for the verification and optimization of radiation treatment plans. J Appl Clin Med Phys 2009; 10:205-220. [PMID: 19692983 PMCID: PMC5720544 DOI: 10.1120/jacmp.v10i3.2998] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Revised: 03/31/2009] [Accepted: 04/02/2009] [Indexed: 11/23/2022] Open
Abstract
The eIMRT platform is a remote distributed computing tool that provides users with Internet access to three different services: Monte Carlo optimization of treatment plans, CRT & IMRT treatment optimization, and a database of relevant radiation treatments/clinical cases. These services are accessible through a user-friendly and platform independent web page. Its flexible and scalable design focuses on providing the final users with services rather than a collection of software pieces. All input and output data (CT, contours, treatment plans and dose distributions) are handled using the DICOM format. The design, implementation, and support of the verification and optimization algorithms are hidden to the user. This allows a unified, robust handling of the software and hardware that enables these computation-intensive services. The eIMRT platform is currently hosted by the Galician Supercomputing Center (CESGA) and may be accessible upon request (there is a demo version at http://eimrt.cesga.es:8080/eIMRT2/demo; request access in http://eimrt.cesga.es/signup.html). This paper describes all aspects of the eIMRT algorithms in depth, its user interface, and its services. Due to the flexible design of the platform, it has numerous applications including the intercenter comparison of treatment planning, the quality assurance of radiation treatments, the design and implementation of new approaches to certain types of treatments, and the sharing of information on radiation treatment techniques. In addition, the web platform and software tools developed for treatment verification and optimization have a modular design that allows the user to extend them with new algorithms. This software is not a commercial product. It is the result of the collaborative effort of different public research institutions and is planned to be distributed as an open source project. In this way, it will be available to any user; new releases will be generated with the new implemented codes or upgrades.
Collapse
Affiliation(s)
- Javier Pena
- Departamento de Fílsica de Partículas, Facultade de Física, Universidade de Santiago de Compostela, Spain
| | - Diego M González-Castaño
- Departamento de Fílsica de Partículas, Facultade de Física, Universidade de Santiago de Compostela, Spain
| | - Faustino Gómez
- Departamento de Fílsica de Partículas, Facultade de Física, Universidade de Santiago de Compostela, Spain
| | - Araceli Gago-Arias
- Departamento de Fílsica de Partículas, Facultade de Física, Universidade de Santiago de Compostela, Spain
| | - Francisco J González-Castaño
- Departamento de Enxeñería Telemática, Escola Técnica Superior de Enxeñería das Telecomunicacións, Universidade de Vigo, Spain
| | - Daniel Rodríguez-Silva
- Departamento de Enxeñería Telemática, Escola Técnica Superior de Enxeñería das Telecomunicacións, Universidade de Vigo, Spain
| | - Andrés Gómez
- Centro de Supercomputación de Galicia, Santiago de Compostela, Spain
| | - Carlos Mouriño
- Centro de Supercomputación de Galicia, Santiago de Compostela, Spain
| | - Miguel Pombar
- Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Manuel Sánchez
- Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| |
Collapse
|