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Pénichoux J, Lanic H, Thill C, Ménard AL, Camus V, Stamatoullas A, Lemasle E, Leprêtre S, Lenain P, Contentin N, Kraut-Tauzia J, Fruchart C, Kammoun L, Damaj G, Farge A, Delette C, Modzelewski R, Vaudaux S, Pépin LF, Tilly H, Jardin F. Correction to: Prognostic relevance of sarcopenia, geriatric, and nutritional assessments in older patients with diffuse large B‑cell lymphoma: results of a multicentric prospective cohort study. Ann Hematol 2024; 103:369. [PMID: 37880485 PMCID: PMC10761374 DOI: 10.1007/s00277-023-05497-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Affiliation(s)
- Juliette Pénichoux
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France.
| | - Hélène Lanic
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
| | - Caroline Thill
- Department of Statistics, Rouen University Hospital, Rouen, France
| | - Anne-Lise Ménard
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
| | - Vincent Camus
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
- INSERM U1245 Unit, Team "Genetic and Biomarkers in Lymphoma and Solid Tumors", Rouen University, Centre Henri Becquerel, Rouen, France
| | - Aspasia Stamatoullas
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
- INSERM U1245 Unit, Team "Genetic and Biomarkers in Lymphoma and Solid Tumors", Rouen University, Centre Henri Becquerel, Rouen, France
| | - Emilie Lemasle
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
| | - Stéphane Leprêtre
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
| | - Pascal Lenain
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
| | - Nathalie Contentin
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
| | | | | | - Leïla Kammoun
- Department of Oncology‑Hematology, Eure-Seine Hospital Center, Evreux, France
| | - Gandhi Damaj
- Institute of Hematology, Caen University Hospital, Caen, France
| | - Agathe Farge
- Institute of Hematology, Caen University Hospital, Caen, France
| | - Caroline Delette
- Department of Clinical Hematology, Amiens University Hospital, Amiens, France
| | | | - Sandrine Vaudaux
- Clinical Research Unit, Henri Becquerel Cancer Center, Rouen, France
| | | | - Hervé Tilly
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
- INSERM U1245 Unit, Team "Genetic and Biomarkers in Lymphoma and Solid Tumors", Rouen University, Centre Henri Becquerel, Rouen, France
| | - Fabrice Jardin
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
- INSERM U1245 Unit, Team "Genetic and Biomarkers in Lymphoma and Solid Tumors", Rouen University, Centre Henri Becquerel, Rouen, France
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Pénichoux J, Lanic H, Thill C, Ménard AL, Camus V, Stamatoullas A, Lemasle E, Leprêtre S, Lenain P, Contentin N, Kraut-Tauzia J, Fruchart C, Kammoun L, Damaj G, Farge A, Delette C, Modzelewski R, Vaudaux S, Pépin LF, Tilly H, Jardin F. Prognostic relevance of sarcopenia, geriatric, and nutritional assessments in older patients with diffuse large B-cell lymphoma: results of a multicentric prospective cohort study. Ann Hematol 2023; 102:1811-1823. [PMID: 37058153 PMCID: PMC10260702 DOI: 10.1007/s00277-023-05200-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 06/27/2022] [Accepted: 03/23/2023] [Indexed: 04/15/2023]
Abstract
This prospective study aimed to investigate the prognostic effect of sarcopenia, geriatric, and nutritional status in older patients with diffuse large B-cell lymphoma (DLBCL). Ninety-five patients with DLBCL older than 70 years who were treated with immunochemotherapy were included. The lumbar L3 skeletal muscle index (L3-SMI) was measured by computed tomography at baseline, and sarcopenia was defined as low L3-SMI. Geriatric assessment included G8 score, CIRS-G scale, Timed Up and Go test, and instrumental activity of daily living. Nutritional status was assessed using the Mini Nutritional Assessment and the body mass index, and several scores used in the literature incorporating nutritional and inflammatory biomarkers, namely the Nutritional and inflammatory status (NIS), Geriatric Nutritional Risk Index, Prognostic Nutritional Index, and Glasgow Prognostic Score.Fifty-three patients were considered sarcopenic. Sarcopenic patients displayed higher levels of inflammation markers and lower levels of prealbumin than non-sarcopenic patients. Sarcopenia was associated with NIS, but was not associated with severe adverse events and treatment disruptions. They were, however, more frequent among patients with elevated NIS. Sarcopenia did not appear in this study as a prognostic factor for progression-free survival (PFS) or overall survival (OS). However, NIS emerged as predictive of the outcome with a 2-year PFS rate of 88% in the NIS ≤ 1 group and 49% in the NIS > 1 group and a significant effect in a multivariate analysis for both PFS (p = 0.049) and OS (HR = 9.61, CI 95% = [1.03-89.66], p = 0.04). Sarcopenia was not associated with adverse outcomes, but was related to NIS, which appeared to be an independent prognostic factor.
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Affiliation(s)
- Juliette Pénichoux
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France.
| | - Hélène Lanic
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
| | - Caroline Thill
- Department of Statistics, Rouen University Hospital, Rouen, France
| | - Anne-Lise Ménard
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
| | - Vincent Camus
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
- INSERM U1245 Unit, Team "Genetic and Biomarkers in Lymphoma and Solid Tumors", Rouen University, Centre Henri Becquerel, Rouen, France
| | - Aspasia Stamatoullas
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
- INSERM U1245 Unit, Team "Genetic and Biomarkers in Lymphoma and Solid Tumors", Rouen University, Centre Henri Becquerel, Rouen, France
| | - Emilie Lemasle
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
| | - Stéphane Leprêtre
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
| | - Pascal Lenain
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
| | - Nathalie Contentin
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
| | | | | | - Leila Kammoun
- Department of Oncology-Hematology, Eure-Seine Hospital Center, Evreux, France
| | - Gandhi Damaj
- Institute of Hematology, Caen University Hospital, Caen, France
| | - Agathe Farge
- Institute of Hematology, Caen University Hospital, Caen, France
| | - Caroline Delette
- Department of Clinical Hematology, Amiens University Hospital, Amiens, France
| | | | - Sandrine Vaudaux
- Clinical Research Unit, Henri Becquerel Cancer Center, Rouen, France
| | | | - Hervé Tilly
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
- INSERM U1245 Unit, Team "Genetic and Biomarkers in Lymphoma and Solid Tumors", Rouen University, Centre Henri Becquerel, Rouen, France
| | - Fabrice Jardin
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
- INSERM U1245 Unit, Team "Genetic and Biomarkers in Lymphoma and Solid Tumors", Rouen University, Centre Henri Becquerel, Rouen, France
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Herault A, Lévêque E, Draye-Carbonnier S, Decazes P, Zduniak A, Modzelewski R, Libraire J, Achamrah N, Ménard AL, Lenain P, Contentin N, Grall M, Leprêtre S, Lemasle E, Lanic H, Alani M, Stamatoullas-Bastard A, Tilly H, Jardin F, Tamion F, Camus V. High prevalence of pre-existing sarcopenia in critically ill patients with hematologic malignancies admitted to the intensive care unit for sepsis or septic shock. Clin Nutr ESPEN 2023; 55:373-383. [PMID: 37202070 DOI: 10.1016/j.clnesp.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: 12/22/2022] [Revised: 03/31/2023] [Accepted: 04/09/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND & AIMS We aimed to evaluate body composition (BC) by computed tomography (CT) in hematologic malignancy (HM) patients admitted to the intensive care unit (ICU) for sepsis or septic shock. METHODS We retrospectively assessed BC and its impact on outcome of 186 patients at the 3rd lumbar (L3) and 12th thoracic vertebral levels (T12) using CT-scan performed before ICU admission. RESULTS The median patient age was 58.0 [47; 69] years. Patients displayed adverse clinical characteristics at admission with median [q1; q3] SAPS II and SOFA scores of 52 [40; 66] and 8 [5; 12], respectively. The mortality rate in the ICU was 45.7%. Overall survival rates at 1 month after admission in the pre-existing sarcopenic vs. non pre-existing sarcopenic patients were 47.9% (95% CI [37.6; 61.0]) and 55.0% (95% CI [41.6; 72.8]), p = 0.99), respectively, at the L3 level and 48.4% (95% CI [40.4; 58.0]) vs. 66.7% (95% CI [51.1; 87.0]), p = 0.062), respectively, at the T12 level. CONCLUSIONS Sarcopenia is assessable by CT scan at both the T12 and L3 levels and is highly prevalent in HM patients admitted to the ICU for severe infections. Sarcopenia may contribute to the high mortality rate in the ICU in this population.
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Affiliation(s)
- Antoine Herault
- Intensive Care Unit, Charles Nicolle University Hospital, Rouen, France; Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Emilie Lévêque
- Clinical Research Unit, Centre Henri Becquerel, Rouen, France
| | | | - Pierre Decazes
- Department of Nuclear Medicine, Centre Henri Becquerel, Rouen, France; Unité QuantIF LITIS EA 4108, Université de Rouen, Normandie, France; Département D'imagerie, Centre Henri-Becquerel, Rouen, France
| | - Alexandra Zduniak
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Romain Modzelewski
- Unité QuantIF LITIS EA 4108, Université de Rouen, Normandie, France; Département D'imagerie, Centre Henri-Becquerel, Rouen, France
| | - Julie Libraire
- Clinical Research Unit, Centre Henri Becquerel, Rouen, France
| | - Najate Achamrah
- Department of Nutrition, Charles Nicolle University Hospital, Rouen, France
| | - Anne-Lise Ménard
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Pascal Lenain
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Nathalie Contentin
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Maximilien Grall
- Intensive Care Unit, Charles Nicolle University Hospital, Rouen, France
| | - Stéphane Leprêtre
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Emilie Lemasle
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Hélène Lanic
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Mustafa Alani
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | | | - Hervé Tilly
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Fabrice Jardin
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Fabienne Tamion
- Intensive Care Unit, Charles Nicolle University Hospital, Rouen, France; Normandie Univ, UNIROUEN, INSERM U1096, CHU Rouen, France
| | - Vincent Camus
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France.
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Guzene L, Beddok A, Nioche C, Modzelewski R, Loiseau C, Salleron J, Thariat J. Assessing Interobserver Variability in the Delineation of Structures in Radiation Oncology: A Systematic Review. Int J Radiat Oncol Biol Phys 2023; 115:1047-1060. [PMID: 36423741 DOI: 10.1016/j.ijrobp.2022.11.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 11/04/2022] [Accepted: 11/09/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE The delineation of target volumes and organs at risk is the main source of uncertainty in radiation therapy. Numerous interobserver variability (IOV) studies have been conducted, often with unclear methodology and nonstandardized reporting. We aimed to identify the parameters chosen in conducting delineation IOV studies and assess their performances and limits. METHODS AND MATERIALS We conducted a systematic literature review to highlight major points of heterogeneity and missing data in IOV studies published between 2018 and 2021. For the main used metrics, we did in silico analyses to assess their limits in specific clinical situations. RESULTS All disease sites were represented in the 66 studies examined. Organs at risk were studied independently of tumor site in 29% of reviewed IOV studies. In 65% of studies, statistical analyses were performed. No gold standard (GS; ie, reference) was defined in 36% of studies. A single expert was considered as the GS in 21% of studies, without testing intraobserver variability. All studies reported both absolute and relative indices, including the Dice similarity coefficient (DSC) in 68% and the Hausdorff distance (HD) in 42%. Limitations were shown in silico for small structures when using the DSC and dependence on irregular shapes when using the HD. Variations in DSC values were large between studies, and their thresholds were inconsistent. Most studies (51%) included 1 to 10 cases. The median number of observers or experts was 7 (range, 2-35). The intraclass correlation coefficient was reported in only 9% of cases. Investigating the feasibility of studying IOV in delineation, a minimum of 8 observers with 3 cases, or 11 observers with 2 cases, was required to demonstrate moderate reproducibility. CONCLUSIONS Implementation of future IOV studies would benefit from a more standardized methodology: clear definitions of the gold standard and metrics and a justification of the tradeoffs made in the choice of the number of observers and number of delineated cases should be provided.
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Affiliation(s)
- Leslie Guzene
- Department of Radiation Oncology, University Hospital of Amiens, Amiens, France
| | - Arnaud Beddok
- Department of Radiation Oncology, Institut Curie, Paris/Saint-Cloud/Orsay, France; Laboratory of Translational Imaging in Oncology (LITO), InsermUMR, Institut Curie, Orsay, France
| | - Christophe Nioche
- Laboratory of Translational Imaging in Oncology (LITO), InsermUMR, Institut Curie, Orsay, France
| | - Romain Modzelewski
- LITIS - EA4108-Quantif, Normastic, University of Rouen, and Nuclear Medicine Department, Henri Becquerel Center, Rouen, France
| | - Cedric Loiseau
- Department of Radiation Oncology, Centre François Baclesse; ARCHADE Research Community Caen, France; Département de Biostatistiques, Institut de Cancérologie de Lorraine, Vandœuvre-lès-Nancy, France
| | - Julia Salleron
- Département de Biostatistiques, Institut de Cancérologie de Lorraine, Vandœuvre-lès-Nancy, France
| | - Juliette Thariat
- Department of Radiation Oncology, Centre François Baclesse; ARCHADE Research Community Caen, France; Laboratoire de Physique Corpusculaire, Caen, France; Unicaen-Université de Normandie, Caen, France.
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Gouel P, Callonnec F, Obongo-Anga FR, Bohn P, Lévêque E, Gensanne D, Hapdey S, Modzelewski R, Vera P, Thureau S. Quantitative MRI to Characterize Hypoxic Tumors in Comparison to FMISO PET/CT for Radiotherapy in Oropharynx Cancers. Cancers (Basel) 2023; 15:cancers15061918. [PMID: 36980806 PMCID: PMC10047588 DOI: 10.3390/cancers15061918] [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: 12/23/2022] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023] Open
Abstract
Intratumoral hypoxia is associated with a poor prognosis and poor response to treatment in head and neck cancers. Its identification would allow for increasing the radiation dose to hypoxic tumor subvolumes. 18F-FMISO PET imaging is the gold standard; however, quantitative multiparametric MRI could show the presence of intratumoral hypoxia. Thus, 16 patients were prospectively included and underwent 18F-FDG PET/CT, 18F-FMISO PET/CT, and multiparametric quantitative MRI (DCE, diffusion and relaxometry T1 and T2 techniques) in the same position before treatment. PET and MRI sub-volumes were segmented and classified as hypoxic or non-hypoxic volumes to compare quantitative MRI parameters between normoxic and hypoxic volumes. In total, 13 patients had hypoxic lesions. The Dice, Jaccard, and overlap fraction similarity indices were 0.43, 0.28, and 0.71, respectively, between the FDG PET and MRI-measured lesion volumes, showing that the FDG PET tumor volume is partially contained within the MRI tumor volume. The results showed significant differences in the parameters of SUV in FDG and FMISO PET between patients with and without measurable hypoxic lesions. The quantitative MRI parameters of ADC, T1 max mapping and T2 max mapping were different between hypoxic and normoxic subvolumes. Quantitative MRI, based on free water diffusion and T1 and T2 mapping, seems to be able to identify intra-tumoral hypoxic sub-volumes for additional radiotherapy doses.
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Affiliation(s)
- Pierrick Gouel
- Department of Radiology and Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF-LITIS [EA (Equipe d'Accueil) 4108-FR CNRS 3638], Faculty of Medicine, University of Rouen, 76000 Rouen, France
| | - Françoise Callonnec
- Department of Radiology and Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF-LITIS [EA (Equipe d'Accueil) 4108-FR CNRS 3638], Faculty of Medicine, University of Rouen, 76000 Rouen, France
| | - Franchel-Raïs Obongo-Anga
- Department of Surgery, Henri Becquerel Cancer Center and Rouen University Hospital, 76000 Rouen, France
| | - Pierre Bohn
- Department of Radiology and Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF-LITIS [EA (Equipe d'Accueil) 4108-FR CNRS 3638], Faculty of Medicine, University of Rouen, 76000 Rouen, France
| | - Emilie Lévêque
- Unit of Clinical Reasearch, Henri Becquerel Cancer Center and Rouen University Hospital, 76000 Rouen, France
| | - David Gensanne
- Department of Radiation Oncology, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF-LITIS [EA (Equipe d'Accueil) 4108], 76000 Rouen, France
| | - Sébastien Hapdey
- Department of Radiology and Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF-LITIS [EA (Equipe d'Accueil) 4108-FR CNRS 3638], Faculty of Medicine, University of Rouen, 76000 Rouen, France
| | - Romain Modzelewski
- Department of Radiology and Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF-LITIS [EA (Equipe d'Accueil) 4108-FR CNRS 3638], Faculty of Medicine, University of Rouen, 76000 Rouen, France
| | - Pierre Vera
- Department of Radiology and Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF-LITIS [EA (Equipe d'Accueil) 4108-FR CNRS 3638], Faculty of Medicine, University of Rouen, 76000 Rouen, France
| | - Sébastien Thureau
- Department of Radiology and Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF-LITIS [EA (Equipe d'Accueil) 4108-FR CNRS 3638], Faculty of Medicine, University of Rouen, 76000 Rouen, France
- Department of Surgery, Henri Becquerel Cancer Center and Rouen University Hospital, 76000 Rouen, France
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Zhou T, Noeuveglise A, Modzelewski R, Ghazouani F, Thureau S, Fontanilles M, Ruan S. Prediction of brain tumor recurrence location based on multi-modal fusion and nonlinear correlation learning. Comput Med Imaging Graph 2023; 106:102218. [PMID: 36947921 DOI: 10.1016/j.compmedimag.2023.102218] [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: 01/27/2023] [Revised: 02/13/2023] [Accepted: 03/06/2023] [Indexed: 03/18/2023]
Abstract
Brain tumor is one of the leading causes of cancer death. The high-grade brain tumors are easier to recurrent even after standard treatment. Therefore, developing a method to predict brain tumor recurrence location plays an important role in the treatment planning and it can potentially prolong patient's survival time. There is still little work to deal with this issue. In this paper, we present a deep learning-based brain tumor recurrence location prediction network. Since the dataset is usually small, we propose to use transfer learning to improve the prediction. We first train a multi-modal brain tumor segmentation network on the public dataset BraTS 2021. Then, the pre-trained encoder is transferred to our private dataset for extracting the rich semantic features. Following that, a multi-scale multi-channel feature fusion model and a nonlinear correlation learning module are developed to learn the effective features. The correlation between multi-channel features is modeled by a nonlinear equation. To measure the similarity between the distributions of original features of one modality and the estimated correlated features of another modality, we propose to use Kullback-Leibler divergence. Based on this divergence, a correlation loss function is designed to maximize the similarity between the two feature distributions. Finally, two decoders are constructed to jointly segment the present brain tumor and predict its future tumor recurrence location. To the best of our knowledge, this is the first work that can segment the present tumor and at the same time predict future tumor recurrence location, making the treatment planning more efficient and precise. The experimental results demonstrated the effectiveness of our proposed method to predict the brain tumor recurrence location from the limited dataset.
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Affiliation(s)
- Tongxue Zhou
- School of Information Science and Technology, Hangzhou Normal University, Hangzhou 311121, China
| | | | - Romain Modzelewski
- Department of Nuclear Medicine, Henri Becquerel Cancer Center, Rouen, 76038, France
| | - Fethi Ghazouani
- Université de Rouen Normandie, LITIS - QuantIF, Rouen 76183, France
| | - Sébastien Thureau
- Department of Nuclear Medicine, Henri Becquerel Cancer Center, Rouen, 76038, France
| | - Maxime Fontanilles
- Department of Nuclear Medicine, Henri Becquerel Cancer Center, Rouen, 76038, France
| | - Su Ruan
- Université de Rouen Normandie, LITIS - QuantIF, Rouen 76183, France.
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7
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Noeuveglise A, Sarafan-Vasseur N, Beaussire L, Marguet F, Modzelewski R, Hanzen C, Alexandru C, Magne N, Langlois O, Di Fiore F, Clatot F, Thureau S, Fontanilles M. Impact of EGFR A289T/V mutation on relapse pattern in glioblastoma. ESMO Open 2023; 8:100740. [PMID: 36566697 PMCID: PMC10024094 DOI: 10.1016/j.esmoop.2022.100740] [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: 09/12/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Molecular factors influence relapse patterns in glioblastoma. The hotspot mutation located at position 289 of the extracellular domain of the epidermal growth factor receptor (EGFRA289mut) is associated with a more infiltrative phenotype. The primary objective of this study was to explore the impact of the EGFRA289 mutation on the pattern of relapse after chemoradiotherapy-based treatment of patients suffering from newly diagnosed glioblastoma. PATIENTS AND METHODS An ancillary study from a prospective cohort of patients suffering from glioblastoma was conducted. All patients received radiotherapy and concomitant temozolomide. The population was divided into two groups according to EGFRA289 status (mutated versus wild-type). The primary endpoint was the overlap score (varying from 0 to 1) between the initial irradiated tumor volume (Vinit) and the relapse volume (Vr). Secondary endpoints explored the impact of EGFRA289mut on survival. RESULTS One hundred twenty-eight patients were included and analyzed: 11% had EGFRA289mut glioblastoma (n = 14/128). EGFRA289mut glioblastomas had a relapse pattern that was more marginal than EGFRA289wt glioblastomas: a median overlap score Vinit/Vr of 0.96 was observed in the EGFRA289mut group versus 1 in the EGFRA289wt group (P = 0.05). Half of the population with EGFRA289mut tumor (n = 7/14) had a marginal relapse (i.e. overlap scoreVr/Vinit ≤ 0.95) compared to 23.7% (n = 27/114) in the EGFRA289wt group, P = 0.035. EGFRA289mut did not influence survival. CONCLUSION We highlighted a link between the EGFRA289 mutation and the relapse pattern in glioblastoma. The independent role of EGFRA289mut and its clinical implication should now be explored in further studies.
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Affiliation(s)
- A Noeuveglise
- Radiotherapy Department, Henri Becquerel Cancer Center, Rouen
| | - N Sarafan-Vasseur
- Univ Rouen Normandie, Inserm U1245, Cancer And Brain Genomics, Rouen
| | - L Beaussire
- Univ Rouen Normandie, Inserm U1245, Cancer And Brain Genomics, Rouen
| | - F Marguet
- Univ Rouen Normandie, Inserm U1245, Cancer And Brain Genomics, Rouen; Department of Pathology, Rouen University Hospital, Rouen
| | - R Modzelewski
- Nuclear Medicine Department, Henri Becquerel Center, Rouen
| | - C Hanzen
- Radiotherapy Department, Henri Becquerel Cancer Center, Rouen
| | - C Alexandru
- Department of Medical Oncology, Cancer Centre Henri Becquerel, Rue d'Amiens, Rouen
| | - N Magne
- Department of Radiology, Rouen University Hospital, Rouen
| | - O Langlois
- Department of Neurosurgery, Rouen University Hospital, Rouen
| | - F Di Fiore
- Univ Rouen Normandie, Inserm U1245, Cancer And Brain Genomics, Rouen; Department of Gastroenterology, Rouen University Hospital, Rouen
| | - F Clatot
- Univ Rouen Normandie, Inserm U1245, Cancer And Brain Genomics, Rouen; Department of Medical Oncology, Cancer Centre Henri Becquerel, Rue d'Amiens, Rouen
| | - S Thureau
- Radiotherapy Department, Henri Becquerel Cancer Center, Rouen; QuantIF-LITIS EA4108, University of Rouen, Rouen, France
| | - M Fontanilles
- Univ Rouen Normandie, Inserm U1245, Cancer And Brain Genomics, Rouen; Department of Medical Oncology, Cancer Centre Henri Becquerel, Rue d'Amiens, Rouen.
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8
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Gagnat G, Hobeika C, Modzelewski R, Collet CS, Di Fiore F, Druesne L, Tuech JJ, Schwarz L. Evaluation of sarcopenia biomarkers in older patients undergoing major surgery for digestive cancer. SAXO prospective cohort study. Eur J Surg Oncol 2023; 49:285-292. [PMID: 36167704 DOI: 10.1016/j.ejso.2022.08.038] [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: 03/14/2022] [Revised: 08/12/2022] [Accepted: 08/31/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The aim of the study was to prospectively evaluate different biomarkers to identify the most reliable for anticipating complications after major abdominal surgery for digestive cancer in older patients and compare their performance to the existing definition and screening algorithm of sarcopenia from EWGSOP. METHODS Ninety-five consecutive patients aged over 65 years who underwent elective surgery for digestive cancer were prospectively included in the SAXO study. Sarcopenia was defined according to EWGSOP criteria (four level from no sarcopenia to severe sarcopenia). Strength and physical performance were evaluated with the handgrip test (HGT) and gait speed test (GST), respectively. CT scan analysis was used to calculate the skeletal muscle index (SMI), intermuscular adipose tissue (IMAT), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT). Measures were adjusted to body mass index (BMI). Complication grading was performed using the Clavien‒Dindo classification. A doubly robust estimator with multivariable regression was used to limit bias. RESULTS Sixteen patients presented with sarcopenia. Adjusted to BMI, sarcopenic patients had an increased IMATBMI (0.35 vs. 0.22; p = 0.003) and increased VATBMI (7.85 vs. 6.13; p = 0.048). In multivariable analysis, IMAT was an independent risk factor for minor and severe complications (OR = 1.298; 95% CI [1.031: 1.635] p = 0.027), while an increased SAT area was a protective factor (OR = 0.982; 95% CI [0.969: 0.995] p = 0.007). Twenty-two patients were obese (BMI ≥30 kg/m2). While no association was observed between obesity and sarcopenia (according to EWGSOP definition), obese patients had increased IMATBMI (0.31 vs. 0.23; p = 0.010) and VATBMI (8.40 vs. 6.49; p = 0.019). The combination of SAT, VAT and IMAT performed well to anticipate severe complication (AUC = 0.759) while AUC of EWGSOP 2010 and 2019 algorithm were 0.660 and 0.519, respectively. DISCUSSION Non-invasive and imaging related measures of IMAT, SAT and VAT seems to be valuable tools to refine risk-assessment of older patients in surgery and specially to detect myosteatosis in obese ones.
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Affiliation(s)
- Guillaume Gagnat
- Normandie Univ, UNIROUEN, Department of Digestive Surgery, Rouen University Hospital, Rouen, France
| | - Christian Hobeika
- Department of Hepatobiliary and Liver Transplantation Surgery, AP-HP, Hôpital Pitié Salpêtrière, CRSA, Sorbonne Université, Paris, France
| | | | - Celine Savoye Collet
- Normandie Univ, UNIROUEN, Quantif-LITIS EA, 4108, Rouen Cedex, France; Normandie Univ, UNIROUEN, Department of Radiology, Rouen University Hospital, Rouen, France
| | - Frederic Di Fiore
- Normandie Univ, UNIROUEN, Department of Digestive Oncology, Rouen University Hospital, Rouen, France; Normandie Univ, UNIROUEN, Inserm, 1245, IRON Group, Rouen Cedex, France
| | - Laurent Druesne
- Normandie Univ, UNIROUEN, Department of Geriatrics, Rouen University Hospital, Rouen, France
| | - Jean Jacques Tuech
- Normandie Univ, UNIROUEN, Department of Digestive Surgery, Rouen University Hospital, Rouen, France; Normandie Univ, UNIROUEN, Inserm, 1245, IRON Group, Rouen Cedex, France
| | - Lilian Schwarz
- Normandie Univ, UNIROUEN, Department of Digestive Surgery, Rouen University Hospital, Rouen, France; Normandie Univ, UNIROUEN, Inserm, 1245, IRON Group, Rouen Cedex, France.
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9
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Amyar A, Modzelewski R, Vera P, Morard V, Ruan S. Multi-task multi-scale learning for outcome prediction in 3D PET images. Comput Biol Med 2022; 151:106208. [PMID: 36306580 DOI: 10.1016/j.compbiomed.2022.106208] [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: 03/14/2022] [Revised: 09/18/2022] [Accepted: 10/09/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Predicting patient response to treatment and survival in oncology is a prominent way towards precision medicine. To this end, radiomics has been proposed as a field of study where images are used instead of invasive methods. The first step in radiomic analysis in oncology is lesion segmentation. However, this task is time consuming and can be physician subjective. Automated tools based on supervised deep learning have made great progress in helping physicians. However, they are data hungry, and annotated data remains a major issue in the medical field where only a small subset of annotated images are available. METHODS In this work, we propose a multi-task, multi-scale learning framework to predict patient's survival and response. We show that the encoder can leverage multiple tasks to extract meaningful and powerful features that improve radiomic performance. We also show that subsidiary tasks serve as an inductive bias so that the model can better generalize. RESULTS Our model was tested and validated for treatment response and survival in esophageal and lung cancers, with an area under the ROC curve of 77% and 71% respectively, outperforming single-task learning methods. CONCLUSIONS Multi-task multi-scale learning enables higher performance of radiomic analysis by extracting rich information from intratumoral and peritumoral regions.
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Affiliation(s)
- Amine Amyar
- General Electric Healthcare, Buc, France; LITIS - EA4108 - Quantif, University of Rouen, Rouen, France.
| | - Romain Modzelewski
- LITIS - EA4108 - Quantif, University of Rouen, Rouen, France; Nuclear Medicine Department, Henri Becquerel Center, Rouen, France
| | - Pierre Vera
- LITIS - EA4108 - Quantif, University of Rouen, Rouen, France; Nuclear Medicine Department, Henri Becquerel Center, Rouen, France
| | | | - Su Ruan
- LITIS - EA4108 - Quantif, University of Rouen, Rouen, France
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10
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Thureau S, Mallet R, Gouel P, Modzelewski R, Vera P. [What dose escalation in the treatment of locally advanced non-small cell lung cancer?]. Cancer Radiother 2022; 26:890-893. [PMID: 36075830 DOI: 10.1016/j.canrad.2022.07.004] [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: 06/24/2022] [Revised: 06/28/2022] [Accepted: 07/01/2022] [Indexed: 11/29/2022]
Abstract
Despite significant therapeutic advances in the treatment of locally advanced inoperable non-small cell lung cancer (NSCLC), notably through adjuvant immunotherapy, the rate of therapeutic failure remains high. The use of positron emission tomography with fluorodeoxyglucose (FDG-PET), respiratory motion and intensity modulated radiotherapy (IMRT) have led to therapeutic improvements with reduced toxicity and better local control. The optimal dose to be delivered remains unknown due to discordant results of studies for almost 20 years and the way to define the area to benefit from a dose increase (whole volume, subvolume defined by pre- or per-radiotherapy PET).
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Affiliation(s)
- S Thureau
- Département de radiothérapie et de physique médicale, centre Henri-Becquerel, Rouen, France; Unité QuantIF LITIS EA 4108, université de Rouen, Normandie, France; Département d'imagerie, centre Henri-Becquerel, Rouen, France.
| | - R Mallet
- Département de radiothérapie et de physique médicale, centre Henri-Becquerel, Rouen, France
| | - P Gouel
- Département d'imagerie, centre Henri-Becquerel, Rouen, France
| | - R Modzelewski
- Unité QuantIF LITIS EA 4108, université de Rouen, Normandie, France; Département d'imagerie, centre Henri-Becquerel, Rouen, France
| | - P Vera
- Unité QuantIF LITIS EA 4108, université de Rouen, Normandie, France; Département d'imagerie, centre Henri-Becquerel, Rouen, France
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11
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Maxime F, Noeuveglise A, Vasseur N, Beaussire L, Marguet F, Modzelewski R, Hanzen C, Alexandru C, Magne N, Langlois O, Di Fiore F, Clatot F, Thureau S. Impact of EGFRA289T/Vmutation on relapse pattern in glioblastoma. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.2046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2046 Background: The prediction of the relapse pattern is an important issue in glioblastoma for personalized approach. Molecular factors, such as MGMT promoter methylation, influence relapse in- or out-field of the initial radiotherapy volume. Recently, a recurrent mutation located at position 289 of the extracellular domain of the epidermal growth factor receptor ( EGFRA289mut) has been associated with a more infiltrative phenotype in glioblastoma. The primary objective of the present study was to explore the impact of EGFRA289mut on the pattern of relapse after a chemo-radiotherapy based treatment of patients suffering from glioblastoma. Methods: An ancillary study from a monocentric prospective cohort of patients suffering from glioblastoma was conducted. All patients received radiotherapy and concomitant temozolomide. The population was divided into two groups according to EGFRA289 status (mutated versus wild-type). Primary endpoint was the overlap score (varying from 0 to 1) between initial irradiated tumor volume (Vinit) and relapse volume (Vr). Vinit was the initial 95% isodose of the radiotherapy and Vr was delineated using the enhanced MRI T1-weighted part of the relapse tumor. Secondary endpoints explored the impact of other EGFR extracellular mutations, EGFR amplification and EGFRvIII on the relapse pattern, as well as the impact of EGFRA289mut on survival. EGFR alterations were identified using next-generation sequencing or droplet-digital PCR based methods on formalin-fixed paraffin-embedded samples collected at initial diagnosis. Results: One hundred patients were included: 11% of the population had EGFRA289mut glioblastoma (n = 11/100). EGFRA289mut glioblastomas had a relapse pattern more marginal compared to EGFRA289wt glioblastomas: a mean overlap score Vinit/Vr of 0.78 was observed in the EGFRA289mut group versus 0.94 in the EGFRA289wt group (p = 0.021). The proportion of EGFR A289mut glioblastomas in the outfield relapse (overlap score < 0.8) has a trend to be higher than in the infield relapse (overlap score > 0.8): 25% (n = 2/8) versus 9.8% (n = 9/92) for the EGFRA289wt population, p = 0.21. Neither EGFR amplification nor EGFRvIII did influence overlap score Vinit/Vr. In our population, EGFRA289mut did not influence survival. Conclusions: EGFR A289mut influences the relapse pattern in a population of patients suffering from glioblastoma. The role of EGFRA289mut as a decision-making biomarker for personalized radiotherapy should now be investigated in dedicated clinical trial. Clinical trial information: NCT02617745.
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Affiliation(s)
| | | | - Nasrin Vasseur
- INSERM, U1079, IRON Group, University of Normandy, Rouen, France
| | - Ludivine Beaussire
- Institute of Research Onco-Normand (IRON), Rouen University Hospital and Centre Henri Becquerel, Rouen, France
| | | | | | | | | | - Nicolas Magne
- Rouen University Hospital Charles Nicolle, Rouen, France
| | | | - Frédéric Di Fiore
- INSERM U1245, IRON Group, Centre Henri Becquerel, University Hospital, University of Normandy, Rouen, France
| | - Florian Clatot
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
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12
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Brochet T, Lapuyade-Lahorgue J, Huat A, Thureau S, Pasquier D, Gardin I, Modzelewski R, Gibon D, Thariat J, Grégoire V, Vera P, Ruan S. Correction: Brochet et al. A Quantitative Comparison between Shannon and Tsallis–Havrda–Charvat Entropies Applied to Cancer Outcome Prediction. Entropy 2022, 24, 436. Entropy 2022; 24:e24050685. [PMID: 35626628 PMCID: PMC9142059 DOI: 10.3390/e24050685] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 11/16/2022]
Abstract
Alexandre Huat, Sébastien Thureau, David Pasquier, Isabelle Gardin, Romain Modzelewski, David Gibon, Juliette Thariat and Vincent Grégoire were not included as authors in the original publication [...]
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Affiliation(s)
- Thibaud Brochet
- LITIS, Quantif, University of Rouen, 76000 Rouen, France; (T.B.); (J.L.-L.); (A.H.); (S.T.); (I.G.); (R.M.); (P.V.)
| | - Jérôme Lapuyade-Lahorgue
- LITIS, Quantif, University of Rouen, 76000 Rouen, France; (T.B.); (J.L.-L.); (A.H.); (S.T.); (I.G.); (R.M.); (P.V.)
| | - Alexandre Huat
- LITIS, Quantif, University of Rouen, 76000 Rouen, France; (T.B.); (J.L.-L.); (A.H.); (S.T.); (I.G.); (R.M.); (P.V.)
- Centre Henri Becquerel, 76038 Rouen, France
- Société Aquilab, 59120 Lille, France;
| | - Sébastien Thureau
- LITIS, Quantif, University of Rouen, 76000 Rouen, France; (T.B.); (J.L.-L.); (A.H.); (S.T.); (I.G.); (R.M.); (P.V.)
- Centre Henri Becquerel, 76038 Rouen, France
| | - David Pasquier
- Département de Radiothérapie, Centre Oscar Lambret, 59000 Lille, France;
| | - Isabelle Gardin
- LITIS, Quantif, University of Rouen, 76000 Rouen, France; (T.B.); (J.L.-L.); (A.H.); (S.T.); (I.G.); (R.M.); (P.V.)
- Centre Henri Becquerel, 76038 Rouen, France
| | - Romain Modzelewski
- LITIS, Quantif, University of Rouen, 76000 Rouen, France; (T.B.); (J.L.-L.); (A.H.); (S.T.); (I.G.); (R.M.); (P.V.)
- Centre Henri Becquerel, 76038 Rouen, France
| | | | - Juliette Thariat
- Département de Radiothérapie, CLCC Francois Baclesse, 14000 Caen, France;
| | - Vincent Grégoire
- Département de Radiothérapie, Centre Léon Berard, 69008 Lyon, France;
| | - Pierre Vera
- LITIS, Quantif, University of Rouen, 76000 Rouen, France; (T.B.); (J.L.-L.); (A.H.); (S.T.); (I.G.); (R.M.); (P.V.)
- Centre Henri Becquerel, 76038 Rouen, France
| | - Su Ruan
- LITIS, Quantif, University of Rouen, 76000 Rouen, France; (T.B.); (J.L.-L.); (A.H.); (S.T.); (I.G.); (R.M.); (P.V.)
- Correspondence:
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13
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Bonardel G, Dupont A, Decazes P, Queneau M, Modzelewski R, Coulot J, Le Calvez N, Hapdey S. Clinical and phantom validation of a deep learning based denoising algorithm for F-18-FDG PET images from lower detection counting in comparison with the standard acquisition. EJNMMI Phys 2022; 9:36. [PMID: 35543894 PMCID: PMC9095795 DOI: 10.1186/s40658-022-00465-z] [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: 08/10/2021] [Accepted: 04/20/2022] [Indexed: 11/21/2022] Open
Abstract
Background PET/CT image quality is directly influenced by the F-18-FDG injected activity. The higher the injected activity, the less noise in the reconstructed images but the more radioactive staff exposition. A new FDA cleared software has been introduced to obtain clinical PET images, acquired at 25% of the count statistics considering US practices. Our aim is to determine the limits of a deep learning based denoising algorithm (SubtlePET) applied to statistically reduced PET raw data from 3 different last generation PET scanners in comparison to the regular acquisition in phantom and patients, considering the European guidelines for radiotracer injection activities. Images of low and high contrasted (SBR = 2 and 5) spheres of the IEC phantom and high contrast (SBR = 5) of micro-spheres of Jaszczak phantom were acquired on 3 different PET devices. 110 patients with different pathologies were included. The data was acquired in list-mode and retrospectively reconstructed with the regular acquisition count statistic (PET100), 50% reduction in counts (PET50) and 66% reduction in counts (PET33). These count reduced images were post-processed with SubtlePET to obtain PET50 + SP and PET33 + SP images. Patient image quality was scored by 2 senior nuclear physicians. Peak-signal-to-Noise and Structural similarity metrics were computed to compare the low count images to regular acquisition (PET100). Results SubtlePET reliably denoised the images and maintained the SUVmax values in PET50 + SP. SubtlePET enhanced images (PET33 + SP) had slightly increased noise compared to PET100 and could lead to a potential loss of information in terms of lesion detectability. Regarding the patient datasets, the PET100 and PET50 + SP were qualitatively comparable. The SubtlePET algorithm was able to correctly recover the SUVmax values of the lesions and maintain a noise level equivalent to full-time images. Conclusion Based on our results, SubtlePET is adapted in clinical practice for half-time or half-dose acquisitions based on European recommended injected dose of 3 MBq/kg without diagnostic confidence loss. Supplementary Information The online version contains supplementary material available at 10.1186/s40658-022-00465-z.
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Affiliation(s)
- Gerald Bonardel
- Nuclear Medicine, Centre Cardiologique du Nord, Saint-Denis, France.,Nuclear Medicine, Hopital Delafontaine, Saint-Denis, France
| | | | - Pierre Decazes
- Nuclear Medicine Department, Henri Becquerel Cancer Center, Rouen, France.,QuantIF-LITIS EA4108, Rouen University Hospital, Rouen, France
| | - Mathieu Queneau
- Nuclear Medicine, Centre Cardiologique du Nord, Saint-Denis, France.,Nuclear Medicine, Hopital Delafontaine, Saint-Denis, France
| | - Romain Modzelewski
- Nuclear Medicine Department, Henri Becquerel Cancer Center, Rouen, France.,QuantIF-LITIS EA4108, Rouen University Hospital, Rouen, France
| | | | - Nicolas Le Calvez
- Nuclear Medicine, Centre Cardiologique du Nord, Saint-Denis, France.,Nuclear Medicine, Hopital Delafontaine, Saint-Denis, France
| | - Sébastien Hapdey
- Nuclear Medicine Department, Henri Becquerel Cancer Center, Rouen, France. .,QuantIF-LITIS EA4108, Rouen University Hospital, Rouen, France.
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14
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Brochet T, Lapuyade-Lahorgue J, Huat A, Thureau S, Pasquier D, Gardin I, Modzelewski R, Gibon D, Thariat J, Grégoire V, Vera P, Ruan S. A Quantitative Comparison between Shannon and Tsallis–Havrda–Charvat Entropies Applied to Cancer Outcome Prediction. Entropy 2022; 24:e24040436. [PMID: 35455101 PMCID: PMC9031340 DOI: 10.3390/e24040436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/18/2022] [Accepted: 03/18/2022] [Indexed: 11/16/2022]
Abstract
In this paper, we propose to quantitatively compare loss functions based on parameterized Tsallis–Havrda–Charvat entropy and classical Shannon entropy for the training of a deep network in the case of small datasets which are usually encountered in medical applications. Shannon cross-entropy is widely used as a loss function for most neural networks applied to the segmentation, classification and detection of images. Shannon entropy is a particular case of Tsallis–Havrda–Charvat entropy. In this work, we compare these two entropies through a medical application for predicting recurrence in patients with head–neck and lung cancers after treatment. Based on both CT images and patient information, a multitask deep neural network is proposed to perform a recurrence prediction task using cross-entropy as a loss function and an image reconstruction task. Tsallis–Havrda–Charvat cross-entropy is a parameterized cross-entropy with the parameter α. Shannon entropy is a particular case of Tsallis–Havrda–Charvat entropy for α=1. The influence of this parameter on the final prediction results is studied. In this paper, the experiments are conducted on two datasets including in total 580 patients, of whom 434 suffered from head–neck cancers and 146 from lung cancers. The results show that Tsallis–Havrda–Charvat entropy can achieve better performance in terms of prediction accuracy with some values of α.
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Affiliation(s)
- Thibaud Brochet
- LITIS, Quantif, University of Rouen, 76000 Rouen, France; (T.B.); (J.L.-L.); (A.H.); (S.T.); (I.G.); (R.M.); (P.V.)
| | - Jérôme Lapuyade-Lahorgue
- LITIS, Quantif, University of Rouen, 76000 Rouen, France; (T.B.); (J.L.-L.); (A.H.); (S.T.); (I.G.); (R.M.); (P.V.)
| | - Alexandre Huat
- LITIS, Quantif, University of Rouen, 76000 Rouen, France; (T.B.); (J.L.-L.); (A.H.); (S.T.); (I.G.); (R.M.); (P.V.)
- Centre Henri Becquerel, 76038 Rouen, France
- Société Aquilab, 59120 Lille, France;
| | - Sébastien Thureau
- LITIS, Quantif, University of Rouen, 76000 Rouen, France; (T.B.); (J.L.-L.); (A.H.); (S.T.); (I.G.); (R.M.); (P.V.)
- Centre Henri Becquerel, 76038 Rouen, France
| | - David Pasquier
- Département de Radiothérapie, Centre Oscar Lambret, 59000 Lille, France;
| | - Isabelle Gardin
- LITIS, Quantif, University of Rouen, 76000 Rouen, France; (T.B.); (J.L.-L.); (A.H.); (S.T.); (I.G.); (R.M.); (P.V.)
- Centre Henri Becquerel, 76038 Rouen, France
| | - Romain Modzelewski
- LITIS, Quantif, University of Rouen, 76000 Rouen, France; (T.B.); (J.L.-L.); (A.H.); (S.T.); (I.G.); (R.M.); (P.V.)
- Centre Henri Becquerel, 76038 Rouen, France
| | | | - Juliette Thariat
- Département de Radiothérapie, CLCC Francois Baclesse, 14000 Caen, France;
| | - Vincent Grégoire
- Département de Radiothérapie, Centre Léon Berard, 69008 Lyon, France;
| | - Pierre Vera
- LITIS, Quantif, University of Rouen, 76000 Rouen, France; (T.B.); (J.L.-L.); (A.H.); (S.T.); (I.G.); (R.M.); (P.V.)
- Centre Henri Becquerel, 76038 Rouen, France
| | - Su Ruan
- LITIS, Quantif, University of Rouen, 76000 Rouen, France; (T.B.); (J.L.-L.); (A.H.); (S.T.); (I.G.); (R.M.); (P.V.)
- Correspondence:
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15
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Dominique C, Callonnec F, Berghian A, Defta D, Vera P, Modzelewski R, Decazes P. Deep learning analysis of contrast-enhanced spectral mammography to determine histoprognostic factors of malignant breast tumours. Eur Radiol 2022; 32:4834-4844. [PMID: 35094119 PMCID: PMC8800426 DOI: 10.1007/s00330-022-08538-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/06/2022]
Abstract
Objective To evaluate if a deep learning model can be used to characterise breast cancers on contrast-enhanced spectral mammography (CESM). Methods This retrospective mono-centric study included biopsy-proven invasive cancers with an enhancement on CESM. CESM images include low-energy images (LE) comparable to digital mammography and dual-energy subtracted images (DES) showing tumour angiogenesis. For each lesion, histologic type, tumour grade, estrogen receptor (ER) status, progesterone receptor (PR) status, HER-2 status, Ki-67 proliferation index, and the size of the invasive tumour were retrieved. The deep learning model used was a CheXNet-based model fine-tuned on CESM dataset. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was calculated for the different models: images by images and then by majority voting combining all the incidences for one tumour. Results In total, 447 invasive breast cancers detected on CESM with pathological evidence, in 389 patients, which represented 2460 images analysed, were included. Concerning the ER, the deep learning model on the DES images had an AUC of 0.83 with the image-by-image analysis and of 0.85 for the majority voting. For the triple-negative analysis, a high AUC was observable for all models, in particularity for the model on LE images with an AUC of 0.90 for the image-by-image analysis and 0.91 for the majority voting. The AUC for the other histoprognostic factors was lower. Conclusion Deep learning analysis on CESM has the potential to determine histoprognostic tumours makers, notably estrogen receptor status, and triple-negative receptor status. Key Points • A deep learning model developed for chest radiography was adapted by fine-tuning to be used on contrast-enhanced spectral mammography. • The adapted models allowed to determine for invasive breast cancers the status of estrogen receptors and triple-negative receptors. • Such models applied to contrast-enhanced spectral mammography could provide rapid prognostic and predictive information. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-022-08538-4.
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Thureau S, Modzelewski R, Bohn P, Hapdey S, Gouel P, Dubray B, Vera P. Comparison of Hypermetabolic and Hypoxic Volumes Delineated on [ 18F]FDG and [ 18F]Fluoromisonidazole PET/CT in Non-small-cell Lung Cancer Patients. Mol Imaging Biol 2021; 22:764-771. [PMID: 31432388 DOI: 10.1007/s11307-019-01422-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE The high rates of failure in the radiotherapy target volume suggest that patients with stage II or III non-small-cell lung cancer (NSCLC) should receive an increased total dose of radiotherapy. 2-Deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) and [18F]fluoromisonidazole ([18F]FMISO) (hypoxia) uptake on pre-radiotherapy positron emission tomography (PET)/X-ray computed tomography (CT) have been independently reported to identify intratumor subvolumes at higher risk of relapse after radiotherapy. We have compared the [18F]FDG and [18F]FMISO volumes defined by PET/CT in NSCLC patients included in a prospective study. PROCEDURES Thirty-four patients with non-resectable lung cancer underwent [18F]FDG and [18F]FMISO PET/CT before (pre-RT) and during radiotherapy (around 42 Gy, per-RT). The criteria were to delineate 40 % and 90 % SUVmax thresholds on [18F]FDG PET/CT (metabolic volumes), and SUV > 1.4 on pre-RT [18F]FMISO PET/CT (hypoxic volume). The functional volumes were delineated within the tumor volume as defined on co-registered CTs. RESULTS The mean pre-RT and per-RT [18F]FDG volumes were not statistically different (30.4 cc vs 22.2; P = 0.12). The mean pre-RT SUVmax [18F]FDG was higher than per-RT SUVmax (12.7 vs 6.5; P < 0.0001). The mean [18F]FMISO SUVmax and volumes were 2.7 and 1.37 cc, respectively. Volume-based analysis showed good overlap between [18F]FDG and [18F]FMISO for all methods of segmentation but a poor correlation for Jaccard or Dice Indices (DI). The DI maximum was 0.45 for a threshold at 40 or 50 %. CONCLUSION The correlation between [18F]FDG and [18F]FMISO uptake is low in NSCLC, making it possible to envisage different management strategies as the studies in progress show.
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Affiliation(s)
- Sébastien Thureau
- Department of Radiation Oncology, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108, FR CNRS 3638], Faculty of Medecine, University of Rouen, Rouen, France. .,Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108 - FR CNRS 3638], Faculty of Medicine, University of Rouen, Rouen, France.
| | - R Modzelewski
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108 - FR CNRS 3638], Faculty of Medicine, University of Rouen, Rouen, France
| | - P Bohn
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108 - FR CNRS 3638], Faculty of Medicine, University of Rouen, Rouen, France
| | - S Hapdey
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108 - FR CNRS 3638], Faculty of Medicine, University of Rouen, Rouen, France
| | - P Gouel
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108 - FR CNRS 3638], Faculty of Medicine, University of Rouen, Rouen, France
| | - B Dubray
- Department of Radiation Oncology, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108, FR CNRS 3638], Faculty of Medecine, University of Rouen, Rouen, France
| | - P Vera
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108 - FR CNRS 3638], Faculty of Medicine, University of Rouen, Rouen, France
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Mallet R, Decazes P, Modzelewski R, Lequesne J, Vera P, Dubray B, Thureau S. Prognostic value of low skeletal muscle mass in patient treated by exclusive curative radiochemotherapy for a NSCLC. Sci Rep 2021; 11:10628. [PMID: 34017035 PMCID: PMC8137692 DOI: 10.1038/s41598-021-90187-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 10/15/2020] [Accepted: 04/20/2021] [Indexed: 12/25/2022] Open
Abstract
Low skeletal muscle mass is a well-known prognostic factor for patients treated for a non-small-cell lung cancer by surgery or chemotherapy. However, its impact in patients treated by exclusive radiochemotherapy has never been explored. Our study tries to evaluate the prognostic value of low skeletal muscle mass and other antropometric parameters on this population. Clinical, nutritional and anthropometric date were collected for 93 patients treated by radiochemotherapy for a NSCLC. Anthropometric parameters were measured on the PET/CT by two methods. The first method was a manual segmentation at level L3, used to define Muscle Body Area (MBAL3), Visceral Fat Area (VFAL3) and Subcutaneous Fat Area (SCFAL3). The second method was an software (Anthropometer3D), allowing an automatic multislice measurement of Lean Body Mass (LBMAnthro3D), Fat Body Mass (FBMAnthro3D), Muscle Body Mass (MBMAnthro3D), Visceral Fat Mass (VFMAnthro3D), and Sub-Cutaneous Fat Mass (SCFMAnthro3D) on the PET/CT. All anthropometrics parameters were normalised by the patient's height. The primary end point was overall survival time. Univariate and then stepwise multivariate cox analysis were performed for significant parameters. Finally, Spearman's correlation between MBAL3 and MBMAnthro3D was assessed. Forty-one (44%) patients had low skeletal muscle mass. The median overall survival was 18 months for low skeletal muscle mass patients versus 36 months for non-low skeletal muscle mass patients (p = 0.019). Low skeletal muscle mass (HR = 1.806, IC95% [1.09–2.98]), serums albumin level < 35 g/l (HR = 2.203 [1.19–4.09]), Buzby Index < 97.5 (HR = 2.31 [1.23–4.33]), WHO score = 0 (HR = 0.59 [0.31–0.86] and MBMAnthro3D < 8.56 kg/m2 (HR = 2.36 [1.41–3.90]) were the only significant features in univariates analysis. In the stepwise multivariate Cox analysis, only MBMAnthro3D < 8.56 kg/m2 (HR = 2.16, p = 0.003) and WHO score = 0 (HR = 0.59, p = 0.04) were significant. Finally, muscle quantified by MBAL3 and MBMAnthro3D were found to be highly correlated (Spearman = 0.9). Low skeletal muscle mass, assessed on the pre-treatment PET/CT is a powerful prognostic factor in patient treated by radiochemotherapy for a NSCLC. The automatic software Anthropometer3D can easily identify patients a risk that could benefit an adapted therapy.
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Affiliation(s)
- R Mallet
- Department of Radiation Oncology, Centre Henri Becquerel and Rouen University Hospital, & QuantIF-LITIS [EA (Equipe d'Accueil) 4108], Rouen, France
| | - P Decazes
- Department of Nuclear Medicine, Centre Henri Becquerel and Rouen University Hospital, & QuantIF-LITIS [EA (Equipe d'Accueil) 4108-FR CNRS 3638], Faculty of Medicine, University of Rouen, Rouen, France
| | - R Modzelewski
- Department of Nuclear Medicine, Centre Henri Becquerel and Rouen University Hospital, & QuantIF-LITIS [EA (Equipe d'Accueil) 4108-FR CNRS 3638], Faculty of Medicine, University of Rouen, Rouen, France
| | - J Lequesne
- Clinical Research Department, Centre Henri Becquerel, Rouen, France
| | - P Vera
- Department of Nuclear Medicine, Centre Henri Becquerel and Rouen University Hospital, & QuantIF-LITIS [EA (Equipe d'Accueil) 4108-FR CNRS 3638], Faculty of Medicine, University of Rouen, Rouen, France
| | - B Dubray
- Department of Radiation Oncology, Centre Henri Becquerel and Rouen University Hospital, & QuantIF-LITIS [EA (Equipe d'Accueil) 4108], Rouen, France
| | - S Thureau
- Department of Radiation Oncology, Centre Henri Becquerel and Rouen University Hospital, & QuantIF-LITIS [EA (Equipe d'Accueil) 4108], Rouen, France. .,Department of Nuclear Medicine, Centre Henri Becquerel and Rouen University Hospital, & QuantIF-LITIS [EA (Equipe d'Accueil) 4108-FR CNRS 3638], Faculty of Medicine, University of Rouen, Rouen, France.
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Le Joncour V, Guichet PO, Dembélé KP, Mutel A, Campisi D, Perzo N, Desrues L, Modzelewski R, Couraud PO, Honnorat J, Ferracci FX, Marguet F, Laquerrière A, Vera P, Bohn P, Langlois O, Morin F, Gandolfo P, Castel H. Targeting the Urotensin II/UT G Protein-Coupled Receptor to Counteract Angiogenesis and Mesenchymal Hypoxia/Necrosis in Glioblastoma. Front Cell Dev Biol 2021; 9:652544. [PMID: 33937253 PMCID: PMC8079989 DOI: 10.3389/fcell.2021.652544] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 01/12/2021] [Accepted: 03/11/2021] [Indexed: 12/15/2022] Open
Abstract
Glioblastomas (GBMs) are the most common primary brain tumors characterized by strong invasiveness and angiogenesis. GBM cells and microenvironment secrete angiogenic factors and also express chemoattractant G protein-coupled receptors (GPCRs) to their advantage. We investigated the role of the vasoactive peptide urotensin II (UII) and its receptor UT on GBM angiogenesis and tested potential ligand/therapeutic options based on this system. On glioma patient samples, the expression of UII and UT increased with the grade with marked expression in the vascular and peri-necrotic mesenchymal hypoxic areas being correlated with vascular density. In vitro human UII stimulated human endothelial HUV-EC-C and hCMEC/D3 cell motility and tubulogenesis. In mouse-transplanted Matrigel sponges, mouse (mUII) and human UII markedly stimulated invasion by macrophages, endothelial, and smooth muscle cells. In U87 GBM xenografts expressing UII and UT in the glial and vascular compartments, UII accelerated tumor development, favored hypoxia and necrosis associated with increased proliferation (Ki67), and induced metalloproteinase (MMP)-2 and -9 expression in Nude mice. UII also promoted a “tortuous” vascular collagen-IV expressing network and integrin expression mainly in the vascular compartment. GBM angiogenesis and integrin αvβ3 were confirmed by in vivo99mTc-RGD tracer imaging and tumoral capture in the non-necrotic area of U87 xenografts in Nude mice. Peptide analogs of UII and UT antagonist were also tested as potential tumor repressor. Urotensin II-related peptide URP inhibited angiogenesis in vitro and failed to attract vascular and inflammatory components in Matrigel in vivo. Interestingly, the UT antagonist/biased ligand urantide and the non-peptide UT antagonist palosuran prevented UII-induced tubulogenesis in vitro and significantly delayed tumor growth in vivo. Urantide drastically prevented endogenous and UII-induced GBM angiogenesis, MMP, and integrin activations, associated with GBM tumoral growth. These findings show that UII induces GBM aggressiveness with necrosis and angiogenesis through integrin activation, a mesenchymal behavior that can be targeted by UT biased ligands/antagonists.
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Affiliation(s)
- Vadim Le Joncour
- UNIROUEN, INSERM U1239, DC2N, Institute for Research and Innovation in Biomedicine (IRIB), Normandie Rouen Université, Rouen, France
| | - Pierre-Olivier Guichet
- UNIROUEN, INSERM U1239, DC2N, Institute for Research and Innovation in Biomedicine (IRIB), Normandie Rouen Université, Rouen, France
| | - Kleouforo-Paul Dembélé
- UNIROUEN, INSERM U1239, DC2N, Institute for Research and Innovation in Biomedicine (IRIB), Normandie Rouen Université, Rouen, France
| | - Alexandre Mutel
- UNIROUEN, INSERM U1239, DC2N, Institute for Research and Innovation in Biomedicine (IRIB), Normandie Rouen Université, Rouen, France
| | - Daniele Campisi
- UNIROUEN, INSERM U1239, DC2N, Institute for Research and Innovation in Biomedicine (IRIB), Normandie Rouen Université, Rouen, France
| | - Nicolas Perzo
- UNIROUEN, INSERM U1239, DC2N, Institute for Research and Innovation in Biomedicine (IRIB), Normandie Rouen Université, Rouen, France
| | - Laurence Desrues
- UNIROUEN, INSERM U1239, DC2N, Institute for Research and Innovation in Biomedicine (IRIB), Normandie Rouen Université, Rouen, France
| | - Romain Modzelewski
- EA 4108, Laboratoire d'Informatique, de Traitement de l'Information et des Systèmes (LITIS), University of Rouen, Mont-Saint-Aignan, France
| | | | - Jérôme Honnorat
- Neuro-Oncology Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France.,Institute NeuroMyoGéne, INSERM U1217/CNRS UMR 5310, Lyon, France.,University Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - François-Xavier Ferracci
- UNIROUEN, INSERM U1239, DC2N, Institute for Research and Innovation in Biomedicine (IRIB), Normandie Rouen Université, Rouen, France.,Neurosurgery Service, Rouen CHU Hospital, Rouen, France
| | - Florent Marguet
- Anathomocytopathology Service, Rouen CHU Hospital, Rouen, France
| | | | - Pierre Vera
- EA 4108, Laboratoire d'Informatique, de Traitement de l'Information et des Systèmes (LITIS), University of Rouen, Mont-Saint-Aignan, France
| | - Pierre Bohn
- EA 4108, Laboratoire d'Informatique, de Traitement de l'Information et des Systèmes (LITIS), University of Rouen, Mont-Saint-Aignan, France
| | - Olivier Langlois
- UNIROUEN, INSERM U1239, DC2N, Institute for Research and Innovation in Biomedicine (IRIB), Normandie Rouen Université, Rouen, France.,Neurosurgery Service, Rouen CHU Hospital, Rouen, France
| | - Fabrice Morin
- UNIROUEN, INSERM U1239, DC2N, Institute for Research and Innovation in Biomedicine (IRIB), Normandie Rouen Université, Rouen, France
| | - Pierrick Gandolfo
- UNIROUEN, INSERM U1239, DC2N, Institute for Research and Innovation in Biomedicine (IRIB), Normandie Rouen Université, Rouen, France
| | - Hélène Castel
- UNIROUEN, INSERM U1239, DC2N, Institute for Research and Innovation in Biomedicine (IRIB), Normandie Rouen Université, Rouen, France
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Pinochet P, Eude F, Becker S, Shah V, Sibille L, Toledano MN, Modzelewski R, Vera P, Decazes P. Evaluation of an Automatic Classification Algorithm Using Convolutional Neural Networks in Oncological Positron Emission Tomography. Front Med (Lausanne) 2021; 8:628179. [PMID: 33718406 PMCID: PMC7953145 DOI: 10.3389/fmed.2021.628179] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 11/11/2020] [Accepted: 01/25/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction: Our aim was to evaluate the performance in clinical research and in clinical routine of a research prototype, called positron emission tomography (PET) Assisted Reporting System (PARS) (Siemens Healthineers) and based on a convolutional neural network (CNN), which is designed to detect suspected cancer sites in fluorine-18 fluorodeoxyglucose (18F-FDG) PET/computed tomography (CT). Method: We retrospectively studied two cohorts of patients. The first cohort consisted of research-based patients who underwent PET scans as part of the initial workup for diffuse large B-cell lymphoma (DLBCL). The second cohort consisted of patients who underwent PET scans as part of the evaluation of miscellaneous cancers in clinical routine. In both cohorts, we assessed the correlation between manually and automatically segmented total metabolic tumor volumes (TMTVs), and the overlap between both segmentations (Dice score). For the research cohort, we also compared the prognostic value for progression-free survival (PFS) and overall survival (OS) of manually and automatically obtained TMTVs. Results: For the first cohort (research cohort), data from 119 patients were retrospectively analyzed. The median Dice score between automatic and manual segmentations was 0.65. The intraclass correlation coefficient between automatically and manually obtained TMTVs was 0.68. Both TMTV results were predictive of PFS (hazard ratio: 2.1 and 3.3 for automatically based and manually based TMTVs, respectively) and OS (hazard ratio: 2.4 and 3.1 for automatically based and manually based TMTVs, respectively). For the second cohort (routine cohort), data from 430 patients were retrospectively analyzed. The median Dice score between automatic and manual segmentations was 0.48. The intraclass correlation coefficient between automatically and manually obtained TMTVs was 0.61. Conclusion: The TMTVs determined for the research cohort remain predictive of total and PFS for DLBCL. However, the segmentations and TMTVs determined automatically by the algorithm need to be verified and, sometimes, corrected to be similar to the manual segmentation.
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Affiliation(s)
- Pierre Pinochet
- Department of Nuclear Medicine, Henri Becquerel Cancer Center, Rouen, France
| | - Florian Eude
- Department of Nuclear Medicine, Henri Becquerel Cancer Center, Rouen, France
| | - Stéphanie Becker
- Department of Nuclear Medicine, Henri Becquerel Cancer Center, Rouen, France.,LITIS Quantif-EA 4108, University of Rouen, Rouen, France
| | - Vijay Shah
- Siemens Medical Solutions USA, Inc., Knoxville, TN, United States
| | - Ludovic Sibille
- Siemens Medical Solutions USA, Inc., Knoxville, TN, United States
| | | | - Romain Modzelewski
- Department of Nuclear Medicine, Henri Becquerel Cancer Center, Rouen, France.,LITIS Quantif-EA 4108, University of Rouen, Rouen, France
| | - Pierre Vera
- Department of Nuclear Medicine, Henri Becquerel Cancer Center, Rouen, France.,LITIS Quantif-EA 4108, University of Rouen, Rouen, France
| | - Pierre Decazes
- Department of Nuclear Medicine, Henri Becquerel Cancer Center, Rouen, France.,LITIS Quantif-EA 4108, University of Rouen, Rouen, France
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20
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Thureau S, Lebret L, Dandoy S, Ebran M, Gouley Toutain C, Guerault F, Lefebvre L, Mallet R, Moldovan C, Veresezan O, Lequesne J, Modzelewski R, Clatot F. PH-0039: Impact of sarcopenia on survival and recurrence after radiotherapy for head and neck cancer. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00065-7] [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: 10/22/2022]
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21
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Thureau S, Lebret L, Jean Christophe F, Modzelewski R, Bonnet N, Marchesi V, Lisbona A. PO-1762: Dummy Run for bone SBRT in french multicentric study. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01780-1] [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: 11/29/2022]
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22
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Abstract
This paper presents an automatic classification segmentation tool for helping screening COVID-19 pneumonia using chest CT imaging. The segmented lesions can help to assess the severity of pneumonia and follow-up the patients. In this work, we propose a new multitask deep learning model to jointly identify COVID-19 patient and segment COVID-19 lesion from chest CT images. Three learning tasks: segmentation, classification and reconstruction are jointly performed with different datasets. Our motivation is on the one hand to leverage useful information contained in multiple related tasks to improve both segmentation and classification performances, and on the other hand to deal with the problems of small data because each task can have a relatively small dataset. Our architecture is composed of a common encoder for disentangled feature representation with three tasks, and two decoders and a multi-layer perceptron for reconstruction, segmentation and classification respectively. The proposed model is evaluated and compared with other image segmentation techniques using a dataset of 1369 patients including 449 patients with COVID-19, 425 normal ones, 98 with lung cancer and 397 of different kinds of pathology. The obtained results show very encouraging performance of our method with a dice coefficient higher than 0.88 for the segmentation and an area under the ROC curve higher than 97% for the classification.
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Affiliation(s)
- Amine Amyar
- General Electric Healthcare, Buc, France; LITIS - EA4108 - Quantif, University of Rouen, Rouen, France.
| | - Romain Modzelewski
- LITIS - EA4108 - Quantif, University of Rouen, Rouen, France; Nuclear Medicine Department, Henri Becquerel Center, Rouen, France.
| | - Hua Li
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
| | - Su Ruan
- LITIS - EA4108 - Quantif, University of Rouen, Rouen, France.
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Amyar A, Modzelewski R, Li H, Ruan S. Multi-task deep learning based CT imaging analysis for COVID-19 pneumonia: Classification and segmentation. Comput Biol Med 2020; 126:104037. [PMID: 33065387 PMCID: PMC7543793 DOI: 10.1016/j.compbiomed.2020.104037] [Citation(s) in RCA: 210] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/29/2020] [Accepted: 10/03/2020] [Indexed: 12/13/2022]
Abstract
This paper presents an automatic classification segmentation tool for helping screening COVID-19 pneumonia using chest CT imaging. The segmented lesions can help to assess the severity of pneumonia and follow-up the patients. In this work, we propose a new multitask deep learning model to jointly identify COVID-19 patient and segment COVID-19 lesion from chest CT images. Three learning tasks: segmentation, classification and reconstruction are jointly performed with different datasets. Our motivation is on the one hand to leverage useful information contained in multiple related tasks to improve both segmentation and classification performances, and on the other hand to deal with the problems of small data because each task can have a relatively small dataset. Our architecture is composed of a common encoder for disentangled feature representation with three tasks, and two decoders and a multi-layer perceptron for reconstruction, segmentation and classification respectively. The proposed model is evaluated and compared with other image segmentation techniques using a dataset of 1369 patients including 449 patients with COVID-19, 425 normal ones, 98 with lung cancer and 397 of different kinds of pathology. The obtained results show very encouraging performance of our method with a dice coefficient higher than 0.88 for the segmentation and an area under the ROC curve higher than 97% for the classification.
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Affiliation(s)
- Amine Amyar
- General Electric Healthcare, Buc, France; LITIS - EA4108 - Quantif, University of Rouen, Rouen, France.
| | - Romain Modzelewski
- LITIS - EA4108 - Quantif, University of Rouen, Rouen, France; Nuclear Medicine Department, Henri Becquerel Center, Rouen, France.
| | - Hua Li
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
| | - Su Ruan
- LITIS - EA4108 - Quantif, University of Rouen, Rouen, France.
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Thureau S, Lebret L, Lequesne J, Mihailescu S, Mallet R, Cabourg M, Lefebvre L, Dandoy S, Modzelewski R, Clatot F. Impact de la sarcopénie sur la survie globale et la survie sans progression après radiothérapie ou chimioradiothérapie pour le carcinome épidermoïde de la tête et du cou. Cancer Radiother 2020. [DOI: 10.1016/j.canrad.2020.08.010] [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: 11/26/2022]
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25
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Decazes P, Thureau S, Modzelewski R, Damilleville-Martin M, Bohn P, Vera P. Benefits of positron emission tomography scans for the evaluation of radiotherapy. Cancer Radiother 2020; 24:388-397. [PMID: 32448741 DOI: 10.1016/j.canrad.2020.02.007] [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: 01/24/2020] [Accepted: 02/03/2020] [Indexed: 12/23/2022]
Abstract
The assessment of tumour response during and after radiotherapy determines the subsequent management of patients (adaptation of treatment plan, monitoring, adjuvant treatment, rescue treatment or palliative care). In addition to its role in extension assessment and therapeutic planning, positron emission tomography combined with computed tomography provides useful functional information for the evaluation of tumour response. The objective of this article is to review published data on positron emission tomography combined with computed tomography as a tool for evaluating external radiotherapy for cancers. Data on positron emission tomography combined with computed tomography scans acquired at different times (during, after initial and after definitive [chemo-]radiotherapy, during post-treatment follow-up) in solid tumours (lung, head and neck, cervix, oesophagus, prostate and rectum) were collected and analysed. Recent recommendations of the National Comprehensive Cancer Network are also reported. Positron emission tomography combined with computed tomography with (18F)-labelled fluorodeoxyglucose has a well-established role in clinical routine after chemoradiotherapy for locally advanced head and neck cancers, particularly to limit the number of neck lymph node dissection. This imaging modality also has a place for the evaluation of initial chemoradiotherapy of oesophageal cancer, including the detection of distant metastases, and for the post-therapeutic evaluation of cervical cancer. Several radiotracers for positron emission tomography combined with computed tomography, such as choline, are also recommended for patients with prostate cancer with biochemical failure. (18F)-fluorodeoxyglucose positron emission tomography combined with computed tomography is optional in many other circumstances and its clinical benefits, possibly in combination with MRI, to assess response to radiotherapy remain a very active area of research.
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Affiliation(s)
- P Decazes
- Département de médecine nucléaire, centre Henri-Becquerel, 1, rue d'Amiens, 76038 Rouen, France; QuantIF-Litis, EA 4108, faculté de médecine, université de Rouen, 22, boulevard Gambetta, 76000 Rouen, France.
| | - S Thureau
- Département de médecine nucléaire, centre Henri-Becquerel, 1, rue d'Amiens, 76038 Rouen, France; QuantIF-Litis, EA 4108, faculté de médecine, université de Rouen, 22, boulevard Gambetta, 76000 Rouen, France; Département de radiothérapie et de physique médicale, centre Henri-Becquerel, 1, rue d'Amiens, 76038 Rouen, France
| | - R Modzelewski
- Département de médecine nucléaire, centre Henri-Becquerel, 1, rue d'Amiens, 76038 Rouen, France; QuantIF-Litis, EA 4108, faculté de médecine, université de Rouen, 22, boulevard Gambetta, 76000 Rouen, France
| | - M Damilleville-Martin
- Département de radiothérapie et de physique médicale, centre Henri-Becquerel, 1, rue d'Amiens, 76038 Rouen, France
| | - P Bohn
- Département de médecine nucléaire, centre Henri-Becquerel, 1, rue d'Amiens, 76038 Rouen, France; QuantIF-Litis, EA 4108, faculté de médecine, université de Rouen, 22, boulevard Gambetta, 76000 Rouen, France
| | - P Vera
- Département de médecine nucléaire, centre Henri-Becquerel, 1, rue d'Amiens, 76038 Rouen, France; QuantIF-Litis, EA 4108, faculté de médecine, université de Rouen, 22, boulevard Gambetta, 76000 Rouen, France
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Mallet R, Modzelewski R, Lequesne J, Mihailescu S, Decazes P, Auvray H, Benyoucef A, Di Fiore F, Vera P, Dubray B, Thureau S. Prognostic value of sarcopenia in patients treated by Radiochemotherapy for locally advanced oesophageal cancer. Radiat Oncol 2020; 15:116. [PMID: 32443967 PMCID: PMC7245030 DOI: 10.1186/s13014-020-01545-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 02/07/2020] [Accepted: 04/22/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Sarcopenia is defined by a loss of skeletal muscle mass with or without loss of fat mass. Sarcopenia has been associated to reduced tolerance to treatment and worse prognosis in cancer patients, including patients undergoing surgery for limited oesophageal cancer. Concomitant chemo-radiotherapy is the standard treatment for locally-advanced tumour, not accessible to surgical resection. Using automated delineation of the skeletal muscle, we have investigated the prognostic value of sarcopenia in locally advanced oesophageal cancer (LAOC) patients treated by curative-intent chemo-radiotherapy. METHODS The clinical, nutritional, anthropometric, and functional-imaging (18FDG-PET/CT) data were collected in 97 patients treated between 2006 and 2012 in our institution. The skeletal muscle area was automatically delineated on cross-sectional CT images acquired at the 3rd. lumbar vertebra level and divided by the patient's squared height (SML3/h2) to obtain the Skeletal Muscle Index (SMI). The primary endpoint was overall survival probability. RESULTS Seventy-six deaths were reported. The median survival time was 27 [95% Confidence Interval 23-40] months for the whole population. Univariate analyses (Cox Proportional Hazard Model) showed decreased survival probabilities in patients with reduced SMI, WHO > 0, Body Mass Index ≤21, and Nutritional Risk Index ≤97.5. Multivariate analyses showed that sarcopenia was the only significant prognostic factor (HR 2.32 [1.24-4.34], p = 0.008). Using Receiver Operating Characteristics curves, the Area Under the Curve (AUC) was 0.73 in males (p = 0.0002], the optimal threshold being 51.5 cm2/m2. In women, the AUC was 0.65 (p = 0.19). CONCLUSION Sarcopenia is a powerful independent prognostic factor, associated with a rise of the overall mortality in patients treated exclusively by radiochemotherapy for a locally advanced oesophageal cancer. L3 CT images are easily gathered from 18FDG-PET/CT acquisitions.
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Affiliation(s)
- Romain Mallet
- Department of Radiation Oncology and Medical Physics, Henri Becquerel Cancer Center and Rouen University Hospital, University of Rouen, CS11516 Rue d'Amiens, 76000, Rouen, France
| | - Romain Modzelewski
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital & QuantIF-LITIS, University of Rouen, Rouen, France
| | - Justine Lequesne
- Clinical Research Department, Henri Becquerel Cancer Center, Rouen, France
| | - Sorina Mihailescu
- Clinical Research Department, Henri Becquerel Cancer Center, Rouen, France
| | - Pierre Decazes
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital & QuantIF-LITIS, University of Rouen, Rouen, France
| | - Hugues Auvray
- Department of Radiation Oncology and Medical Physics, Henri Becquerel Cancer Center and Rouen University Hospital, University of Rouen, CS11516 Rue d'Amiens, 76000, Rouen, France
| | - Ahmed Benyoucef
- Department of Radiation Oncology and Medical Physics, Henri Becquerel Cancer Center and Rouen University Hospital, University of Rouen, CS11516 Rue d'Amiens, 76000, Rouen, France
| | - Fréderic Di Fiore
- Department of Hepatogastroenterology, Rouen University Hospital & Department of Medical Oncology, Henri Becquerel Cancer Centre, University of Rouen, Rouen, France
| | - Pierre Vera
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital & QuantIF-LITIS, University of Rouen, Rouen, France
| | - Bernard Dubray
- Department of Radiation Oncology and Medical Physics, Henri Becquerel Cancer Center and Rouen University Hospital & QuantIF-LITIS, University of Rouen, Rouen, France
| | - Sébastien Thureau
- Department of Radiation Oncology and Medical Physics, Henri Becquerel Cancer Center and Rouen University Hospital, University of Rouen, CS11516 Rue d'Amiens, 76000, Rouen, France. .,Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital & QuantIF-LITIS, University of Rouen, Rouen, France.
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Modzelewski R, Gensanne D, Hapdey S, Gouel P, Vera P, Thureau S. How to work together between nuclear medicine and radiotherapy departments? Cancer Radiother 2020; 24:358-361. [PMID: 32278652 DOI: 10.1016/j.canrad.2020.02.011] [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: 01/22/2020] [Revised: 02/18/2020] [Accepted: 02/20/2020] [Indexed: 11/28/2022]
Abstract
Among the available imaging techniques, functional imaging provided by nuclear medicine departments represents a tool of choice for the oncoradiotherapist for targeting tumour activity, with positron emission tomography as the main modality. Before, during or after radiotherapy, functional imaging helps guide the oncoradiotherapist in making decisions and in the strategic choice of pathology management. Setting up a working group to ensure perfect coordination at all levels is the first step. Key points for a common and coordinated management between the two departments are the definition of an organizational logistic, training of personnel at every levels, standardization of nomenclatures, the choice of adapted and common equipment, implementation of regulatory controls, and research/clinical routine continuum. The availability of functional examinations dedicated to radiotherapy in clinical routine is possible and requires a convergence of teams and a pooling of tools and techniques.
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Affiliation(s)
- R Modzelewski
- Department of Nuclear Medicine, centre Henri-Becquerel, 1, rue d'Amiens, 76038 Rouen, France; CNRS, EA4108-Litis, FR UMR 3638, laboratoire QuantIF, 1, rue d'Amiens, 76000 Rouen, France.
| | - D Gensanne
- CNRS, EA4108-Litis, FR UMR 3638, laboratoire QuantIF, 1, rue d'Amiens, 76000 Rouen, France; Department of Radiation Oncology, centre Henri-Becquerel, 1, rue d'Amiens, 76038 Rouen, France
| | - S Hapdey
- Department of Nuclear Medicine, centre Henri-Becquerel, 1, rue d'Amiens, 76038 Rouen, France; CNRS, EA4108-Litis, FR UMR 3638, laboratoire QuantIF, 1, rue d'Amiens, 76000 Rouen, France
| | - P Gouel
- Department of Nuclear Medicine, centre Henri-Becquerel, 1, rue d'Amiens, 76038 Rouen, France; CNRS, EA4108-Litis, FR UMR 3638, laboratoire QuantIF, 1, rue d'Amiens, 76000 Rouen, France
| | - P Vera
- Department of Nuclear Medicine, centre Henri-Becquerel, 1, rue d'Amiens, 76038 Rouen, France; CNRS, EA4108-Litis, FR UMR 3638, laboratoire QuantIF, 1, rue d'Amiens, 76000 Rouen, France
| | - S Thureau
- CNRS, EA4108-Litis, FR UMR 3638, laboratoire QuantIF, 1, rue d'Amiens, 76000 Rouen, France; Department of Radiation Oncology, centre Henri-Becquerel, 1, rue d'Amiens, 76038 Rouen, France
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Poret B, Desrues L, Bonin MA, Pedard M, Dubois M, Leduc R, Modzelewski R, Decazes P, Morin F, Vera P, Castel H, Bohn P, Gandolfo P. Development of Novel 111-In-Labelled DOTA Urotensin II Analogues for Targeting the UT Receptor Overexpressed in Solid Tumours. Biomolecules 2020; 10:biom10030471. [PMID: 32204509 PMCID: PMC7175314 DOI: 10.3390/biom10030471] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 12/11/2022] Open
Abstract
Overexpression of G protein-coupled receptors (GPCRs) in tumours is widely used to develop GPCR-targeting radioligands for solid tumour imaging in the context of diagnosis and even treatment. The human vasoactive neuropeptide urotensin II (hUII), which shares structural analogies with somatostatin, interacts with a single high affinity GPCR named UT. High expression of UT has been reported in several types of human solid tumours from lung, gut, prostate, or breast, suggesting that UT is a valuable novel target to design radiolabelled hUII analogues for cancer diagnosis. In this study, two original urotensinergic analogues were first conjugated to a DOTA chelator via an aminohexanoic acid (Ahx) hydrocarbon linker and then -hUII and DOTA-urantide, complexed to the radioactive metal indium isotope to successfully lead to radiolabelled DOTA-Ahx-hUII and DOTA-Ahx-urantide. The 111In-DOTA-hUII in human plasma revealed that only 30% of the radioligand was degraded after a 3-h period. DOTA-hUII and DOTA-urantide exhibited similar binding affinities as native peptides and relayed calcium mobilization in HEK293 cells expressing recombinant human UT. DOTA-hUII, not DOTA-urantide, was able to promote UT internalization in UT-expressing HEK293 cells, thus indicating that radiolabelled 111In-DOTA-hUII would allow sufficient retention of radioactivity within tumour cells or radiolabelled DOTA-urantide may lead to a persistent binding on UT at the plasma membrane. The potential of these radioligands as candidates to target UT was investigated in adenocarcinoma. We showed that hUII stimulated the migration and proliferation of both human lung A549 and colorectal DLD-1 adenocarcinoma cell lines endogenously expressing UT. In vivo intravenous injection of 111In-DOTA-hUII in C57BL/6 mice revealed modest organ signals, with important retention in kidney. 111In-DOTA-hUII or 111In-DOTA-urantide were also injected in nude mice bearing heterotopic xenografts of lung A549 cells or colorectal DLD-1 cells both expressing UT. The observed significant renal uptake and low tumour/muscle ratio (around 2.5) suggest fast tracer clearance from the organism. Together, DOTA-hUII and DOTA-urantide were successfully radiolabelled with 111Indium, the first one functioning as a UT agonist and the second one as a UT-biased ligand/antagonist. To allow tumour-specific targeting and prolong body distribution in preclinical models bearing some solid tumours, these radiolabelled urotensinergic analogues should be optimized for being used as potential molecular tools for diagnosis imaging or even treatment tools.
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Affiliation(s)
- Benjamin Poret
- Institute for Research and Innovation in Biomedicine (IRIB), University of Rouen Normandy, INSERM U1239, DC2N, 76000 Rouen, France; (B.P.); (L.D.); (M.P.); (M.D.); (F.M.); (P.G.)
- EA 4108, Laboratory of Computer Science, Information Processing and Systems (LITIS), team “QuantIF”, Centre Henri Becquerel, 76000 Rouen, France; (R.M.); (P.D.); (P.V.); (P.B.)
- Department of Physiology & Pharmacology, Institute of Sherbrooke, Faculty of Medicine and Health Sciences, Sherbrooke University, Sherbrooke, QC J1H 5N4, Canada; (M.-A.B.); (R.L.)
| | - Laurence Desrues
- Institute for Research and Innovation in Biomedicine (IRIB), University of Rouen Normandy, INSERM U1239, DC2N, 76000 Rouen, France; (B.P.); (L.D.); (M.P.); (M.D.); (F.M.); (P.G.)
- EA 4108, Laboratory of Computer Science, Information Processing and Systems (LITIS), team “QuantIF”, Centre Henri Becquerel, 76000 Rouen, France; (R.M.); (P.D.); (P.V.); (P.B.)
- Institute for Research and Innovation in Biomedicine (IRIB), 76000 Rouen, France
| | - Marc-André Bonin
- Department of Physiology & Pharmacology, Institute of Sherbrooke, Faculty of Medicine and Health Sciences, Sherbrooke University, Sherbrooke, QC J1H 5N4, Canada; (M.-A.B.); (R.L.)
| | - Martin Pedard
- Institute for Research and Innovation in Biomedicine (IRIB), University of Rouen Normandy, INSERM U1239, DC2N, 76000 Rouen, France; (B.P.); (L.D.); (M.P.); (M.D.); (F.M.); (P.G.)
- Institute for Research and Innovation in Biomedicine (IRIB), 76000 Rouen, France
| | - Martine Dubois
- Institute for Research and Innovation in Biomedicine (IRIB), University of Rouen Normandy, INSERM U1239, DC2N, 76000 Rouen, France; (B.P.); (L.D.); (M.P.); (M.D.); (F.M.); (P.G.)
- Institute for Research and Innovation in Biomedicine (IRIB), 76000 Rouen, France
| | - Richard Leduc
- Department of Physiology & Pharmacology, Institute of Sherbrooke, Faculty of Medicine and Health Sciences, Sherbrooke University, Sherbrooke, QC J1H 5N4, Canada; (M.-A.B.); (R.L.)
| | - Romain Modzelewski
- EA 4108, Laboratory of Computer Science, Information Processing and Systems (LITIS), team “QuantIF”, Centre Henri Becquerel, 76000 Rouen, France; (R.M.); (P.D.); (P.V.); (P.B.)
- Institute for Research and Innovation in Biomedicine (IRIB), 76000 Rouen, France
| | - Pierre Decazes
- EA 4108, Laboratory of Computer Science, Information Processing and Systems (LITIS), team “QuantIF”, Centre Henri Becquerel, 76000 Rouen, France; (R.M.); (P.D.); (P.V.); (P.B.)
- Institute for Research and Innovation in Biomedicine (IRIB), 76000 Rouen, France
| | - Fabrice Morin
- Institute for Research and Innovation in Biomedicine (IRIB), University of Rouen Normandy, INSERM U1239, DC2N, 76000 Rouen, France; (B.P.); (L.D.); (M.P.); (M.D.); (F.M.); (P.G.)
- EA 4108, Laboratory of Computer Science, Information Processing and Systems (LITIS), team “QuantIF”, Centre Henri Becquerel, 76000 Rouen, France; (R.M.); (P.D.); (P.V.); (P.B.)
- Institute for Research and Innovation in Biomedicine (IRIB), 76000 Rouen, France
| | - Pierre Vera
- EA 4108, Laboratory of Computer Science, Information Processing and Systems (LITIS), team “QuantIF”, Centre Henri Becquerel, 76000 Rouen, France; (R.M.); (P.D.); (P.V.); (P.B.)
- Institute for Research and Innovation in Biomedicine (IRIB), 76000 Rouen, France
| | - Hélène Castel
- Institute for Research and Innovation in Biomedicine (IRIB), University of Rouen Normandy, INSERM U1239, DC2N, 76000 Rouen, France; (B.P.); (L.D.); (M.P.); (M.D.); (F.M.); (P.G.)
- Institute for Research and Innovation in Biomedicine (IRIB), 76000 Rouen, France
- Correspondence: ; Tel.: +(33)-2-35-14-66-23
| | - Pierre Bohn
- EA 4108, Laboratory of Computer Science, Information Processing and Systems (LITIS), team “QuantIF”, Centre Henri Becquerel, 76000 Rouen, France; (R.M.); (P.D.); (P.V.); (P.B.)
- Institute for Research and Innovation in Biomedicine (IRIB), 76000 Rouen, France
| | - Pierrick Gandolfo
- Institute for Research and Innovation in Biomedicine (IRIB), University of Rouen Normandy, INSERM U1239, DC2N, 76000 Rouen, France; (B.P.); (L.D.); (M.P.); (M.D.); (F.M.); (P.G.)
- Institute for Research and Innovation in Biomedicine (IRIB), 76000 Rouen, France
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Lemaitre C, Devilder M, Modzelewski R, Dolores M, Montialoux H, Riachi G, Goria O, Michel P, Savoye G, Dacher J, Tamion F, Dechelotte P, Savoye-Collet C. SUN-PO014: Interest of Body Composition Analysis in CT in Cirrhotic Patients with Septic Shock. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32649-4] [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: 11/15/2022]
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Vera P, Mihailescu SD, Lequesne J, Modzelewski R, Bohn P, Hapdey S, Pépin LF, Dubray B, Chaumet-Riffaud P, Decazes P, Thureau S. Radiotherapy boost in patients with hypoxic lesions identified by 18F-FMISO PET/CT in non-small-cell lung carcinoma: can we expect a better survival outcome without toxicity? [RTEP5 long-term follow-up]. Eur J Nucl Med Mol Imaging 2019; 46:1448-1456. [PMID: 30868230 DOI: 10.1007/s00259-019-04285-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [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: 11/20/2018] [Accepted: 02/06/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE Chemoradiotherapy is the reference curative-intent treatment for nonresectable locally advanced non-small-cell lung carcinoma (NSCLC), with unsatisfactory survival, partially due to radiation resistance in hypoxic tissues. The objective was to update survival and toxicity at 3 years following radiotherapy boost to hypoxic tumours in NSCLC patients treated with curative-intent chemoradiotherapy. METHODS This was an open-label, nonrandomized, multicentre, phase II clinical trial. 18F-Fluoromisonidazole (18F-FMISO) PET/CT was used to determine the hypoxic profile of the patients. 18F-FMISO-positive patients and those without organ-at-risk constraints received a radiotherapy boost (70-84 Gy); the others received standard radiotherapy (66 Gy). Overall survival (OS), progression-free survival (PFS) and safety were assessed. RESULTS A total of 54 patients were evaluated. OS and PFS rates at 3 years were 48.5% and 28.8%, respectively. The median OS in the 18F-FMISO-positive patients was 25.8 months and was not reached in the 18F-FMISO-negative patients (p = 0.01). A difference between the groups was also observed for PFS (12 months vs. 26.2 months, p = 0.048). In 18F-FMISO-positive patients, no difference was observed in OS in relation to dose, probably because of the small sample size (p = 0.30). However, the median OS seemed to be in favour of patients who received the radiotherapy boost (26.5 vs. 15.3 months, p = 0.71). In patients who received the radiotherapy boost, no significant late toxicities were observed. CONCLUSION 18F-FMISO uptake in NSCLC patients is strongly associated with features indicating a poor prognosis. In 18F-FMISO-positive patients, the radiotherapy boost seemed to improve the OS by 11.2 months. A further clinical trial is needed to investigate the efficacy of a radiotherapy boost in patients with hypoxic tumours.
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Affiliation(s)
- Pierre Vera
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108 - FR CNRS 3638], Faculty of Medicine, University of Rouen, Rouen, France.
| | - Sorina-Dana Mihailescu
- Department of Statistics and Clinical Research Unit, Henri Becquerel Cancer Center, Rouen, France
| | - Justine Lequesne
- Department of Statistics and Clinical Research Unit, Henri Becquerel Cancer Center, Rouen, France
| | - Romain Modzelewski
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108 - FR CNRS 3638], Faculty of Medicine, University of Rouen, Rouen, France
| | - Pierre Bohn
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108 - FR CNRS 3638], Faculty of Medicine, University of Rouen, Rouen, France
| | - Sébastien Hapdey
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108 - FR CNRS 3638], Faculty of Medicine, University of Rouen, Rouen, France
| | - Louis-Ferdinand Pépin
- Department of Statistics and Clinical Research Unit, Henri Becquerel Cancer Center, Rouen, France
| | - Bernard Dubray
- Department of Radiation Oncology, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108], Rouen, France
| | | | - Pierre Decazes
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108 - FR CNRS 3638], Faculty of Medicine, University of Rouen, Rouen, France
| | - Sébastien Thureau
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108 - FR CNRS 3638], Faculty of Medicine, University of Rouen, Rouen, France
- Department of Radiation Oncology, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108], Rouen, France
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Thiberge C, Charpentier C, Gillibert A, Modzelewski R, Dacher JN, Savoye G, Savoye-Collet C. Lower Subcutaneous or Visceral Adiposity Assessed by Abdominal Computed Tomography Could Predict Adverse Outcome in Patients With Crohn's Disease. J Crohns Colitis 2018; 12:1429-1437. [PMID: 30260374 DOI: 10.1093/ecco-jcc/jjy124] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS Changes in body composition have been described in patients with Crohn's disease, but their predictive performances on disease evolution remain undefined. The aims of our study were to assess, in patients with Crohn's disease requiring abdominal computed tomography, body composition by computed tomography, and to study the outcome according to various body composition parameters at the time of the computed tomography. METHODS Patients with Crohn's disease who underwent abdominal computed tomography for suspected complications were retrospectively included. The definition of adverse outcome included death or need for surgery within 6 months of the computed tomography. Skeletal muscle index and visceral and subcutaneous adiposity indexes were calculated from tissue surface areas measured at the third lumbar vertebra, divided by the height squared. RESULTS The prevalence of underweight was 26.8% and the prevalence of sarcopenia was 33.6%. After gender adjustment, skeletal muscle index tended to be reduced in patients with adverse outcome, compared with patients without surgery or death [p = 0.07]. Moreover, subcutaneous adiposity index and visceral adiposity index were significantly lower in patients with surgery or death [p = 0.009 and p < 0.001, respectively]. These differences were almost equivalent in both genders for the subcutaneous adiposity index but were clearly stronger in men for the visceral adiposity index. CONCLUSIONS Subcutaneous and visceral adiposity indexes correlate inversely with adverse outcome in patients with Crohn's disease. Alteration of body composition assessed by computed tomography in these patients appears to be a marker of disease severity.
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Affiliation(s)
- Claire Thiberge
- Rouen University Hospital, Department of Radiology, Rouen cedex, France
| | - Cloé Charpentier
- Rouen University Hospital, Department of Radiology, Rouen cedex, France.,Department of Gastroenterology, Rouen University Hospital-Charles Nicolle, Rouen cedex, France
| | - André Gillibert
- Department of Biostatistics, Rouen University Hospital-Charles Nicolle, Rouen cedex, France
| | | | | | - Guillaume Savoye
- Department of Gastroenterology, Rouen University Hospital-Charles Nicolle, Rouen cedex, France
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Thureau S, Dubray B, Modzelewski R, Bohn P, Hapdey S, Vincent S, Anger E, Gensanne D, Pirault N, Pierrick G, Vera P. FDG and FMISO PET-guided dose escalation with intensity-modulated radiotherapy in lung cancer. Radiat Oncol 2018; 13:208. [PMID: 30352608 PMCID: PMC6199734 DOI: 10.1186/s13014-018-1147-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 08/14/2018] [Accepted: 10/03/2018] [Indexed: 12/25/2022] Open
Abstract
Background Concomitant chemo-radiotherapy is the reference treatment for non-resectable locally-advanced Non-Small Cell Lung Cancer (NSCLC). Increasing radiotherapy total dose in the whole tumour volume has been shown to be deleterious. Functional imaging with positron emission tomography (PET/CT) offers the potential to identify smaller and biologically meaningful target volumes that could be irradiated with larger doses without compromising Organs At Risk (OAR) tolerance. This study investigated four scenarios, based on 18FDG and 18F-miso PET/CT, to delineate the target volumes and derive radiotherapy plans delivering up to 74Gy. Method Twenty-one NSCLC patients, selected from a prospective phase II trial, had 18FDG- and 18F-miso PET/CT before the start of radiotherapy and 18FDG PET/CT during the radiotherapy (42Gy). The plans were based planned on a standard plan delivering 66 Gy (plan 1) and on three different boost strategies to deliver 74Gy total dose in pre-treatment 18FDG hotspot (70% of SUVmax) (plan 2), pre-treatment 18F-miso target (SUVmax > 1.4) (plan 3) and per-treatment 18FDG residual (40% of SUVmax). (plan 4). Results The mean target volumes were 4.8 cc (± 1.1) for 18FDG hotspot, 38.9 cc (± 14.5) for 18F-miso and 36.0 cc (± 10.1) for per-treatment 18FDG. In standard plan (66 Gy), the mean dose covering 95% of the PTV (D95%) were 66.5 (± 0.33), 66.1 (± 0.32) and 66.1 (± 0.32) Gy for 18FDG hotspot, 18F-miso and per-treatment 18FDG. In scenario 2, the mean D95% was 72.5 (± 0.25) Gy in 18FDG hotspot versus 67.9 (± 0.49) and 67.9 Gy (± 0.52) in 18F-miso and per-treatment 18FDG, respectively. In scenario 3, the mean D95% was 72.2 (± 0.27) Gy to 18F-miso versus 70.4 (± 0.74) and 69.5Gy (± 0.74) for 18FDG hotspot and per-treatment 18FDG, respectively. In scenario 4, the mean D95% was 73.1 (± 0.3) Gy to 18FDG per-treatment versus 71.9 (± 0.61) and 69.8 (± 0.61) Gy for 18FDG hotspot and 18F-miso, respectively. The dose/volume constraints to OARs were matched in all scenarios. Conclusion Escalated doses can be selectively planned in NSCLC target volumes delineated on 18FDG and 18F-miso PET/CT functional images. The most relevant strategy should be investigated in clinical trials. Trial registration (RTEP5, NCT01576796, registered 15 june 2012)
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Affiliation(s)
- Sébastien Thureau
- Department of Radiation Oncology and Medical Physics, Centre Henri Becquerel, QuantIF - LITIS [EA 4108], Université de Normandie, CS 11516, rue d'Amiens, 76038, Rouen Cedex 1, France. .,Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108 - FR CNRS 3638], Faculty of Medicine, University of Rouen, Rouen, France.
| | - Bernard Dubray
- Department of Radiation Oncology and Medical Physics, Centre Henri Becquerel, QuantIF - LITIS [EA 4108], Université de Normandie, CS 11516, rue d'Amiens, 76038, Rouen Cedex 1, France
| | - Romain Modzelewski
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108 - FR CNRS 3638], Faculty of Medicine, University of Rouen, Rouen, France
| | - Pierre Bohn
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108 - FR CNRS 3638], Faculty of Medicine, University of Rouen, Rouen, France
| | - Sébastien Hapdey
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108 - FR CNRS 3638], Faculty of Medicine, University of Rouen, Rouen, France
| | - Sabine Vincent
- Department of Radiation Oncology and Medical Physics, Centre Henri Becquerel, QuantIF - LITIS [EA 4108], Université de Normandie, CS 11516, rue d'Amiens, 76038, Rouen Cedex 1, France
| | - Elodie Anger
- Department of Radiation Oncology and Medical Physics, Centre Henri Becquerel, QuantIF - LITIS [EA 4108], Université de Normandie, CS 11516, rue d'Amiens, 76038, Rouen Cedex 1, France
| | - David Gensanne
- Department of Radiation Oncology and Medical Physics, Centre Henri Becquerel, QuantIF - LITIS [EA 4108], Université de Normandie, CS 11516, rue d'Amiens, 76038, Rouen Cedex 1, France
| | - Nicolas Pirault
- Department of Radiation Oncology and Medical Physics, Centre Henri Becquerel, QuantIF - LITIS [EA 4108], Université de Normandie, CS 11516, rue d'Amiens, 76038, Rouen Cedex 1, France
| | - Gouel Pierrick
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108 - FR CNRS 3638], Faculty of Medicine, University of Rouen, Rouen, France
| | - Pierre Vera
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108 - FR CNRS 3638], Faculty of Medicine, University of Rouen, Rouen, France
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Mallet R, Decazes P, Modzelewski R, Vera P, Dubray B, Lequesne J, Thureau S. Impact pronostique de la sarcopénie chez les patients pris en charge par chimioradiothérapie pour un cancer pulmonaire non à petites cellules. Cancer Radiother 2018. [DOI: 10.1016/j.canrad.2018.07.052] [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: 10/28/2022]
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Thureau S, Gensanne D, Pirault N, Modzelewski R, Gouel P, Bohn P, Hapdey S, Vera P, Dubray B. EP-1401: FDG and FMISO-PET for guided dose escalation with intensity-modulated radiotherapy in lung cancers. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31710-9] [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: 11/30/2022]
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Dandoy S, Modzelewski R, Lebret L, Cabourg M, Veresezan O, Lefebvre L, Clatot F, Thureau S. Impact de la sarcopénie dans les cancers des voies aérodigestives supérieures traités par irradiation. Cancer Radiother 2017. [DOI: 10.1016/j.canrad.2017.08.008] [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]
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Belharbi S, Chatelain C, Hérault R, Adam S, Thureau S, Chastan M, Modzelewski R. Spotting L3 slice in CT scans using deep convolutional network and transfer learning. Comput Biol Med 2017; 87:95-103. [PMID: 28558319 DOI: 10.1016/j.compbiomed.2017.05.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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: 02/28/2017] [Revised: 05/15/2017] [Accepted: 05/17/2017] [Indexed: 11/16/2022]
Abstract
In this article, we present a complete automated system for spotting a particular slice in a complete 3D Computed Tomography exam (CT scan). Our approach does not require any assumptions on which part of the patient's body is covered by the scan. It relies on an original machine learning regression approach. Our models are learned using the transfer learning trick by exploiting deep architectures that have been pre-trained on imageNet database, and therefore it requires very little annotation for its training. The whole pipeline consists of three steps: i) conversion of the CT scans into Maximum Intensity Projection (MIP) images, ii) prediction from a Convolutional Neural Network (CNN) applied in a sliding window fashion over the MIP image, and iii) robust analysis of the prediction sequence to predict the height of the desired slice within the whole CT scan. Our approach is applied to the detection of the third lumbar vertebra (L3) slice that has been found to be representative to the whole body composition. Our system is evaluated on a database collected in our clinical center, containing 642 CT scans from different patients. We obtained an average localization error of 1.91±2.69 slices (less than 5 mm) in an average time of less than 2.5 s/CT scan, allowing integration of the proposed system into daily clinical routines.
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Affiliation(s)
- Soufiane Belharbi
- Normandie Univ, UNIROUEN, UNIHAVRE, INSA Rouen, LITIS, 76000, Rouen, France
| | - Clément Chatelain
- Normandie Univ, UNIROUEN, UNIHAVRE, INSA Rouen, LITIS, 76000, Rouen, France
| | - Romain Hérault
- Normandie Univ, UNIROUEN, UNIHAVRE, INSA Rouen, LITIS, 76000, Rouen, France
| | - Sébastien Adam
- Normandie Univ, UNIROUEN, UNIHAVRE, INSA Rouen, LITIS, 76000, Rouen, France.
| | - Sébastien Thureau
- Henri Becquerel Center, Department of Radiotherapy, 76000, Rouen, France; Normandie Univ, UNIROUEN, UNIHAVRE, INSA Rouen, LITIS, 76000, Rouen, France
| | - Mathieu Chastan
- Henri Becquerel Center, Department of Nuclear Medicine, 76000, Rouen, France
| | - Romain Modzelewski
- Normandie Univ, UNIROUEN, UNIHAVRE, INSA Rouen, LITIS, 76000, Rouen, France; Henri Becquerel Center, Department of Nuclear Medicine, 76000, Rouen, France
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Desbordes P, Ruan S, Modzelewski R, Pineau P, Vauclin S, Gouel P, Michel P, Di Fiore F, Vera P, Gardin I. Predictive value of initial FDG-PET features for treatment response and survival in esophageal cancer patients treated with chemo-radiation therapy using a random forest classifier. PLoS One 2017; 12:e0173208. [PMID: 28282392 PMCID: PMC5345816 DOI: 10.1371/journal.pone.0173208] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 02/16/2017] [Indexed: 12/11/2022] Open
Abstract
Purpose In oncology, texture features extracted from positron emission tomography with 18-fluorodeoxyglucose images (FDG-PET) are of increasing interest for predictive and prognostic studies, leading to several tens of features per tumor. To select the best features, the use of a random forest (RF) classifier was investigated. Methods Sixty-five patients with an esophageal cancer treated with a combined chemo-radiation therapy were retrospectively included. All patients underwent a pretreatment whole-body FDG-PET. The patients were followed for 3 years after the end of the treatment. The response assessment was performed 1 month after the end of the therapy. Patients were classified as complete responders and non-complete responders. Sixty-one features were extracted from medical records and PET images. First, Spearman’s analysis was performed to eliminate correlated features. Then, the best predictive and prognostic subsets of features were selected using a RF algorithm. These results were compared to those obtained by a Mann-Whitney U test (predictive study) and a univariate Kaplan-Meier analysis (prognostic study). Results Among the 61 initial features, 28 were not correlated. From these 28 features, the best subset of complementary features found using the RF classifier to predict response was composed of 2 features: metabolic tumor volume (MTV) and homogeneity from the co-occurrence matrix. The corresponding predictive value (AUC = 0.836 ± 0.105, Se = 82 ± 9%, Sp = 91 ± 12%) was higher than the best predictive results found using the Mann-Whitney test: busyness from the gray level difference matrix (P < 0.0001, AUC = 0.810, Se = 66%, Sp = 88%). The best prognostic subset found using RF was composed of 3 features: MTV and 2 clinical features (WHO status and nutritional risk index) (AUC = 0.822 ± 0.059, Se = 79 ± 9%, Sp = 95 ± 6%), while no feature was significantly prognostic according to the Kaplan-Meier analysis. Conclusions The RF classifier can improve predictive and prognostic values compared to the Mann-Whitney U test and the univariate Kaplan-Meier survival analysis when applied to several tens of features in a limited patient database.
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Affiliation(s)
- Paul Desbordes
- LITIS Quantif – EA4108, University of Rouen, Rouen, France
- Dosisoft, Cachan, France
- * E-mail:
| | - Su Ruan
- LITIS Quantif – EA4108, University of Rouen, Rouen, France
| | - Romain Modzelewski
- LITIS Quantif – EA4108, University of Rouen, Rouen, France
- Nuclear Medicine Department, Henri Becquerel Centre, Rouen, France
| | | | | | - Pierrick Gouel
- Nuclear Medicine Department, Henri Becquerel Centre, Rouen, France
| | - Pierre Michel
- Normandie Univ, UNIROUEN, Inserm 1245, Rouen University Hospital, Department of Hepato-gastroenterology, Rouen, France
| | | | - Pierre Vera
- LITIS Quantif – EA4108, University of Rouen, Rouen, France
- Nuclear Medicine Department, Henri Becquerel Centre, Rouen, France
| | - Isabelle Gardin
- LITIS Quantif – EA4108, University of Rouen, Rouen, France
- Nuclear Medicine Department, Henri Becquerel Centre, Rouen, France
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Chaput A, Calais J, Robin P, Thureau S, Bourhis D, Modzelewski R, Schick U, Vera P, Salaün PY, Abgral R. Correlation between fluorodeoxyglucose hotspots on pretreatment positron emission tomography/CT and preferential sites of local relapse after chemoradiotherapy for head and neck squamous cell carcinoma. Head Neck 2017; 39:1155-1165. [PMID: 28263422 DOI: 10.1002/hed.24738] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 08/26/2016] [Accepted: 12/29/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The potential benefits of 18 F-fluoro-2-deoxy-D-glucose-positron emission tomography/CT (FDG-PET/CT) imaging for radiotherapy (RT) treatment planning of head and neck squamous cell carcinoma (HNSCC) are increasingly being recognized. It has been suggested that intratumoral subvolumes with high FDG avidity ("hotspots") are potential targets for selected dose escalation. The purposes of this study were to demonstrate that pre-RT FDG-PET/CT can identify intratumoral sites at increased risk of local relapse after RT and to determine an optimal threshold to delineate smaller RT target volumes that would facilitate RT dose escalation without impaired tolerance. METHODS Seventy-two consecutive patients with locally advanced HNSCC treated by RT ± chemotherapy were included in this study. All patients underwent FDG-PET/CT at initial staging (PETA ) and during systematic follow-up (PETR ). FDG-PET/CT was coregistered on the initial CT scan with a rigid method. Various subvolumes (AX ; × = 30%, 40%, 50%, 60%, 70%, 80%, and 90% standardized uptake value maximum [SUVmax] thresholds) within the primary tumor and in the subsequent local relapse (RX ; × = 40% and 70% SUVmax thresholds) were compared together (Dice, Jaccard, overlap fraction, common volume/baseline volume, and common volume/recurrent volume). RESULTS Nineteen patients (26%) had local relapses. Using a 40% SUVmax threshold, the initial metabolic tumor volume was significantly higher in patients with local relapses than in controlled patients (10.4 ± 8.6 vs 5.1 ± 4.9 cc; p = .002) as well as total lesion glycolysis (117.9 ± 88.6 vs 60.6 ± 80.4; p = .013). For both methods, the overlap index among A30 , A40 , and A50 subvolumes on PETA and the whole metabolic volume of recurrence R40 and R70 on PETR showed a moderate agreement (0.52 to 0.43). CONCLUSION Our study does not find high overlap index values between the initial tumor and recurrence subvolumes, probably because of a suboptimal coregistration. Our results also confirm that metabolic tumor volume and total lesion glycolysis are independently correlated with recurrence-free survival in patients with HNSCC. Further larger prospective studies with FDG-PET/CT performed in the same RT position and with a validated elastic registration method are needed. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1155-1165, 2017.
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Affiliation(s)
- Anne Chaput
- Department of Nuclear Medicine, Brest University Hospital, Brest, France
| | - Jérémie Calais
- Department of Nuclear Medicine, Bichat University Hospital, Inserm 1148, DHU FIRE, Assistance Publique - Hôpitaux de Paris, Paris, France.,Department of Nuclear Medicine and Radiology, Henri Becquerel Center, QuantIF (LITIS EA 4108 - FR CNRS 3638), Rouen University Hospital, Rouen, France
| | - Philippe Robin
- Department of Nuclear Medicine, Brest University Hospital, Brest, France.,European University of Brittany, EA3878 GETBO, IFR 148, Brest, France
| | - Sébastien Thureau
- Department of Nuclear Medicine and Radiology, Henri Becquerel Center, QuantIF (LITIS EA 4108 - FR CNRS 3638), Rouen University Hospital, Rouen, France
| | - David Bourhis
- Department of Nuclear Medicine, Brest University Hospital, Brest, France
| | - Romain Modzelewski
- Department of Nuclear Medicine and Radiology, Henri Becquerel Center, QuantIF (LITIS EA 4108 - FR CNRS 3638), Rouen University Hospital, Rouen, France
| | - Ulrike Schick
- Department of Radiotherapy, Brest University Hospital, Brest, France
| | - Pierre Vera
- Department of Nuclear Medicine and Radiology, Henri Becquerel Center, QuantIF (LITIS EA 4108 - FR CNRS 3638), Rouen University Hospital, Rouen, France
| | - Pierre-Yves Salaün
- Department of Nuclear Medicine, Brest University Hospital, Brest, France.,European University of Brittany, EA3878 GETBO, IFR 148, Brest, France
| | - Ronan Abgral
- Department of Nuclear Medicine, Brest University Hospital, Brest, France.,European University of Brittany, EA3878 GETBO, IFR 148, Brest, France
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Vera P, Thureau S, Chaumet-Riffaud P, Modzelewski R, Bohn P, Vermandel M, Hapdey S, Pallardy A, Mahé MA, Lacombe M, Boisselier P, Guillemard S, Olivier P, Beckendorf V, Salem N, Charrier N, Chajon E, Devillers A, Aide N, Danhier S, Denis F, Muratet JP, Martin E, Riedinger AB, Kolesnikov-Gauthier H, Dansin E, Massabeau C, Courbon F, Farcy Jacquet MP, Kotzki PO, Houzard C, Mornex F, Vervueren L, Paumier A, Fernandez P, Salaun M, Dubray B. Phase II Study of a Radiotherapy Total Dose Increase in Hypoxic Lesions Identified by 18F-Misonidazole PET/CT in Patients with Non-Small Cell Lung Carcinoma (RTEP5 Study). J Nucl Med 2017; 58:1045-1053. [PMID: 28254869 DOI: 10.2967/jnumed.116.188367] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [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: 12/08/2016] [Accepted: 02/07/2017] [Indexed: 01/09/2023] Open
Abstract
See an invited perspective on this article on page 1043.This multicenter phase II study investigated a selective radiotherapy dose increase to tumor areas with significant 18F-misonidazole (18F-FMISO) uptake in patients with non-small cell lung carcinoma (NSCLC). Methods: Eligible patients had locally advanced NSCLC and no contraindication to concomitant chemoradiotherapy. The 18F-FMISO uptake on PET/CT was assessed by trained experts. If there was no uptake, 66 Gy were delivered. In 18F-FMISO-positive patients, the contours of the hypoxic area were transferred to the radiation oncologist. It was necessary for the radiotherapy dose to be as high as possible while fulfilling dose-limiting constraints for the spinal cord and lungs. The primary endpoint was tumor response (complete response plus partial response) at 3 mo. The secondary endpoints were toxicity, disease-free survival (DFS), and overall survival at 1 y. The target sample size was set to demonstrate a response rate of 40% or more (bilateral α = 0.05, power 1-β = 0.95). Results: Seventy-nine patients were preincluded, 54 were included, and 34 were 18F-FMISO-positive, 24 of whom received escalated doses of up to 86 Gy. The response rate at 3 mo was 31 of 54 (57%; 95% confidence interval [CI], 43%-71%) using RECIST 1.1 (17/34 responders in the 18F-FMISO-positive group). DFS and overall survival at 1 y were 0.86 (95% CI, 0.77-0.96) and 0.63 (95% CI, 0.49-0.74), respectively. DFS was longer in the 18F-FMISO-negative patients (P = 0.004). The radiotherapy dose was not associated with DFS when adjusting for the 18F-FMISO status. One toxic death (66 Gy) and 1 case of grade 4 pneumonitis (>66 Gy) were reported. Conclusion: Our approach results in a response rate of 40% or more, with acceptable toxicity. 18F-FMISO uptake in NSCLC patients is strongly associated with poor prognosis features that could not be reversed by radiotherapy doses up to 86 Gy.
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Affiliation(s)
- Pierre Vera
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital & QuantIF-LITIS, University of Rouen, Rouen, France
| | - Sébastien Thureau
- Department of Radiation Oncology and Medical Physics, Henri Becquerel Cancer Center and Rouen University Hospital & QuantIF-LITIS, Rouen, France
| | - Philippe Chaumet-Riffaud
- Department of Nuclear Medicine, Hôpitaux universitaires Paris Sud Bicêtre AP-HP and University Paris Sud, Paris, France
| | - Romain Modzelewski
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital & QuantIF-LITIS, University of Rouen, Rouen, France
| | - Pierre Bohn
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital & QuantIF-LITIS, University of Rouen, Rouen, France
| | - Maximilien Vermandel
- University Lille, Inserm, CHU Lille, U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, Lille, France
| | - Sébastien Hapdey
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital & QuantIF-LITIS, University of Rouen, Rouen, France
| | - Amandine Pallardy
- Department of Nuclear Medicine, Nantes University Hospital, Nantes, France
| | - Marc-André Mahé
- Department of Radiation Oncology, Institut de Cancérologie de l'Ouest (ICO)-René Gauducheau, Nantes, France
| | - Marie Lacombe
- Department of Nuclear Medicine, Institut de Cancérologie de l'Ouest (ICO), Nantes, France
| | - Pierre Boisselier
- Department of Radiation Oncology, Institut régional du Cancer Montpellier (ICM), Montpellier, France
| | - Sophie Guillemard
- Department of Nuclear Medicine, Institut régional du Cancer Montpellier (ICM), Montpellier, France
| | - Pierre Olivier
- Department of Nuclear Medicine, Brabois University Hospital, Nancy, France
| | - Veronique Beckendorf
- Department of Radiation Oncology, Institut de Cancérologie de Lorraine, Nancy, France
| | - Naji Salem
- Department of Radiation Oncology, Institut Paoli Calmette, Marseille, France
| | - Nathalie Charrier
- Department of Nuclear Medicine, Institut Paoli Calmette, Marseille, France
| | - Enrique Chajon
- Department of Radiation Oncology, Centre regional de lutte contre le cancer de Bretagne Eugène Marquis, Rennes, France
| | - Anne Devillers
- Department of Nuclear Medicine, Centre regional de lutte contre le cancer de Bretagne Eugène Marquis, Rennes, France
| | - Nicolas Aide
- Nicolas Aide, Nuclear Medicine and TEP Centre, Caen University Hospital and Inserm U1086 ANTICIPE, Caen, France
| | - Serge Danhier
- Department of Radiation Oncology, François Baclesse Cancer Center, Caen, France
| | - Fabrice Denis
- Department of Radiation Oncology, Institut Inter-Régional de Cancérologie (ILC), Centre Jean Bernard/Clinique Victor Hugo, Le Mans, France
| | - Jean-Pierre Muratet
- Department of Nuclear Medicine, Institut Inter-Régional de Cancérologie (ILC), Centre Jean Bernard/Clinique Victor Hugo, Le Mans, France
| | - Etienne Martin
- Radiation Oncology, Centre Georges-Francois Leclerc, Dijon, France
| | | | | | - Eric Dansin
- Department of Radiation Oncology, Oscar Lambret Center, Lille cedex, France
| | - Carole Massabeau
- Département de Radiothérapie. Institut Universitaire du Cancer, Toulouse cedex 9, France
| | - Fredéric Courbon
- Department of Nuclear Medicine, Institut Claudius Regaud, IUCT, Toulouse cedex 9, France
| | - Marie-Pierre Farcy Jacquet
- Department of Radiation Oncology, CHU de Nîmes, Institut de cancérologie du Gard, Rue Henri Pujol, Nîmes, France
| | - Pierre-Olivier Kotzki
- Department of Nuclear Medicine, Institut régional du Cancer Montpellier (ICM), Montpellier, France.,Department of Nuclear Medicine, CHU de Nîmes, Institut de cancérologie du Gard, Nîmes, France
| | - Claire Houzard
- Department of Nuclear Medicine, Hospices Civils de Lyon, Lyon, France
| | - Francoise Mornex
- Department of Radiation Oncology, Hospices Civils de Lyon, Lyon, France
| | | | - Amaury Paumier
- Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, site Paul Papin, France
| | - Philippe Fernandez
- Department of Nuclear Medicine, Hôpital Pellegrin, CHU de Bordeaux, France; and
| | - Mathieu Salaun
- Normandy University, UNIROUEN, QuantIF-LITIS EA 4108, Rouen University Hospital, Department of Pulmonology-Thoracic Oncology-Respiratory Intensive Care, Rouen, France
| | - Bernard Dubray
- Department of Radiation Oncology and Medical Physics, Henri Becquerel Cancer Center and Rouen University Hospital & QuantIF-LITIS, Rouen, France
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Marion-Letellier R, Bohn P, Modzelewski R, Vera P, Aziz M, Guérin C, Savoye G, Savoye-Collet C. SPECT-computed tomography in rats with TNBS-induced colitis: A first step toward functional imaging. World J Gastroenterol 2017; 23:216-223. [PMID: 28127195 PMCID: PMC5236501 DOI: 10.3748/wjg.v23.i2.216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 09/06/2016] [Accepted: 09/28/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the feasibility of SPECT-computed tomography (CT) in rats with trinitrobenzene sulfonic acid (TNBS)-induced acute colitis and confront it with model inflammatory characteristics.
METHODS Colitis was induced in Sprague-Dawley rats by intrarectal injection of TNBS (n = 10) while controls received vehicle (n = 10). SPECT-CT with intravenous injection of 10 MBq of 67Ga-Citrate was performed at day 2. SPECT-CT criteria were colon wall thickness and maximal wall signal intensity. Laboratory parameters were assessed: colon weight:length ratio, colon cyclooxygenase-2 expression by western blot and histological inflammatory score.
RESULTS Colon weight/length ratio, colon COX-2 expression and histological inflammatory score were significantly higher in the TNBS group than in the control group (P = 0.0296, P < 0.0001, P = 0.0007 respectively). Pixel max tend to be higher in the TNBS group than in the control group but did not reach statistical significance (P = 0.0662). Maximal thickness is significantly increased in the TNBS group compared to the control group (P = 0.0016) while colon diameter is not (P = 0.1904). Maximal thickness and colon diameter were correlated to colon COX-2 expression (P = 0.0093, P = 0.009 respectively) while pixel max was not (P = 0.22). Maximal thickness was significantly increased when inflammation was histologically observed (P = 0.0043) while pixel max and colon diameter did not (P = 0.2452, P = 0.3541, respectively).
CONCLUSION SPECT-CT is feasible and easily distinguished control from colitic rats.
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Cottereau AS, Hapdey S, Chartier L, Modzelewski R, Casasnovas O, Itti E, Tilly H, Vera P, Meignan MA, Becker S. Baseline Total Metabolic Tumor Volume Measured with Fixed or Different Adaptive Thresholding Methods Equally Predicts Outcome in Peripheral T Cell Lymphoma. J Nucl Med 2016; 58:276-281. [PMID: 27754905 DOI: 10.2967/jnumed.116.180406] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [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: 06/29/2016] [Accepted: 09/08/2016] [Indexed: 01/14/2023] Open
Abstract
The purpose of this study was to compare in a large series of peripheral T cell lymphoma, as a model of diffuse disease, the prognostic value of baseline total metabolic tumor volume (TMTV) measured on 18F-FDG PET/CT with adaptive thresholding methods with TMTV measured with a fixed 41% SUVmax threshold method. METHODS One hundred six patients with peripheral T cell lymphoma, staged with PET/CT, were enrolled from 5 Lymphoma Study Association centers. In this series, TMTV computed with the 41% SUVmax threshold is a strong predictor of outcome. On a dedicated workstation, we measured the TMTV with 4 adaptive thresholding methods based on characteristic image parameters: Daisne (Da) modified, based on signal-to-background ratio; Nestle (Ns), based on tumor and background intensities; Fit, including a 3-dimensional geometric model based on spatial resolution (Fit); and Black (Bl), based on mean SUVmax The TMTV values obtained with each adaptive method were compared with those obtained with the 41% SUVmax method. Their respective prognostic impacts on outcome prediction were compared using receiver-operating-characteristic (ROC) curve analysis and Kaplan-Meier survival curves. RESULTS The median value of TMTV41%, TMTVDa, TMTVNs, TMTVFit, and TMTVBl were, respectively, 231 cm3 (range, 5-3,824), 175 cm3 (range, 8-3,510), 198 cm3 (range, 3-3,934), 175 cm3 (range, 8-3,512), and 333 cm3 (range, 3-5,113). The intraclass correlation coefficients were excellent, from 0.972 to 0.988, for TMTVDa, TMTVFit, and TMTVNs, and less good for TMTVBl (0.856). The mean differences obtained from the Bland-Altman plots were 48.5, 47.2, 19.5, and -253.3 cm3, respectively. Except for Black, there was no significant difference within the methods between the ROC curves (P > 0.4) for progression-free survival and overall survival. Survival curves with the ROC optimal cutoff for each method separated the same groups of low-risk (volume ≤ cutoff) from high-risk patients (volume > cutoff), with similar 2-y progression-free survival (range, 66%-72% vs. 26%-29%; hazard ratio, 3.7-4.1) and 2-y overall survival (79%-83% vs. 50%-53%; hazard ratio, 3.0-3.5). CONCLUSION The prognostic value of TMTV remained quite similar whatever the methods, adaptive or 41% SUVmax, supporting its use as a strong prognosticator in lymphoma. However, for implementation of TMTV in clinical trials 1 single method easily applicable in a multicentric PET review must be selected and kept all along the trial.
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Affiliation(s)
- Anne-Ségolène Cottereau
- Nuclear Medicine Department, Hôpital Henri Mondor, University Paris-Est Créteil, Créteil, France
| | - Sebastien Hapdey
- Nuclear Medicine Department, Henri Becquerel Cancer Center and Rouen University Hospital, Rouen, France.,QuantIF-LITIS (EA [Equipe d'Accueil] 4108), Faculty of Medicine, University of Rouen, Rouen, France
| | - Loic Chartier
- Department of Biostatistics (LYSARC), Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Romain Modzelewski
- Nuclear Medicine Department, Henri Becquerel Cancer Center and Rouen University Hospital, Rouen, France.,QuantIF-LITIS (EA [Equipe d'Accueil] 4108), Faculty of Medicine, University of Rouen, Rouen, France
| | | | - Emmanuel Itti
- Nuclear Medicine Department, Hôpital Henri Mondor, University Paris-Est Créteil, Créteil, France
| | - Herve Tilly
- Hematology Department, UMR918, Henri Becquerel Cancer Center and Rouen University Hospital, Rouen, France
| | - Pierre Vera
- Nuclear Medicine Department, Henri Becquerel Cancer Center and Rouen University Hospital, Rouen, France.,QuantIF-LITIS (EA [Equipe d'Accueil] 4108), Faculty of Medicine, University of Rouen, Rouen, France
| | - Michel A Meignan
- Nuclear Medicine Department, Hôpital Henri Mondor, University Paris-Est Créteil, Créteil, France
| | - Stéphanie Becker
- Nuclear Medicine Department, Henri Becquerel Cancer Center and Rouen University Hospital, Rouen, France.,QuantIF-LITIS (EA [Equipe d'Accueil] 4108), Faculty of Medicine, University of Rouen, Rouen, France
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Becker S, Bohn P, Bouyeure-Petit AC, Modzelewski R, Gensanne D, Picquenot JM, Dubray B, Vera P. Bevacizumab enhances efficiency of radiotherapy in a lung adenocarcinoma rodent model: Role of αvβ3 imaging in determining optimal window. Nucl Med Biol 2015; 42:923-30. [DOI: 10.1016/j.nucmedbio.2015.08.002] [Citation(s) in RCA: 8] [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] [Received: 06/15/2015] [Revised: 07/30/2015] [Accepted: 08/10/2015] [Indexed: 11/25/2022]
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Thureau S, Modzelewski R, Dubray B, Vera P. Corrélation entre les zones les plus hypermétaboliques par fluorodésoxyglucose (hotspot) et la fixation du fluoromisonidazole dans les cancers bronchiques non à petites cellules. Cancer Radiother 2015. [DOI: 10.1016/j.canrad.2015.07.041] [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: 10/23/2022]
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Calais J, Dubray B, Nkhali L, Thureau S, Lemarignier C, Modzelewski R, Gardin I, Di Fiore F, Michel P, Vera P. High FDG uptake areas on pre-radiotherapy PET/CT identify preferential sites of local relapse after chemoradiotherapy for locally advanced oesophageal cancer. Eur J Nucl Med Mol Imaging 2015; 42:858-67. [PMID: 25680400 DOI: 10.1007/s00259-015-3004-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Accepted: 01/16/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE The high failure rates in the radiotherapy (RT) target volume suggest that patients with locally advanced oesophageal cancer (LAOC) would benefit from increased total RT doses. High 2-deoxy-2-[(18)F]fluoro-D-glucose (FDG) uptake (hotspot) on pre-RT FDG positron emission tomography (PET)/CT has been reported to identify intra-tumour sites at increased risk of relapse after RT in non-small cell lung cancer and in rectal cancer. Our aim was to confirm these observations in patients with LAOC and to determine the optimal maximum standardized uptake value (SUVmax) threshold to delineate smaller RT target volumes that would facilitate RT dose escalation without impaired tolerance. METHODS The study included 98 consecutive patients with LAOC treated by chemoradiotherapy (CRT). All patients underwent FDG PET/CT at initial staging and during systematic follow-up in a single institution. FDG PET/CT acquisitions were coregistered on the initial CT scan. Various subvolumes within the initial tumour (30, 40, 50, 60, 70, 80 and 90% SUVmax thresholds) and in the subsequent local recurrence (LR, 40 and 90% SUVmax thresholds) were pasted on the initial CT scan and compared[Dice, Jaccard, overlap fraction (OF), common volume/baseline volume, common volume/recurrent volume]. RESULTS Thirty-five patients had LR. The initial metabolic tumour volume was significantly higher in LR tumours than in the locally controlled tumours (mean 25.4 vs 14.2 cc; p = 0.002). The subvolumes delineated on initial PET/CT with a 30-60% SUVmax threshold were in good agreement with the recurrent volume at 40% SUVmax (OF = 0.60-0.80). The subvolumes delineated on initial PET/CT with a 30-60% SUVmax threshold were in good to excellent agreement with the core volume (90% SUVmax) of the relapse (common volume/recurrent volume and OF indices 0.61-0.89). CONCLUSION High FDG uptake on pretreatment PET/CT identifies tumour subvolumes that are at greater risk of recurrence after CRT in patients with LAOC. We propose a 60% SUVmax threshold to delineate high FDG uptake areas on initial PET/CT as reduced target volumes for RT dose escalation.
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Affiliation(s)
- Jérémie Calais
- Nuclear Medicine Department, Henri Becquerel Cancer Center and Rouen University Hospital, Rouen, France,
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Calais J, Thureau S, Dubray B, Modzelewski R, Thiberville L, Gardin I, Vera P. Areas of high 18F-FDG uptake on preradiotherapy PET/CT identify preferential sites of local relapse after chemoradiotherapy for non-small cell lung cancer. J Nucl Med 2015; 56:196-203. [PMID: 25572091 DOI: 10.2967/jnumed.114.144253] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
UNLABELLED The high rates of failure in the radiotherapy target volume suggest that patients with stage II or III non-small cell lung cancer (NSCLC) should receive an increased total dose of radiotherapy. Areas of high (18)F-FDG uptake on preradiotherapy (18)F-FDG PET/CT have been reported to identify intratumor subvolumes at high risk of relapse after radiotherapy. We wanted to confirm these observations on a cohort of patients included in 3 sequential prospective studies. Our aim was to assess an appropriate threshold (percentage of maximum standardized uptake value [SUVmax]) to delineate subvolumes on staging (18)F-FDG PET/CT scans assuming that a smaller target volume would facilitate isotoxic radiotherapy dose escalation. METHODS Thirty-nine patients with inoperable stage II or III NSCLC, treated with chemoradiation or with radiotherapy alone, were extracted from 3 prospective studies (ClinicalTrials.gov identifiers NCT01261585, NCT01261598, and RECF0645). All patients underwent (18)F-FDG PET/CT at initial staging, before radiotherapy, during radiotherapy, and during systematic follow-up in a single institution. All (18)F-FDG PET/CT acquisitions were coregistered on the initial scan. Various subvolumes in the initial acquisition (30%, 40%, 50%, 60%, 70%, 80%, and 90% SUVmax thresholds) and in the 3 subsequent acquisitions (40% and 90% SUVmax thresholds) were pasted on the initial scan and compared. RESULTS Seventeen patients had a local relapse. The SUVmax measured during radiotherapy was significantly higher in locally relapsed tumors than in locally controlled tumors (mean, 6.8 vs. 4.6; P = 0.02). The subvolumes delineated on initial PET/CT scans with 70%-90% SUVmax thresholds were in good agreement with the recurrent volume at a 40% SUVmax threshold (common volume/baseline volume, 0.60-0.80). The subvolumes delineated on initial PET/CT scans with 30%-60% SUVmax thresholds were in good to excellent agreement with the core volume of the relapse (90% SUVmax threshold) (common volume/recurrent volume and overlap fraction indices, 0.60-0.93). The agreement was moderate (>0.51) when a 70% SUVmax threshold was used to delineate on initial PET/CT scans. CONCLUSION High (18)F-FDG uptake areas on pretreatment PET/CT scans identify tumor subvolumes at greater risk of relapse in patients with NSCLC treated by concomitant chemoradiation. We propose a 70% SUVmax threshold to delineate areas of high (18)F-FDG uptake on initial PET/CT scans as the target volumes for potential radiotherapy dose escalation.
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Affiliation(s)
- Jérémie Calais
- Nuclear Medicine Department, Henri Becquerel Cancer Center and Rouen University Hospital, Rouen, France QuantIF-LITIS (EA [Equipe d'Accueil] 4108-FR CNRS [Fédération de Recherche-Centre National pour la Recherche Scientifique] 3638), Faculty of Medicine, University of Rouen, Rouen, France
| | - Sébastien Thureau
- Nuclear Medicine Department, Henri Becquerel Cancer Center and Rouen University Hospital, Rouen, France QuantIF-LITIS (EA [Equipe d'Accueil] 4108-FR CNRS [Fédération de Recherche-Centre National pour la Recherche Scientifique] 3638), Faculty of Medicine, University of Rouen, Rouen, France Department of Radiotherapy and Medical Physics, Henri Becquerel Cancer Centre and Rouen University Hospital, Rouen, France; and
| | - Bernard Dubray
- QuantIF-LITIS (EA [Equipe d'Accueil] 4108-FR CNRS [Fédération de Recherche-Centre National pour la Recherche Scientifique] 3638), Faculty of Medicine, University of Rouen, Rouen, France Department of Radiotherapy and Medical Physics, Henri Becquerel Cancer Centre and Rouen University Hospital, Rouen, France; and
| | - Romain Modzelewski
- Nuclear Medicine Department, Henri Becquerel Cancer Center and Rouen University Hospital, Rouen, France QuantIF-LITIS (EA [Equipe d'Accueil] 4108-FR CNRS [Fédération de Recherche-Centre National pour la Recherche Scientifique] 3638), Faculty of Medicine, University of Rouen, Rouen, France Department of Radiotherapy and Medical Physics, Henri Becquerel Cancer Centre and Rouen University Hospital, Rouen, France; and
| | - Luc Thiberville
- QuantIF-LITIS (EA [Equipe d'Accueil] 4108-FR CNRS [Fédération de Recherche-Centre National pour la Recherche Scientifique] 3638), Faculty of Medicine, University of Rouen, Rouen, France Department of Pneumology, Rouen University Hospital, Rouen, France
| | - Isabelle Gardin
- Nuclear Medicine Department, Henri Becquerel Cancer Center and Rouen University Hospital, Rouen, France QuantIF-LITIS (EA [Equipe d'Accueil] 4108-FR CNRS [Fédération de Recherche-Centre National pour la Recherche Scientifique] 3638), Faculty of Medicine, University of Rouen, Rouen, France Department of Radiotherapy and Medical Physics, Henri Becquerel Cancer Centre and Rouen University Hospital, Rouen, France; and
| | - Pierre Vera
- Nuclear Medicine Department, Henri Becquerel Cancer Center and Rouen University Hospital, Rouen, France QuantIF-LITIS (EA [Equipe d'Accueil] 4108-FR CNRS [Fédération de Recherche-Centre National pour la Recherche Scientifique] 3638), Faculty of Medicine, University of Rouen, Rouen, France
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Salaün M, Modzelewski R, Marie JP, Moreno-Swirc S, Bourg-Heckly G, Thiberville L. In vivo assessment of the pulmonary microcirculation in elastase-induced emphysema using probe-based confocal fluorescence microscopy. IntraVital 2014. [DOI: 10.4161/intv.23471] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Onoma DP, Ruan S, Thureau S, Nkhali L, Modzelewski R, Monnehan GA, Vera P, Gardin I. Segmentation of heterogeneous or small FDG PET positive tissue based on a 3D-locally adaptive random walk algorithm. Comput Med Imaging Graph 2014; 38:753-63. [PMID: 25450759 DOI: 10.1016/j.compmedimag.2014.09.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [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: 09/20/2013] [Revised: 08/19/2014] [Accepted: 09/19/2014] [Indexed: 10/24/2022]
Abstract
A segmentation algorithm based on the random walk (RW) method, called 3D-LARW, has been developed to delineate small tumors or tumors with a heterogeneous distribution of FDG on PET images. Based on the original algorithm of RW [1], we propose an improved approach using new parameters depending on the Euclidean distance between two adjacent voxels instead of a fixed one and integrating probability densities of labels into the system of linear equations used in the RW. These improvements were evaluated and compared with the original RW method, a thresholding with a fixed value (40% of the maximum in the lesion), an adaptive thresholding algorithm on uniform spheres filled with FDG and FLAB method, on simulated heterogeneous spheres and on clinical data (14 patients). On these three different data, 3D-LARW has shown better segmentation results than the original RW algorithm and the three other methods. As expected, these improvements are more pronounced for the segmentation of small or tumors having heterogeneous FDG uptake.
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Affiliation(s)
- D P Onoma
- LITIS EA 4108 - QuantIF, University of Rouen, France; LPNR, UFR-SSMT, University of Cocody, 22 BP 582 Abidjan 22, Côte d'Ivoire.
| | - S Ruan
- LITIS EA 4108 - QuantIF, University of Rouen, France
| | - S Thureau
- LITIS EA 4108 - QuantIF, University of Rouen, France; Department of Nuclear Medicine, Centre Henri-Becquerel & LITIS EA 4108 - QuantIF, France
| | - L Nkhali
- LITIS EA 4108 - QuantIF, University of Rouen, France; Department of Nuclear Medicine, Centre Henri-Becquerel & LITIS EA 4108 - QuantIF, France
| | - R Modzelewski
- LITIS EA 4108 - QuantIF, University of Rouen, France; Department of Nuclear Medicine, Centre Henri-Becquerel & LITIS EA 4108 - QuantIF, France
| | - G A Monnehan
- LPNR, UFR-SSMT, University of Cocody, 22 BP 582 Abidjan 22, Côte d'Ivoire
| | - P Vera
- LITIS EA 4108 - QuantIF, University of Rouen, France; Department of Nuclear Medicine, Centre Henri-Becquerel & LITIS EA 4108 - QuantIF, France
| | - I Gardin
- LITIS EA 4108 - QuantIF, University of Rouen, France; Department of Nuclear Medicine, Centre Henri-Becquerel & LITIS EA 4108 - QuantIF, France.
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Hapdey S, Edet-Sanson A, Gouel P, Martin B, Modzelewski R, Baron M, Berghian A, Forestier-Lebreton F, Georgescu D, Picquenot JM, Gardin I, Dubray B, Vera P. Delineation of small mobile tumours with FDG-PET/CT in comparison to pathology in breast cancer patients. Radiother Oncol 2014; 112:407-12. [DOI: 10.1016/j.radonc.2014.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 07/08/2014] [Accepted: 08/06/2014] [Indexed: 12/21/2022]
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Kraft J, Fechter T, Götz I, Papke T, Modzelewski R, Lemarignier C, Chirindel A, Gardin I, Grosu A, Nestle U. Evaluation and Comparison of Segmentation Algorithms in Low Contrast FET-PET Scans for Gross Tumor Volume Delineation. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.2361] [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: 10/24/2022]
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Lemarignier C, Di Fiore F, Marre C, Hapdey S, Modzelewski R, Gouel P, Michel P, Dubray B, Vera P. Pretreatment metabolic tumour volume is predictive of disease-free survival and overall survival in patients with oesophageal squamous cell carcinoma. Eur J Nucl Med Mol Imaging 2014; 41:2008-16. [DOI: 10.1007/s00259-014-2839-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 06/16/2014] [Indexed: 12/22/2022]
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