how to integrate more effective systemic treatment into combined modality treatment?
TRANSCRIPT
How to integrate more effective systemic treatment into combined modality treatment?
T0
Pre-treatment Treatment
T1 T2 TN
…
An
ato
mic
al
Fun
ctio
nal
Time
Info
rmati
on
Combination of physics and biology for treatment optimization/adaptation
10 patients
PET FDG
F-MISO
CT
MR
TME (10)
5 patientsPET FDG
FLTCTMRTME (7)
……..Week 1 Week 2 Week 3 Week 4 Week 5 Surgery
1 2 3
1 2 3
MR
Delineation MR: manually
1 2 3
CT
FDG
CT
FLT
Signal to Background
Daisne JF, Radioth Oncol, 2003 J. Lee, 2006
background
tumor
Watershed & Clustering
FDG
FMISO
FLT
Delineation FDG signal: SBR & WCA
Deformed FDG
FMISO signal
Delineation FLT/FMISO signal: WCA + ROI (FDG)
M R - FD G volume (cc)
M R FD G SBR FD G W CA-10
0
10
20
30
40
50
60
70
80 Before R T D uring R T After R T
M eanBox: M ean±SEW hisker: M ean±SD
Mean STDEV Mean STDEV Mean STDEV
Before RT
27,1(100%)
16,5 18,3(100%)
12,415,5
(100%) 10,6
During RT
13,4(47%)
10,2 11,4(65%)
8,17,2
(46%) 6,7
After RT6,7
(25%) 5,7 4,9
(25%) 4,3
2,5(13%)
2,3
n=15
MR FDG (SBR) FDG (WCA)
FD G - FLT volume (cc)
FD G (W C A) FLT (W C A)
G R O U P
-2
0
2
4
6
8
10
12
14
16
18
20M eanBox: M ean±SEW hisker: M ean±SD
before R T during RT
FDG - FM ISO volume (cc)
FDG (W CA) FM ISO (W CA)-10
0
10
20
30
40
50M eanBox: M ean±SEW hisker: M ean±SD
before RT during RT
FDG (WCA) FMISO (WCA)
n=10
FDG (WCA) FLT (WCA)
n=5
Mean STDEV Mean STDEV
Before RT 14,8 7,3 5,2 3,8
During RT 7,3 7,6 1,6 1,5
Mean STDEV Mean STDEV
Before RT 14,5 6,0 9,2 3,3
During RT 5,3 3,9 4,0 2,4
Multi-temporal image registration of FDG PET-CT images Rigid within tumor volume
Biological Follow-up imaging during RT treatment
before radiotherapy
during therapy
after therapy
CT Image Registration
CT CT CT
CT
PET PET PET
PET
PET
PET
FDG volume Mismatch FDG MR volume MR mismatch
Mean Before RT 16 47% 27 69%
During RT 7 53% 13 79%
After RT 2 68% 7 85%
range Before RT 4-46 20%-100% 11-75 27%-100%
During RT 2-27 12%-99% 4-42 60%-99%
After RT 0-7 35%-100% 0,5-20 44%-100%
mismatch A-B = B-A/B (%)
mismatch B-A = A-B/A (%)
mismatch A-B = 0%
Mismatch FDG-MR