Adapting Biological Feedback in Radiotherapy Eirik Malinen

Introduction • Tumor and normal tissue function is not spatially homogenous • Tissue characteristics change during fractionated radiotherapy • Quantitative volumetric imaging for monitoring functional changes • Adapt treatment to spatial changes

Tumors

FDG-PET, H&N, pre and post RT Annals of Oncology 21, 1078–1082

FDG-PET, H&N, patterns of failure Recurrent volume on IMRT CT scan original PET scan • 9/9 of failures were in-field, 8/9 were inside pretreatment PET-BTV. Radiother Oncol 89, 13–18

FDG-PET-based adaptive dose painting Int J Radiat Oncol Biol Phys 80, 1045-1055

FDG-PET, NSCLC, time trends Radiother Oncol 82, 145–152 Int J Radiat Oncol Biol Phys 71, 1402-1407

FDG-PET, NSCLC, residual uptake post RT Radiotherapy and Oncology 91, 386–392

Reproducibility J Nucl Med 51, 1368–1376

DWI, H&N Pre Tx Wk1 Tx Post Tx Am J Roentgen 32, 1904–1910 Clin Cancer Res 15, 986-994

MRSI and fMRI, gliomas Br J Radiol 80, 347–354

DCEMRI, cancers of the uterine cervix See talks by E. Andersen, Thursday 16:20 C. Halle, Friday 12:30 Int J Radiat Oncol Biol Phys 77, 502–508

DCEMRI monitoring, spontaneous canine tumors Acta Oncol 47, 1249-1256 Radiother Oncol 93, 618-624

Contrast-enhanced cone beam CT Radiother Oncol 97, 521-524 Acta Oncol 49, 972-977

Serial imaging and prescription Int J Radiat Oncol Biol Phys 68, 1496-1504

Normal tissue

Lung perfusion – SPECT Base plan SPECT plan Int J Radiat Oncol Biol Phys 66, 1543-1552

Lung inflammation and RILT – FDG-PET • Intense pre-RT uptake in lung associated with RILT • Intense uptake + dose > 2-5 Gy most significant Radiother Oncol 93, 618-624

4D-CT assessment of lung function Pre-RT Post-RT Difference Dose distribution Med Phys 37, 1261-1273

Cardiac perfusion – SPECT Int J Radiat Oncol Biol Phys 63, 214-223

DCECT – liver • Perfusion correlated with liver function • Doses > 45 Gy gave perfusion shut-down Int J Radiat Oncol Biol Phys 70, 154-160

Adaptive strategies A. Compare images B. Compare plans Semin Radiat Oncol 20, 138-146

Costs • Imaging session: CT - 1 u, MR - 3 u, PET - 9 u • Planning session: 3 u • Fractionated treatment (35 fr): 70 u

Acknowledgements Dag Rune Olsen & Åste Søvik

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