Name: dynamic lung tumor tracking for stereotactic ablative body radiation therapy
Uploaded: 2015-06-07T15:00:00.000+00:00
Duration: 8 min 17 s
Description: Watch this Scientific Journal Video about Dynamic Lung Tumor Tracking for Stereotactic Ablative Body Radiation Therapy at JoVE.com

这项研究是由大全癌症研究所的支持。

伦理声明:报告总结卫生系统机构审查委员会批准这项研究获得。 1.治疗咨询<ol><li>描述新肺SBRT治疗的病人。 注:新SBRT平台提供共面和非共面高辐射剂量的癌症靶，同时​​降低辐射剂量的非靶器官。 </li><li>讨论治疗的风险。 注:SBRT可能导致可能短期皮肤色素沉着或红斑，疲倦，咳嗽频繁，恶心，食管炎，以及罕见的内脏器官损伤。肺炎，或低烧和非生产性咳嗽的肺部炎症，治疗后可能会出现长达三个月。急性或迟伤到心脏，其他肌肉，周围神经或脊髓和骨是罕见的。有一个很小的危害为辐射诱发恶性肿瘤。 </li></ol> 2.基准标记布局<ol><li> PErform经皮CT引导下或单金涂覆标记的支气管镜放置插入肿瘤靶中心的质量。 <ol><li>问放射科医师执行患者胸部7的3-5毫米厚的连续轴向断层扫描成像。 </li><li>确定安全针的方法最大限度地减少加气的肺组织走过（避免大疱和裂缝）7。 </li><li>局部注射麻醉皮下注射（ 例如，1％利多卡因）。 </li><li>引入17或18G的同轴针来放置单个短（0.75×10毫米）或单长（0.75×20mm的）标记物10。 </li></ol></li><li>通过询问胸腔收购胸部断层成像支气管映射21做电磁导航支气管镜引导基准标记的位置。 <ol><li>楔形疑似支气管段支气管镜。 </li><li>引导支气管镜传感器探针与靶病灶。 </li><li>部署一个基准标记ER经支气管针。 注:在肺基准无放射技术被认为是研究性，并受到积极的研究22,23。 </li></ol></li><li>作为替代方案，为了至少三个短（1.6×3毫米），金涂覆标记可以定位在一个6厘米"框"在目标周围。如果一个以上的基准标记的放置位置，标记间2cm的物理分离，建议。 </li></ol> 3.治疗计划<ol><li>进行CT引导下模拟基准标记后放置4-7天（步骤3.2和3.3中所述）。 </li><li>让患者躺在上治疗机平板桌面仰卧，头先。 <ol><li>定位患者的手臂在他们头上，由上臂和手腕持有人或一个真空袋防盗支持。确保胸部和腹部都没有固定。 </li><li>或者，使用两针局部膝盖海绵索引。 </li><li>地方至少4个红外跟踪身体标记胸部本地化。红外跟踪呼吸标记过于本体区展现一致垂直呼吸运动（3mm以上的峰 - 峰运动建议）。 </li></ol></li><li>进行非连续的对比轴螺旋CT扫描（1毫米层厚，电压120 kVp的，350 MAS）。 注:治疗医生可以命令一个4D CT扫描胸部12或三维CT扫描的胸部，其中包括自由呼吸，吸气末和呼气末屏气图像设置24。 </li><li>获得18架F-FDG PET / CT扫描肺部肿瘤运动的增强型捕捉。 <ol><li>询问患者躺在一个头第一扫描位置的连续螺旋CT扫描（ 如电压120 kVp的，450 MAS）从orbitomeatal线大腿在平静呼吸。 </li><li>对平均18 F-FDG 11毫居里的在同一SC静脉内给药后获得18 F-FDG PET在平静呼吸安宁从orbitomeatal线大腿位置。如果采用这种方法，（18）F-FDG PET / CT扫描自动轮廓由软件设定在40％SUVmax值的阈值，然后，如所述1共同配准的CT模拟图像。 </li></ol></li><li>轮廓原发性肺总目标或多个卷（GTVp）由手绘图上的4D​​ CT数据集，最好的呼气阶段。扩大GTVp用5毫米的边距创建规划肿瘤体积（PTV）。辐射剂量规划发生了动态跟踪呼气末期扫描。 注意:作为替代，并使用三维CT数据集时，在自由呼吸CT模拟扫描是参考扫描。使用这种技术，所述治疗放射肿瘤学家轮廓GTV在自由呼吸（GTVfb），启示（GTVi），和到期日（GTVe）CT模拟扫描。在18F-FDG PET影像的阈值的40％的最大标准摄取值轮廓创建<suP&gt; 18F-FDG PET临床靶区（CTVpet）1。复合ITV表示GTVfb，GTVi，GTVe和CTVpet卷的补充总和。一个5毫米的利润率复合ITV的创建PTV。在这里，辐射剂量规划发生在自由呼吸扫描进行动态跟踪。 </li><li>轮廓附近的正常组织结​​构，由专人对4D CT数据集，最好呼气相拉伸。这可以包括正常肺，心脏加心包，食道，肝，双侧肾，臂丛神经和脊髓。可以产生气管，右主支气管和左主支气管的轮廓，扩展3毫米，并用作高优先级的规划约束，以避免后期毒性气道纤维化。 </li><li>点击在规划软件中的动态跟踪按钮。这个动作接合新SBRT平台上的万向平移和倾斜跟踪。 </li><li>规定的辐射剂量的PTV。考虑三种辐射蒙特卡洛剂量处方1S:3×17戈瑞= 51戈瑞每日周围型肺病灶; 4×12戈瑞= 48戈瑞在中央型肺癌病变和周围胸壁病变;或隔日5×10戈瑞= 50戈瑞。罕见当PTV体积约束（ 即，95％的覆盖）或器官高危约束不满足，可以使用8×7.5戈瑞= 60 Gy的处方。 </li></ol> 4.治疗交付和工作流程<ol><li>打造仰卧头第一校准后的安静的呼吸相关性模型。 <ol><li>放置4（或多达6个）红外线体标记在主体中鉴定在CT模拟相同的标记的位置。 </li><li>检查身体标记和病人对准通过红外摄像头和屏幕位置精度在治疗控制台。 注:身体标记位置作为一个波束上检查不规则运动，这样的咳嗽。 </li><li>获得跨平面双诊断千伏X射线或锥形束CT图像在治疗控制台来检测植入标记物内部positional精度。 </li><li>助理和关联身体标记运动（作为替代呼吸）和内部植入标记的运动与链接到新的平台SBRT工作流程的计算机软件。 注:另一种定位方法涉及病人根据前方和横向纹身CT模拟激光三角测量标记和使用标准化的参考阵列（星）有六个浸渍红外线人体标记的正交对准。 </li></ol></li><li>生成肺癌运动相关性模型。 <ol><li>得出一个万向平移和倾斜路径加速器使用链接到新SBRT平台的工作流程的计算机软件来跟踪肿瘤运动。 </li><li>视觉评估之前交付的辐射肺肿瘤运动相关性模型。 </li></ol></li><li>辐射在分娩过程中遵守的基准标记漂移。 </li><li>评估机器碰撞的患者由于机架旋转，O型圈支点，和万向节泛和倾斜动作事先计划交付。 注:辐射工作人员将执行此步骤。治疗可能需要八时五十五静态共面非共面治疗束，通过辐射传递工作人员手动和目视检查。治疗可能会持续15-30分钟，以完成大约每7分钟肺部肿瘤运动相关模型验证。 </li></ol>

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作者什么都没有透露。

有前途的早期立体定向放射治疗的临床经验驱使治疗肺癌25,26烧蚀辐射的临床试验研究。经验带领侦查员使用烧蚀辐射对多种肿瘤类型转移性肺27,28中。新SBRT平台引入了一个辐射光传输系统特别是切合移动肿瘤的治疗。 新SBRT平台提供由安装在一个旋转的O形环龙门直线加速器产生的看不见的X射线治疗。万向节机制使得直线加速器的泛和倾斜运动，提供即时动态肿瘤运动跟踪。双交叉平面千伏X射线之前和治疗过程中所获得验证自由度的6患者定位。共面和非共面的唯一的自由度提高输送高辐射剂量的癌症靶的同时最大限度地减少辐射剂量临界内脏器官。可以预料，处理消毒癌细胞目标而不对正常细胞的降辐射相关的毒性不可挽回的损失。新SBRT平台，今后的研究将记录在目标控制和副作用的减少任何收益。 新SBRT平台显示的初步经验保证10。肺肿瘤继续探讨动态跟踪的细微差别;然而，一些概括是显而易见的。肺肿瘤展示运动小于7毫米可以通过复合ITV加5毫米扩张的方式来对待最好。对于肺肿瘤表示7mm以上垂直平移，使用GTVp加5毫米膨胀可能是最好的用于治疗动态跟踪的方法。需要进一步研究确定这些限制。此外，在三维CT图像数据集叠加18F-FDG PET图像通常会增加复合ITV卷。这种方法假定容积EXPAN锡永在PET扫描仪的3-5分钟，时段时间由于18F-FDG信号涂抹发生。 40％的阈值18 F-FDG临床靶区进行了研究，并在我们的节目1人被使用。进一步的研究是否表征18F-FDG PET图像充分复制肿瘤滞后是必要的。最后，最多3个病灶在单个肺可以在一个时间被认为对于治疗。否则，顺序方法完成。 新SBRT平台上动态跟踪使用肺肿瘤运动相关模型来预测肺肿瘤运动长达40毫秒到未来。位置和红外身体和呼吸标记的速度被包括在模型中。的70％中获得的千伏X射线的标记检测率是一个必要条件动态跟踪。基准跟踪在三个维度（ 即，X，Y，Z）。由千伏X射线装置生成的图像自动注册和比较实时。 Ø在动态跟踪bserved延迟是由于在平移和倾斜万向节的硬件，软件的处理，和的千伏x射线单元的位置控制性能限制。研究调查人员正在从事改善跟踪延迟。 在使用新SBRT平台上动态跟踪辐射光传输，这是至关重要的，以观察基准标记漂移。趋势超出预定3毫米误差在任何方向上导致操作员启动处理暂停或自动束保持基准标记漂移。如果发生暂停的治疗，建议运营商之前的相关性模型允许恢复平静呼吸运动，在未来的几个病人呼吸，然后治疗恢复重建。如果暂停不成功，病人重新定位，红外呼吸标志运动检测，标记千伏检测，相关模型重建完成后恢复治疗。根据我们的经验，呼吸相关模型准确üP至7分钟，往往是由病人紧张或放松休息时对治疗桌面的限制。 悬而未决的问题依然存在。什么是放射生物学后果和细胞死亡的模式在正常细胞和癌细胞烧蚀辐射剂量后发生？为什么会如此难以融合高精度烧蚀辐射放射增敏化疗？而有必要调查提供烧蚀辐射在胸部的其他方式，目前还不清楚，以烧蚀辐射是否能提供等效的治疗效力开胸手术。事实上，胸外科是较常用的和验证的技术来实现肿瘤根除在肺当常规疗法已经得到了应用。在这里，新的SBRT平台提供了治疗的妇女和男子肺肿瘤显示运动中的创新的非侵入性的方式。

肺癌占癌症相关死亡的妇女和男子世界各地2的最大数量。最多的持续性或复发性肺癌63％涉及到已经通过征税或化疗之前照射肺组织3,4。在持续或反复的肺肿瘤位点进一步照射可能导致不能容忍的肺发病5,6，特别是当常规手术，化疗和放射疗法已经被尝试过。因此，在这样的情况下，临床上男性和女性都需要类似于本杂志7之前提出新的治疗癌症治疗策略。立体定向烧蚀体放射治疗（SBRT）可以通过精确的目标，高剂量辐射-8,9-灭菌肺肿瘤满足这种治疗的需要。 有一个新的SBRT平台，能够治疗这个任务10-12。它本身从其他SBRT平台通过分离积分双诊断Exactrac千伏x射线单元（能够锥束计算机断层摄影目标定位的）和红外线摄像机单元（能够体表标识跟踪作为替代内部运动），这两个允许的癌症立体开环反馈目标intrafraction运动。它也有一个独特的±4厘米万向平移和倾斜辐射加速器，具有其辐射束形60钨合金叶（0.25厘米物理宽度，11厘米物理高度）。它采用的是全过中心行程多叶准直为最多15×15cm的区域尺寸。它集成了一个机器人驱动的±60°转动O型环和±185°的旋转台架允许共面和非共面加速器束设置角度和独特的治疗自由度。最后，它具有亚毫米的精度（0.6毫米等角点）13。与此相反，其他SBRT放疗平台装入临床辐射加速器或者向工业机器人手臂14，或一个螺旋片逐片台架15，或者在一个传统的机器连接到图像引导调强放射治疗或动态弧传送软件16。每个平台从事各种机械部件的跟踪，从呼吸运动，心跳，消化或产生的运动。肺癌放射治疗已临床成功17,18，呈现方式放射肿瘤19,20一种新的治疗选择。该如何对文章提供了一种新的放射治疗协议，介绍动态肺肿瘤跟踪治疗目的。

<table><tbody><tr><td>Vero SBRT Linac System 1.0</td><td>Brainlab, Inc. (Munich, Germany)&lt;br /&gt;Mitsubishi Heavy Industries, Ltd. (Tokyo, Japan)</td><td>46300</td><td>High accuracy first-of-its-kind gimbaled irradiation head with tilt function and gantry rotation</td></tr><tr><td>Visicoil fiducial marker</td><td>IBA Dosimetry America (Bartlett, TN, USA)</td><td>67245</td><td>0.75 x 10 mm marker or 0.75 x 20 mm marker</td></tr><tr><td>Gold fiducial marker</td><td>Civco Medical Solutions (Orange City, IA, USA)</td><td>MTNW887860</td><td>Sterile placement needle (14 G ETW x 20 cm) with one 1.6 x 3 mm marker</td></tr></tbody></table>

dynamic lung tumor tracking for stereotactic ablative body radiation therapy

医生考虑立体定向消融体内放射治疗（SBRT）为颅外癌症靶点治疗必须注意的正常组织损伤和相当大的风险的物理肿瘤小姐的危害。第一-的，其独一无二的SBRT平台通过多功能实时成像解决方案和先进的肿瘤跟踪功能的组合实现了高精度的消融放射治疗。它采用双诊断千伏X光机对癌症的目标intrafraction运动中发生呼吸运动和心跳的后果立体开环反馈。图像引导的反馈驱动万向辐射加速器（最大15×15cm的区域尺寸）能够实时±4厘米平移和倾斜动作。机器人驱动的±60°转动的集成±185°的旋转台架允许为共面和非共面加速器束设置角度，最终允许独特的治疗自由度。国家-的-ART辅助软件的实时六维定位，确保癌症靶点与亚毫米级精度（0.6毫米等中心）照射。使用这些特性使得能够治疗医生来引导辐射剂量的癌症肿瘤靶，同时降低辐射剂量对正常组织。通过加入呼吸相关计算机断层扫描（CT）和2- [18 F]氟-2-脱氧ᴅ葡萄糖（18 F-FDG）正电子发射断层扫描（PET）的图像转换成用于增强肿瘤靶轮廓规划系统，可能物理肿瘤小姐就变得少1。在这篇文章中，我们描述了移动肺肿瘤的治疗提供新的辐射计划。

SBRT新平台上当前涉及多个静态的辐射束会聚在单个或多个紧密相关的临床辐射目标，如在图1中描绘例如，一个代表良好的规划结果提供烧蚀辐射具有95％的覆盖率癌症靶体积和癌症靶的剂量一致性。 图1显示5共面和4个非共面的光束（ 即，环旋转+ 20°，波束2，4，6和8）用于治疗的单个PTV表示在右侧肺鳞状细胞癌。梁边距PTV是1毫米。辐射剂量，规定为95％的等剂量线，呈现95％的PTV覆盖率为1.48一致性指数。处方为50戈瑞五隔日10 Gy的分数。这里所示的结构包括规划靶体积（红），内部目标体积（白色），脊髓（绿），和食道（浅蓝色）。等剂量线所指示的。&lt;/ P&gt; <img alt="图1" src="/files/ftp_upload/52875/52875fig1highres.jpg" width="700" /> 图1:的右侧肺肿瘤肿瘤动态跟踪图为烧蚀辐射剂量（50戈瑞五10戈瑞隔日部分）传递到采用九静态梁单右侧肺部肿瘤为例（蓝/绿色，34°的）。 4规划软件窗口描绘:（A）一梁和临界结构碰撞地图，（B）的beam&#39;s眼视图（这里，波束1），（C）的三维CT和束重构地图，和（D）的轴向CT与剂量分布。 <table border="0" cellpadding="0" cellspacing="0"><tbody><tr><td> 结构体 </td><td> 公 </td><td> 音量 </td><td> 可接受的变化 </td></tr><tr><td> PTV </td><td> V50Gy </td><td> ≥95％ </td><td> ≥90％ </td></tr><tr><td>最小剂量</td><td> 0.03厘米3 </td><td> ≥46戈瑞（92％） </td><td> ≥45戈瑞（90％）的</td></tr><tr><td>极量</td><td> 0.03厘米3 </td><td> ≤60戈瑞（120％） </td><td> ≤62.5戈瑞（125％） </td></tr><tr><td>脊髓</td><td> 0.03厘米3 </td><td> ≤15戈瑞</td><td> ≤22戈瑞</td></tr><tr><td>隆（减去GTV） </td><td> V20Gy </td><td> ≤10％ </td><td> ≤15％ </td></tr><tr><td></td><td>平均剂量</td><td> ≤8戈瑞</td><td> ≤10戈瑞</td></tr><tr><td>心脏/心包</td><td> 15厘米3 </td><td> ≤32戈瑞</td><td> ≤36戈瑞</td></tr><tr><td>食道</td><td>平均剂量</td><td> ≤18戈瑞</td><td> ≤20戈瑞</td></tr><tr><td></td><td> 0.03厘米3 </td><td> ≤27​​戈瑞</td><td> ≤30戈瑞</td></tr><tr><td>肱丛</td><td> 0.03厘米3 </td><td> ≤24戈瑞</td><td> ≤30戈瑞</td></tr></tbody></table> 表1:结构治疗计划的约束。

Watch this Scientific Journal Video about Dynamic Lung Tumor Tracking for Stereotactic Ablative Body Radiation Therapy at JoVE.com

Dynamic Lung Tumor Tracking for Stereotactic Ablative Body Radiation Therapy

Stereotactic ablative body radiation therapy (SBRT) involves the precise delivery of high-dose radiation to cancer tumor targets. A novel SBRT platform offers a first-of-its-kind gimbaled radiation accelerator mounted within a pivoting O-ring gantry capable of dynamic image-guided tumor tracking. Here, we describe dynamic tumor tracking for lung targets.

动态肺肿瘤跟踪烧蚀立体定向放射身体治疗

Physicians considering stereotactic ablative body radiation therapy (SBRT) for the treatment of extracranial cancer targets must be aware of the sizeable ...

dynamic-lung-tumor-tracking-for-stereotactic-ablative-body-radiation

Research

JoVE Journal

Medicine

15.5K 次观看.  Summa Cancer Institute. Stereotactic ablative body radiation therapy (SBRT) involves the precise delivery of high-dose radiation to cancer tumor targets. A novel SBRT platform offers a first-of-its-kind gimbaled radiation accelerator mounted within a pivoting O-ring gantry capable of dynamic image-guided tumor tracking. Here, we describe dynamic tumor tracking for lung targets.

视频: Dynamic Lung Tumor Tracking for Stereotactic Ablative Body Radiation Therapy

Endobronchial Ultrasound-guided Intratumoral Injection of Cisplatin for the Treatment of Isolated Mediastinal Recurrence of Lung Cancer

Isolated hilar and mediastinal recurrence (IMHR) following external beam radiation therapy (EBRT) in patients with lung cancer is common. These patients do not have many treatment options and are usually offered palliative chemotherapy or best supportive care. Endobronchial ultrasound (EBUS)-guided intratumoral injection of cisplatin (ITC) is a novel approach for these patients. The procedure is performed under conscious sedation. The lesion is located with a bronchoscopy using EBUS, and a 22-gauge EBUS needle is advanced through the working channel of the scope and locked in position. Under ultrasound guidance, the wall of the tracheobronchial tree is punctured and the needle is moved into the target lesion. The needle stylet is then removed and cisplatin (40 mg/40 mL) is injected into the lesion. One to two sites are treated per session. Details of the procedure are described in the protocol section of paper. At our center, 50 sites were treated in 36 patients (19 males, 17 females). The mean age of our cohort was 61.9 &#177;8.5 years. We performed final analyses on 35 patients and 41 sites. 24/35 (69%) had complete or partial response (responders), whereas 11/35 (31%) had stable or progressive disease (non-responders). Overall, survival in our group was 8 months (95% CI of 6-11 months), with patients who responded having significantly better survival than the ones who did not.

The management of isolated recurrent lung cancer in a previously-irradiated field is challenging. Here, we describe an endobronchial ultrasound (EBUS)-guided cisplatin injection for the management of patients with localized lung cancer recurrence in a previously-radiated field.

支气管内超声引导下顺铂瘤内注射对肺癌纵隔孤立复发的治疗

Isolated hilar and mediastinal recurrence (IMHR) following external beam radiation therapy (EBRT) in patients with lung cancer is common. These patients ...

科研

癌症研究

PET and MRI Guided Irradiation of a Glioblastoma Rat Model Using a Micro-irradiator

For decades, small animal radiation research was mostly performed using fairly crude experimental setups applying simple single-beam techniques without the ability to target a specific or well-delineated tumor volume. The delivery of radiation was achieved using fixed radiation sources or linear accelerators producing megavoltage (MV) X-rays. These devices are unable to achieve sub-millimeter precision required for small animals. Furthermore, the high doses delivered to healthy surrounding tissue hamper response assessment. To increase the translation between small animal studies and humans, our goal was to mimic the treatment of human glioblastoma in a rat model. To enable a more accurate irradiation in a preclinical setting, recently, precision image-guided small animal radiation research platforms were developed. Similar to human planning systems, treatment planning on these micro-irradiators is based on computed tomography (CT). However, low soft-tissue contrast on CT makes it very challenging to localize targets in certain tissues, such as the brain. Therefore, incorporating magnetic resonance imaging (MRI), which has excellent soft-tissue contrast compared to CT, would enable a more precise delineation of the target for irradiation. In the last decade also biological imaging techniques, such as positron emission tomography (PET) gained interest for radiation therapy treatment guidance. PET enables the visualization of e.g., glucose consumption, amino-acid transport, or hypoxia, present in the tumor. Targeting those highly proliferative or radio-resistant parts of the tumor with a higher dose could give a survival benefit. This hypothesis led to the introduction of the biological tumor volume (BTV), besides the conventional gross target volume (GTV), clinical target volume (CTV), and planned target volume (PTV).
At the preclinical imaging lab of Ghent University, a micro-irradiator, a small animal PET, and a 7 T small animal MRI are available. The goal was to incorporate MRI-guided irradiation and PET-guided sub-volume boosting in a glioblastoma rat model.

In the past, small animal irradiation was usually performed without the ability to target a well-delineated tumor volume. The goal was to mimic the treatment of human glioblastoma in rats. Using a small animal irradiation platform, we performed MRI-guided 3D conformal irradiation with PET-based sub-volume boosting in a preclinical setting.

PET 与 MRI 引导下微器对大鼠胶质瘤模型的照射

For decades, small animal radiation research was mostly performed using fairly crude experimental setups applying simple single-beam techniques without ...

Stereotactic Radiosurgery for Gynecologic Cancer

Stereotactic body radiotherapy (SBRT) distinguishes itself by necessitating more rigid patient immobilization, accounting for respiratory motion, intricate treatment planning, on-board imaging, and reduced number of ablative radiation doses to cancer targets usually refractory to chemotherapy and conventional radiation. Steep SBRT radiation dose drop-off permits narrow 'pencil beam' treatment fields to be used for ablative radiation treatment condensed into 1 to 3 treatments.
Treating physicians must appreciate that SBRT comes at a bigger danger of normal tissue injury and chance of geographic tumor miss. Both must be tackled by immobilization of cancer targets and by high-precision treatment delivery. Cancer target immobilization has been achieved through use of indexed customized Styrofoam casts, evacuated bean bags, or body-fix molds with patient-independent abdominal compression.1-3 Intrafraction motion of cancer targets due to breathing now can be reduced by patient-responsive breath hold techniques,4 patient mouthpiece active breathing coordination,5 respiration-correlated computed tomography,6 or image-guided tracking of fiducials implanted within and around a moving tumor.7-9 The Cyberknife system (Accuray [Sunnyvale, CA]) utilizes a radiation linear accelerator mounted on a industrial robotic arm that accurately follows patient respiratory motion by a camera-tracked set of light-emitting diodes (LED) impregnated on a vest fitted to a patient.10 Substantial reductions in radiation therapy margins can be achieved by motion tracking, ultimately rendering a smaller planning target volumes that are irradiated with submillimeter accuracy.11-13
Cancer targets treated by SBRT are irradiated by converging, tightly collimated beams. Resultant radiation dose to cancer target volume histograms have a more pronounced radiation "shoulder" indicating high percentage target coverage and a small high-dose radiation "tail." Thus, increased target conformality comes at the expense of decreased dose uniformity in the SBRT cancer target. This may have implications for both subsequent tumor control in the SBRT target and normal tissue tolerance of organs at-risk. Due to the sharp dose falloff in SBRT, the possibility of occult disease escaping ablative radiation dose occurs when cancer targets are not fully recognized and inadequate SBRT dose margins are applied. Clinical target volume (CTV) expansion by 0.5 cm, resulting in a larger planning target volume (PTV), is associated with increased target control without undue normal tissue injury.7,8 Further reduction in the probability of geographic miss may be achieved by incorporation of 2-[18F]fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography (PET).8 Use of 18F-FDG PET/CT in SBRT treatment planning is only the beginning of attempts to discover new imaging target molecular signatures for gynecologic cancers.

Stereotactic body radiotherapy (SBRT) involves image-guided, ablative radiation delivered to cancer targets refractory to chemotherapy or to conventional radiation treatment. The robotic-armed Cyberknife SBRT system, using sophisticated target localization, delivers hypofractionated radiation doses capable of sterilizing cancer targets. This article will consider new therapeutic roles of SBRT for gynecological cancers.

妇科肿瘤的立体定向放射外科

Stereotactic body radiotherapy (SBRT) distinguishes itself by necessitating more rigid patient immobilization, accounting for respiratory motion, ...

医学

Detection of Lung Tumor Progression in Mice by Ultrasound Imaging

With ~1.6 million victims per year, lung cancer contributes tremendously to the worldwide burden of cancer. Lung cancer is partly driven by genetic alterations in oncogenes such as the KRAS oncogene, which constitutes ~25% of lung cancer cases. The difficulty in therapeutically targeting KRAS-driven lung cancer partly stems from having poor models that can mimic the progression of the disease in the lab. We describe a method that permits the relative quantification of primary KRAS lung tumors in a Cre-inducible LSL-KRAS G12D mouse model via ultrasound imaging. This method relies on brightness (B)-mode acquisition of the lung parenchyma. Tumors that are initially formed in this model are visualized as B-lines and can be quantified by counting the number of B-lines present in the acquired images. These would represent the relative tumor number formed on the surface of the mouse lung. As the formed tumors develop with time, they are perceived as deep clefts within the lung parenchyma. Since the circumference of the formed tumor is well-defined, calculating the relative tumor volume is achieved by measuring the length and width of the tumor and applying them in the formula used for tumor caliper measurements. Ultrasound imaging is a non-invasive, fast and user-friendly technique that is often used for tumor quantifications in mice. Although artifacts may appear when obtaining ultrasound images, it has been shown that this imaging technique is more advantageous for tumor quantifications in mice compared to other imaging techniques such as computed tomography (CT) imaging and bioluminescence imaging (BLI). Researchers can investigate novel therapeutic targets using this technique by comparing lung tumor initiation and progression between different groups of mice.

This protocol describes the steps taken to induce KRAS lung tumors in mice as well as the quantification of formed tumors by ultrasound imaging. Small tumors are visualized in early timepoints as B-lines. At later timepoints, relative tumor volume measurements are achieved by the measurement tool in the ultrasound software.

超声成像对小鼠肺肿瘤进展的检测

With ~1.6 million victims per year, lung cancer contributes tremendously to the worldwide burden of cancer. Lung cancer is partly driven by genetic ...

Positron Emission Tomography-based Dose Painting Radiation Therapy in a Glioblastoma Rat Model using the Small Animal Radiation Research Platform

A rat glioblastoma model to mimic chemo-radiation treatment of human glioblastoma in the clinic was previously established. Similar to the clinical treatment, computed tomography (CT) and magnetic resonance imaging (MRI) were combined during the treatment-planning process. Positron emission tomography (PET) imaging was subsequently added to implement sub-volume boosting using a micro-irradiation system. However, combining three imaging modalities (CT, MRI, and PET) using a micro-irradiation system proved to be labor-intensive because multimodal imaging, treatment planning, and dose delivery have to be completed sequentially in the preclinical setting. This also results in a workflow that is more prone to human error. Therefore, a user-friendly algorithm to further optimize preclinical multimodal imaging-based radiation treatment planning was implemented. This software tool was used to evaluate the accuracy and efficiency of dose painting radiation therapy with micro-irradiation by using an in silico study design. The new methodology for dose painting radiation therapy is superior to the previously described method in terms of accuracy, time efficiency, and intra- and inter-user variability. It is also an important step towards the implementation of inverse treatment planning on micro-irradiators, where forward planning is still commonly used, in contrast to clinical systems.

Here we present a protocol to perform preclinical positron emission tomography-based radiotherapy in a rat glioblastoma model using algorithms developed in-house to optimize the accuracy and efficiency.

使用小动物辐射研究平台在胶质母细胞瘤大鼠模型中基于正电子发射断层扫描的剂量绘画放射治疗

A rat glioblastoma model to mimic chemo-radiation treatment of human glioblastoma in the clinic was previously established. Similar to the clinical ...

检查肺转移瘤的肿瘤细胞播散

Tracking Tumor Cell Dissemination from Lung Metastases Using Photoconversion

Metastasis - the systemic spread of cancer - is the leading cause of cancer-related deaths. Although metastasis is commonly thought of as a unidirectional process wherein cells from the primary tumor disseminate and seed metastases, tumor cells in existing metastases can also redisseminate and give rise to new lesions in tertiary sites in a process known as &#34;metastasis-from-metastases&#34; or &#34;metastasis-to-metastasis seeding.&#34; Metastasis-to-metastasis seeding may increase the metastatic burden and decrease the patient&#39;s quality of life and survival. Therefore, understanding the processes behind this phenomenon is crucial to refining treatment strategies for patients with metastatic cancer.
Little is known about metastasis-to-metastasis seeding, due in part to logistical and technological limitations. Studies on metastasis-to-metastasis seeding rely primarily on sequencing methods, which may not be practical for researchers studying the exact timing of metastasis-to-metastasis seeding events or what promotes or prevents them. This highlights the lack of methodologies that facilitate the study of metastasis-to-metastasis seeding. To address this, we have developed - and describe herein - a murine surgical protocol for the selective photoconversion of lung metastases, allowing specific marking and fate tracking of tumor cells redisseminating from the lung to tertiary sites. To our knowledge, this is the only method for studying tumor cell redissemination and metastasis-to-metastasis seeding from the lungs that does not require genomic analysis.

作者聚焦:使用新的体内技术解码转移转移播种以追踪乳腺癌扩散 

We present a method for studying tumor cell redissemination from lung metastases involving a surgical protocol for the selective photoconversion of lung metastases, followed by the identification of redisseminated tumor cells in tertiary organs.

使用光转换追踪肺转移瘤的肿瘤细胞播散

Metastasis - the systemic spread of cancer - is the leading cause of cancer-related deaths. Although metastasis is commonly thought of as a unidirectional ...

Clinical Factors Influencing the Radiation Dose of Circulating Immune Cells during Radiotherapy for Small Cell Lung Cancer

Small cell lung cancer (SCLC) has garnered significant attention due to its high malignancy, propensity for distant metastasis, and poor prognosis. Radiotherapy remains the cornerstone of treatment for limited-stage small cell lung cancer (LS-SCLC). However, outcomes with radiotherapy alone or in combination with chemotherapy remain suboptimal. Radiotherapy can induce lymphopenia by directly irradiating hematopoietic organs or destroying mature circulating lymphocytes, leading to immunosuppression and consequently diminishing therapeutic efficacy. The estimated dose of radiation to immune cells (EDRIC) model integrates factors such as hemodynamics, lymphocyte radiosensitivity, and proliferation capacity. This study employs the EDRIC model with enhancements to calculate the circulating immune cell radiation dose. By utilizing the EDRIC methodology, the study explores the correlation between EDRIC and tumor target size, average lung dose, average heart dose, clinical features, and peripheral blood lymphocytopenia during radiotherapy for LS-SCLC, aiming to inform personalized patient treatment strategies.
This study analyzed data from 64 LS-SCLC patients who met the inclusion criteria at the General Hospital of Ningxia Medical University from January 2023 to January 2024, all of whom received radical thoracic conventional fractionated radiotherapy. Lymphocyte counts were recorded at the following points: before radiotherapy, at the lowest observed value during radiotherapy, at the end of radiotherapy, and one-month post-radiotherapy. Dosimetric data, including average lung, heart, and body doses, were extracted from the treatment planning system, and the circulating EDRIC was calculated using this model. The relationship between EDRIC values and therapeutic outcomes was analyzed. In LS-SCLC, the EDRIC model effectively predicts lymphocyte count reduction, correlating with planning target volume (PTV; cm3), TNM stage, and the percentage of target lesion shrinkage. Post-radiotherapy, there was a significant decrease in peripheral blood lymphocyte counts, with greater EDRIC values indicating more pronounced lymphocyte reduction.

Here, we present a protocol to evaluate the effects of radiation therapy on immune system lymphocytes in small cell lung cancer.

Small cell lung cancer (SCLC) has garnered significant attention due to its high malignancy, propensity for distant metastasis, and poor prognosis. ...

Using Micro-computed Tomography for the Assessment of Tumor Development and Follow-up of Response to Treatment in a Mouse Model of Lung Cancer

Lung cancer is the most lethal cancer in the world. Intensive research is ongoing worldwide to identify new therapies for lung cancer. Several mouse models of lung cancer are being used to study the mechanism of cancer development and to experiment with various therapeutic strategies. However, the absence of a real-time technique to identify the development of tumor nodules in mice lungs and to monitor the changes in their size in response to various experimental and therapeutic interventions hampers the ability to obtain an accurate description of the course of the disease and its timely response to treatments. In this study, a method using a micro-computed tomography (CT) scanner for the detection of the development of lung tumors in a mouse model of lung adenocarcinoma is described. Next, we show that monthly follow-up with micro-CT can identify dynamic changes in the lung tumor, such as the appearance of additional nodules, increase in the size of previously detected nodules, and decrease in the size or complete resolution of nodules in response to treatment. Finally, the accuracy of this real-time assessment method was confirmed with end-point histological quantification. This technique paves the way for planning and conducting more complex experiments on lung cancer animal models, and it enables us to better understand the mechanisms of carcinogenesis and the effects of different treatment modalities while saving time and resources.

We describe a method for the detection of tumor nodule development in the lungs of an adenocarcinoma mouse model using micro-computed tomography and its use for monitoring changes in nodule size over time and in response to treatment. The accuracy of the assessment was confirmed with end-point histological quantification.

采用微计算机断层扫描对肿瘤发展的评估和后续反应来治疗肺癌的小鼠模型

Lung cancer is the most lethal cancer in the world. Intensive research is ongoing worldwide to identify new therapies for lung cancer. Several mouse ...

动态肺肿瘤跟踪烧蚀立体定向放射身体治疗

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