how to integrate more effective systemic treatment into combined modality treatment?

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