Hypoxia imaging with [18F]-FMISO-PET for guided dose escalation with intensity-modulated radiotherapy in head-and-neck cancers.

BACKGROUND AND PURPOSE: Positron emission tomography (PET) with [(18)F]-fluoromisonidazole ([(18)F]-FMISO) provides a non-invasive assessment of hypoxia. The aim of this study is to assess the feasibility of a dose escalation with volumetric modulated arc therapy (VMAT) guided by [(18)F]-FMISO-PET for head-and-neck cancers (HNC). PATIENTS AND METHODS: Ten patients with inoperable stages III-IV HNC underwent [(18)F]-FMISO-PET before radiotherapy. Hypoxic target volumes (HTV) were segmented automatically by using the fuzzy locally adaptive Bayesian method. Retrospectively, two VMAT plans were generated delivering 70 Gy to the gross tumour volume (GTV) defined on computed tomography simulation or 79.8 Gy to the HTV. A dosimetric comparison was performed, based on calculations of tumour control probability (TCP), normal tissue complication probability (NTCP) for the parotid glands and uncomplicated tumour control probability (UTCP). RESULTS: The mean hypoxic fraction, defined as the ratio between the HTV and the GTV, was 0.18. The mean average dose for both parotids was 22.7 Gy and 25.5 Gy without and with dose escalation respectively. FMISO-guided dose escalation led to a mean increase of TCP, NTCP for both parotids and UTCP by 18.1, 4.6 and 8% respectively. CONCLUSION: A dose escalation up to 79.8 Gy guided by [(18)F]-FMISO-PET with VMAT seems feasible with improvement of TCP and without excessive increase of NTCP for parotids.

Comparison of GEANT4 very low energy cross section models with experimental data in water.

PURPOSE: The GEANT4 general-purpose Monte Carlo simulation toolkit is able to simulate physical interaction processes of electrons, hydrogen and helium atoms with charge states (H0, H+) and (He0, He+, He2+), respectively, in liquid water, the main component of biological systems, down to the electron volt regime and the submicrometer scale, providing GEANT4 users with the so-called "GEANT4-DNA" physics models suitable for microdosimetry simulation applications. The corresponding software has been recently re-engineered in order to provide GEANT4 users with a coherent and unique approach to the simulation of electromagnetic interactions within the GEANT4 toolkit framework (since GEANT4 version 9.3 beta). This work presents a quantitative comparison of these physics models with a collection of experimental data in water collected from the literature. METHODS: An evaluation of the closeness between the total and differential cross section models available in the GEANT4 toolkit for microdosimetry and experimental reference data is performed using a dedicated statistical toolkit that includes the Kolmogorov-Smirnov statistical test. The authors used experimental data acquired in water vapor as direct measurements in the liquid phase are not yet available in the literature. Comparisons with several recommendations are also presented. RESULTS: The authors have assessed the compatibility of experimental data with GEANT4 microdosimetry models by means of quantitative methods. The results show that microdosimetric measurements in liquid water are necessary to assess quantitatively the validity of the software implementation for the liquid water phase. Nevertheless, a comparison with existing experimental data in water vapor provides a qualitative appreciation of the plausibility of the simulation models. The existing reference data themselves should undergo a critical interpretation and selection, as some of the series exhibit significant deviations from each other. CONCLUSIONS: The GEANT4-DNA physics models available in the GEANT4 toolkit have been compared in this article to available experimental data in the water vapor phase as well as to several published recommendations on the mass stopping power. These models represent a first step in the extension of the GEANT4 Monte Carlo toolkit to the simulation of biological effects of ionizing radiation.

Geant4 physics list comparison for the simulation of phase-contrast mammography (XPulse project).

PURPOSE: Breast cancer is the most frequent cancer in women. Early and accurate detection of the disease is a major factor in patient survival. To this end, phase-contrast imaging has gained significant interest in recent years. The aim of this work was to validate the physics models of a Geant4 mammography imaging simulation (in the context of the XPulse project) by comparing to EGSnrc results. METHODS: We used three Geant4 electromagnetic physics lists of the version 10.4 of the toolkit: Standard, Livermore and Penelope. We calculated energy distributions in homogeneous and inhomogeneous phantoms and breast doses in DICOM images. The simulations used photon beams of energies 20-100 keV. The Geant4 calculations were compared with EGSnrc/DOSXYZnrc simulations. RESULTS: We found a very good agreement between the Standard Electromagnetic option 4 and Livermore Physics Lists (within 1% for all beam energies). Larger differences were found between Standard Electromagnetic option 4 and Penelope Physics Lists (about 4%). The agreement of longitudinal energy distributions between Geant4 Standard Electromagnetic option 4 and EGSnrc was good in water and light biological materials, but important discrepancies were found in heavy elements. We confirmed with both codes that dose to the breast is minimal at beam energy around 60 keV. CONCLUSIONS: Overall, we found good agreement between the option 4 of the Standard Electromagnetic physics list and Livermore physics lists of Geant4, as well as EGSnrc for materials relevant to mammography screening. Further investigations are needed for the case of heavier materials.

[Adaptive radiotherapy in routine: The radiation oncologist's point of view]. / Radiothérapie adaptative en routine : point de vue de l'oncologue radiothérapeute.

Adaptive radiotherapy is defined as all processes leading to the modification of a treatment plan on the basis of patient-specific variations observed during the course of a treatment. This concept is currently of particular relevance due to the development of onboard volumetric imaging systems, which allow for daily viewing of variations in both tumour and organs at risk in terms of position, shape or volume. However, its application in routine clinical practice is limited due to the demanding nature of the processes involved (re-delineation and replanning) and increased dependence on available human resources. Even if "online" strategies, based on deformable image registration (DIR) algorithms, could lead to a reduction in both work and calculation time, for the moment their use is limited to the research field due to uncertainties surrounding the validity of results gathered. Other strategies without DIR can be used as "offline" or "hybrid offline-online" strategies that seem to offer a compromise between time consumption and therapeutic gain for the patient.