PET-determined prostate brachytherapy dosing using intraoperative image-guidance

使用术中图像引导 PET 确定前列腺近距离放射治疗剂量

• 批准号: 9505848
• 负责人: Everette C Burdette
• 金额: $ 62.81万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-06-09 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9505848
• 关键词: Algorithms; Anatomy; Assessment tool; Brachytherapy; Cancer Control; Cancer Etiology; Cancer Survivor; Cancerous; Cessation of life; Clinical; Clinical Research; Clinical Trials; Computing Methodologies; Data; Development; Diagnosis; Dose; Edema; Extraprostatic; FDA approved; FOLH1 gene; Feasibility Studies; Fluoroscopy; Future; Generations; Gland; High-Risk Cancer; Image-Guided Surgery; Imagery; Implant; Individual; Institutional Review Boards; Lead; Malignant Neoplasms; Malignant neoplasm of prostate; Normal tissue morphology; Organ; Outcome; PET/CT scan; PSA screening; Patients; Performance; Phase II Clinical Trials; Physicians; Positioning Attribute; Positron-Emission Tomography; Postoperative Period; Procedures; Prostate; Prostate Cancer therapy; Prostatic; Public Health; Quality of life; Quantitative Evaluations; Radiation; Radiation exposure; Radioactive Seed Implantation; Randomized; Rectum; Screening for Prostate Cancer; Seeds; Software Tools; Source; Structure; System; Techniques; Tissues; Toxic effect; Ultrasonography; Uncertainty; Update; Urethra; Validation; Work; X-Ray Computed Tomography; antigen binding; base; cancer imaging; disorder control; dosimetry; feasibility trial; image guided; improved; individual patient; men; mortality; personalized medicine; phase II trial; pre-clinical; randomized trial; reconstruction; response; standard of care; stem; targeted imaging; treatment planning; tumor

PROJECT SUMMARY/ ABSTRACT Prostate cancer remains a worldwide public health issue and cause of mortality, with annual diagnosis and mortality rates exceeding 1.1 billion and 307 million patients, respectively.1 Brachytherapy is widely accepted and utilized in the management of prostate cancer. Due to recent evidence showing improved disease control in patients with potentially lethal cancers using approaches incorporating brachytherapy, its utilization is expected to increase. Successful brachytherapy hinges on adequately dosing prostate while avoiding excessive radiation to adjacent tissues. Well-recognized contributors to poor dosimetry are source positioning errors, poor source visualization and edema, which in aggregate lead to regions of excessive as well as inadequate dose. In response to the recognized need for dynamic visualization of sources and intraoperative dose analysis during the procedure, our work has led to the development of a system of intraoperative ultrasound and fluoroscopy (iRUF) dynamic dose calculation using fluoroscopy-based seed reconstruction and fusion with intraprocedure ultrasound imaging. Following our pilot feasibility trial, we developed an FDA-approved dedicated brachytherapy platform, and have confirmed this technique in a Phase II trial, with outstanding dosimetry on a consistent basis.2,3 Currently, whole-gland treatment is standard in prostate cancer therapy. The need for whole-gland treatment stems from the uncertainty and difficulty in precisely identifying tumor foci within. Unfortunately, such approaches inevitably result in radiation exposure of adjacent critical structures, with potential toxicity and permanent quality of life effects. As long as whole gland therapy is delivered, the ability to limit normal tissue doses remains constrained by their proximity. New advances in PET imaging targeting Prostate Specific Membrane Antigen (PSMA) and second-generation PSMA-binding agents now allow highly specific and sensitive identification of extraprostatic and intraprostatic tumors.4,5,6 Focal therapy using PSMA PET/CT-and dynamic dosimetry-guided seed placement promises to further improve the standard of care in brachytherapy, allowing the physician to precisely tailor the dose to the individual’s tumor. This requires precise tumor imaging combined with dynamic intra-operative localization of the implant in relation to the target volume, as well as surrounding uninvolved prostate and normal anatomy.7,8,9,10 Combining iRUF and PSMA PET/CT would break new ground through addition of precise targeting via purely computational methods. We aim to develop a clinically feasible image-guidance platform for dynamic, quantitative evaluation of partial-gland, focal dosimetry during brachytherapy. The system would allow personalized brachytherapy, achieving excellent cancer control while avoiding unnecessary toxicity for prostate cancer survivors.

项目摘要/摘要 前列腺癌仍然是全球公共卫生问题和死亡率的原因，包括年度诊断和 死亡率分别超过11亿和3.07亿患者。1近距离放射治疗被广泛接受 并用于前列腺癌的管理。由于最近显示疾病控制改善的证据 在使用编码近距离放射治疗的方法的潜在致命癌症患者中，其利用是 预计会增加。成功的近距离放射治疗取决于足够给前列腺的戒断 过度辐射到相邻组织。公认的剂量法的众所周知的贡献者是源定位 错误，源可视化和水肿差，总体上导致了多余的区域 剂量不足。 响应公认的对源的动态可视化和术中剂量分析的需求 在过程中，我们的工作导致了术中超声系统的发展， 荧光镜（IRUF）使用基于荧光镜的种子重建和融合与与 载流量超声成像。在我们的飞行员可行性试验之后，我们开发了FDA批准的 专用近距离放射治疗平台，并在II期试验中确认了这一技术，并具有杰出的 剂量始终如一。2,3 目前，全gland治疗是前列腺癌疗法的标准配置。对整个gland的需求 从不确定性的治疗植物和精确识别内部肿瘤焦点的困难。不幸的是，这样 方法不可避免地会导致相邻临界结构的辐射暴露，并具有潜在的毒性和 永久的生活质量影响。只要整个腺治疗都可以限制正常组织 剂量仍然受其接近性的约束。针对前列腺特定的宠物成像的新进展 膜抗原（PSMA）和第二代PSMA结合剂现在允许高度具体，并且 敏感的鉴定外压外肿瘤和脑内肿瘤。使用PSMA PET/CT-及 动态剂量学引导的种子放置有望进一步改善近距离放射治疗的护理标准， 允许物理精确地量身定制剂量。这需要精确的肿瘤 成像与植入物在目标体积相关的植入物的动态术中定位相结合，AS 以及周围的未参与的前列腺和正常解剖结构。7,8,9,10结合IRUF和PSMA PET/CT 通过通过纯粹的计算方法添加精确的靶向来打破新的地面。 我们旨在开发一个在临床上可行的图像指导平台，以进行动态，定量评估 部分gland，近距离放射治疗期间的局灶性剂量法。该系统将允许个性化的近距离疗法， 在避免对前列腺癌存活不必要的毒性的同时，获得了极好的癌症控制。