Changing brachytherapy with MRI remnant-tumor segmentation and active-catheter placement

通过 MRI 残余肿瘤分割和主动导管放置改变近距离放射治疗

• 批准号: 10642660
• 负责人: Akila Viswanathan
• 金额: $ 51.41万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-03-01 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10642660
• 关键词: Acceleration; Adopted; Bladder; Blood Vessels; Brachytherapy; Cancer Patient; Catheters; Cause of Death; Cervical; Cervix Uteri; Clinical; Clinical Trials; Collaborations; Communities; Complex; Complication; Computer software; Consumption; Detection; Devices; Diagnosis; Diffusion; Disease; Dose; Edema; Endometrial; Engineering; Environment; External Beam Radiation Therapy; Fibrosis; Goals; Gynecologic Brachytherapy; Hospitals; Hypoxia; Image; Indwelling Catheter; Infiltration; Institutional Review Boards; Intraoperative Radiation Therapy; Location; MRI Scans; Magnetic Resonance; Magnetic Resonance Imaging; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Maps; Measures; Medical; Metals; Methods; Normal tissue morphology; Outcome; Patients; Pelvis; Perfusion; Physicians; Procedures; Process; Proliferating; Property; Prostate; Public Health; Radiation; Radiation Dose Unit; Radiation Oncologist; Radiation Oncology; Radiation therapy; Radioactivity; Recommendation; Rectum; Recurrence; Recurrent Malignant Neoplasm; Recurrent tumor; Research; Research Personnel; Residual Neoplasm; Rod; Roentgen Rays; Scanning; Software Tools; Source; Survival Rate; System; Technology; Time; Tissues; Toxic effect; Tube; Universities; Vagina; Validation; Woman; Work; X-Ray Computed Tomography; advanced disease; cancer imaging; cancer recurrence; cancer site; clinical implementation; cohort; curative treatments; design; dosimetry; flexibility; image guided; implantation; improved; industry partner; innovation; interstitial; metallicity; method development; mortality; novel; procedure cost; product development; prototype; radiologist; rectal; side effect; software development; success; tissue mapping; tool; treatment planning; tumor

Cervical cancer is a worldwide public health problem and significant cause of mortality, with over 500,000 women diagnosed each year. Optimal curative treatment for women with locally advanced disease calls for treatment with external beam radiation (EBRT) followed by brachytherapy. Brachytherapy allows delivering larger dose into the tumor with interstitial catheters, which are placed into the residual tumors that survive EBRT. The placement of these catheters, hollow plastic tubes with metal rods placed inside for pushing through body tissue, is typically done without any guidance, and complications due to inadvertent insertion into normal tissues (blood vessels, rectum, bladder), rather than into residual tumor, may result. Magnetic resonance-guided brachytherapy (MRBT) has significantly improved survival and reduced complications caused by inadvertently radiating neighboring tissues. In order to locate the catheters properly and to calculate radiation dose, a CT is required after the MRBT. This lengthens an already complex and labor- intensive procedure, which also suffers from imperfect methods to identify residual tumor after EBRT and before MRBT. Identifying normal tissues as residual tumor before MRBT may result in inadvertent treatment with radiation of healthy tissues, which increases complications. MRI multi-parametric identification of post- EBRT residual tumor, combined with actively-tracked catheter placement into the disease as seen on MR scanning, can result in a more precise treatment volume, and faster and more accurate MRBT catheter placement, leading to better outcomes and reduced complications. This should increase the use of MRBT in treating cervical cancer, as well as recurrent endometrial, vaginal, prostate, and other cancers. The proposed procedure utilizes several novel tools: (a) MRI sequences that map the tissue parameters perfusion, diffusion, fibrosis and oxygenation in the post-EBRT pelvis, which are analyzed by expert clinicians, and used to develop a method for providing refined remnant tumor maps; (b) a novel active- obturator MRI coil which is placed in the vagina, that reduces MRI scan times by >50%; (c) flexible actively- tracked metallic catheters, integrated with the new Elekta Venezia applicator, improving localization precision and accelerating placement; and, (d) instantaneous intraoperative dose mapping, where catheter locations at any time during placement are used to predict and guide what the clinician's best next move should be, such as changing current catheter locations or adding more catheters. Together, these methods will culminate in dose-optimized catheter placements that will lower tumor recurrence and limit radiation side effects. This project is a collaboration between Johns Hopkins University and Elekta Inc. JHU radiation oncologists, radiologists, medical physicists and MRI physicists, along with a panel of experts in identifying remnant tumor, will work jointly with Elekta engineers to develop an innovative platform with broad applications in radiation oncology. The tools developed are validated in a 20-patient cohort of cervical cancer patients.

宫颈癌是全球公共卫生问题和死亡率的重大原因， 每年有500,000名妇女被诊断出。局部晚期疾病女性的最佳治疗治疗 呼吁用外束辐射（EBRT）进行治疗，然后进行近距离放射治疗。近距离放射治疗允许 用间质导管将较大剂量输送到肿瘤中，将其放入残留肿瘤中 幸存于EBRT。将这些导管的放置，空心塑料管，里面放置了金属棒 通常在没有任何指导的情况下进行穿过身体组织，并且由于无意而引起的并发症 可能会导致插入正常组织（血管，直肠，膀胱），而不是导致残留肿瘤。 磁共振引导的近距离放射治疗（MRBT）显着提高了生存率并降低了 并发症是由于无意间辐射的邻近组织引起的。为了正确找到导管 为了计算辐射剂量，MRBT后需要一个CT。这延长了已经很复杂且劳动 - 密集程序，这也遭受了不完美的方法，以鉴定EBRT和EBRT之后的残留肿瘤 MRBT之前。在MRBT之前将正常组织识别为残留肿瘤可能导致无意治疗 随着健康组织的辐射，增加并发症。 MRI多参数鉴定后 EBRT残留肿瘤，与主动跟踪的导管放置在该疾病中，如MR所示 扫描，可能导致更精确的治疗量，并更快，更准确 放置，导致更好的结果和减少并发症。这应该增加MRBT在 治疗宫颈癌，以及复发性子宫内膜，阴道，前列腺和其他癌症。 提出的程序利用了几种新工具：（a）绘制组织的MRI序列 骨盆后骨盆中的参数灌注，扩散，纤维化和氧合作用，通过 专业临床医生，用于开发一种提供精制残留肿瘤图的方法； （b）一种新颖的活动 - 放置在阴道中的闭孔MRI线圈，将MRI扫描时间降低> 50％； （c）灵活地主动 - 跟踪的金属导管，与新的Elekta Venezia涂抹器集成，提高了本地化精度 和加速位置； （d）瞬时术中剂量映射，导管位置位于 安置过程中的任何时间都用于预测和指导临床医生最好的下一步行动，这样 随着电流导管位置的变化或增加更多导管。这些方法一起将在 剂量优化的导管放置将降低肿瘤复发并限制辐射副作用。 这个项目是约翰·霍普金斯大学和Elekta Inc. Jhu Radiation之间的合作 肿瘤学家，放射科医生，医学物理学家和MRI物理学家以及一组专家识别 残留肿瘤将与Elekta工程师共同合作，开发一个具有广泛应用的创新平台 在辐射肿瘤学中。开发的工具在20名患者宫颈癌患者中得到了验证。