Radio-opaque contrast agents for liver cancer targeting with KIM during radiation therapy (ROCK-RT): an observational feasibility study.
Humans
Liver Neoplasms
/ radiotherapy
Feasibility Studies
Contrast Media
Carcinoma, Hepatocellular
/ radiotherapy
Radiotherapy, Image-Guided
/ methods
Retrospective Studies
Cone-Beam Computed Tomography
/ methods
Male
Female
Radiotherapy Planning, Computer-Assisted
/ methods
Chemoembolization, Therapeutic
/ methods
Radiosurgery
/ methods
Image Guidance
Kilovoltage Intrafraction Monitoring
Liver
Neoplasms
Radio-opaque contrast
Radiotherapy
Stereotactic ablative Radiation Therapy (SABR)
Transarterial chemoemobilisation (TACE)
Journal
Radiation oncology (London, England)
ISSN: 1748-717X
Titre abrégé: Radiat Oncol
Pays: England
ID NLM: 101265111
Informations de publication
Date de publication:
08 Oct 2024
08 Oct 2024
Historique:
received:
09
01
2024
accepted:
17
09
2024
medline:
9
10
2024
pubmed:
9
10
2024
entrez:
8
10
2024
Statut:
epublish
Résumé
This observational study aims to establish the feasibility of using x-ray images of radio-opaque chemoembolisation deposits in patients as a method for real-time image-guided radiation therapy of hepatocellular carcinoma. This study will recruit 50 hepatocellular carcinoma patients who have had or will have stereotactic ablative radiation therapy and have had transarterial chemoembolisation with a radio-opaque agent. X-ray and computed tomography images of the patients will be analysed retrospectively. Additionally, a deep learning method for real-time motion tracking will be developed. We hypothesise that: (i) deep learning software can be developed that will successfully track the contrast agent mass on two thirds of cone beam computed tomography (CBCT) projection and intra-treatment images (ii), the mean and standard deviation (mm) difference in the location of the mass between ground truth and deep learning detection are ≤ 2 mm and ≤ 3 mm respectively and (iii) statistical modelling of study data will predict tracking success in 85% of trial participants. Developing a real-time tracking method will enable increased targeting accuracy, without the need for additional invasive procedures to implant fiducial markers. Registered to ClinicalTrials.gov (NCT05169177) 12th October 2021.
Sections du résumé
BACKGROUND
BACKGROUND
This observational study aims to establish the feasibility of using x-ray images of radio-opaque chemoembolisation deposits in patients as a method for real-time image-guided radiation therapy of hepatocellular carcinoma.
METHODS
METHODS
This study will recruit 50 hepatocellular carcinoma patients who have had or will have stereotactic ablative radiation therapy and have had transarterial chemoembolisation with a radio-opaque agent. X-ray and computed tomography images of the patients will be analysed retrospectively. Additionally, a deep learning method for real-time motion tracking will be developed. We hypothesise that: (i) deep learning software can be developed that will successfully track the contrast agent mass on two thirds of cone beam computed tomography (CBCT) projection and intra-treatment images (ii), the mean and standard deviation (mm) difference in the location of the mass between ground truth and deep learning detection are ≤ 2 mm and ≤ 3 mm respectively and (iii) statistical modelling of study data will predict tracking success in 85% of trial participants.
DISCUSSION
CONCLUSIONS
Developing a real-time tracking method will enable increased targeting accuracy, without the need for additional invasive procedures to implant fiducial markers.
TRIAL REGISTRATION
BACKGROUND
Registered to ClinicalTrials.gov (NCT05169177) 12th October 2021.
Identifiants
pubmed: 39380004
doi: 10.1186/s13014-024-02524-4
pii: 10.1186/s13014-024-02524-4
doi:
Substances chimiques
Contrast Media
0
Banques de données
ClinicalTrials.gov
['NCT05169177']
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
139Subventions
Organisme : Cancer Institute NSW
ID : 2019/TPG2165
Organisme : Cancer Institute NSW
ID : 2019/TPG2165
Organisme : Cancer Institute NSW
ID : 2019/TPG2165
Organisme : National Health and Medical Research Council
ID : APP1194004
Informations de copyright
© 2024. The Author(s).
Références
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer statistics 2020: GLOBOCAN estimates of incidence and Mortality Worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–49.
doi: 10.3322/caac.21660
pubmed: 33538338
Llovet JM, Kelley RK, Villanueva A, Singal AG, Pikarsky E, Roayaie S, et al. Hepatocellular carcinoma. Nat Rev Dis Primers. 2021;7(1):6.
doi: 10.1038/s41572-020-00240-3
pubmed: 33479224
Villanueva A, Hepatocellular Carcinoma. N Engl J Med. 2019;380(15):1450–62.
doi: 10.1056/NEJMra1713263
pubmed: 30970190
Cocker F, Chien Yee K, Palmer AJ, de Graaff B. Increasing incidence and mortality related to liver cancer in Australia: time to turn the tide. Aust N Z J Public Health. 2019;43(3):267–73.
doi: 10.1111/1753-6405.12889
pubmed: 30958629
Chang BK, Timmerman RD. Stereotactic body radiation therapy: a comprehensive review. Am J Clin Oncol. 2007;30(6):637–44.
doi: 10.1097/COC.0b013e3180ca7cb1
pubmed: 18091059
Timmerman R, Paulus R, Galvin J, Michalski J, Straube W, Bradley J, et al. Stereotactic body radiation therapy for inoperable early stage lung cancer. JAMA. 2010;303(11):1070–6.
doi: 10.1001/jama.2010.261
pubmed: 20233825
pmcid: 2907644
Hoyer M, Swaminath A, Bydder S, Lock M, Mendez Romero A, Kavanagh B, et al. Radiotherapy for liver metastases: a review of evidence. Int J Radiat Oncol Biol Phys. 2012;82(3):1047–57.
doi: 10.1016/j.ijrobp.2011.07.020
pubmed: 22284028
Hall WA, Stapleford LJ, Hadjipanayis CG, Curran WJ, Crocker I, Shu HK. Stereotactic body radiosurgery for spinal metastatic disease: an evidence-based review. Int J Surg Oncol. 2011;2011:979214.
pubmed: 22312536
pmcid: 3263656
Shirato H, Seppenwoolde Y, Kitamura K, Onimura R, Shimizu S. Intrafractional tumor motion: lung and liver. Semin Radiat Oncol. 2004;14(1):10–8.
doi: 10.1053/j.semradonc.2003.10.008
pubmed: 14752729
Gargett M, Haddad C, Kneebone A, Booth JT, Hardcastle N. Clinical impact of removing respiratory motion during liver SABR. Radiat Oncol. 2019;14(1):93.
doi: 10.1186/s13014-019-1300-6
pubmed: 31159840
pmcid: 6547575
Keall PJ, Nguyen DT, O’Brien R, Caillet V, Hewson E, Poulsen PR, et al. The first clinical implementation of real-time image-guided adaptive radiotherapy using a standard linear accelerator. Radiother Oncol. 2018;127(1):6–11.
doi: 10.1016/j.radonc.2018.01.001
pubmed: 29428258
Sengupta C, Nguyen DT, Moodie T, Mason D, Luo J, Causer T et al. The first clinical implementation of real-time 6 degree-of-freedom image-guided Radiotherapy for Liver SABR patients. Radiother Oncol. 2023:110031.
Dutta D, Kataki KJ, George S, Reddy SK, Sashidharan A, Kannan R, et al. Prospective evaluation of fiducial marker placement quality and toxicity in liver CyberKnife stereotactic body radiotherapy. Radiat Oncol J. 2020;38(4):253–61.
doi: 10.3857/roj.2020.00472
pubmed: 33249803
pmcid: 7785839
Bertholet J, Knopf A, Eiben B, McClelland J, Grimwood A, Harris E, et al. Real-time intrafraction motion monitoring in external beam radiotherapy. Phys Med Biol. 2019;64(15):15TR01.
doi: 10.1088/1361-6560/ab2ba8
pubmed: 31226704
pmcid: 7655120
Yue J, Sun X, Cai J, Yin FF, Yin Y, Zhu J, et al. Lipiodol: a potential direct surrogate for cone-beam computed tomography image guidance in radiotherapy of liver tumor. Int J Radiat Oncol Biol Phys. 2012;82(2):834–41.
doi: 10.1016/j.ijrobp.2010.12.050
pubmed: 21377291
Buckstein M, Kim E, Ozbek U, Tabrizian P, Gunasekaran G, Facciuto M, et al. Combination Transarterial Chemoembolization and Stereotactic Body Radiation Therapy for Unresectable single large Hepatocellular Carcinoma: results from a prospective phase 2 trial. Int J Radiat Oncol Biol Phys. 2022;114(2):221–30.
doi: 10.1016/j.ijrobp.2022.05.021
pubmed: 35643250
Yoon SM, Ryoo BY, Lee SJ, Kim JH, Shin JH, An JH, et al. Efficacy and Safety of Transarterial Chemoembolization Plus External Beam Radiotherapy vs Sorafenib in Hepatocellular Carcinoma with Macroscopic Vascular Invasion: a Randomized Clinical Trial. JAMA Oncol. 2018;4(5):661–9.
doi: 10.1001/jamaoncol.2017.5847
pubmed: 29543938
pmcid: 5885246
Isola P, Zhu J-Y, Zhou T, Efros AA, editors. Image-to-image translation with conditional adversarial networks. Proceedings of the IEEE conference on computer vision and pattern recognition; 2017.