Silke Engelholm - Academia.edu (original) (raw)
Papers by Silke Engelholm
Acta Oncologica, 2022
BACKGROUND Chemo- and radiotherapy (RT) is standard treatment for patients with high-grade glioma... more BACKGROUND Chemo- and radiotherapy (RT) is standard treatment for patients with high-grade glioma, but may cause side-effects on the patient's cognitive function. AIM Use of diffusion tensor imaging (DTI) to investigate the longitudinal changes in normal-appearing brain tissue in glioblastoma patients undergoing modern arc-based RT with volumetric modulated arc therapy (VMAT) or helical tomotherapy. MATERIALS AND METHODS The study included 27 patients newly diagnosed with glioblastoma and planned for VMAT or tomotherapy. All subjects underwent magnetic resonance imaging at the start of RT and at week 3, 6, 15, and 26. Fourteen subjects were additionally imaged at week 52. The DTI data were co-registered to the dose distribution maps. Longitudinal changes in fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) were assessed in the corpus callosum, the centrum semiovale, the hippocampus, and the amygdala. RESULTS Significant longitudinal changes in FA, MD, and RD were mainly found in the corpus callosum. In the other examined brain structures, only sparse and transient changes were seen. No consistent correlations were found between biodose, age, or gender and changes in DTI parameters. CONCLUSION Longitudinal changes in MD, FA, and RD were observed but only in a limited number of brain structures and the changes were smaller than expected from literature. The results suggest that modern, arc-based RT may have less negative effect on normal-appearing parts of the brain tissue up to 12 months after radiotherapy.
Radiotherapy and Oncology, 2019
Conclusion The results demonstrate that CNN-based methods trained on a relatively small database ... more Conclusion The results demonstrate that CNN-based methods trained on a relatively small database of CT scans can detect the cranial and caudal limits of breast CTVs with an accuracy comparable to that of an atlas-based segmentation. Besides the accuracy level, a CNN-based method might be a better option than atlas-based segmentation for this application because it requires less manual effort for setup. In the future, methods 2 and 3 will be evaluated in larger datasets to observe how the accuracy and computation scale. Additionally, breast limits on other imaging planes will be considered.
Journal of Thoracic Oncology, 2017
were higher in patients with vs without events (mean 22Gy vs 11Gy, V5Gy 60% vs 35%, V30Gy 35% vs ... more were higher in patients with vs without events (mean 22Gy vs 11Gy, V5Gy 60% vs 35%, V30Gy 35% vs 14%). On multivariate pair analysis accounting for baseline risk, heart doses remained significant predictors of cardiac events (e.g. Heart mean dose, p¼0.001, HR 1.05 / 1Gy). 2-year competing risk-adjusted rate of symptomatic cardiac events was 11.1% vs 1.5% for Heart mean dose 15Gy vs <15Gy (p¼0.003, HR 6.7). 34 patients (30%) had asymptomatic pericardial effusions. There was no association between heart doses and OS. Conclusion: Clinically significant symptomatic cardiac events following high-dose thoracic RT for Stage III NSCLC occurred in 13% of patients at a median 2 years post-RT, with the rate appearing to be heart dose dependent. RT-associated cardiac toxicity in the definitive treatment of Stage III NSCLC may occur earlier than historically understood, and heart doses should be minimized. Supported in part by NIH grant CA69579.
Neuroradiology, 2016
This meeting will provide you with interesting scientific program enriched with multiple educatio... more This meeting will provide you with interesting scientific program enriched with multiple educational workshops, scientific lectures related to both, clinical problems and scientific topics. Numerous distinguished lecturers and experts from all around the world will join their efforts to present current topics and interesting cases, covering all fields of Neuroradiology. We invite you to take active participation during the sessions, since such meetings are a unique opportunity for the exchange of knowledge and experiences between colleagues from different countries and continents. The 39th ESNR Annual Meeting will offer the opportunity for younger radiologist to present their work and achievements through poster presentation and parallel scientific sessions. After a hard working day, we offer you the opportunities to explore and enjoy Belgrade, the city which lays at the confluence of the Sava and the Danube rivers, through the social events that we have arranged for you. Belgrade is one of the oldest cities in Europe and has been an important crossroad since ancient times. It's the place where Western and Eastern Europe meet. Belgrade presents at the same time a mixture of a modern European metropole and an old historical town. Serbian people have made some greatest contributions to science, art and culture. And finally, Belgrade is famous for its interesting night life and various types of restaurants with excellent music from jazz to folk.
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, Oct 9, 2016
Positron emission tomography (PET) provides quantitative metabolic information and potential biom... more Positron emission tomography (PET) provides quantitative metabolic information and potential biomarkers of treatment outcome. We aimed to determine the prognostic value of early (18)F-fluoroethyl-tyrosine ((18)F-FET) PET scans acquired during re-irradiation for recurrent high-grade glioma (HGG). A phase I clinical trial of re-irradiation of HGG was carried out. MRI and (18)F-FET PET were used for target delineation and follow-up. Images were acquired at baseline, during radiotherapy and 4weeks post-treatment and compared by measuring the metabolically active biological tumor volume (BTV) and maximal activity (Tmax/B). Correlations with outcomes were assessed by multivariate Cox regression analysis. Thirty-one patients were included and all patients have died. The median overall survival was 7.0 mos. Both baseline BTV and baseline MRI volume (necrotic/cystic cavities subtracted) were prognostic for overall survival (OS) in multivariate analysis (HR=1.3 p<0.01 and HR=1.3 p<0.01,...
International Journal of Radiation Oncology*Biology*Physics, 2014
<6 biopsy cores, insufficient pathology detail, or <0.5 y follow-up. Outcomes were compared by cu... more <6 biopsy cores, insufficient pathology detail, or <0.5 y follow-up. Outcomes were compared by cumulative incidence (Gray's) and competing risks regression (Fine and Gray's). Results: Median clinical and PSA follow-up were 4.9 y (0.5-15.1) and 3.4 y (0.5-14.5). A median of 10 (6-47) biopsy cores were sampled. ROC curves identified PPC !36% and PCV !16.5% as prognostic of Phoenix biochemical control (BC). Median (range) or percentages are shown (Table).
Neuro-Oncology, 2014
BACKGROUND AND PURPOSE: Re-irradiation of HGG at recurrence may be a viable treatment option for ... more BACKGROUND AND PURPOSE: Re-irradiation of HGG at recurrence may be a viable treatment option for some patients. Positron emission tomography (PET) using the amino acid tracer, 18F-fluoro-ethyltyrosine (FET) may have higher specificity and sensitivity than MRI in this setting. Both FET PET and MRI were used for target delineation in a prospective trial. The purpose of
Acta Oncologica, 2014
Background. Surgery followed by radiotherapy and concomitant and adjuvant temozolomide is standar... more Background. Surgery followed by radiotherapy and concomitant and adjuvant temozolomide is standard therapy in newly diagnosed glioblastoma multiforme (GBM). Bevacizumab combined with irinotecan produces impressive response rates in recurrent GBM. In a randomized phase II study, we investigated the effi cacy of neoadjuvant bevacizumab combined with irinotecan (Bev-Iri) versus bevacizumab combined with temozolomide (Bev-Tem) before, during and after radiotherapy in newly diagnosed GBM. Material and methods. After surgery, patients were randomized to Bev-Iri or Bev-Tem for eight weeks, followed by standard radiotherapy (60 Gy/30 fractions) and concomitant Bev-Iri or Bev-Tem followed by adjuvant Bev-Iri or Bev-Tem for another eight weeks. Bev-Iri: Bevacizumab and irinotecan were given every 14 days before, during and after radiotherapy. Bev-Tem: Bevacizumab was given as in Bev-Iri and temozolomide was given for fi ve days every four weeks before and after radiotherapy and once daily during radiotherapy. The primary endpoint was response after neoadjuvant chemotherapy and a pre-specifi ed response rate of 30% or more was considered of interest for future studies. Secondary endpoints were progression-free survival (PFS) and toxicity. Results. The response rate was 32% (95% CI 17-51%) for Bev-Tem (n ϭ 32) and 23% (95% CI 9-44%) for Bev-Iri (n ϭ 31) (p ϭ 0.56). Median PFS was 7.7 and 7.3 months for Bev-Tem and Bev-Iri, respectively. Hematological toxicity was more frequent with Bev-Tem including one death from febrile neutropenia whereas non-hematological toxicity was manageable. Conclusions. Only the Bev-Tem arm met the pre-specifi ed level of activity of interest. Our results did not indicate any benefi t from Bev-Iri in fi rst-line therapy as opposed to Bev-Tem in terms of response and PFS.
Background.We sought to assess the impact of amino-acid 18F-fluoro-ethyl-tyrosine (FET) positron ... more Background.We sought to assess the impact of amino-acid 18F-fluoro-ethyl-tyrosine (FET) positron emission tomography (PET) on the volumetric target definition for radiation therapy of high-grade glioma versus the current standard using MRI alone. Specifically, we investigated the influence of tumor grade, MR-defined tumor volume, and the extent of surgical resection on PET positivity. Methods. Fifty-four consecutive high-grade glioma patients (World Health Organization grades III–IV) with confirmed histology were scanned using FET-PET/CT and T1 and T2/fluid attenuated inversion recovery MRI. Gross tumor volume and clinical target volumes (CTVs) were defined in a blinded fashion based on MRI and subsequently PET, and volumetric analysis was performed. The extent of the surgical resection was reviewed using postoperative MRI. Results. Overall, for90 % of the patients, the PET-positive volumes were encompassed by T1 MRI with contrast-defined tumor plus a 20-mm margin. The tumor volume ...
Radiotherapy and Oncology, 2020
Purpose:To find out differences in cerebral blood volume (CBV) maps derived from dynamic suscepti... more Purpose:To find out differences in cerebral blood volume (CBV) maps derived from dynamic susceptibility contrast-enhanced magnetic resonance imaging (DSCE-MRI) in glioblastomas and cerebral metastases. The main purpose was to compare CBV maps between metastases with different primary malignancies. Furthermore the metastasis group was compared with the glioblastoma group.Method:Conventional imaging and DSCE-MRI using 3T MRI system was performed in 114 patients, 38 glioblastomas and 76 metastases, 32 lung, 12 breast, 12 melanoma, 10 gastrointestinal (GI), and 10 other. CBV values were measured in the solid tumor area, peritumoral edema, area adjacent to peritumoral edema, and in normal apparent white matter in contralateral semioval center. The four subgroups of metastases were compared with one-way ANOVA to determine differences in CBV of significance. CBV values in glioblastomas and metastases were then statistically compared using paired t-test. Receiver -operating characteristic a...
Radiotherapy and Oncology, 2020
European Journal of Haematology
Total body irradiation (TBI) is commonly used prior to hematopoietic stem cell transplantation (H... more Total body irradiation (TBI) is commonly used prior to hematopoietic stem cell transplantation (HSCT) in myeloablative conditioning regimens. However, TBI may be replaced by total marrow irradiation (TMI) at centres with access to Helical TomoTherapy, a modality that has the advantage of delivering intensity‐modulated radiotherapy to long targets such as the entire bone marrow compartment. Toxicity after organ sparing TMI prior to HSCT has not previously been reported compared to TBI or with regard to engraftment data.
Journal of Thoracic Oncology
Technical Innovations & Patient Support in Radiation Oncology
Journal of Applied Clinical Medical Physics
Abstract Purpose In this study, we have quantified the setup deviation and time gain when using f... more Abstract Purpose In this study, we have quantified the setup deviation and time gain when using fast surface scanning for daily setup/positioning with weekly megavoltage computed tomography (MVCT) and compared it to daily MVCT. Methods A total of 16 835 treatment fractions were analyzed, treated, and positioned using our TomoTherapy HD (Accuray Inc., Madison, USA) installed with a Sentinel optical surface scanning system (C‐RAD Positioning AB, Uppsala, Sweden). Patients were positioned using in‐room lasers, surface scanning and MVCT for the first three fractions. For the remaining fractions, in‐room laser was used for setup followed by daily surface scanning with MVCT once weekly. The three‐dimensional (3D) setup correction for surface scanning was evaluated from the registration between MVCT and the planning CT. The setup correction vector for the in‐room lasers was assessed from the surface scanning and the MVCT to planning CT registration. The imaging time was evaluated as the time from imaging start to beam‐on. Results We analyzed 894 TomoTherapy treatment plans from 2012 to 2018. Of all the treatment fractions performed with surface scanning, 90 % of the residual errors were within 2.3 mm for CNS (N = 284), 2.9 mm for H&N (N = 254), 8.7 mm for thorax (N = 144) and 10.9 for abdomen (N = 134) patients. The difference in residual error between surface scanning and positioning with in‐room lasers was significant (P < 0.005) for all sites. The imaging time was assessed as total imaging time per treatment plan, modality, and treatment site and found that surface scanning significantly reduced patient on‐couch time compared to MVCT for all treatment sites (P < 0.005). Conclusions The results indicate that daily surface scanning with weekly MVCT can be used with the current target margins for H&N, CNS, and thorax, with reduced imaging time.
Acta Oncologica
Introduction: Cognitive function is an important outcome measure in patients with brain tumor, pr... more Introduction: Cognitive function is an important outcome measure in patients with brain tumor, providing information about the patient's clinical situation, treatment effects and possible progressive disease. The aim of this longitudinal study was to evaluate effects of the currently used radiation and chemotherapy treatment on cognitive function and to investigate associations between cognitive function at baseline and progression as well as overall survival. Methods: 32 patients newly diagnosed with malignant glioma were evaluated at baseline with CNS Vital Signs (CNS-VS), a computerized standardized neuropsychological test battery, prior to arc-based radiotherapy and concomitant chemotherapy with Temozolomide. CNS-VS measures the cognitive functions known to be affected in patients with brain tumor, covering nine cognitive domains. Followup cognitive evaluations were performed in 26 patients after 3.5 months and in 13 patients 1 year after treatment start. Results: Overall cognitive scores were lower in the studied patient cohort at baseline compared to standardized domain scores. At 3.5 months follow-up cognitive functioning was slightly decreased, but only in 1/9 cognitive domainsvisual memorywhere significant changes were found compared to baseline test results. Similarly, at 12 months follow-up no significant changes in cognitive test results were seen compared to baseline examination, except for a decrease in the visual memory domain. In relation to early progression, the most significant cognitive deficits were dysfunctional visual memory and low executive functioning at baseline. Low executive function at baseline correlated most significantly with shorter overall survival. Conclusion: The present study suggests that the currently used arc-based radiotherapy and chemotherapy might affect cognitive function less negatively than previously described during treatment and in the first year after treatment in malignant glioma patients. In general, a high cognitive test score at baseline was associated with longer time to progression and with longer survival.
Radiation Oncology, Apr 9, 2020
BackgroundRetrospective studies on MRI-only radiotherapy have been presented. Widespread clinical... more BackgroundRetrospective studies on MRI-only radiotherapy have been presented. Widespread clinical implementations of MRI-only workflows are however limited by the absence of guidelines. The MR-PROTECT trial presents an MRI-only radiotherapy workflow for prostate cancer using a new single sequence strategy. The workflow incorporated the commercial synthetic CT (sCT) generation software MriPlanner™ (Spectronic Medical, Helsingborg, Sweden). Feasibility of the workflow and limits for acceptance criteria were investigated for the suggested workflow with the aim to facilitate future clinical implementations.MethodsAn MRI-only workflow including imaging, post imaging tasks, treatment plan creation, quality assurance and treatment delivery was created with questionnaires. All tasks were performed in a single MR-sequence geometry, eliminating image registrations. Prospective CT-quality assurance (QA) was performed prior treatment comparing the PTV mean dose between sCT and CT dose-distributions. Retrospective analysis of the MRI-only gold fiducial marker (GFM) identification, DVH- analysis, gamma evaluation and patient set-up verification using GFMs and cone beam CT were performed.ResultsAn MRI-only treatment was delivered to 39 out of 40 patients. The excluded patient was too large for the predefined imaging field-of-view. All tasks could successfully be performed for the treated patients. There was a maximum deviation of 1.2% in PTV mean dose was seen in the prospective CT-QA. Retrospective analysis showed a maximum deviation below 2% in the DVH-analysis after correction for rectal gas and gamma pass-rates above 98%. MRI-only patient set-up deviation was below 2 mm for all but one investigated case and a maximum of 2.2 mm deviation in the GFM-identification compared to CT.ConclusionsThe MR-PROTECT trial shows the feasibility of an MRI-only prostate radiotherapy workflow. A major advantage with the presented workflow is the incorporation of a sCT-generation method with multi-vendor capability. The presented single sequence approach are easily adapted by other clinics and the general implementation procedure can be replicated. The dose deviation and the gamma pass-rate acceptance criteria earlier suggested was achievable, and these limits can thereby be confirmed. GFM-identification acceptance criteria are depending on the choice of identification method and slice thickness. Patient positioning strategies needs further investigations to establish acceptance criteria.
Acta Oncologica, 2022
BACKGROUND Chemo- and radiotherapy (RT) is standard treatment for patients with high-grade glioma... more BACKGROUND Chemo- and radiotherapy (RT) is standard treatment for patients with high-grade glioma, but may cause side-effects on the patient's cognitive function. AIM Use of diffusion tensor imaging (DTI) to investigate the longitudinal changes in normal-appearing brain tissue in glioblastoma patients undergoing modern arc-based RT with volumetric modulated arc therapy (VMAT) or helical tomotherapy. MATERIALS AND METHODS The study included 27 patients newly diagnosed with glioblastoma and planned for VMAT or tomotherapy. All subjects underwent magnetic resonance imaging at the start of RT and at week 3, 6, 15, and 26. Fourteen subjects were additionally imaged at week 52. The DTI data were co-registered to the dose distribution maps. Longitudinal changes in fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) were assessed in the corpus callosum, the centrum semiovale, the hippocampus, and the amygdala. RESULTS Significant longitudinal changes in FA, MD, and RD were mainly found in the corpus callosum. In the other examined brain structures, only sparse and transient changes were seen. No consistent correlations were found between biodose, age, or gender and changes in DTI parameters. CONCLUSION Longitudinal changes in MD, FA, and RD were observed but only in a limited number of brain structures and the changes were smaller than expected from literature. The results suggest that modern, arc-based RT may have less negative effect on normal-appearing parts of the brain tissue up to 12 months after radiotherapy.
Radiotherapy and Oncology, 2019
Conclusion The results demonstrate that CNN-based methods trained on a relatively small database ... more Conclusion The results demonstrate that CNN-based methods trained on a relatively small database of CT scans can detect the cranial and caudal limits of breast CTVs with an accuracy comparable to that of an atlas-based segmentation. Besides the accuracy level, a CNN-based method might be a better option than atlas-based segmentation for this application because it requires less manual effort for setup. In the future, methods 2 and 3 will be evaluated in larger datasets to observe how the accuracy and computation scale. Additionally, breast limits on other imaging planes will be considered.
Journal of Thoracic Oncology, 2017
were higher in patients with vs without events (mean 22Gy vs 11Gy, V5Gy 60% vs 35%, V30Gy 35% vs ... more were higher in patients with vs without events (mean 22Gy vs 11Gy, V5Gy 60% vs 35%, V30Gy 35% vs 14%). On multivariate pair analysis accounting for baseline risk, heart doses remained significant predictors of cardiac events (e.g. Heart mean dose, p¼0.001, HR 1.05 / 1Gy). 2-year competing risk-adjusted rate of symptomatic cardiac events was 11.1% vs 1.5% for Heart mean dose 15Gy vs <15Gy (p¼0.003, HR 6.7). 34 patients (30%) had asymptomatic pericardial effusions. There was no association between heart doses and OS. Conclusion: Clinically significant symptomatic cardiac events following high-dose thoracic RT for Stage III NSCLC occurred in 13% of patients at a median 2 years post-RT, with the rate appearing to be heart dose dependent. RT-associated cardiac toxicity in the definitive treatment of Stage III NSCLC may occur earlier than historically understood, and heart doses should be minimized. Supported in part by NIH grant CA69579.
Neuroradiology, 2016
This meeting will provide you with interesting scientific program enriched with multiple educatio... more This meeting will provide you with interesting scientific program enriched with multiple educational workshops, scientific lectures related to both, clinical problems and scientific topics. Numerous distinguished lecturers and experts from all around the world will join their efforts to present current topics and interesting cases, covering all fields of Neuroradiology. We invite you to take active participation during the sessions, since such meetings are a unique opportunity for the exchange of knowledge and experiences between colleagues from different countries and continents. The 39th ESNR Annual Meeting will offer the opportunity for younger radiologist to present their work and achievements through poster presentation and parallel scientific sessions. After a hard working day, we offer you the opportunities to explore and enjoy Belgrade, the city which lays at the confluence of the Sava and the Danube rivers, through the social events that we have arranged for you. Belgrade is one of the oldest cities in Europe and has been an important crossroad since ancient times. It's the place where Western and Eastern Europe meet. Belgrade presents at the same time a mixture of a modern European metropole and an old historical town. Serbian people have made some greatest contributions to science, art and culture. And finally, Belgrade is famous for its interesting night life and various types of restaurants with excellent music from jazz to folk.
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, Oct 9, 2016
Positron emission tomography (PET) provides quantitative metabolic information and potential biom... more Positron emission tomography (PET) provides quantitative metabolic information and potential biomarkers of treatment outcome. We aimed to determine the prognostic value of early (18)F-fluoroethyl-tyrosine ((18)F-FET) PET scans acquired during re-irradiation for recurrent high-grade glioma (HGG). A phase I clinical trial of re-irradiation of HGG was carried out. MRI and (18)F-FET PET were used for target delineation and follow-up. Images were acquired at baseline, during radiotherapy and 4weeks post-treatment and compared by measuring the metabolically active biological tumor volume (BTV) and maximal activity (Tmax/B). Correlations with outcomes were assessed by multivariate Cox regression analysis. Thirty-one patients were included and all patients have died. The median overall survival was 7.0 mos. Both baseline BTV and baseline MRI volume (necrotic/cystic cavities subtracted) were prognostic for overall survival (OS) in multivariate analysis (HR=1.3 p<0.01 and HR=1.3 p<0.01,...
International Journal of Radiation Oncology*Biology*Physics, 2014
<6 biopsy cores, insufficient pathology detail, or <0.5 y follow-up. Outcomes were compared by cu... more <6 biopsy cores, insufficient pathology detail, or <0.5 y follow-up. Outcomes were compared by cumulative incidence (Gray's) and competing risks regression (Fine and Gray's). Results: Median clinical and PSA follow-up were 4.9 y (0.5-15.1) and 3.4 y (0.5-14.5). A median of 10 (6-47) biopsy cores were sampled. ROC curves identified PPC !36% and PCV !16.5% as prognostic of Phoenix biochemical control (BC). Median (range) or percentages are shown (Table).
Neuro-Oncology, 2014
BACKGROUND AND PURPOSE: Re-irradiation of HGG at recurrence may be a viable treatment option for ... more BACKGROUND AND PURPOSE: Re-irradiation of HGG at recurrence may be a viable treatment option for some patients. Positron emission tomography (PET) using the amino acid tracer, 18F-fluoro-ethyltyrosine (FET) may have higher specificity and sensitivity than MRI in this setting. Both FET PET and MRI were used for target delineation in a prospective trial. The purpose of
Acta Oncologica, 2014
Background. Surgery followed by radiotherapy and concomitant and adjuvant temozolomide is standar... more Background. Surgery followed by radiotherapy and concomitant and adjuvant temozolomide is standard therapy in newly diagnosed glioblastoma multiforme (GBM). Bevacizumab combined with irinotecan produces impressive response rates in recurrent GBM. In a randomized phase II study, we investigated the effi cacy of neoadjuvant bevacizumab combined with irinotecan (Bev-Iri) versus bevacizumab combined with temozolomide (Bev-Tem) before, during and after radiotherapy in newly diagnosed GBM. Material and methods. After surgery, patients were randomized to Bev-Iri or Bev-Tem for eight weeks, followed by standard radiotherapy (60 Gy/30 fractions) and concomitant Bev-Iri or Bev-Tem followed by adjuvant Bev-Iri or Bev-Tem for another eight weeks. Bev-Iri: Bevacizumab and irinotecan were given every 14 days before, during and after radiotherapy. Bev-Tem: Bevacizumab was given as in Bev-Iri and temozolomide was given for fi ve days every four weeks before and after radiotherapy and once daily during radiotherapy. The primary endpoint was response after neoadjuvant chemotherapy and a pre-specifi ed response rate of 30% or more was considered of interest for future studies. Secondary endpoints were progression-free survival (PFS) and toxicity. Results. The response rate was 32% (95% CI 17-51%) for Bev-Tem (n ϭ 32) and 23% (95% CI 9-44%) for Bev-Iri (n ϭ 31) (p ϭ 0.56). Median PFS was 7.7 and 7.3 months for Bev-Tem and Bev-Iri, respectively. Hematological toxicity was more frequent with Bev-Tem including one death from febrile neutropenia whereas non-hematological toxicity was manageable. Conclusions. Only the Bev-Tem arm met the pre-specifi ed level of activity of interest. Our results did not indicate any benefi t from Bev-Iri in fi rst-line therapy as opposed to Bev-Tem in terms of response and PFS.
Background.We sought to assess the impact of amino-acid 18F-fluoro-ethyl-tyrosine (FET) positron ... more Background.We sought to assess the impact of amino-acid 18F-fluoro-ethyl-tyrosine (FET) positron emission tomography (PET) on the volumetric target definition for radiation therapy of high-grade glioma versus the current standard using MRI alone. Specifically, we investigated the influence of tumor grade, MR-defined tumor volume, and the extent of surgical resection on PET positivity. Methods. Fifty-four consecutive high-grade glioma patients (World Health Organization grades III–IV) with confirmed histology were scanned using FET-PET/CT and T1 and T2/fluid attenuated inversion recovery MRI. Gross tumor volume and clinical target volumes (CTVs) were defined in a blinded fashion based on MRI and subsequently PET, and volumetric analysis was performed. The extent of the surgical resection was reviewed using postoperative MRI. Results. Overall, for90 % of the patients, the PET-positive volumes were encompassed by T1 MRI with contrast-defined tumor plus a 20-mm margin. The tumor volume ...
Radiotherapy and Oncology, 2020
Purpose:To find out differences in cerebral blood volume (CBV) maps derived from dynamic suscepti... more Purpose:To find out differences in cerebral blood volume (CBV) maps derived from dynamic susceptibility contrast-enhanced magnetic resonance imaging (DSCE-MRI) in glioblastomas and cerebral metastases. The main purpose was to compare CBV maps between metastases with different primary malignancies. Furthermore the metastasis group was compared with the glioblastoma group.Method:Conventional imaging and DSCE-MRI using 3T MRI system was performed in 114 patients, 38 glioblastomas and 76 metastases, 32 lung, 12 breast, 12 melanoma, 10 gastrointestinal (GI), and 10 other. CBV values were measured in the solid tumor area, peritumoral edema, area adjacent to peritumoral edema, and in normal apparent white matter in contralateral semioval center. The four subgroups of metastases were compared with one-way ANOVA to determine differences in CBV of significance. CBV values in glioblastomas and metastases were then statistically compared using paired t-test. Receiver -operating characteristic a...
Radiotherapy and Oncology, 2020
European Journal of Haematology
Total body irradiation (TBI) is commonly used prior to hematopoietic stem cell transplantation (H... more Total body irradiation (TBI) is commonly used prior to hematopoietic stem cell transplantation (HSCT) in myeloablative conditioning regimens. However, TBI may be replaced by total marrow irradiation (TMI) at centres with access to Helical TomoTherapy, a modality that has the advantage of delivering intensity‐modulated radiotherapy to long targets such as the entire bone marrow compartment. Toxicity after organ sparing TMI prior to HSCT has not previously been reported compared to TBI or with regard to engraftment data.
Journal of Thoracic Oncology
Technical Innovations & Patient Support in Radiation Oncology
Journal of Applied Clinical Medical Physics
Abstract Purpose In this study, we have quantified the setup deviation and time gain when using f... more Abstract Purpose In this study, we have quantified the setup deviation and time gain when using fast surface scanning for daily setup/positioning with weekly megavoltage computed tomography (MVCT) and compared it to daily MVCT. Methods A total of 16 835 treatment fractions were analyzed, treated, and positioned using our TomoTherapy HD (Accuray Inc., Madison, USA) installed with a Sentinel optical surface scanning system (C‐RAD Positioning AB, Uppsala, Sweden). Patients were positioned using in‐room lasers, surface scanning and MVCT for the first three fractions. For the remaining fractions, in‐room laser was used for setup followed by daily surface scanning with MVCT once weekly. The three‐dimensional (3D) setup correction for surface scanning was evaluated from the registration between MVCT and the planning CT. The setup correction vector for the in‐room lasers was assessed from the surface scanning and the MVCT to planning CT registration. The imaging time was evaluated as the time from imaging start to beam‐on. Results We analyzed 894 TomoTherapy treatment plans from 2012 to 2018. Of all the treatment fractions performed with surface scanning, 90 % of the residual errors were within 2.3 mm for CNS (N = 284), 2.9 mm for H&N (N = 254), 8.7 mm for thorax (N = 144) and 10.9 for abdomen (N = 134) patients. The difference in residual error between surface scanning and positioning with in‐room lasers was significant (P < 0.005) for all sites. The imaging time was assessed as total imaging time per treatment plan, modality, and treatment site and found that surface scanning significantly reduced patient on‐couch time compared to MVCT for all treatment sites (P < 0.005). Conclusions The results indicate that daily surface scanning with weekly MVCT can be used with the current target margins for H&N, CNS, and thorax, with reduced imaging time.
Acta Oncologica
Introduction: Cognitive function is an important outcome measure in patients with brain tumor, pr... more Introduction: Cognitive function is an important outcome measure in patients with brain tumor, providing information about the patient's clinical situation, treatment effects and possible progressive disease. The aim of this longitudinal study was to evaluate effects of the currently used radiation and chemotherapy treatment on cognitive function and to investigate associations between cognitive function at baseline and progression as well as overall survival. Methods: 32 patients newly diagnosed with malignant glioma were evaluated at baseline with CNS Vital Signs (CNS-VS), a computerized standardized neuropsychological test battery, prior to arc-based radiotherapy and concomitant chemotherapy with Temozolomide. CNS-VS measures the cognitive functions known to be affected in patients with brain tumor, covering nine cognitive domains. Followup cognitive evaluations were performed in 26 patients after 3.5 months and in 13 patients 1 year after treatment start. Results: Overall cognitive scores were lower in the studied patient cohort at baseline compared to standardized domain scores. At 3.5 months follow-up cognitive functioning was slightly decreased, but only in 1/9 cognitive domainsvisual memorywhere significant changes were found compared to baseline test results. Similarly, at 12 months follow-up no significant changes in cognitive test results were seen compared to baseline examination, except for a decrease in the visual memory domain. In relation to early progression, the most significant cognitive deficits were dysfunctional visual memory and low executive functioning at baseline. Low executive function at baseline correlated most significantly with shorter overall survival. Conclusion: The present study suggests that the currently used arc-based radiotherapy and chemotherapy might affect cognitive function less negatively than previously described during treatment and in the first year after treatment in malignant glioma patients. In general, a high cognitive test score at baseline was associated with longer time to progression and with longer survival.
Radiation Oncology, Apr 9, 2020
BackgroundRetrospective studies on MRI-only radiotherapy have been presented. Widespread clinical... more BackgroundRetrospective studies on MRI-only radiotherapy have been presented. Widespread clinical implementations of MRI-only workflows are however limited by the absence of guidelines. The MR-PROTECT trial presents an MRI-only radiotherapy workflow for prostate cancer using a new single sequence strategy. The workflow incorporated the commercial synthetic CT (sCT) generation software MriPlanner™ (Spectronic Medical, Helsingborg, Sweden). Feasibility of the workflow and limits for acceptance criteria were investigated for the suggested workflow with the aim to facilitate future clinical implementations.MethodsAn MRI-only workflow including imaging, post imaging tasks, treatment plan creation, quality assurance and treatment delivery was created with questionnaires. All tasks were performed in a single MR-sequence geometry, eliminating image registrations. Prospective CT-quality assurance (QA) was performed prior treatment comparing the PTV mean dose between sCT and CT dose-distributions. Retrospective analysis of the MRI-only gold fiducial marker (GFM) identification, DVH- analysis, gamma evaluation and patient set-up verification using GFMs and cone beam CT were performed.ResultsAn MRI-only treatment was delivered to 39 out of 40 patients. The excluded patient was too large for the predefined imaging field-of-view. All tasks could successfully be performed for the treated patients. There was a maximum deviation of 1.2% in PTV mean dose was seen in the prospective CT-QA. Retrospective analysis showed a maximum deviation below 2% in the DVH-analysis after correction for rectal gas and gamma pass-rates above 98%. MRI-only patient set-up deviation was below 2 mm for all but one investigated case and a maximum of 2.2 mm deviation in the GFM-identification compared to CT.ConclusionsThe MR-PROTECT trial shows the feasibility of an MRI-only prostate radiotherapy workflow. A major advantage with the presented workflow is the incorporation of a sCT-generation method with multi-vendor capability. The presented single sequence approach are easily adapted by other clinics and the general implementation procedure can be replicated. The dose deviation and the gamma pass-rate acceptance criteria earlier suggested was achievable, and these limits can thereby be confirmed. GFM-identification acceptance criteria are depending on the choice of identification method and slice thickness. Patient positioning strategies needs further investigations to establish acceptance criteria.