PET-based dose painting in non-small cell lung cancer: Comparing uniform dose escalation with boosting hypoxic and metabolically active sub-volumes.

BACKGROUND AND PURPOSE: We compared two imaging biomarkers for dose-escalation in patients with advanced non-small cell lung cancer (NSCLC). Treatment plans boosting metabolically active sub-volumes defined by FDG-PET or hypoxic sub-volumes defined by HX4-PET were compared with boosting the entire tumour.MATERIALS AND METHODS: Ten NSCLC patients underwent FDG- and HX4-PET/CT scans prior to radiotherapy. Three isotoxic dose-escalation plans were compared per patient: plan A, boosting the primary tumour (PTVprim); plan B, boosting sub-volume with FDG >50% SUVmax (PTVFDG); plan C, boosting..

Nitroglycerin as a radiosensitizer in non-small cell lung cancer: Results of a prospective imaging-based phase II trial

Background: Nitroglycerin is proposed as an agent to reduce tumour hypoxia by improving tumour perfusion. We investigated the potent

External Validation of a Bayesian Network for Error Detection in Radiotherapy Plans

Artificial intelligence (AI) applications have recently been proposed to detect errors in radiotherapy plans. External validation of such systems is essential to assess their performance and safety before applying them to clinical practice. We collected data from 5238 patients treated at Maastro Clinic and introduced a range of common radiotherapy plan errors for the model to detect. We estimated the model's discrimination by calculating the area under the receiver-operating characteristic curve (AUC). We also assessed its clinical usefulness as an alert system that could reduce the need for manual checks by calculating the percentage of values flagged as errors and the positive predictive value (PPV) for a range of high sensitivities (95 %-99 %) and error prevalence. The AUC when considering all variables was 67.8% (95% CI, 65.6%-69.9%). The AUC varied widely for different types of errors (from 90.4% for table angle errors to 54.5% for planning tumor volume-PTV dose errors). The percentage of flagged values ranged from 84% to 90% for sensitivities between 95% and 99% and the PPV was only slightly higher than the prevalence of the errors. The model's performance in the external validation was significantly worse than that in its original setting (AUC of 68% versus 89%). Its usefulness as an alert system to reduce the need for manual checks is questionable due to the low PPV and high percentage of values flagged as potential errors to achieve a high sensitivity. We analyzed the apparent limitations of the model and we proposed actions to overcome them

Data from: Nitroglycerin in non-small cell lung cancer: does it impact tumor hypoxia and tumor perfusion? A window-of-opportunity clinical trial.

Despite preclinical evidence that nitric oxide (NO) donors influence both tumor perfusion and hypoxia, in clinical trials nitroglycerin has not been shown to improve the treatment results of all patients with non-small cell lung cancer (NSCLC). Biomarkers are therefore needed to select patients for treatment with NO donors. In this window-of-opportunity study we demonstrate the effect of nitroglycerin on hypoxia in patients using repeated hypoxia PET-imaging: we observed a reduction of hypoxia - quantified by uptake of PET tracer HX4- of varying magnitude upon application of a nitroglycerin..

Clinical implementation of standardized neurocognitive assessment before and after radiation to the brain

Background: Radiotherapy induced impairment of cognitive function can lead to a reduced quality of life. The aim of this study was to describe the implementation and compliance of standardized neurocognitive assessment. In addition, the first results of cognitive changes for patients receiving a radiation dose to the brain are described. Materials and methods: Patients that received radiation dose to the brain (neuro, head and neck and prophylactic cranial irradiation between April-2019 and Dec-2021 were included. Three neuro cognitive tests were performed a verbal learning and memory test, the Hopkins Verbal Learning Test; a verbal fluency test, the Controlled Oral Word Association Test and a speed and cognitive flexibility test, the Trail Making Test A&B. Tests were performed before the start of radiation, 6 months (6 m) and 1 year (1y) after irradiation. The Reliable Change Index (RCI) between baseline and follow-up was calculated using reference data from literature. Results: 644 patients performed the neurocognitive tests at baseline, 346 at 6 months and 205 at 1y after RT, with compliance rates of 90.4%, 85.6%, and 75.3%, respectively. Reasons for non-compliance were: 1. Patient did not attend appointment (49%), 2. Patient was unable to perform the test due to illness (12%), 3. Patient refused the test (8 %), 4. Various causes, (31%). A semi-automated analysis was developed to evaluate the test results. In total, 26% of patients showed a significant decline in at least one of variables at 1y and 11% on at least 2 variables at 1y. However, an increase in cognitive performance was observed in 49% (≥1 variable) and 22% (≥2 variables). Conclusion: Standardized neurocognitive testing within the radiotherapy clinic was successfully implemented, with a high patient compliance. A semi-automatic method to evaluate cognitive changes after treatment was defined. Data collection is ongoing, long term follow-up (up to 5 years after treatment) and dose–effect analysis will be performed