5 research outputs found
An Artificial Intelligence Approach to Tumor Volume Delineation
Postponed access: the file will be accessible after 2023-11-14Masteroppgave for radiograf/bioingeniĂžrRABD395MAMD-HELS
Feasibility of deep learning-based tumor segmentation for target delineation and response assessment in grade-4 glioma using multi-parametric MRI
Background
Tumor burden assessment is essential for radiation therapy (RT), treatment response evaluation, and clinical decision-making. However, manual tumor delineation remains laborious and challenging due to radiological complexity. The objective of this study was to investigate the feasibility of the HD-GLIO tool, an ensemble of pre-trained deep learning models based on the nnUNet-algorithm, for tumor segmentation, response prediction, and its potential for clinical deployment.
Methods
We analyzed the predicted contrast-enhanced (CE) and non-enhancing (NE) HD-GLIO output in 49 multi-parametric MRI examinations from 23 grade-4 glioma patients. The volumes were retrospectively compared to corresponding manual delineations by 2 independent operators, before prospectively testing the feasibility of clinical deployment of HD-GLIO-output to a RT setting.
Results
For CE, median Dice scores were 0.81 (95% CI 0.71â0.83) and 0.82 (95% CI 0.74â0.84) for operator-1 and operator-2, respectively. For NE, median Dice scores were 0.65 (95% CI 0.56â0,69) and 0.63 (95% CI 0.57â0.67), respectively. Comparing volume sizes, we found excellent intra-class correlation coefficients of 0.90 (P .01) for non-responders, and 0.80 (P = .05) for intermediate/mixed responders.
Conclusions
HD-GLIO was feasible for RT target delineation and MRI tumor volume assessment. CE/NE tumor-compartment growth correlation showed potential to predict clinical response to treatment.publishedVersio
Sequential bortezomib and temozolomide treatment promotes immunological responses in glioblastoma patients with positive clinical outcomes: A phase 1B study
Background
Glioblastoma (GBM) is an aggressive malignant brain tumor where median survival is approximately 15 months after best available multimodal treatment. Recurrence is inevitable, largely due to O6 methylguanine DNA methyltransferase (MGMT) that renders the tumors resistant to temozolomide (TMZ). We hypothesized that pretreatment with bortezomib (BTZ) 48âhours prior to TMZ to deplete MGMT levels would be safe and tolerated by patients with recurrent GBM harboring unmethylated MGMT promoter. The secondary objective was to investigate whether 26S proteasome blockade may enhance differentiation of cytotoxic immune subsets to impact treatment responses measured by radiological criteria and clinical outcomes.
Methods
Ten patients received intravenous BTZ 1.3âmg/m2 on days 1, 4, and 7 during each 4th weekly TMZâchemotherapy starting on day 3 and escalated from 150âmg/m2 per oral 5 days/wk via 175 to 200âmg/m2 in cycles 1, 2, and 3, respectively. Adverse events and quality of life were evaluated by CTCAE and EQâ5Dâ5L questionnaire, and immunological biomarkers evaluated by flow cytometry and Luminex enzymeâlinked immunosorbent assay.
Results
Sequential BTZâ+âTMZ therapy was safe and well tolerated. Pain and performance of daily activities had greatest impact on patients' selfâreported quality of life and were inversely correlated with Karnofsky performance status. Patients segregated a priori into three groups, where group 1 displayed stable clinical symptoms and/or slower magnetic resonance imaging radiological progression, expanded CD4+ effector Tâcells that attenuated cytotoxic Tâlymphocyte associated proteinâ4 and PDâ1 expression and secreted interferon Îł and tumor necrosis factor α in situ and ex vivo upon stimulation with PMA/ionomycin. In contrast, rapidly progressing group 2 patients exhibited tolerised Tâcell phenotypes characterized by fourfold to sixfold higher interleukin 4 (ILâ4) and ILâ10 Thâ2 cytokines after BTZâ+âTMZ treatment, where group 3 patients exhibited intermediate clinical/radiological responses.
Conclusion
Sequential BTZâ+âTMZ treatment is safe and promotes Th1âdriven immunological responses in selected patients with improved clinical outcomes (Clinicaltrial.gov (NCT03643549)).publishedVersio
Clinical characteristics of patients seeking treatment for common mental disorders presenting with workplace bullying experiences
Background: Targets of workplace bullying tend to develop severe mental health complaints, having increased risk of sick leave and expulsion from the workplace. Hence, these individuals are likely to be overrepresented among patients seeking treatment for common mental disorders (CMD). This study investigated the prevalence of exposure to workplace bullying in a patient group seeking treatment for CMD. Further we explored if exposed and non-exposed patients differed on clinical and work-related characteristics.
Methods: The sample comprised of 675 patients from an outpatient clinic in Norway and consisted of 70% women and had a mean age of 39 (SD = 10.5) years. The study had a cross-sectional design and differences between the patient groups were analysed using chi-square, MannâWhitney U-tests and independent sample t-tests.
Results: The prevalence of exposure to bullying was 25.8%. The patients exposed to bullying reported significantly more major depressive disorders (MDDs) measured with the MINI psychiatric interview, higher levels of depressive symptoms, anxiety symptoms, subjective health complaints, alcohol use, and lower resilience as measured with questionnaires. Twice as many were on full-time sick leave, reported lower work ability, lower return to work self-efficacy, and lower job satisfaction. A majority preferred another job than the one they have today over returning to their current employment.
Conclusion: Victims of workplace bullying are a vulnerable group at risk of expulsion from working life, being overrepresented among patients seeking mental health treatment for CMD. One in four patients represented with such experience have higher levels of psychological symptoms and are more often diagnosed with depression as compared to other patients. Thus, this is a problem that should be addressed in clinical settings. If not addressed there is an increased risk of sick leave and permanent exclusion from working life.publishedVersio