| 1. |
|
|
| 2. |
|
|
| 3. |
- Lindberg, K., et al.
(författare)
-
The HILUS-Trial—a Prospective Nordic Multicenter Phase 2 Study of Ultracentral Lung Tumors Treated With Stereotactic Body Radiotherapy
- 2021
-
Ingår i: Journal of Thoracic Oncology. - : Elsevier BV. - 1556-0864. ; 16:7, s. 1200-1210
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction: Stereotactic body radiation therapy of thoracic tumors close to the central airways implies risk of severe toxicity. We report a prospective multicenter phase 2 trial for tumors located less than or equal to 1 cm from the proximal bronchial tree with primary end point of local control and secondary end point of toxicity. Methods: Stereotactic body radiation therapy with 7 Gy × 8 was prescribed to the 67% isodose encompassing the planning target volume. The patients were stratified to group A (tumors ≤ 1 cm from the main bronchi and trachea) or group B (all other tumors). Risk factors for treatment-related death were tested in univariate analysis, and a logistic regression model was developed for fatal bronchopulmonary bleeding versus dose to the main bronchi and trachea. Results: A total of 65 patients (group A/group B, n = 39/26) were evaluated. The median distance between the tumor and the proximal bronchial tree was 0 mm (0–10 mm). The 2-year local control was 83%. Grade 3 to 5 toxicity was noted in 22 patients, including 10 cases of treatment-related death (bronchopulmonary hemorrhage, n = 8; pneumonitis, n = 1; fistula, n = 1). Dose to the combined structure main bronchi and trachea and tumor distance to the main bronchi were important risk factors. Dose modeling revealed minimum dose to the “hottest” 0.2 cc to the structure main bronchi and trachea as the strongest predictor for lethal bronchopulmonary hemorrhage. Conclusions: On the basis of the presented data, 7 Gy × 8, prescribed to the planning target volume-encompassing isodose, should not be used for tumors located within 1 cm from the main bronchi and trachea. Group B-type tumors may be considered for the treatment on the basis of an individual risk-benefit assessment and a maximum dose to the main bronchi and trachea in the order of 70 to 80 Gy (equivalent dose in 2 Gy fractions). © 2021 International Association for the Study of Lung Cancer
|
|
| 4. |
|
|
| 5. |
|
|
| 6. |
- F., Durmo, et al.
(författare)
-
Multivoxel 1H MR spectroscopy biometrics for preoprerative differentiation between brain tumors
- 2018
-
Ingår i: Neuroradiology. - : Springer Science and Business Media LLC. - 1432-1920 .- 0028-3940. ; 60:S2, s. 444-444
-
Konferensbidrag (refereegranskat)abstract
- Purpose To investigate multivoxel proton Magnetic Resonance Spectroscopy (1HMRS) biometrics for preoperative differentiation and prognosis of patients with brain metastases (MET), low-(LGG) and high grade glioma (HGG). Methods Thirty-five patients (15 HGG, 9 LGG and 11 MET) were included. Proton Magnetic Resonance Spectroscopy Imaging(1H-MRSI) data was assessed and neurochemical profiles for metabolites (NAA+NAAG, Cr+PCr, Glu+Gln (Glx), Lac, Ins, GPC+PCho) and total Lipids (tLip) and macromolecule (tMM) signals were estimated. Concentrations were reported as either absolute or ratios to total choline (tCho=GPC+PCho) and creatine (tCr=Cr+PCr) levels. Voxels of interest (VOIs) in a MRSI matrix were labelled accordingly to contrast-enhancing/nonenhancing lesional, edema, ipsi- or contralateral healthy appearing tissue and the metabolite averages were reported for each tissue type. Multi-biometric analysis with logistic regression, ROC- and Kaplan-Meier survival analysis was performed in SPSS v.24 and postprocessing with LC Model. Results Across HGG/LGG/MET; the average Ins/tCho was shown to be prognostic for overall survival (OS): with low values (≤1.29) in affected hemisphere predicting worse OS than high values (>1.29), (Log Rank
|
|
| 7. |
|
|
| 8. |
- F., Durmo, et al.
(författare)
-
Mutlimodality MR imaging for differentiation between brain tumor lesions
- 2016
-
Ingår i: Neuroradiology. - : Springer Science and Business Media LLC. - 0028-3940 .- 1432-1920. ; 58:Suppl 1, s. 53-54
-
Konferensbidrag (refereegranskat)abstract
- Purpose: Applying diffusion and perfusion metrics for evaluation of low-(LGG), high grade glioma (HGG) and metastases (MET) for differential diagnosis. Materials and Method: 43 patients (18HGG, 10 LGG, and 15MET) were included. MR data for tumour volume, perilesional edema, rCBF-, rCBV-, FLAIR-, FA-, ADC-maps were quantified by regions of interest (ROI). Measures of different parameters, and ratios, using contralateral white matter as denominator, were performed. A binary logistic regression model was constructed for multi-parametric analysis and ROCanalysis. Results: Significant difference was found for nADCt, rCBF, rCBV between LGG and HGG, nADCe between HGG and MET, and Ev, Ev-Tv ratio, nADCt, nADCe, rCBF, rCBV between LGG and MET. ROCanalysis for HGG compared to LGG showed 80 % sensitivity and 81.2 % specificity for nADCt, 100 % sensitivity and 100 % specificity for rCBF and 80 % sensitivity and 90 % specificity for rCBV. ROC-curves betweenMETand LGG showed sensitivity and specificity for Ev 73.3 % and 90 %, Ev-Tv ratio 80 % and 100 %, nADCt 90 % and 86.7 %, nADCe 80 % and 90 %, rCBF 93.3 % and 100 %, and rCBV 60 % and 100 %. Combining Ev, Ev-Tv ratio, nADCt, nADCe and rCBV between METand LGG gave 93.3%sensitivity and 100%specificity. Combining nADCt and rCBV between HGG and LGG 86.7 % sensitivity and 100 % specificity. Conclusion: Multi-parametric imaging protocols is an advantage for preoperative distinction of LGG, HGG and MET.
|
|
| 9. |
- Rydelius, A., et al.
(författare)
-
Predictive value of diffusion MRI-based parametric response mapping for prognosis and treatment response in glioblastoma
- 2023
-
Ingår i: Magnetic Resonance Imaging. - 0730-725X. ; 104, s. 88-96
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Early detection of treatment response is important for the management of patients with malignant brain tumors such as glioblastoma to assure good quality of life in relation to therapeutic efficacy. Aim: To investigate whether parametric response mapping (PRM) with diffusion MRI may provide prognostic information at an early stage of standard therapy for glioblastoma. Materials and methods: This prospective study included 31 patients newly diagnosed with glioblastoma WHO grade IV, planned for primary standard postoperative treatment with radiotherapy 60Gy/30 fractions with concomitant and adjuvant Temozolomide. MRI follow-up including diffusion and perfusion weighting was performed at 3 T at start of postoperative chemoradiotherapy, three weeks into treatment, and then regularly until twelve months postoperatively. Regional mean diffusivity (MD) changes were analyzed voxel-wise using the PRM method (MD-PRM). At eight and twelve months postoperatively, after completion of standard treatment, patients were classified using conventional MRI and clinical evaluation as either having stable disease (SD, including partial response) or progressive disease (PD). It was assessed whether MD-PRM differed between patients having SD versus PD and whether it predicted the risk of disease progression (progression-free survival, PFS) or death (overall survival, OS). A subgroup analysis was performed that compared MD-PRM between SD and PD in patients only undergoing diagnostic biopsy. MGMT-promotor methylation status (O6-methylguanine-DNA methyltransferase) was registered and analyzed with respect to PFS, OS and MD-PRM. Results: Of the 31 patients analyzed: 21 were operated by resection and ten by diagnostic biopsy. At eight months, 19 patients had SD and twelve had PD. At twelve months, ten patients had SD and 20 had PD, out of which ten were deceased within twelve months and one was deceased without known tumor progression. Median PFS was nine months, and median OS was 17 months. Eleven patients had methylated MGMT-promotor, 16 were MGMT unmethylated, and four had unknown MGMT-status. MD-PRM did not significantly predict patients having SD versus PD neither at eight nor at twelve months. Patients with an above median MD-PRM reduction had a slightly longer PFS (P = 0.015) in Kaplan-Maier analysis, as well as a non-significantly longer OS (P = 0.099). In the subgroup of patients only undergoing biopsy, total MD-PRM change at three weeks was generally higher for patients with SD than for patients with PD at eight months, although no tests were performed. MGMT status strongly predicted both PFS and OS but not MD-PRM change. Conclusion: MD-PRM at three weeks was not demonstrated to be predictive of treatment response, disease progression, or survival. Preliminary results suggested a higher predictive value in non-resected patients, although this needs to be evaluated in future studies.
|
|
| 10. |
|
|
