Conventional radiotherapy prescribes the same dose for nearly all patients based on the type of their tumor and standard tissue anatomy. Advances in PET imaging, however, allow physicians to create biologic maps that show the unique characteristics of a tumor and can be utilized to develop a personalized treatment plan.
"This study shows a new way to personalize radiotherapy using two different PET tracers in the same patient. In a novel approach, we combined PET imaging of tumor oxygen levels, which influence radiation resistance, with PET imaging of tumor cell density, and used this information to calculate how much radiation dose is needed in different tumor regions," said Marta Lazzeroni, PhD, associate professor of Medical Radiation Physics at Stockholm University in Sweden.
Researchers explored a biologically guided treatment strategy for head and neck squamous cell carcinoma (HNSCC), using 18F-FDG PET to estimate relative cell density and 18F-FMISO PET to quantify hypoxia-related radioresistance. Twenty-eight patients received both scans, and cellular information was analyzed to create individual tumor profiles. These biologic maps informed personalized treatment plans, with escalated doses designed for regions of the tumors with unfavorable characteristics.
Planned dose distributions achieved greater than 90 percent predicted tumor control probability based on radiobiological modeling in all cases, a significant increase from the approximately 60 percent tumor control probability reported in previous literature. All treatment plans met standard clinical feasibility criteria to protect healthy organs and tissues, demonstrating the overall feasibility of the personalized strategy.
"The results from this proof-of-concept study highlight how molecular imaging can play an active role in guiding treatment decisions, not just diagnosing disease," stated Lazzeroni. "In the future, PET imaging could become a key tool for designing truly personalized radiotherapy treatments and for adapting therapy as tumors change over time."
Reference:
Marta Lazzeroni, Ana Ureba, Henning Schäfer, Nils H. Nicolay, Alexander Rühle, Dimos Baltas, Alexandru Dasu, Philipp T. Meyer, Michael Mix, Iuliana Toma-Dasu and Anca L. Grosu, Biologically Individualized Radiotherapy Based on PET: A Novel Approach to Treatment Optimization of Head and Neck Cancer, Journal of Nuclear Medicine, DOI: https://doi.org/10.2967/jnumed.125.270403
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