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Hypoxia Imaging and Adaptive Radiotherapy: A State-of-the-Art Approach in the Management of Glioma
Severe hypoxia [oxygen partial pressure (pO(2)) below 5–10 mmHg] is more frequent in glioblastoma multiforme (GBM) compared to lower-grade gliomas. Seminal studies in the 1950s demonstrated that hypoxia was associated with increased resistance to low–linear energy transfer (LET) ionizing radiation....
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6582242/ https://www.ncbi.nlm.nih.gov/pubmed/31249831 http://dx.doi.org/10.3389/fmed.2019.00117 |
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author | Gérard, Michael Corroyer-Dulmont, Aurélien Lesueur, Paul Collet, Solène Chérel, Michel Bourgeois, Mickael Stefan, Dinu Limkin, Elaine Johanna Perrio, Cécile Guillamo, Jean-Sébastien Dubray, Bernard Bernaudin, Myriam Thariat, Juliette Valable, Samuel |
author_facet | Gérard, Michael Corroyer-Dulmont, Aurélien Lesueur, Paul Collet, Solène Chérel, Michel Bourgeois, Mickael Stefan, Dinu Limkin, Elaine Johanna Perrio, Cécile Guillamo, Jean-Sébastien Dubray, Bernard Bernaudin, Myriam Thariat, Juliette Valable, Samuel |
author_sort | Gérard, Michael |
collection | PubMed |
description | Severe hypoxia [oxygen partial pressure (pO(2)) below 5–10 mmHg] is more frequent in glioblastoma multiforme (GBM) compared to lower-grade gliomas. Seminal studies in the 1950s demonstrated that hypoxia was associated with increased resistance to low–linear energy transfer (LET) ionizing radiation. In experimental conditions, the total radiation dose has to be multiplied by a factor of 3 to achieve the same cell lethality in anoxic situations. The presence of hypoxia in human tumors is assumed to contribute to treatment failures after radiotherapy (RT) in cancer patients. Therefore, a logical way to overcome hypoxia-induced radioresistance would be to deliver substantially higher doses of RT in hypoxic volumes delineated on pre-treatment imaging as biological target volumes (BTVs). Such an approach faces various fundamental, technical, and clinical challenges. The present review addresses several technical points related to the delineation of hypoxic zones, which include: spatial accuracy, quantitative vs. relative threshold, variations of hypoxia levels during RT, and availability of hypoxia tracers. The feasibility of hypoxia imaging as an assessment tool for early tumor response to RT and for predicting long-term outcomes is discussed. Hypoxia imaging for RT dose painting is likewise examined. As for the radiation oncologist's point of view, hypoxia maps should be converted into dose-distribution objectives for RT planning. Taking into account the physics and the radiobiology of various irradiation beams, preliminary in silico studies are required to investigate the feasibility of dose escalation in terms of normal tissue tolerance before clinical trials are undertaken. |
format | Online Article Text |
id | pubmed-6582242 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-65822422019-06-27 Hypoxia Imaging and Adaptive Radiotherapy: A State-of-the-Art Approach in the Management of Glioma Gérard, Michael Corroyer-Dulmont, Aurélien Lesueur, Paul Collet, Solène Chérel, Michel Bourgeois, Mickael Stefan, Dinu Limkin, Elaine Johanna Perrio, Cécile Guillamo, Jean-Sébastien Dubray, Bernard Bernaudin, Myriam Thariat, Juliette Valable, Samuel Front Med (Lausanne) Medicine Severe hypoxia [oxygen partial pressure (pO(2)) below 5–10 mmHg] is more frequent in glioblastoma multiforme (GBM) compared to lower-grade gliomas. Seminal studies in the 1950s demonstrated that hypoxia was associated with increased resistance to low–linear energy transfer (LET) ionizing radiation. In experimental conditions, the total radiation dose has to be multiplied by a factor of 3 to achieve the same cell lethality in anoxic situations. The presence of hypoxia in human tumors is assumed to contribute to treatment failures after radiotherapy (RT) in cancer patients. Therefore, a logical way to overcome hypoxia-induced radioresistance would be to deliver substantially higher doses of RT in hypoxic volumes delineated on pre-treatment imaging as biological target volumes (BTVs). Such an approach faces various fundamental, technical, and clinical challenges. The present review addresses several technical points related to the delineation of hypoxic zones, which include: spatial accuracy, quantitative vs. relative threshold, variations of hypoxia levels during RT, and availability of hypoxia tracers. The feasibility of hypoxia imaging as an assessment tool for early tumor response to RT and for predicting long-term outcomes is discussed. Hypoxia imaging for RT dose painting is likewise examined. As for the radiation oncologist's point of view, hypoxia maps should be converted into dose-distribution objectives for RT planning. Taking into account the physics and the radiobiology of various irradiation beams, preliminary in silico studies are required to investigate the feasibility of dose escalation in terms of normal tissue tolerance before clinical trials are undertaken. Frontiers Media S.A. 2019-06-12 /pmc/articles/PMC6582242/ /pubmed/31249831 http://dx.doi.org/10.3389/fmed.2019.00117 Text en Copyright © 2019 Gérard, Corroyer-Dulmont, Lesueur, Collet, Chérel, Bourgeois, Stefan, Limkin, Perrio, Guillamo, Dubray, Bernaudin, Thariat and Valable. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Medicine Gérard, Michael Corroyer-Dulmont, Aurélien Lesueur, Paul Collet, Solène Chérel, Michel Bourgeois, Mickael Stefan, Dinu Limkin, Elaine Johanna Perrio, Cécile Guillamo, Jean-Sébastien Dubray, Bernard Bernaudin, Myriam Thariat, Juliette Valable, Samuel Hypoxia Imaging and Adaptive Radiotherapy: A State-of-the-Art Approach in the Management of Glioma |
title | Hypoxia Imaging and Adaptive Radiotherapy: A State-of-the-Art Approach in the Management of Glioma |
title_full | Hypoxia Imaging and Adaptive Radiotherapy: A State-of-the-Art Approach in the Management of Glioma |
title_fullStr | Hypoxia Imaging and Adaptive Radiotherapy: A State-of-the-Art Approach in the Management of Glioma |
title_full_unstemmed | Hypoxia Imaging and Adaptive Radiotherapy: A State-of-the-Art Approach in the Management of Glioma |
title_short | Hypoxia Imaging and Adaptive Radiotherapy: A State-of-the-Art Approach in the Management of Glioma |
title_sort | hypoxia imaging and adaptive radiotherapy: a state-of-the-art approach in the management of glioma |
topic | Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6582242/ https://www.ncbi.nlm.nih.gov/pubmed/31249831 http://dx.doi.org/10.3389/fmed.2019.00117 |
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