5-ALA Photodynamic Therapy in Neurosurgery, Towards the Design of a Treatment Planning System: A Proof of Concept - 08/02/17
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Abstract |
Purpose. Glioblastoma (GBM) treatment still remains a complex challenge. Among alternatives or adjuvant therapies, photodynamic therapy (5-ALA PDT) appears to be a promising approach. 5-ALA PDT can be delivered intraoperatively, early after tumor resection, or interstitially according to brain tumor location. A treatment planning system was designed to manage dosimetry issues before PDT delivery.
Methods. The TPS was developed according to a specific workflow from stereotactic image registration to light fluence rate modeling. Here, we describe a proof of concept of a treatment planning system (TPS) dedicated to interstitial 5-ALA PDT. This tool enables the planning of a whole treatment in surgical stereotactic conditions. Stereotactic registration and dosimetry components are detailed and evaluated. The registration process is compared to a commercial solution (Leksell Gamma Plan®, Elekta®, Sweden) defined as the ground truth and dosimetry model implemented in our TPS and is compared to numerical simulations.
Results. Registration achieved a sub-millimetric mean relative error that matched the standard MRI resolution. Dosimetry comparison showed a negligible error between analytical and numerical models and enabled a validation of the dosimetry algorithm implemented.
Conclusions. A treatment planning system was designed to achieve 5-ALA PDT simulations before the patients underwent surgery. Similarly, for radiation therapy, we proposed a system to plan and evaluate the 5-ALA PDT dosimetry for optimizing treatment delivery. Although this system remains to be perfected, this preliminary work aimed to demonstrate the feasibility of planning 5-ALA PDT treatments in stereotactic conditions. Future improvements will mainly focus on the optimization of the treatment delivery, automatic segmentation and GPU-accelerated Monte-Carlo management to take into account GBM tissue heterogeneity.
Le texte complet de cet article est disponible en PDF.Graphical abstract |
Highlights |
• | Photodynamic therapies are promising solutions for treatment of glioblastoma. |
• | A proof of concept for planning stereotactic interstitial photodynamic therapy is described. |
• | Algorithms of light transport modeling are compared. |
• | Optical fiber needed to transport light into the tumor core can be planned with an error below 1 mm. |
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Vol 38 - N° 1
P. 34-41 - février 2017 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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