0000000000349570
AUTHOR
Gilles Créhange
Deep Generative Model-Driven Multimodal Prostate Segmentation in Radiotherapy
Deep learning has shown unprecedented success in a variety of applications, such as computer vision and medical image analysis. However, there is still potential to improve segmentation in multimodal images by embedding prior knowledge via learning-based shape modeling and registration to learn the modality invariant anatomical structure of organs. For example, in radiotherapy automatic prostate segmentation is essential in prostate cancer diagnosis, therapy, and post-therapy assessment from T2-weighted MR or CT images. In this paper, we present a fully automatic deep generative model-driven multimodal prostate segmentation method using convolutional neural network (DGMNet). The novelty of …
Salvage reirradiation for locoregional failure after radiation therapy for prostate cancer: Who, when, where and how?
Even in the current era of dose-escalated radiotherapy for prostate cancer, biochemical recurrence is not uncommon. Furthermore, biochemical failure is not specific to the site of recurrence. One of the major challenges in the management of prostate cancer patients with biochemical failure after radiotherapy is the early discrimination between those with locoregional recurrence only and those with metastatic disease. While the latter are generally considered incurable, patients with locoregional disease may benefit from emerging treatment options. Ultimately, the objective of salvage therapy is to control disease while ensuring minimal collateral damage, thereby optimizing both cancer and t…
The radiosensitization effect of titanate nanotubes as a new tool in radiation therapy for glioblastoma: A proof-of-concept
Abstract Background and purpose One of the new challenges to improve radiotherapy is to increase the ionizing effect by using nanoparticles. The interest of titanate nanotubes (TiONts) associated with radiotherapy was evaluated in two human glioblastoma cell lines (SNB-19 and U87MG). Materials and methods Titanate nanotubes were synthetized by the hydrothermal treatment of titanium dioxide powder in a strongly basic NaOH solution. The cytotoxicity of TiONts was evaluated on SNB-19 and U87MG cell lines by cell proliferation assay. The internalization of TiONts was studied using Transmission Electron Microscopy (TEM). Finally, the effect of TiONts on cell radiosensitivity was evaluated using …
Prostate Metabolism After the Completion of Exclusive Radiation Is More Depleted After Seeds Brachytherapy Compared to External Beam Radiation Therapy for Prostate Cancer Patients
International audience; Biochemical outcome after radiation therapy requires a protracted time. PSA decreases slowly over time so that it is difficult to differentiate immediately after the completion of radiation the impact of radiation in the prostate using brachytherapy or external radiotherapy. At 3 months, the mean PSA values were similar between the 2 groups: 2.54 ng/mL (±1.59) in the EBRT group and 1.88 ng/mL (±1.14) in the PPI group (p=0.23). For Choline levels, 3-months Choline / Baseline Choline ratios were 1.13 (±0.60) after EBRT vs. 0.45 (±0.23) in the PPI group (p=0.003). Similar results were observed for Citrate levels: 3-months Citrate level / Baseline Citrate level ratios we…
Safety and efficacy of intensity-modulated radiotherapy in the management of spermatic cord sarcoma.
International audience; Purpose. - Spermatic cord sarcoma is a rare disease, which management remains controversial due to the lack of guidelines. The standard therapeutic approach is surgical: wide soft-tissue resection with radical inguinal orchidectomy, The diagnosis is made during the analysis of the specimen. The high rate of local recurrence indicates adjuvant radiotherapy of the tumor bed. The aim of this series is to determine the efficacy and safety of postoperative intensity-modulated radiotherapy for spermatic cord sarcomas. Patients and methods. - Our series included five consecutive cases of spermatic cord sarcoma treated between 2011 and 2014. The indications for radiotherapy …
Radical cystectomy or bladder preservation with radiochemotherapy in elderly patients with muscle-invasive bladder cancer: Retrospective International Study of Cancers of the Urothelial Tract (RISC) Investigators.
IF 3.156; International audience; Background: Radical cystectomy (RC) and radiochemotherapy (RCT) are curative options for muscle-invasive bladder cancer (MIBC). Optimal treatment strategy remains unclear in elderly patients.Material and methods: Patients aged 80 years old and above with T2-T4aN0-2M0-Mx MIBC were identified in the Retrospective International Study of Cancers of the Urothelial Tract (RISC) database. Patients treated with RC were compared with those treated with RCT. The impact of surgery on overall survival (OS) was assessed using a Cox proportional hazard model. Progression included locoregional and metastatic relapse and was considered a time-dependent variable.Results: Be…
Absolute volume of the rectum and AUC from rectal DVH between 25Gy and 50Gy predict acute gastrointestinal toxicity with IG-IMRT in prostate cancer
International audience; Background: To determine whether dose/volume specific endpoints (DVSE) or Area under the rectal DVH curve (rAUC) better predict acute gastrointestinal (GI) toxicity in prostate cancer patients treated with IMRT in the era of daily image guidance (IG-IMRT). Methods: A set of DVSE was recorded from V25 to V75 (increments of 5Gy) (both in % and in cc) for 180 men. The rAUC was calculated for doses ranging between 25Gy and 50Gy (rAUC(25-50)). Univariate and multivariate logistic regressions were performed to determine the relationship between DVSE or rAUC(25-50) and the appearance of any acute GI toxicity. Results: The rates of acute grade 1 (G1), G2 and G3 GI toxicities…
Automatic Myocardial Infarction Evaluation from Delayed-Enhancement Cardiac MRI using Deep Convolutional Networks
In this paper, we propose a new deep learning framework for an automatic myocardial infarction evaluation from clinical information and delayed enhancement-MRI (DE-MRI). The proposed framework addresses two tasks. The first task is automatic detection of myocardial contours, the infarcted area, the no-reflow area, and the left ventricular cavity from a short-axis DE-MRI series. It employs two segmentation neural networks. The first network is used to segment the anatomical structures such as the myocardium and left ventricular cavity. The second network is used to segment the pathological areas such as myocardial infarction, myocardial no-reflow, and normal myocardial region. The segmented …
Association de radiothérapie externe et de curiethérapie pour les cancers de la prostate
International audience; Brachytherapy as sole treatment is standard of care for D’Amico classification low-risk prostate cancer. For intermediate and high-risk patients, brachytherapy can be associated to external beam radiation therapy to better take into account the risk of extracapsular effraction and/or seminal vesicle involvement. Three randomized studies have shown that this association increases freedom from relapse survival compared to exclusive external beam radiation therapy. This benefit is not shown for overall survival. The addition of a hormonal therapy to this association is most likely mandatory for high-risk patients, and needs to be confirmed for intermediate risk patients…
Mapping of failures after radiochemotherapy in patients with non-metastatic esophageal cancer: A posteriori analysis of the dose distribution in the sites of loco-regional relapse.
Abstract Background and purpose We aimed to evaluate the patterns of loco-regional failure (LRF) after exclusive chemoradiotherapy (eCRT) for esophageal cancer with respect to planned dose and/or the incidental (unplanned) dose outside target volumes. Materials and methods Co-image registration of CT or 18 F-FDG PET-CT at the time of failure (tf) and at the time of CRT (t0) was performed in 34 patients with LRF. Dosimetric parameters with regard to local failure (LF), nodal failure (NF) and involved nodal stations (NS) were derived. Results Twenty-two patients (64.7%) had LF, the majority of which (95.5%) were located at the epicenter of the GTV of the primary tumor. The mean doses recalcul…
Etude LYMPHOREC. Réponse immunitaire intra-tumorale à la radiothérapie préopératoire pour des cancers du rectum de stades II-III: nouveau paramètre pronostic de la survie des patients
National audience
Multiparametric MRI and post implant CT-based dosimetry after prostate brachytherapy with iodine seeds: The higher the dose to the dominant index lesion, the lower the PSA bounce
Abstract Purpose To determine whether post-implant MRI-based dosimetry of the Dominant Intra-prostatic Lesion (DIL) could best predict the occurrence of PSA bounce after prostate brachytherapy. Methods and materials We selected 66 patients with a low risk prostate cancer treated with 125 I prostate brachytherapy as monotherapy. Post-implant dosimetry based on day 30 CT-scan and multiparametric MRI co-registration was generated: planned D 90, D 95, V 100, V 150 values were calculated for each DIL. Bounce was defined as a PSA elevation ⩾0.2ng/mL from the previous baseline value followed by a decrease to or below the prior nadir with no additional treatment. Results After a median follow-up of…
Learning With Context Feedback Loop for Robust Medical Image Segmentation
Deep learning has successfully been leveraged for medical image segmentation. It employs convolutional neural networks (CNN) to learn distinctive image features from a defined pixel-wise objective function. However, this approach can lead to less output pixel interdependence producing incomplete and unrealistic segmentation results. In this paper, we present a fully automatic deep learning method for robust medical image segmentation by formulating the segmentation problem as a recurrent framework using two systems. The first one is a forward system of an encoder-decoder CNN that predicts the segmentation result from the input image. The predicted probabilistic output of the forward system …
The SCOPE of definitive chemoradiotherapy in locally advanced esophageal cancer: what direction for the future?
Exclusive chemoradiotherapy (CRT) delivering 50 Gy over 5 weeks with cisplatin and fluorouracil-based chemotherapy is a cornerstone in locally advanced esophageal cancer or non-operable patients since the results of the pivotal study of US Intergroup RTOG-8501 (1). This trial has successfully demonstrated that some patients with esophageal carcinoma may be long-term survivors so that this treatment is now definitely accepted as curative (2). Nevertheless the prognosis is still very disappointing with a 5-year overall survival rate of approximately 25%. Attempts to improve overall survival by escalating the dose of radiotherapy with concurrent cisplatin and fluorouracil has been assessed in …
Innovations thérapeutiques en radiothérapie du cancer de la prostate localisé
Intensity-modulated radiation therapy, image-guided radiation therapy with fiducial markers and prostate brachytherapy allow the delivery of dose escalation for localized prostate cancer with very low rates of long-term toxicity and sequelae. Nowadays, modern radiotherapy techniques make it possible to shorten treatment time with hypofractionation, to better protect surrounding healthy tissues and to escalate the dose even further. Advances in radiotherapy are closely linked to advances in magnetic resonance imaging (MRI) and/or PET imaging. Functional imaging makes it possible to deliver personalised pelvic nodal radiotherapy, targeting the nodal areas at higher risk of microscopic involve…
Focal or whole-gland salvage prostate brachytherapy with iodine seeds with or without a rectal spacer for postradiotherapy local failure: How best to spare the rectum?
International audience; PURPOSE: Salvage prostate permanent implant (sPPI) for postradiation local failure provides high rates of biochemical control. The cumulative dose delivered to the prostate and the rectum is still unknown. METHODS AND MATERIALS: We reviewed the postimplant CT-based dosimetry of 18 selected patients who underwent sPPI with I-125 seeds for isolated biopsy-proven local failure several years after external beam radiation therapy. Ten patients had whole-prostate sPPI, and 8 patients had multiparametric MRI-based focal sPPI. In 8 patients, hyaluronic acid (HA) gel was injected into the prostate rectum space. RESULTS: The median cumulative biological effective dose after EB…
Chimioradiothérapie des cancers de l’œsophage : quelles aires ganglionnaires faut-il irradier ?
Esophageal cancer has a high likelihood of distant lymphatic spread even at an early stage. Radiotherapy plays a major role in the management of localized or locally-advanced esophageal cancer with a regional or distant lymph node involvement. Radiotherapy can sterilize micrometastatic nodes and cancer cells in transit in the peri-esophageal fat that are not removed by surgery. After preoperative chemoradiotherapy followed by monobloc esophagectomy including lymph node dissection above and below the diaphragm, the locoregional failure rate was around 3% in the Chemoradiotherapy for Esophageal Cancer followed by Surgery Study Group (CROSS) trial. This is significantly lower than that observe…
18F-Choline PET/CT and multiparametric MRI for the detection of local recurrence of prostate cancer initially treated by radiotherapy: comparison with systematic transperineal mapping biopsy
International audience
Automatic Myocardial Infarction Evaluation from Delayed-Enhancement Cardiac MRI Using Deep Convolutional Networks
In this paper, we propose a new deep learning framework for an automatic myocardial infarction evaluation from clinical information and delayed enhancement-MRI (DE-MRI). The proposed framework addresses two tasks. The first task is automatic detection of myocardial contours, the infarcted area, the no-reflow area, and the left ventricular cavity from a short-axis DE-MRI series. It employs two segmentation neural networks. The first network is used to segment the anatomical structures such as the myocardium and left ventricular cavity. The second network is used to segment the pathological areas such as myocardial infarction, myocardial no-reflow, and normal myocardial region. The segmented …
Radiothérapie guidée par l’image des cancers prostatiques : concepts et implications
Resume La radiotherapie conformationnelle avec modulation d’intensite (RCMI) et la radiotherapie guidee par l’image sont deux evolutions technologiques qui, appliquees au modele des cancers prostatiques, ont permis de voir diminuer significativement la toxicite et les sequelles digestives et urinaires de la radiotherapie conformationnelle tridimensionnelle. Le benefice clinique majeur de ces techniques sur la diminution de la toxicite digestive et urinaire est indiscutable puisque les sequelles observees a dix ans sont devenues rares avec ces techniques (2 % de cas de toxicite digestive de grade 2 et 1 % de grade 3, 11 % de cas de toxicite urinaire de grade 2 et 5 % de grade 3). Si ces deux…
Adjuvant treatments for gastric cancer: From practice guidelines to clinical practice
Abstract Background For gastric cancers, the benefits of adjuvant radiochemotherapy and of perioperative chemotherapy have been demonstrated since 2001 and 2006 respectively. The aim of this study was to evaluate the diffusion of adjuvant treatments in a French population. Methods 334 incident gastric cancers UICC Stage IB, II, III or IVM0 resected for cure and recorded in the Burgundy digestive cancer registry were retrospectively included. Patients were classified as having received an effective adjuvant treatment if they had been treated by adjuvant radiochemotherapy since 2001 or perioperative chemotherapy since 2006. Results The proportion of patients treated with an effective adjuvant…
Pattern of occult nodal relapse diagnosed with 18F-fluoro-choline PET/CT in prostate cancer patients with biochemical failure after prostate-only radiotherapy
Abstract Introduction The purpose of this study was to describe the pattern of nodal relapse with 18 F-fluoro-choline (FCH) Positron Emission Tomography/Computerized Tomography (PET/CT) in prostate cancer patients after radiotherapy. Materials and methods Eighty-three patients had a FCH PET/CT at time of biochemical failure. Of 65 patients with positive findings, 33 had positive nodes. This analysis included 31 patients who had undergone prior prostate-only radiotherapy with or without a prior radical prostatectomy. Each FCH positive node was assigned to a lymph node station with respect to the CTV defined by the RTOG guidelines (CTV RTOG ). 3D mapping was performed after each node was manu…
Correlation between clinical prognostic factors and MR spectroscopy-based biomarkers determined at 3.0 T without endorectal coils for patients with localised prostate cancer
International audience
The role of telomeres in predicting individual radiosensitivity of patients with cancer in the era of personalized radiotherapy.
Radiotherapy plays a key role in cancer treatments, but tumor cell death differs from one tumor to another. The response of patients to radiotherapy varies considerably and adverse side effects are difficult to prevent. The mechanisms involved in the heterogeneity of this response are not well understood. In order to enhance the efficacy and safety of radiotherapy, it is important to identify subpopulations most at risk of developing a late adverse response to radiotherapy. Telomeres are composed of multiple repeats of a unique sequence of nucleotides forming a TTAGGG pattern. They protect chromosomes from end-to-end fusion and maintain genomic stability. Telomeres have been shown to be ext…
Multiparametric MRI-based Dosimetric Parameters Best Predict Short-term Time Course of PSA After Iodine 125 Permanent Prostate Implantation for Localized Prostate Cancer
International audience; D90% and V150% of the entire prostate are recognized as the best dosimetric predictors of outcome after 125 I permanent prostate implantation (PPI). The purpose of this study was 2-fold: 1) to determine the relationship between dose-volume parameters of the Dominant Intraprostatic Lesion (DIL) when compared to the prostate and early biochemical outcome after PPI; 2) to define if dose-volume parameters of the central gland (CG), the peripheral zone (PZ) and the DIL could best predict PSA bounce occurrence. The time course of PSA and mechanisms of bounces still remain unclear after PPI. Patients who had a higher dose in the DIL had a worse PSA level at 1 year which is …
Tumor lymphocyte immune response to preoperative radiotherapy in locally advanced rectal cancer: The LYMPHOREC study
IF 7.719; International audience; Introduction: Some studies have suggested that baseline tumor-infiltrating-lymphocytes (TILs), such as CD8+ and FoxP3+ T-cells, may be associated with a better prognosis in colorectal cancer. We sought to investigate modulation of the immune response by preoperative radiotherapy (preopRT) and its impact on survival in locally advanced rectal cancer (LARC). Materials & Methods: We analyzed data for 237 patients with LARC who received RT. Density of TILS (CD8+ and FoxP3+) in intraepithelial (iTILs) and stromal compartments (sTILs) were evaluated from surgery pathological specimens and biopsies performed at baseline. The primary endpoint was to assess the impa…
Temozolomide and radiotherapy antitumor efficacy evaluation with magnetic resonance imaging and proton magnetic resonance spectroscopy in human glioma models in nude rats
International audience
Patterns of Bladder Preservation Therapy Utilization for Muscle-Invasive Bladder Cancer
Background: Trimodality bladder preservation therapy (BPT) in muscle invasive bladder cancer (MIBC) includes a maximal transurethral resection followed by concurrent chemoradiotherapy as an alternative to radical cystectomy (RC) in appropriately selected patients, or as a treatment option in non-cystectomy candidates. Several chemotherapy regimens can be used in BPT, but little is known about current practice patterns. Objective: To describe utilization patterns of BPT and associated survival outcomes in MIBC. Methods: Data were collected from the Retrospective International Study of Cancers of the Urothelial Tract (RISC), a database of 3,024 consecutive patients from 29 international acade…
Bonnes pratiques de radiothérapie guidée par l’image
Image-guided radiotherapy (IGRT) aims to take into account the anatomical variations occurring during the course of radiotherapy, by direct or indirect visualization of the target volume followed by a corrective action. The movements of the target, or at least the set-up errors are corrected by moving the treatment table, corresponding to the simplest and most validated IGRT modality in a standard practice. The deformations of the target volume and organs at risk are however much more common, and unfortunately much more complicated to consider, requiring multiple planning before or during the treatment, corresponding to the adaptive radiotherapy strategies. The planning target volume must b…
EARLY CHOLINE LEVELS FROM 3-TESLA MR SPECTROSCOPY AFTER EXCLUSIVE RADIATION THERAPY IN PATIENTS WITH CLINICALLY LOCALIZED PROSTATE CANCER ARE PREDICTIVE OF PLASMATIC LEVELS OF PSA AT 1 YEAR
International audience; Abstract: Purpose: To investigate the time course response of prostate metabolism to irradiation using magnetic resonance spectroscopy (MRS) at 3-month intervals and its impact on biochemical control. Methods and Materials: Between January 2008 and April 2010, 24 patients with localized prostate cancer were prospectively enrolled in the Evaluation of the Response to Irradiation with MR Spectroscopy (ERIS) trial. All the patients had been treated with intensity-modulated radiation therapy with or without long-term adjuvant hormonal therapy (LTHT) and underwent 3-T MRS and prostate-specific antigen (PSA) assays at baseline and every 3 months thereafter up to 12 months.…
Impact of rectal distension on prostate CBCT-based positioning assessed with 6 degrees-of-freedom couch
International audience; Introduction: Prostate requires a daily correction of its 3-dimensional position in relation with rectal distension. In this study, we sought to determine whether rectal distension with respect to the rectal behavior might have an impact on prostate translations and/or rotations during prostate image guided radiation therapy using a 6 degrees-of-freedom (DOF) couch.Methods and materials: We reviewed the data from 39 patients with localized prostate cancer treated with protracted external radiation therapy using a 6 DOF couch. Before each fraction, a kilovoltage cone beam computed tomography (kV-CBCT) scan was performed. The automatic fusion algorithm was set to fuse …
Inferring postimplant dose distribution of salvage permanent prostate implant (PPI) after primary PPI on CT images
International audience; PURPOSE:To evaluate the dose distribution of additional radioactive seeds implanted during salvage permanent prostate implant (sPPI) after a primary permanent prostate implant (pPPI).METHODS AND MATERIALS:Patients with localized prostate cancer were primarily implanted with iodine-125 seeds and had a dosimetric assessment based on day 30 postimplant CT (CT1). After an average of 6 years, these patients underwent sPPI followed by the same CT-based evaluation of dosimetry (CT2). Radioactive seeds on each CT were detected. The detected primary seeds on CT1 and CT2 were registered and then removed from CT2 referred as a modified CT2 (mCT2). Dosimetry evaluations (D90 and…
MR-based biomarkers in the diagnosis and the evaluation of the therapeutic response to radiotherapy (ETRR) in prostatic carcinoma (PCa): Implementation of clinical and experimental approaches
e16136 Background: ETRR in PCa remains a challenging task. New biomarkers in the form of metabolites, detected with Proton Magnetic Resonance Spectroscopy (1H-MRS), and quantitative Apparent Diffusion Coefficient (ADC), determined with Diffusion-Weighted Magnetic Resonance Imaging, could be of value in the ETRR for PCa. Methods: Twenty-one men with biopsy proven localized PCa were examined before external radiotherapy. 3D-1H-MRS was performed at 3.0T without endorectal coils. The delivered radiotherapy dose was 78 Gy in 39 fractions with 6 MV photons. MR follow-up examinations up to 36 months post-radiotherapy were performed. For the pre-clinical study, healthy rat prostate was studied in …
Impact of neoadjuvant chemotherapy on survival in breast cancer patients in daily practice: a population-based study
This population-based study aimed to describe the effects of neoadjuvant chemotherapy (NC) on survival in breast cancer (BC) patients in daily practice. BC patients treated with NC followed by surgery and radiotherapy, were retrospectively selected from 1982 to 2005 using the Cote d’Or BC registry. These patients were matched for the baseline AJCC (American Joint Committee on Cancer) stage, age at diagnosis, date of diagnosis and oestrogens receptors status to those who had undergone surgery followed by adjuvant chemotherapy and radiotherapy. The prognostic effect of NC on survival in BC patients was assessed with relative survival (RS) analyses. From 1982 to 2005, 210 patients with BC diag…