ESTRO 35 Abstract-book

S882 ESTRO 35 2016 _____________________________________________________________________________________________________

We also measured the variation of ADC during the treatment (Figure B), and three months later. The colour in the dots shows the initial IRE values in arbitrary units. As the dose is delivered, best-vascularized dots move to the upper part of the cloud corresponding to different instants along the treatment.

Conclusion: A reasonable high correlation in response during chemoradiation between the primary lung tumour and lymph nodes was observed, but a large inter- and intra-patient variability was observed. These preliminary results suggest that treatment plan modification based on metabolic treatment response should be tailored to individual lesions. [1] van Elmpt et al., J Nucl Med. 2012 EP-1870 Improving Tumor Response Assessment using DWMRI corrected by reversed gradient method and DCEMRI A. Lopez Medina 1 , S. Reigosa 1 , J. Del Olmo 1 , D. Aramburu Nunez 2 , F. Salvador 1 , I. Landesa 3 , J. Alba 3 , M. Salgado 1 , I. Nieto 4 , V. Ochagavia 4 , V. Muñoz 4 2 Memorial Sloan Kettering Cancer Center, Quantitative Imaging Department, New York, USA 3 University of Vigo, SignalTheory and Communications Department, Vigo, Spain 4 Hospital do Meixoeiro, Radiotherapy Department, Vigo Pontevedra, Spain Purpose or Objective: Apparent diffusion coefficient (ADC), derived from diffusion-weighted MRI (DW-MRI) is a promising assessment method during radiotherapy treatment, but geometric distortion is its main disadvantage. This study investigates the use of the reversed gradient method (RGM) in DW-MRI for reduction in geometric distortion and vascularization from dynamic studies of MRI (DCEMRI), as a surrogate measure of oxygenation in H&N cancer. Material and Methods: We studied the variation of ADC of three oropharynx cancer patients included in ARTFIBIO project. Three functional imaging scans were performed before treatment: PET/CT, DWMRI and DCEMRI; two MRI scans during the treatment; and three months after the treatment, the initial studies were repeated. Geometric distortion of DWMRI was corrected using RGM (SPM8 software, HySCO options). DCEMRI analyses were performed using Dynamika® v4.0 (www.imageanalysis.org.uk). Registration and mutual information were calculated with ARTFIBio tools. Mutual information of T2-weighted and DW-MRI was calculated for corrected and uncorrected DW-MRI. Initial Rate Enhancement (IRE) from DCEMRI was selected as a possible biomarker associated with vascularization / hypoxia. Results: Table shows the increment in mutual information for the initial ADC maps of the three patients when correcting by RGM. For two first patients, a large increment is observed and for the third patient, although the mutual information didn’t show it, the visual appreciation is quite relevant. In Figure A, the visual improvement of corrected images can be appreciated. 1 Hospital do Meixoeiro, Medical Physics Department, Vigo Pontevedra, Spain

b = 0 s / mm²

b = 600 s / mm²

Corrected by Reversed gradient

Corrected by Reversed gradient

Posterior shift

Anterior shift

Posterior shift

Patient Anterior shift

#1 #2 #3

0.563 0.656 0.308 0.454 0.439 0.548

0.872 0.775 0.548

0.655 0.381 0.545

0.325 0.445 0.522

0.900 0.730 0.567

Conclusion: RGM improves registration and provides accurate ADC in tumors. We suggest correction of distortion with the RGM should form part of an imaging method for treatment response using ADC to assess tumor response or tumor cell density variation with treatment in cancer patients, and DCEMRI can be useful for characterizing hypoxia in H&N cancers. Supported by ISCIII Grant DTS14/00188 EP-1871 Optimization of gross tumour volume definition in lung- sparing VMAT for pleural mesothelioma A. Botticella 1 University Hospital Gasthuisberg, Laboratory of Experimental Radiotherapy- Oncology Department, Leuven, Belgium 1 , G. Defraene 2 , K. Nackaerts 3 , C. Deroose 4 , P. Nafteux 5 , S. Peeters 2 , D. De Ruysscher 2 2 KU Leuven - University of Leuven- University Hospitals Leuven, Department of Oncology- Experimental Radiation Oncology, Leuven, Belgium 3 KU Leuven - University of Leuven- University Hospitals Leuven, Respiratory Diseases/Respiratory Oncology Unit, Leuven, Belgium 4 KU Leuven - University of Leuven- University Hospitals Leuven, Department Imaging and Pathology- Nuclear Medicine and Molecular Imaging, Leuven, Belgium 5 KU Leuven - University of Leuven- University Hospitals Leuven, Department of Thoracic Surgery, Leuven, Belgium