Target Volume Delineation In Hypoxia Dose Painting

Abstract: Purpose: Tumour hypoxia is the result of uncontrolled growth of the tumour and its vasculature and is often found in solid tumours. It has been known for some time that tumour hypoxia is associated with increased radio resistance and poorer treatment outcomes. While there are several techniques to image the tumour’s oxygenation, no metric or guideline exists that helps in automatically delineating those hypoxic cells into target volumes. Even though several hypoxic biomarkers have been developed and tested to detect visualise and localise hypoxic areas, most of these delineated areas show volumes that are not immediately suitable for dose planning (i.e. a speckled hypoxia distribution). This work deals with 18 cases of tumour hypoxia in patients with non-small cell lung cancer (NSCLC) and presents a method that gives guidance on how to construct hypoxic target volumes feasible for dose planning. Materials and Methods: PET-CT scans have been taken with the hypoxic biomarker 18F-HX4. Hypoxic volumes have been extracted using a threshold of 10mmHg. A region growing algorithm was used to develop the HTV delineation method. Individually calculated doses based on the pO2-distribution within the hypoxic target volume have been used for the construction of dose plans with 24 fractions. Results: Treatment plans that boost the hypoxic target volume whilst sparing surrounding organs at risk were possible to construct for those tumours lying outside the mediastinum. Tumours which volumes were partially or fully overlapping with the mediastinum showed conflicts with delivering the dose necessary for a tumour control probability (TCP) of at least 95% and not exceeding the dose constraints set for the mediastinum.