Biomedical subjects

D Lefkopoulos

Publications and source records attributed to D Lefkopoulos.

44 records · Page 3Linked to original sources

PubMed1993

A 3-D radiosurgical methodology for complex arteriovenous malformations.

A 3-D methodology, the associated targets methodology, for planning radiosurgical irradiations of complex arteriovenous malformations (AVMs) is presented. It uses the ARTEMIS-3D treatment planning system and has been devised and adopted by our group since January 1990. Its main features are: (a) prescription and delivery of a minimal target dose on the surface of the lesion, corresponding to a 60-70% isodose range. The dose to adjacent functional neurological structures is taken into account as well as the maximum dose to the lesion; (b) An optimisation approach consisting of obtaining the optimal superimposition of the isodose surface and the 3-D contour of the lesion and sharp fall-offs by interactive manipulation of the treatment parameters. The clinical choice of the treatment plan is based on a compromise between the optimal reference isodose surface encompassing the lesion and the minimisation of the volumetric dose fall-off. In complex AVMs the angiographic results have been significantly improved in comparison with our previous experience because of the better achieved lesion encompassing.

Humans↗

PubMed1992

Total-body irradiation before bone marrow transplantation. Results of two randomized instantaneous dose rates in 157 patients.

One hundred fifty-seven patients referred to the Department of Radiation Oncology of the Hôpital Tenon, Paris, France, between December 10, 1986 and December 31, 1989 for total-body irradiation (TBI) were treated according to the following two techniques: (1) either in one fraction (1000 cGy administered to the midplane at L4 and 800 cGy to the lungs) or (2) in six fractions (1200 cGy on 3 consecutive days to the midplane at L4 and 900 cGy to the lungs). The patients were randomized according to two instantaneous dose rates, called LOW and HIGH, in single-dose (6 versus 15 cGy/min) and hexafractionated (3 versus 6 cGy/min) TBI groups. There were 77 patients in the LOW group and 80 in the HIGH group, with 57 patients receiving single-dose TBI (28 LOW and 29 HIGH) and 100 patients receiving fractionated-dose TBI (49 LOW and 51 HIGH). In March 1991, the 4-year relapse-free and overall survival rates were 58.4% and 52.1%, respectively. The 4-year relapse-free survival and survival rates were 54.9% and 50.7% in the LOW group; 61.9% and 53.5% in the HIGH group (P = 0.69 and 0.82, respectively); 60.3% and 50.4% in the single-dose group; and 57.9% and 53.3% in the fractionated group (P = 0.65 and 0.78, respectively). There was no difference in the incidence of graft versus host disease, interstitial pneumonitis, or venoocclusive disease either between the LOW and the HIGH groups or between the single-dose and fractionated-dose TBI groups. The 4-year estimated cataract incidence was significantly higher in the single-dose HIGH instantaneous dose rate group than in the LOW instantaneous dose rate TBI group (P = 0.049). Multivariate analyses showed that instantaneous dose rate and fractionation do not influence the relapse-free and overall survival rates or the incidence of interstitial pneumonitis.

Adolescent↗

PubMed1991

[Stereotaxic irradiation of 46 cerebral angiomas. Analysis of the angiographic results 2 and a half years after treatment].

Between May 1986 and March 1987, 46 small and medium sized cerebral arteriovenous malformations (AVM) were treated by radiosurgery in Paris. The stereotaxic coordinates of the lesions were determined according to the method of J. Talairach and the total radiation dose was delivered on spherical or ovoid target volumes with minibeams of 18 MV photons, using the technique developed by Osvaldo Betti. A review of the cases was undertaken in december 89. Twenty-one patients had previously been treated by embolization and/or surgery (46.6%). During the 25 to 40 months follow-up there were only 2 recurrences of bleeding (4.3). Control arteriography was performed in 38 cases (38/46 = 82.6%). There were thirteen cases of total disappearance of the AVM (13/36 = 34.2%), 17 incomplete obliterations (44.7%) and 9 (23%) arteriographies failed to show any radiological improvement. Eight patients had no arteriographic follow-up: 2 of them experienced a recurrence of bleeding and died before the planned arteriography, 1 was lost to follow-up and 5 patients refused control arteriography. A multidisciplinary team is needed to study the shape, the volume, the hemodynamic features of the AVM and the dosimetry in order to attain the best definition of the target volume and of the dose distribution. It seems that when the target volume included the nidus and the venous collector, follow-up arteriography results were satisfactory. Even though the optimum dose is yet to be determined, our results imply that a dose distribution allowing for 25 grays at the periphery of the AVM (isodose 70%) seems sufficient provided that the target volume is included within the 25.00 Gy isodose curve.

Adolescent↗

PubMed1989

[Stereoradiotherapy of small brain lesions].

Stereoradiotherapy is the stereotaxy guided high-dose irradiation of small (less than 3 cm) intracerebral lesions. Its aim is to induce necrosis or sclerosis inside the target volume. Several techniques permit us to obtain a steep dose gradient between the lesion and the adjacent healthy cerebral parenchyma. They use minibeams (diameter less than 3 cm) of different types of radiations: protons (Kjellberg from Harvard, since 1962); gamma rays of cobalt 60 (Leksell from Stockholm, since 1968); and X-rays from a linear accelerator (Betti from Buenos-Aires, since 1982). The most commonly treated lesions are arterio-venous malformations, hypophyseal adenomas and low grade parenchymatous tumors. The stereotaxic technique is the only means by which to insure that these high dose irradiations, administered in a single session, are actually delivered to the small lesions situated in the cerebral parenchyma.

Adenoma↗

PubMedDate not supplied

[Implementation of receiver operating characteristics for the quantitative evaluation of stereotactic radiotherapy treatment plans].

The definition of criteria and of a methodology dedicated to the quantitative evaluation of conformal stereotactic treatment plans is presented. We implemented the 'Receiver Operating Characteristics' (ROC) analysis, already used in medical imaging, for the quantitative evaluation of irradiation treatment plans. This implementation is based on data provided by dose-volume histograms (DVH). Three techniques, each one using a different dosimetric criterion, were defined for the choice of a reference isodose for a given treatment plan. We used this ROC analysis for the selection of the most conformal treatment plan and its reference isodose among the treatment plans proposed for one patient. This study revealed the interest of ROC analysis based on dose-volume histograms for the quantitative evaluation of treatment plans.

Humans↗

PubMedDate not supplied

[Progress in optimizing dosimetry plans in stereotactic radiotherapy in the Salt Group (Saint-Anne-Lariboisière-Tenon].

We began intracranial stereotactic irradiation under the direction of O Betti 11 years ago. At the present time, we believe it is interesting to present the methodologies of the SALT (Saint-Anne-Lariboisière-Tenon) group. Up to the present time we have irradiated 693 patients using a single fraction. Arteriovenous malformations (AVMs) represented the majority (90%) of treated lesions. Irradiation protocol has little changed since 1986, and the localization of the target volume was performed in the neurosurgery department of St Anne Hospital, France. The stereotactic images (computerized tomography [CT], angiography) were sent to the radiotherapy department of Tenon Hospital through the French public digital network NUMERIS. Protocol was realized using the stereotactic ARTEMIS-3D/Dosigray TPS. The lesion volume was filled by one or more spherical or elliptical subvolumes using the "Associated Target Methodology". The interactive adjustment of subvolumes was based on the 3D graphical representations of the lesion. The direct optimization of the irradiation space was performed by managing parameters provided by the DDB (Dosimetric Data Base) such as the number of arcs, their angular position, as well as the starting and the ending point of each arc. The evaluation of the calculated dose distribution was made using quantitative parameters. The second method of optimization was based on the minibeam intensity modulation using a mathematical theory of inverse problems and singular value decomposition (SVD) analysis. At the present time, due to technical reasons, linear accelerators do not permit the modulation of intensity of arctherapy. Thus we transformed the profiles of irregular forms into rectangular profiles of modulated ponderation, with each optimized plan being evaluated before its implementation. The criteria of evaluation were derived from the differential and cumulative dose volume histograms (DVH). The DVHs permitted the evaluation of the volumes of underdosage and overdosage inside the lesion and in the healthy tissue, respectively. Using DVHs, we have defined parameters such as the conform factor and the homogeneity index. We stress that the methodology of protocol optimization is valid for single or multiple fractions as well as for intra- and extra-cranial irradiation.

Humans↗

PubMedDate not supplied

[Intensity modulation by inverse planning: preliminary results].

An inverse planning algorithm for determining the intensity of modulated beams that generates conformal radiotherapy dose distributions is presented. This algorithm is based on the mathematical analysis of the singular values decomposition. It is integrated in the DOSIGRAY 3D treatment planning software. The dose is calculated by the separation of the primary and scattered radiation. We presented, for a prostate cancer, the modulated intensity profiles and the optimal dose distribution obtained by the inverse optimization software developed and integrated in the treatment planning system. We obtained a region with high doses which geometrically conforms the target volume and spares the neighboring critical structures. This preliminary study showed the feasibility and the managing of the singular value decomposition to generate conformal dose distribution in a clinical environment.

Algorithms↗

PubMedDate not supplied

The influence of arc weights on the dose distribution for single target radiosurgery.

To stereotactically irradiate ellipsoidal inclined arteriovenous malformations (AVMs) with a single isocenter one can use an adjusted inclined irradiation space with a reduced angular range of arcs. If one uses the maximum available irradiation space it is necessary to weight some of the arcs in order to closely encompass the lesion. It has been found that there is a relationship between the lesion inclination angle beta and the weights of arcs. Conversely when the beta angle is known, the weights of the arcs can be determined in advance by means of weighting vectors. The dose volume analysis shows that the isodose volumes remain constant for the different weighting vectors except for the 10% isodose volume which increases slightly as the linear weighting vector's slope alpha increases. Moreover, this procedure permits the optimization of the superimposition between the lesion and the reference isodose. These results enable the construction of an "a priori knowledge" database that can be included in an optimization algorithm procedure.

Biophysical Phenomena↗