Research Program "Radiation Oncology and Imaging (ROI)"
Imaging and Radiation Oncology are indispensible components of multidisciplinary management of cancer. Both have substantial cross-linkage with each other.
Innovative data mining approaches as well as the handling, sharing and archiving of big data are prerequistes for research as well as clinical applications. The overall aim of the Radiation Oncology part of the Program is to improve treatment by biological individualization and by technical optimization, including the use of particle radiotherapy. Program activities cover translational clinical trials on particle therapy and biological individualization, the development and preclinical testing of novel technologies (e.g., particle beam imaging; laser acceleration), biomarkers and bioimaging for radiation therapy patient stratification, as well as novel combinations and preclinical trials. In Imaging science the aim is to develop novel PET, MR and CT biomarkers and theranostics as well as to implement standardized, quality-controlled, multiparametric imaging protocols and workflows to enable multicenter preclinical/clinical studies. In view of the growing field of multiparametric imaging an additional aim is to further develop and improve image/texture analysis and radiomics for biological tumor characterization, therapy planning, as well as monitoring and prediction of response to therapy.
Selected major translational highlights
1. The first prospective phase I/II interventional trial (de-escalation trial for HPV-positive oropharyngeal cancer (DELPHI, NCT03396718), which is based on the results of a completed Joint Funding project funded by the DKTK, was initiated jointly at all DKTK sites under the lead of Dresden and is now ongoing with NCT funding.
2. PET (18F-MISO or FAZA) for detection of tumor hypoxia was shown to predict outcome in head and neck cancer in prospective hypothesis-generating and validation studies, as well as in an international meta-analysis performed on individual patient data. Hypoxia-image guided dose escalation was further evaluated in early clinical trials and a randomized interventional clinical phase II trial has been conditionally accepted for financing by Deutsche Krebshilfe (DD, FR, TÜ).
3. The results of the workshop on “Radiobiology of Proton Therapy” with international and DKTK experts held in DD have been published and defined avenues for radiobiological proton research. Scientists in DD and HD investigated the variability of clinical radiobiological effectiveness (RBE) of protons with endpoints normal brain toxicity and radiation induced pulmonary fibrosis. At both sites, clinically relevant mouse models for precise radiation of brain subvolumes with standard photon, protons and carbon ions were developed and evaluated for back-translation. Scientists in DD and HD investigated the variability of clinical RBE of protons and proposed the subventricular zone as an organ at risk in brain tumor treatment with proton therapy.
4. The implementation of the Joint Imaging Platform (JIP), including protocols, testing, and installation of hardware at all sites as a backbone for future imaging studies within the DKTK was a major success.
5. Together with 25 European research teams, reference values for radiomics characteristics were established and validated within the Image Biomarker Standardization Initiative (IBSI, https://theibsi.github.io/) initiated by A. Zwanenburg and S. Löck (DD).
6. The prospective multicenter clinical trial on “Ga-PSMA-11 in high-risk prostate cancer” (NCT03362359, PI: F. Giesel, DKTK sites DD, E/D, FR, HD, M, TÜ and two international sites) represents a successful translational highlight. Based on this radiotracer, DKTK scientists developed intraoperative concepts for fluorescence-guided surgery in HD and FR, which are currently being investigated in a first-in-human study in FR.