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5-ALA Photodynamic Therapy in Neurosurgery, Towards the Design of a Treatment Planning System: A Proof of Concept

Abstract : Purpose: Glioblastoma (GBM) treatment still remains a complex challenge. Among alternatives or adjuvant therapies, photodynamic therapy (5-ALA PDT) appears to be a promising approach. 5-ALA PDT can be delivered intraoperatively, early after tumour resection, or interstitially according to brain tumour location. A treatment planning system was designed to manage dosimetry issues before PDT delivery. Methods: The TPS was developed according to a specific workflow from stereotactic image registration to light fluence rate modelling. Here, we describe a proof of concept of a treatment planning system (TPS) dedicated to interstitial 5-ALA PDT. This tool enables the planning of a whole treatment in surgical stereotactic conditions. Stereotactic registration and dosimetry components are detailed and evaluated. The registration process is compared to a commercial solution (Leksell Gamma Plan®, Elekta®, Sweden) defined as the ground truth and dosimetry model implemented in our TPS and is compared to numerical simulations. Results: Registration achieved a sub-millimetric mean relative error that matched the standard MRI resolution. Dosimetry comparison showed a negligible error between analytical and numerical models and enabled a validation of the dosimetry algorithm implemented. Conclusions: A treatment planning system was designed to achieve 5-ALA PDT simulations before the patients underwent surgery. Similarly, for radiation therapy, we proposed a system to plan and evaluate the 5-ALA PDT dosimetry for optimizing treatment delivery. Although this system remains to be perfected, this preliminary work aimed to demonstrate the feasibility of planning 5-ALA PDT treatments in stereotactic conditions. Future improvements will mainly focus on the optimization of the treatment delivery, automatic segmentation and GPU-accelerated Monte-Carlo management to take into account GBM tissue heterogeneity.
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https://hal.archives-ouvertes.fr/hal-01403867
Contributor : Serge Mordon <>
Submitted on : Monday, November 28, 2016 - 8:06:43 AM
Last modification on : Wednesday, October 21, 2020 - 3:40:52 AM
Long-term archiving on: : Tuesday, March 21, 2017 - 10:04:21 AM

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Dupont C., N. Betrouni, S. Mordon, N. Reyns, M. Vermandel. 5-ALA Photodynamic Therapy in Neurosurgery, Towards the Design of a Treatment Planning System: A Proof of Concept. Innovation and Research in BioMedical engineering, Elsevier Masson, 2016, ⟨10.1016/j.irbm.2016.11.002⟩. ⟨hal-01403867⟩

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