(Radiation) oncologist with long experience in molecular imaging and management and research of patients with head
less
Uploads
Papers by Heikki Minn
Head and Neck Cancer: Detection of Recurrence with Three-dimensional Principal Components Analysis at Dynamic FDG PET
Radiology, 1999
To evaluate positron emission tomography (PET) with 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG)... more To evaluate positron emission tomography (PET) with 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG) in detection of suspected recurrence of head and neck cancer, and to compare visual, static, and kinetic analyses of the tracer uptake. Seventeen dynamic FDG PET studies were performed in 15 patients. The images were interpreted visually, and the uptake was quantitated as the standardized uptake value (SUV) and as the regional FDG metabolic rate. Sensitivity of blinded visual interpretation of the PET images for the presence of malignancy was 88% and specificity was 86%. Malignant lesions accumulated significantly more FDG than benign lesions (P = .008 for SUVs, P = .002 for regional metabolic rates). When maximum uptake of FDG in the benign lesions was used as a threshold, the sensitivity of SUV analysis for malignancy was 75% and that of regional metabolic rates was 86%. Detection of recurrent head and neck cancer is feasible with FDG PET. Quantitation of FDG uptake assists in correct interpretation of the PET images.
Combined RBE and OER optimization in proton therapy with FLUKA based on EF5‐PET
Journal of Applied Clinical Medical Physics, May 10, 2023
IntroductionTumor hypoxia is associated with poor treatment outcome. Hypoxic regions are more rad... more IntroductionTumor hypoxia is associated with poor treatment outcome. Hypoxic regions are more radioresistant than well‐oxygenated regions, as quantified by the oxygen enhancement ratio (OER). In optimization of proton therapy, including OER in addition to the relative biological effectiveness (RBE) could therefore be used to adapt to patient‐specific radioresistance governed by intrinsic radiosensitivity and hypoxia.MethodsA combined RBE and OER weighted dose (ROWD) calculation method was implemented in a FLUKA Monte Carlo (MC) based treatment planning tool. The method is based on the linear quadratic model, with α and β parameters as a function of the OER, and therefore a function of the linear energy transfer (LET) and partial oxygen pressure (pO2). Proton therapy plans for two head and neck cancer (HNC) patients were optimized with pO2 estimated from [18F]‐EF5 positron emission tomography (PET) images. For the ROWD calculations, an RBE of 1.1 (RBE1.1,OER) and two variable RBE models, Rørvik (ROR) and McNamara (MCN), were used, alongside a reference plan without incorporation of OER (RBE1.1).ResultsFor the HNC patients, treatment plans in line with the prescription dose and with acceptable target ROWD could be generated with the established tool. The physical dose was the main factor modulated in the ROWD. The impact of incorporating OER during optimization of HNC patients was demonstrated by the substantial difference found between ROWD and physical dose in the hypoxic tumor region. The largest physical dose differences between the ROWD optimized plans and the reference plan was 12.2 Gy.ConclusionThe FLUKA MC based tool was able to optimize proton treatment plans taking the tumor pO2 distribution from hypoxia PET images into account. Independent of RBE‐model, both elevated LET and physical dose were found in the hypoxic regions, which shows the potential to increase the tumor control compared to a conventional optimization approach.
3rd ESTRO Forum 2015 1.31), p=0.91; 74Gy vs 57Gy: HR 1.02 (0.74-1.30), p=0.86). Analysis of chang... more 3rd ESTRO Forum 2015 1.31), p=0.91; 74Gy vs 57Gy: HR 1.02 (0.74-1.30), p=0.86). Analysis of change from pre-RT showed no evidence of a difference between treatment groups (figure ). The odds of an increase in overall bowel bother were reduced (compared to the 74Gy control arm) by 11% (odds ratio (OR) 0.89 99% CI: (0.62-1.27), p=0.4) and 8% (OR 0.92 (0.77-1.10), p=0.24) in the 60Gy and 57Gy groups respectively. For overall urinary bother, odds of an increase were increased by 31% (OR 1.31, (0.93-1.85) p=0.04) and 2% (OR 1.02 (0.86-1.20), p=0.79) for the 60Gy and 57Gy groups respectively. Conclusions: Overall bowel bother and overall urinary bother was low in the CHHiP trial, cross sectional and longitudinal analysis found no evidence of differences between either hypofractionated arm and the 74Gy control arm to 24 months of follow up.
In high-income countries, cancer is the leading cause of death among middle-aged adults. Prospect... more In high-income countries, cancer is the leading cause of death among middle-aged adults. Prospective data on the effects of childhood risk exposures on subsequent cancer mortality are scarce. METHODS: We examined whether childhood body mass index (BMI), blood pressure, glucose and lipid levels were associated with adult cancer mortality, using data from 21,012 children enrolled aged 3-19 years in seven prospective cohort studies from the U.S., Australia, and Finland that have followed participants from childhood into adulthood. Cancer mortality (cancer as a primary or secondary cause of death) was captured using registries. RESULTS: 354 cancer deaths occurred over the follow-up. In age-, sex, and cohort-adjusted analyses, childhood BMI (Hazard ratio [HR], 1.13; 95% confidence interval [CI] 1.03-1.24 per 1-SD increase) and childhood glucose (HR 1.22; 95%CI 1.01-1.47 per 1-SD increase), were associated with subsequent cancer mortality. In a multivariable analysis adjusted for age, sex, cohort, and childhood measures of fasting glucose, total cholesterol, triglycerides, and systolic blood pressure, childhood BMI remained as an independent predictor of subsequent cancer mortality (HR, 1.24; 95%CI, 1.03-1.49). The association of childhood BMI and subsequent cancer mortality persisted after adjustment for adulthood BMI (HR for childhood BMI, 1.35; 95%CI 1.12-1.63). CONCLUSIONS: Higher childhood BMI was independently associated with increased overall cancer mortality.
Earlier studies have suggested that smoking impairs survival in patients with cutaneous melanoma,... more Earlier studies have suggested that smoking impairs survival in patients with cutaneous melanoma, but the effect of smoking, along with other established prognostic factors, has not been described in detail. This study examined the association of smoking status (persistent, former, or never) with survival in patients with cutaneous melanoma treated in Southwest Finland in 2005 to 2019. Smoking was an independent prognostic factor for shorter survival after adjustment for other risk factors, including age, sex, TNM stage, and comorbidities. The detrimental effect of smoking on survival was most marked in patients with metastatic melanoma and these patients should routinely be supported to stop smoking. Previous studies have suggested that persistent tobacco smoking impairs survival in cutaneous melanoma, but the effects of smoking and other prognostic factors have not been described in detail. This study examined the association of smoking (persistent, former, or never) with melanoma-specific (MSS) and overall survival (OS) in patients with cutaneous melanoma treated in Southwest Finland during 2005 to 2019. Clinical characteristics were obtained from electronic health records for 1,980 patients. Smoking status was available for 1,359 patients. Patients were restaged according to the 8 th edition of the tumour-nodemetastasis (TNM) classification. Smoking remained an independent prognostic factor for inferior melanomaspecific survival regardless of age, sex, stage, and comorbidities. The hazard ratio of death from melanoma was 1.81 (1.27-2.58, p = 0.001) in persistent and 1.75 (1.28-2.40, p = 0.001) in former smokers compared with never smokers. In 351 stage IV patients, smoking was associated with increased melanoma-specific and overall mortality: median MSS 10.4 (6.5-14.3), 14.6 (9.1-20.1), and 14.9 (11.4-18.4) months, p = 0.01 and median OS 10.4 (6.5-14.3), 13.9 (8.6-19.2), and 14.9 (11.7-18.1) months, p = 0.01 in persistent, former, and never smokers, respectively. In conclusion, since smoking represents an independent modifiable poor prognostic factor in patients with cutaneous melanoma, smoking habits should be proactively asked about by healthcare professionals, in order to support smoking cessation.
The overview summarizes recent developments in radiation oncology for high risk and recurrent pro... more The overview summarizes recent developments in radiation oncology for high risk and recurrent prostate cancer. A number of well known phase III prostate hypofractionated radiation therapy (HFxRT) trials were finally published with long-term follow-ups. These trials demonstrate patterns of equivalent tumor control with several showing worse toxicity rates. The ASCENDE-RT randomized trial demonstrated the superiority of brachytherapy boost in intermediate and high-risk prostate cancer. Important randomized trials show a clear benefit to androgen deprivation therapy (ADT) in both intermediate-risk prostate cancer and postprostatectomy patients with rising PSA. Finally, the first randomized trial of metastasis-directed therapy showed a delay in time to ADT and biochemical failures in oligometastatic prostate cancer.
Background: Patients with cancer move between institutions and settings and have different knowle... more Background: Patients with cancer move between institutions and settings and have different knowledge expectations during their illness trajectory. To provide individually tailored, timely, and relevant education, healthcare professionals should collaborate in the patient education process. Objectives: This study aimed to describe procedures used by healthcare professionals involved in cancer management when assessing knowledge expectations, cognitive resources, and comprehension of adult patients with cancer during and after education in various phases of their illness trajectory. Intraprofessional and interprofessional collaboration concerning the patient education process is described. Methods: Eleven focus group interviews were conducted for nurses (n = 42) and physicians (n = 23) involved in cancer care from four healthcare organizations: a private occupational health care and three hospital settings. Interview data were analyzed with inductive content analysis. Results: In the assessment of the knowledge expectations, cognitive resources, and comprehension of a patient with cancer, both the nurses and physicians first applied objective assessment methods and then used dialogue with the patient. No validated instruments were used by either group. Among nurses, educational content was based on the patient's possible or actual problems in everyday life during cancer management, whereas the physicians focused on the patient's rights to information and informed consent for treatment. The patient education process was often incompletely documented into patient records and not always utilized interprofessionally or between care units. Discussion: In oncology services, there is a gap between research evidence utilization and the patient education process. Patients should be involved in the planning, implementation, and evaluation of their education and be informed about the division of responsibilities in patient education between different professional groups. This would allow patients to participate more extensively in the decision making concerning their own treatments. To ensure effective interprofessional patient education for individual patients, improvement in information exchange among members of the cancer care team is needed.
The role of exercise in cancer prevention and control is increasingly recognized, and based on pr... more The role of exercise in cancer prevention and control is increasingly recognized, and based on preclinical studies, it is hypothesized that mobilization of leukocytes plays an important role in the anti-tumor effect. Thus, we examined how 10-min acute exercise modulates immune cells in newly diagnosed breast cancer patients. Blood samples were taken at rest, immediately after exercise and 30 min after exercise and phenotypic characterization of major leukocyte subsets was done using 9-color flow cytometry. Total leukocyte count increased by 29%, CD8 + T cell count by 34%, CD19 + B cell count by 18%, CD56 + CD16 + NK cell count by 130%, and CD14 + CD16 + monocyte count by 51% immediately after acute exercise. Mobilization of CD45 + , CD8 + , CD19 + , and CD56 + CD16 + cells correlated positively with exercising systolic blood pressure, heart rate percentage of age predicted maximal heart rate, rate pressure product, and mean arterial pressure. Our findings indicate that a single bout of acute exercise of only 10 min can cause leukocytosis in breast cancer patients. Mobilization of leukocytes appear to be directly related to the intensity of exercise. It is possible that the positive effect of exercise on oncologic outcome might be partly due to immune cell mobilization as documented in the present study.
Background and purpose: Magnetic resonance imaging (MRI) is increasingly used in radiation therap... more Background and purpose: Magnetic resonance imaging (MRI) is increasingly used in radiation therapy planning of prostate cancer (PC) to reduce target volume delineation uncertainty. This study aimed to assess and validate the performance of a fully automated segmentation tool (AST) in MRI based radiation therapy planning of PC. Material and methods: Pelvic structures of 65 PC patients delineated in an MRI-only workflow according to established guidelines were included in the analysis. Automatic vs manual segmentation by an experienced oncologist was compared with geometrical parameters, such as the dice similarity coefficient (DSC). Fifteen patients had a second MRI within 15 days to assess repeatability of the AST for prostate and seminal vesicles. Furthermore, we investigated whether hormonal therapy or body mass index (BMI) affected the AST results. Results: The AST showed high agreement with manual segmentation expressed as DSC (mean, SD) for delineating prostate (0.84, 0.04), bladder (0.92, 0.04) and rectum (0.86, 0.04). For seminal vesicles (0.56, 0.17) and penile bulb (0.69, 0.12) the respective agreement was moderate. Performance of AST was not influenced by neoadjuvant hormonal therapy, although those on treatment had significantly smaller prostates than the hormone-naïve patients (p < 0.0001). In repeat assessment, consistency of prostate delineation resulted in mean DSC of 0.89, (SD 0.03) between the paired MRI scans for AST, while mean DSC of manual delineation was 0.82, (SD 0.05). Conclusion: Fully automated MRI segmentation tool showed good agreement and repeatability compared with manual segmentation and was found clinically robust in patients with PC. However, manual review and adjustment of some structures in individual cases remain important in clinical use.
The detection of circulating tumor DNA (ctDNA) has gained increasing interest in precision oncolo... more The detection of circulating tumor DNA (ctDNA) has gained increasing interest in precision oncology. In head and neck squamous cell carcinoma (HNSCC), a heterogenous mutational landscape contributes to substantial challenges in prognostic and predictive assessment. We report our observations of associations between quantitative parameters in ctDNA and the metabolic tumor burden determined based on FDG-PET/CT. We found that maximum variant allele frequency (VAF) in venous liquid biopsy correlated positively with metabolic tumor burden measured with whole-body total lesion glycolysis (TLG). The prognostic significance of this PET parameter has been documented repeatedly in previous meta-analyses in HNSCC. Our findings indicate that a complex mutational landscape contributes to this metabolic burden. A combination of ctDNA detection and FDG-PET/CT may provide added value for the prognostic and predictive evaluation of HNSCC in the setting of initial diagnosis and follow-up after definitive therapy.
International Journal of Radiation Oncology Biology Physics, 1999
of the 4 1 st Annual ASTRO Meeting 239 tumor region was assessed by cross-sectional imaging in al... more of the 4 1 st Annual ASTRO Meeting 239 tumor region was assessed by cross-sectional imaging in all cases and real-time radiotherapy review was included in the protocol. The pre-op RT protocol used a field margin of 5-cm surrounding gross tumour, or less if protected by an intact barrier to tumour invasion such as a thick fascial sheath. In post-op RT, the 5-cm margin was also used but also surrounded the surgical field including scars, drain sites, or post-op changes apparent on imaging studies.
European Journal of Nuclear Medicine and Molecular Imaging, Dec 11, 2019
The aim of this guideline is to provide standards for the recommendation, performance, interpreta... more The aim of this guideline is to provide standards for the recommendation, performance, interpretation, and reporting of [ 18 F]Fluciclovine PET/CT for prostate cancer imaging. These recommendations will help to improve accuracy, precision, and repeatability of [ 18 F]Fluciclovine PET/CT for prostate cancer essentially needed for implementation of this modality in science and routine clinical practice. [ 18 F]Fluciclovine . PET . Prostate cancer . Staging . Restaging . Guideline This article is part of the Tropical Collection on Oncology -Genitourinary Preamble The Society of Nuclear Medicine and Molecular Imaging (SNMMI) is an international non-profit scientific and professional organization founded in 1954 to promote the science, technology, and practical application of nuclear medicine. The European Association of Nuclear Medicine (EANM) is a professional nonprofit medical association that facilitates communication worldwide between individuals pursuing clinical and research excellence in nuclear medicine. The EANM was founded in 1985. SNMMI and EANM members are physicians, technologists, and scientists specializing in the research and practice of nuclear medicine. The SNMMI and EANM will periodically define new guidelines for nuclear medicine practice to help advance the science of nuclear medicine and to improve the quality of service to patients throughout the world. Existing practice guidelines will be reviewed for revision or renewal, as appropriate, on their fifth anniversary or sooner, if indicated. Each practice guideline, representing a policy statement by the SNMMI/EANM, has undergone a thorough consensus process in which it has been subjected to extensive review. The SNMMI and EANM recognize that the safe and effective use of diagnostic nuclear medicine imaging requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guideline by those entities not providing these services is not authorized. These guidelines are an educational tool designed to assist practitioners in providing appropriate care for patients. They are not inflexible rules or requirements of practice and are not intended, nor should they be used, to establish a legal standard of care. For these reasons and those set forth below, both the SNMMI and the EANM caution against the use of these guidelines in litigation in which the clinical decisions of a practitioner are called into question. The ultimate judgment regarding the propriety of any specific procedure or course of action must be made by the physician or medical physicist in light of all the circumstances presented. Thus, there is no implication that an approach differing from the guidelines, standing alone, is below the standard of care. To the contrary, a conscientious practitioner may responsibly adopt a course of action different from that set forth in the guidelines when, in the reasonable judgment of the practitioner, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology subsequent to publication of the guidelines. The practice of medicine includes both the art and the science of the prevention, diagnosis, alleviation, and treatment of disease. The variety and complexity of human conditions make it impossible to always reach the most appropriate diagnosis or to predict with certainty a particular response to treatment. Therefore, it should be recognized that adherence to these guidelines will not ensure an accurate diagnosis or a successful outcome. All that should be expected is that the practitioner will follow a reasonable course of action based on current knowledge, available resources, and the needs of the patient to deliver effective and safe medical care. The sole purpose of these guidelines is to assist practitioners in achieving this objective.
Uploads
Papers by Heikki Minn