arXiv:2506.17491physics.med-phcs.AI2025-06被引 1

用扩散模型预测脑癌放疗中肿瘤的动态变化,实现个性化治疗调整。

Exploring Strategies for Personalized Radiation Therapy Part II Predicting Tumor Drift Patterns with Diffusion Models

  • 基于扩散模型从治疗前影像预测肿瘤演变路径。
  • 单步与迭代去噪策略均能准确模拟患者特异性肿瘤变化。
  • 适合需要早期自适应放疗决策的临床研究者使用。

放疗效果由剂量和时机两个关键参数决定,其最优值在不同患者间差异显著,尤其在脑癌治疗中更为突出。分次立体定向放射外科相比单次治疗更安全,但增加了疗效预测难度。为应对这一挑战,本文采用个性化超分次自适应放疗(PULSAR)策略,根据肿瘤随时间的演化动态调整治疗方案。然而,该策略的成功依赖于可指导早期决策、避免过度或不足治疗的预测工具。现有影像组学与剂量组学模型对肿瘤响应的时空演变模式洞察有限。为此,本文提出一种新型框架,利用去噪扩散隐式模型(DDIM),学习从治疗前到治疗后影像的数据驱动映射。本研究开发了单步与迭代去噪策略并进行对比评估。结果表明,扩散模型能有效模拟患者特异性的肿瘤演化过程,并定位与治疗响应相关的区域。该方法为建模异质性治疗反应提供了可靠基础,有助于实现早期自适应干预,推动更个性化、生物学驱动的放疗发展。

原文摘要 · Abstract (English)

Radiation therapy outcomes are decided by two key parameters, dose and timing, whose best values vary substantially across patients. This variability is especially critical in the treatment of brain cancer, where fractionated or staged stereotactic radiosurgery improves safety compared to single fraction approaches, but complicates the ability to predict treatment response. To address this challenge, we employ Personalized Ultra-fractionated Stereotactic Adaptive Radiotherapy (PULSAR), a strategy that dynamically adjusts treatment based on how each tumor evolves over time. However, the success of PULSAR and other adaptive approaches depends on predictive tools that can guide early treatment decisions and avoid both overtreatment and undertreatment. However, current radiomics and dosiomics models offer limited insight into the evolving spatial and temporal patterns of tumor response. To overcome these limitations, we propose a novel framework using Denoising Diffusion Implicit Models (DDIM), which learns data-driven mappings from pre to post treatment imaging. In this study, we developed single step and iterative denoising strategies and compared their performance. The results show that diffusion models can effectively simulate patient specific tumor evolution and localize regions associated with treatment response. The proposed strategy provides a promising foundation for modeling heterogeneous treatment response and enabling early, adaptive interventions, paving the way toward more personalized and biologically informed radiotherapy.

放疗扩散模型肿瘤演化个性化医疗

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