- 作者：Nina A. Mayr ; M.D.&lowast ; ; Nina.Mayr@osumc.edu ; Zhibin Huang ; Ph.D.&dagger ; ; Jian Z. Wang ; Ph.D.&lowast ; ; Simon S. Lo ; M.D.&Dagger ; ; Joline M. Fan ; B.S.§ ; ; John C. Grecula ; M.D.&lowast ; ; Steffen Sammet ; M.D. ; Ph.D.¶ ; ; 鈥?/sup> ; Christina L. Sammet ; Ph.D.¶ ; ; Guang Jia ; Ph.D.鈥?/sup> ; Jun Zhang ; Ph.D.鈥?/sup> ; Michael V. Knopp ; M.D. ; Ph.D.鈥?/sup> ; William T.C. Yuh ; M.D. ; M.S.E.E.鈥?/sup>
- 关键词：Tumor heterogeneity ; Magnetic resonance imaging (MRI) ; Dynamic contrast enhanced (DCE) MRI ; Cervical cancer ; Anatomic tumor volume ; Functional tumor imaging
- 刊名：International Journal of Radiation Oncology*Biology*Physics
- 出版年：2012
- 期刊代码：136_03603016
- 类别：med
- 出版时间：1 July, 2012
- 卷：83
- 期：3
- 页码：972-979
- 文件大小：530 K
Purpose
Treatment response in cancer has been monitored by measuring anatomic tumor volume (ATV) at various times without considering the inherent functional tumor heterogeneity known to critically influence ultimate treatment outcome: primary tumor control and survival. This study applied dynamic contrast-enhanced (DCE) functional MRI to characterize tumors' heterogeneous subregions with low DCE values, at risk for treatment failure, and to quantify the functional risk volume (FRV) for personalized early prediction of treatment outcome.Methods and Materials
DCE-MRI was performed in 102 stage IB2-IVA cervical cancer patients to assess tumor perfusion heterogeneity before and during radiation/chemotherapy. FRV represents the total volume of tumor voxels with critically low DCE signal intensity (<2.1 compared with precontrast image, determined by previous receiver operator characteristic analysis). FRVs were correlated with treatment outcome (follow-up: 0.2-9.4, mean 6.8 years) and compared with ATVs (Mann-Whitney, Kaplan-Meier, and multivariate analyses).
Results
Before and during therapy at 2-2.5 and 4-5 weeks of RT, FRVs >20, >13, and聽>5聽cm3, respectively, significantly predicted unfavorable 6-year primary tumor control (p聽= 0.003, 7.3 脳 10鈭?, 2.0 脳 10鈭?) and disease-specific survival (p = 1.9 脳 10鈭?, 2.1聽脳聽10鈭?, 2.5 脳 10鈭?, respectively). The FRVs were superior to the ATVs as early predictors of outcome, and the differentiating power of FRVs increased during treatment.
Discussion
Our preliminary results suggest that functional tumor heterogeneity can be characterized by DCE-MRI to quantify FRV for predicting ultimate long-term treatment outcome. FRV is a novel functional imaging heterogeneity parameter, superior to ATV, and聽can be clinically translated for personalized early outcome prediction before or as early as 2-5 weeks into treatment.