Frequent optical imaging during breast cancer neoadjuvant chemotherapy reveals dynamic tumor physiology in an individual patient.
Frequent optical imaging during breast cancer neoadjuvant chemotherapy reveals dynamic tumor physiology in an individual patient.
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DOI：
10.1016/j.acra.2010.05.002
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发表时间：
2010-08-01
影响因子：
4.8
通讯作者：
Tromberg, Bruce J
中科院分区：
文献类型：
--
作者：
Cerussi, Albert E;Tanamai, Vaya W;Tromberg, Bruce J
依据和目标：体内成像肿瘤对新辅助化疗的反应为患者护理和临床决策提供了独特的机会。详细的影像学研究可以使肿瘤学家根据个体患者的反应优化治疗药物的类型和剂量。大多数放射学方法由于成本而很少使用，因此可能会错过有关肿瘤反应动力学的重要功能信息。此外，目前的临床标准是基于确定肿瘤大小的变化;因此，标准的解剖成像可能对早期或频繁的生化反应不敏感。由于光学方法提供功能成像终点，我们的目标是开发一种低障碍的访问床边的方法，可用于频繁，功能评估的动态肿瘤生理学在个别patients.MATERIALS和METHODS：扩散光学光谱成像（DOSI）是一种非侵入性的，床边功能成像技术，量化的浓度和分子状态的组织血红蛋白，水和脂质。初步临床研究表明，DOSI可能是一个有用的工具，用于量化新辅助化疗反应，通常通过比较治疗前后肿瘤水和脱氧血红蛋白浓度的变化程度。1周和治疗期间的患者反应已用于预测临床结果。在这份报告中，我们通过在19个不同的日子里对一名51岁的浸润性导管癌患者进行DOSI监测来评估其潜在价值。（初始肿瘤大小60 x 27 mm），接受新辅助化疗（蒽环类和贝伐单抗）在18周的时间内。一个复合指数，组织光学指数（TOI），显示了显着（约50%）的下降超过近18周的化疗。肿瘤反应对化疗药物的类型敏感，功能指数波动的方式与动态肿瘤生理学一致。最后的病理学发现4毫米的残留疾病，这是可检测的DOSI在化疗结束前surgery.CONCLUSION：本病例研究表明，DOSI可能是一个床边的能力工具，经常纵向监测新辅助化疗的治疗功能反应。
RATIONALE AND OBJECTIVES: Imaging tumor response to neoadjuvant chemotherapy in vivo offers unique opportunities for patient care and clinical decision-making. Detailed imaging studies may allow oncologists to optimize therapeutic drug type and dose based on individual patient response. Most radiologic methods are used sparingly because of cost; thus, important functional information about tumor response dynamics may be missed. In addition, current clinical standards are based on determining tumor size changes; thus, standard anatomic imaging may be insensitive to early or frequent biochemical responses. Because optical methods provide functional imaging end points, our objective is to develop a low-barrier-to-access bedside approach that can be used for frequent, functional assessment of dynamic tumor physiology in individual patients.MATERIALS AND METHODS: Diffuse Optical Spectroscopic Imaging (DOSI) is a noninvasive, bedside functional imaging technique that quantifies the concentration and molecular state of tissue hemoglobin, water, and lipid. Pilot clinical studies have shown that DOSI may be a useful tool for quantifying neoadjuvant chemotherapy response, typically by comparing the degree of change in tumor water and deoxy-hemoglobin concentration before and after therapy. Patient responses at 1 week and mid-therapy have been used to predict clinical outcome. In this report, we assess the potential value of frequent DOSI monitoring by performing measurements on 19 different days in a 51-year-old subject with infiltrating ductal carcinoma (initial tumor size 60 x 27 mm) who received neoadjuvant chemotherapy (anthracyclines and bevacizumab) over an 18-week period.RESULTS: A composite index, the Tissue Optical Index (TOI), showed a significant ( approximately 50%) decrease over the nearly 18 weeks of chemotherapy. Tumor response was sensitive to the type of chemotherapy agent, and functional indices fluctuated in a manner consistent with dynamic tumor physiology. Final pathology revealed 4 mm of residual disease, which was detectible by DOSI at the conclusion of chemotherapy before surgery.CONCLUSION: This case study suggests that DOSI may be a bedside-capable tool for frequent longitudinal monitoring of therapeutic functional response to neoadjuvant chemotherapy.