METABOLIC MEASUREMENT AND MONITORING IN CLINICAL HYPERTHERMIA

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This project has successfully studied magnetic resonance imaging (MRI) and 31P spectroscopy (MRS) to assess prognosis and monitor therapeutic results in human and canine patients with soft tissue sarcomas treated with combined hyperthermia (HT) and radiation therapy (RT). There is strong rationale to look for correlated profiles of physiologic data in a defined group of tumors, both in the unperturbed state and after therapeutic intervention to improve our understanding of the physiological mechanisms of clinical response to thermoradiotherapy. Such physiologic metabolic data could greatly assist in the development and deployment of anti- neoplastic therapy, especially if this information can be shown to be independent of other known prognostic variables. Specifically, we need to be able (l) to identify, prior to therapy, those patients most likely to benefit from a specific course of therapy, (2) to identify, early during the course of therapy, nonresponding patients for whom therapy alternatives can be implemented with the greatest efficacy. The goal of this study is to continue to evaluate the usefulness of tumor physiologic profiles, as assessed by 31P MRS, 1H MRl, Eppendorf pO2 histographs, and electrode pHe measurements as methods of assessing prognosis and monitoring therapy in cancer patients. It is important that this be done in well controlled studies with clearly specified therapeutic protocols and well defined clinical endpoints. We expect to evaluate the prior developed model that MRS/MRI derived pretherapy and posttherapy metabolic characteristics of STS are prognostic for combined HT/RT as well as evaluate multiple parameter metabolic profiles as indices of therapeutic prognosis. We also will evaluate whether these parameters are consistent for "heatable" and "non-heatable" tumors in the context of the therapy protocol. The benefits of predicting therapeutic response in individual patients derive from the concept that non-responders could be offered an alternative therapy if such a therapy exists. Such benefits are hard to overstate both in terms of patient morbidity and dollar costs. There are also very important benefits beyond direct cost savings: (l) non-treated patients would be spared morbidity, time, and stress of ineffective treatment; (2) the cancer would have less opportunity to metastasize during an ineffectual treatment; and (3) alternate treatments could be tried earlier in the patient's therapy course.