PET/MRS guided radiotherapy

PET/MRS引导放射治疗

• 批准号: 9293290
• 负责人: Georges El Fakhri
• 金额: $ 21.38万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-07-01 至 2019-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9293290
• 关键词: Adjuvant Chemotherapy; Aftercare; Anatomy; Biological; Clinical; Clinical Research; Consensus; Dimensions; Disease; Disease Outcome; Dose; Edema; Ensure; Family; Goals; Histologic; Histology; Image; Inflammation; Lesion; Limb structure; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Malignant Neoplasms; Measurement; Meta-Analysis; Metabolic; Microscopic; Modality; Modernization; Morbidity - disease rate; Motion; Necrosis; Neoadjuvant Therapy; Neoplasm Metastasis; Normal tissue morphology; Operative Surgical Procedures; Organ; Pathologic; Patients; Pilot Projects; Play; Positron-Emission Tomography; Predictive Value; Primary Neoplasm; Radial; Radiation; Radiation Therapy Oncology Group; Radiation therapy; Resected; Residual Tumors; Residual state; Risk; Role; Scanning; Sensitivity and Specificity; Soft tissue sarcoma; Specificity; Specimen; Surrogate Markers; Techniques; Tissue imaging; Tissues; Toxic effect; Treatment Efficacy; Tumor Volume; Uncertainty; Work; analog; base; cancer imaging; chemoradiation; clinical imaging; contrast enhanced; cost; high risk; histological slides; image guided; image guided radiation therapy; in vivo; novel; predict clinical outcome; prevent; response; response biomarker; sarcoma; spectroscopic imaging; systemic toxicity; treatment planning; treatment response; tumor; uptake

ABSTRACT Radiation therapy plays a key role in the loco-regional management of patients with high- grade STS. Currently, T2-weighted Magnetic Resonance Imaging (MR) is the modality of choice in the treatment planning of STS. Unfortunately, peri-tumoral edema in soft STS can extend up to 4 cm from the T2 gross tumor. This is the reason why the current radiation therapy oncology group (RTOG) consensus a volume that exceeds MRI defined tumor dimension by 3.5 cm longitudinally and 1.5 cm radially. Additional T1-weighted contrast enhanced suspicious edemas are usually added to the expansion that can be further problematic given the extensive T1 abnormalities associated with many of these lesions and extra cost of T1-weighted dynamic study. In some cases, high dose radiation can be difficult in the management of STS because the morbidity would be unacceptable or nearby critical organs make extended radiation impossible. Thus, it becomes clear why the morbidity associated with STS is so prohibitive. Our proposal tackles this very important question. Instead of standard anatomical based MRI delineation, metabolic oncologic imaging with FDG-PET or MRS has been shown to higher sensitivity and specificity. By using the strengths of combined PET and MRI/MRS, we propose to define a more accurate delineation of suspicious peri-tumoral edema for preoperative radiation therapy Clinical Target Volume (CTV). If successful, the impact of our work will be substantial as it would reduce the CTV of radiation therapy, and the associated morbidity, without compromising the treatment efficacy and while allowing greater specificity is assessing response to treatment that can be achieved with PET or MRS alone.

抽象的 放射治疗在高危患者的局部区域管理中发挥着关键作用。 等级STS。目前，T2 加权磁共振成像 (MR) 是 STS 治疗计划的选择。不幸的是，软 STS 中的瘤周水肿可以 从 T2 肉眼肿瘤延伸至 4 厘米。这就是目前辐射的原因 肿瘤治疗组 (RTOG) 共识体积超过 MRI 定义的肿瘤 尺寸纵向 3.5 厘米，径向 1.5 厘米。附加 T1 加权对比度 增强的可疑水肿通常会增加到可以进一步扩大的范围 考虑到与许多这些病变相关的广泛 T1 异常，这是有问题的 T1 加权动态研究的额外费用。在某些情况下，高剂量辐射可能很困难 在 STS 的管理中，因为发病率是不可接受的或接近危急的 器官使长时间的辐射成为不可能。至此，发病原因就清楚了 与 STS 相关的情况是如此令人望而却步。我们的提案解决了这个非常重要的问题。 代谢肿瘤成像代替基于标准解剖学的 MRI 描绘 FDG-PET 或 MRS 已被证明具有更高的敏感性和特异性。通过使用 结合 PET 和 MRI/MRS 的优势，我们建议定义更准确的轮廓 术前放射治疗中可疑瘤周水肿的临床靶区 （央视）。如果成功的话，我们的工作的影响将是巨大的，因为它将减少 放射治疗以及相关的发病率，而不影响治疗效果 在允许更大特异性的同时，评估对治疗的反应，可以 单独使用 PET 或 MRS 即可实现。