MR Dynamic Imaging and Spectroscopy in Head & Neck Cancers

描述(申请人提供)：该项目旨在评估1H-MR波谱(MRS)和动态增强MRI(DCE-MRI)在头颈部鳞状细胞癌(HNSCC)治疗中的预后价值。HNSCC是世界上第五大最常见的恶性肿瘤，每年在美国影响超过29,370人。尽管积极的手术和放射治疗(XRT)可能导致主要功能丧失，但在过去的30年里，HNSCC患者的存活率相对保持不变。为了提高存活率，化疗已被纳入新诊断病例的初始非手术治疗。不幸的是，没有早期或先验的标记物可以预测治疗失败/应答。肿瘤微环境对恶性肿瘤的进展和治疗耐药起着至关重要的作用。已被证明与治疗结果相关的微环境参数包括肿瘤细胞缺氧和增殖。提示治疗前1H-MRS和DCE-MRI检测乳酸的变化可以预测肿瘤的缺氧和预后。我们建议评估1H-MRS和DCE-MRI的价值，为更好地选择患者提供工具。我们的假设是，光谱变化和/或DCE-MRI变化在化疗-XRT之前或过程早期可以预测接受化疗-XRT或手术治疗的患者的治疗反应和/或长期无病生存。本项目的目标是：1.评估先验或早期1H-MRS(胆碱和乳酸)和DCE-MRI(Akep和KTrans)改变可以可靠地在肿瘤明显消退和/或长期无病生存之前预测化疗临床疗效的假设。2.确定先验~1H-MRS和DCE-MRI改变是否与18F-MISO正电子发射断层扫描(18F-MISO PET)检查相关。3.确定先验1H-MRS和DCE-MRI的变化是否与所选的增殖、缺氧分子标志物和基因芯片分析有关。4.确定与潜在的分子和临床预测指标相比，1H-MRS和DCE-MRI结果是否是肿瘤反应和/或长期无病生存的更好和独立的标记。如果成功，它将提供化疗失败/反应和/或长期无病生存的先验预测因素，导致针对患者的治疗，这可能会改善结果。

DESCRIPTION (provided by applicant): This project is designed to evaluate the prognostic utility of 1H- MR Spectroscopy (MRS) and Dynamic Contrast Enhanced MRI (DCE-MRI) in the management of squamous cell carcinoma of the head and neck (HNSCC). HNSCC is the fifth most common malignancy worldwide and affects more than 29,370 persons in the United States annually. Despite agressive surgery and radiation therapy (XRT), which may result in major functional loss, the survival rate of patients with HNSCC has remained relatively unchanged over the past 3 decades. In an effort to improve survival, chemotherapy has been incorporated in the initial non- surgical management of newly diagnosed cases. Unfortunately, there are no early or a priori markers that are predictive of treatment failure/response. The tumor microenvironment plays a critical role in malignant tumor progression and treatment resistance. Microenvironment parameters that have shown to be relevant for treatment outcome include tumor cell hypoxia and proliferation. It has been suggested that pretreatment lactate detection by 1H-MRS and DCE-MRI changes are predictive of tumor hypoxia and outcome. We propose to asssess the value of 1H-MRS and DCE-MRI for providing tools for better selection of patients. Our hypothesis is that spectroscopic changes and/or DCE-MRI changes prior to, or early in the course of chemotherapy-XRT can predict response to treatment and/or long term disease-free survival in patients treated with chemotherapy-XRT or surgery. The goals of this project are to 1. Evaluate the hypothesis that a priori or early 1 H- MRS (choline and lactate) and DCE-MRI (Akep and Ktrans) changes can reliably predict chemotherapy clinical response before apparent tumor regression and/or long term disease-free survival. 2. Determine whether the a priori 1 H-MRS and DCE-MRI changes correlate with 18F-MISO PET (18Fluoro - misonidazole Positron Emission Tomography) studies. 3. Determine whether the a priori 1 H-MRS and DCE-MRI changes correlate with selected proliferative, hypoxia molecular markers and gene array analysis. 4. Determine if the 1 H-MRS and DCE-MRI results are superior and independent markers of tumor response and/or long term disease-free survival compared to potential molecular and clinical prognosticators. If successful, it will provide an a priori predictor of failure/response to chemotherapy and/or long term disease free-survival, resulting in patient specific treatment which will likely enhance outcome.