Previous studies have shown that metabolic information provided by 3D Magnetic Resonance Spectroscopy Imaging (MRSI) could affect the definition of target volumes for radiation treatments (RT). This study aimed to (i) investigate the effect of incorporating spectroscopic volumes as determined by MRSI on target volume definition, patient selection eligibility, and dose prescription for stereotactic radiosurgery treatment planning; (ii) correlate the spatial extent of pre-SRS spectroscopic abnormality and treatment volumes with areas of focal recurrence as defined by changes in contrast enhancement; and (iii) examine the metabolic changes following SRS to assess treatment response. Twenty-six patients treated with Gamma Knife radiosurgery for recurrent glioblastoma multiforme (GBM) were retrospectively evaluated. All patients underwent both MRI and MRSI studies prior to SRS. Follow-up MRI exams were available for all 26 patients, with MRI/MRSI available in only 15/26 patients. We observed that the initial CNI 2 contours extended beyond the pre-SRS CE in 25/26 patients ranging in volume from 0.8 cc to 18.8 cc (median 5.6 cc). The inclusion of the volume of CNI 2 extending beyond the CE would have increased the SRS target volume by 5-165% (median 23.4%). This would have necessitated decreasing the SRS prescription dose in 19/26 patients to avoid increased toxicity; the resultant treatment volume would have exceeded 20cc in five patients, thus possibly excluding those from RS treatment per our institutional practice. MRSI follow-up studies showed a decrease in Choline, stable Creatine, and increased NAA indicative of response to SRS in the majority of patients. When combined with patient survival data, metabolic information obtained during follow-up MRSI studies seemed to indicate the potential to help to distinguish necrosis from new/recurrent tumor; however, this should be further verified by biopsy studies.
"MRI and MRSI are often combined in clinical oncology diagnostics because 1H MRSI is easily compatible with currently available MRI scanners in clinics132-134. 1H MRSI has a high sensitivity and could be applied on a number of tracers120. During the past few years, MRSI has made significant advances and rapidly become a reliable imaging modality. "
[Show abstract][Hide abstract] ABSTRACT: Cancer cells are well documented to rewire their metabolism and energy production networks to support and enable rapid proliferation, continuous growth, survival in harsh conditions, invasion, metastasis, and resistance to cancer treatments. Since Dr. Otto Warburg's discovery about altered cancer cell metabolism in 1930, thousands of studies have shed light on various aspects of cancer metabolism with a common goal to find new ways for effectively eliminating tumor cells by targeting their energy metabolism. This review highlights the importance of the main features of cancer metabolism, summarizes recent remarkable advances in this field, and points out the potentials to translate these scientific findings into life-saving diagnosis and therapies to help cancer patients.
Cancer Biology and Medicine 03/2014; 11(1):1-19. DOI:10.7497/j.issn.2095-3941.2014.01.001
[Show abstract][Hide abstract] ABSTRACT: Une incidence inférieure à 3/100 000 sujets par an définit mieux les cancers rares qu’une notion de prévalence. Des cancers
très variés répondent à cette définition: cancers intrinsèquement rares (sarcomes conjonctifs, tumeurs primitives du tronc
cérébral, cancers des glandes endocrines, des voies biliaires, tumeurs neuroendocrines); sous-entités de cancers fréquents
(adénocarcinomes mammaires de l’homme, cancers non épithéliaux de l’ovaire, carcinomes apocrines, lymphomes du MALT...); formes
à déterminisme génétique de cancers plus ou moins fréquents; cancers survenant sur des terrains particuliers, comme les cancers
de la femme enceinte et les cancers des sujets porteurs de transplantation d’organe. Quoique très différents les uns des autres,
ils relèvent de problématiques communes: 1) limitation des possibilités d’études précliniques: préservation de tissu tumoral
et normal; rareté des modèles précliniques; investissement limité de la pharmacologie préclinique; 2) nombre limité de centres
«experts» en Europe — souvent moins d’une dizaine — et importance des réseaux nationaux et européens; 3) difficulté des essais
cliniques et thérapeutiques. Certains soutiens apparaissent indispensables pour renforcer la recherche sur ces cancers et
améliorer leur prise en charge (constitution et maintien des bases de données les concernant, centres de ressources biologiques
«virtuels», harmonisation des pratiques diagnostiques, notamment en anatomopathologie et en imagerie, soutien aux essais thérapeutiques
dont la promotion ne peut être qu’académique). L’existence à l’APHP d’une vingtaine de centres et réseaux d’expertise intéressant
pratiquement tous les cancers rares permet la mise en œuvre et l’évaluation de ce soutien méthodologique et logistique.
Rare cancers are better defined by their incidence (< 3/100 000 per year) than by their prevalence. Rare cancers include various
types of cancer: intrinsically rare cancers (sarcomas, primary CNS tumours, cancers of the endocrine system, and cancers of
the biliary tract); sub-entities of frequent cancers (male breast cancer, non epithelial ovarian cancers, apocrine carcinomas,
MALT lymphomas); genetically determined cancers; and cancers occurring during pregnancy or in organ transplant recipients.
Although widely different, these cancers raise common questions and problems: 1) the limitation of preclinical studies in
relation with insufficient preserved tumour samples, the rarity of preclinical models, and the poor interest for preclinical
pharmacology; 2) the limited number of comprehensive “expert” centres (less than 10–15 in Europe), emphasizing the role of
networks; 3) the difficulties in conducting clinical and therapeutic studies due to the small number of concerned patients
and methods available to run studies in rare populations. Effective support appears necessary to improve both research on
these rare cancers and their management (constitution and maintenance of databases on this topic, constitution of virtual
tumour banks, harmonization of the diagnostic procedures, especially regarding pathology and imaging, and “academic” support
for clinical studies. Paris University Hospitals include more than 20 comprehensive centres dedicated to almost all rare cancers;
these centres are useful for the implementation and evaluation of such methodological and logistic support.
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