Blood Flow Change Quantification in Cervical Cancer before and during Radiation Therapy Using Perfusion CT

Shibuya, Kazuhiko; Tsushima, Yoshito; Horisoko, Eri; Noda, Shin‐ei; Taketomi-Takahashi, Ayako; Ohno, Tatsuya; Amaki, Makoto; Endo, Keigo; Nakano, Takashi

doi:10.1269/jrr.11079

Cited by 19 publications

(14 citation statements)

References 22 publications

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“…They observed increased perfusion after 2 weeks of treatment after which a decline in perfusion was observed. A comparable finding was reported by Shibuya et al [50] using perfusion CT. Improved tumor perfusion following fractionated irradiation was also reported in other tumor types, including in non-locally advanced rectal tumors (5 × 5 Gy) [51], and inoperable non-small cell lung tumors (6 × 4.5 Gy) [52].…”

Section: The Rationale Behind Combining Angiostatic Drugs With Radiotsupporting

confidence: 91%

The clinical application of angiostatic therapy in combination with radiotherapy: past, present, future

et al. 2017

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Although monotherapy with angiostatic drugs is still far from effective, there is abundant evidence that angiostatic therapy can improve the efficacy of conventional treatments like radiotherapy. This has instigated numerous efforts to optimize and clinically implement the combination of angiostatic drugs with radiation treatment. The results from past and present clinical trials that explored this combination therapy indeed show encouraging results. However, current findings also show that the combination has variable efficacy and is associated with increased toxicity. This indicates that combining radiotherapy with angiostatic drugs not only holds opportunities but also provides several challenges. In the current review, we provide an update of the most recent insights from clinical trials that evaluated the combination of angiostatic drugs with radiation treatment. In addition, we discuss the outstanding questions for future studies in order to improve the clinical benefit of combining angiostatic therapy with radiation therapy.

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Section: The Rationale Behind Combining Angiostatic Drugs With Radiotsupporting

confidence: 91%

The clinical application of angiostatic therapy in combination with radiotherapy: past, present, future

et al. 2017

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“…The effect of radiotherapy on perfusion is controversial, and an increase, no effect, and a decrease in perfusion parameters after radiotherapy have all been reported. Timing of the measurement might be an important confounding factor, as inflammation and contrast leakage might be seen early after treatment.…”

Section: Application In Perfusion‐related Clinical Situationsmentioning

confidence: 99%

Intravoxel incoherent motion MRI as a means to measure in vivo perfusion: A review of the evidence

Federau

2017

NMR in Biomedicine

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The idea that in vivo intravoxel incoherent motion magnetic resonance signal is influenced by blood motion in the microvasculature is exciting, because it suggests that local and quantitative perfusion information can be obtained in a simple and elegant way from a few diffusion-weighted images, without contrast injection. When the method was proposed in the late 1980s some doubts appeared as to its feasibility, and, probably because the signal to noise and image quality at the time was not sufficient, no obvious experimental evidence could be produced to alleviate them. Helped by the tremendous improvements seen in the last three decades in MR hardware, pulse design, and post-processing capabilities, an increasing number of encouraging reports on the value of intravoxel incoherent motion perfusion imaging have emerged. The aim of this article is to review the current published evidence on the feasibility of in vivo perfusion imaging with intravoxel incoherent motion MRI.

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“…We also observed significant increase in the average midtreatment mean BV and permeability values compared to pretreatment baseline values, a result that to our knowledge has not been previously reported. Even though there was a trend toward mean BF increase it was not significant, in contrast to a result reported by Shibuya et al 16. This discrepancy may be attributable to the fact that Shibuya et al did not use volumetric perfusion scans for their longitudinal study and thus their results were prone to the systematic sampling errors discussed above.…”

Section: Discussionmentioning

confidence: 56%

“…Previous studies investigating perfusion CT in cervical cancer chemoradiotherapy used cine scanning with a fixed table position, which limited perfusion imaging to only a few slices covering 8‐20 mm of the tumor volume in axial direction 11, 12, 16. In contrast, using the recently introduced Adaptive 4D Volume Perfusion CT (Siemens, Erlangen, Germany) which employs continuous shuttling table motion, we could assess perfusion parameters throughout the tumor region.…”

Section: Discussionmentioning

confidence: 99%

Pilot study of combined FDG‐PET and dynamic contrast‐enhanced CT of locally advanced cervical carcinoma before and during concurrent chemoradiotherapy suggests association between changes in tumor blood volume and treatment response

et al. 2018

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Modern PET/CT radiotherapy simulators offer FDG‐PET and dynamic contrast‐enhanced (DCE) CT imaging for combined volumetric assessment of tumor metabolism and perfusion. However, the clinical utility of such assessment has not been clearly defined. Thus, in a prospective longitudinal study of primary cervical tumors treated with concurrent chemoradiotherapy (CCRT) we evaluated: (1) whether PET and perfusion parameters correlate or provide complementary information; (2) what imaging changes occur during CCRT; and (3) whether any parameters are predictive of treatment response as assessed by PET/CT 3 months posttherapy. FDG‐PET/CT and DCE‐CT scans were performed on 21 patients prior to and during CCRT. Coregistered volumetric parametric maps of standardized uptake value (SUV) measures and perfusion parameters blood flow (BF), blood volume (BV), and permeability were generated. Summary statistics for these parameters and their changes were calculated within the metabolic tumor volume (MTV). Correlations between SUV and BF/BV/permeability on local and global bases were assessed with Pearson's coefficient r. MTV, maximum SUV, and mean SUV decreased significantly between the pre‐ and during‐treatment time points, while mean BV and permeability increased significantly. Global correlations between mean BF/BV/permeability and mean SUV values (−.15 < r < .29) were at most moderate. An increase in mean tumor BV during treatment was significantly correlated with complete metabolic response on 3‐month posttreatment PET/CT. Weak correlations of SUV and perfusion parameters suggest a complementary role of FDG‐PET and DCE‐CT for tumor characterization. The association between relative change in mean BV and outcome suggests a potential role for DCE‐CT in early evaluation of cervical tumor response to chemoradiotherapy.

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Blood Flow Change Quantification in Cervical Cancer before and during Radiation Therapy Using Perfusion CT

Cited by 19 publications

References 22 publications

The clinical application of angiostatic therapy in combination with radiotherapy: past, present, future

The clinical application of angiostatic therapy in combination with radiotherapy: past, present, future

Intravoxel incoherent motion MRI as a means to measure in vivo perfusion: A review of the evidence

Pilot study of combined FDG‐PET and dynamic contrast‐enhanced CT of locally advanced cervical carcinoma before and during concurrent chemoradiotherapy suggests association between changes in tumor blood volume and treatment response

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