Whole-Tumor Perfusion CT in Patients with Advanced Lung Adenocarcinoma Treated with Conventional and Antiangiogenetic Chemotherapy: Initial Experience

Fraioli, Francesco; Anzidei, Michele; Zaccagna, Fulvio; Mennini, Maria Luisa; Serra, Goffredo; Gori, Bruno; Longo, Flavia; Catalano, Carlo; Passariello, Roberto

doi:10.1148/radiol.11100600

Cited by 76 publications

(78 citation statements)

References 25 publications

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“…Among other imaging modalities, CT perfusion (CT-p) recently experienced a progressive increase in interest and acceptance in the radiological community for oncological applications [9][10][11][12][13], including both the diagnostic process and follow-up of lung cancer [14][15][16]. Substantial differences between treatment response to conventional and anti-angiogenic drugs assessed by RECIST criteria and CT-p in patients with lung adenocarcinoma have been evidenced [17].…”

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confidence: 99%

Whole-tumour CT-perfusion of unresectable lung cancer for the monitoring of anti-angiogenetic chemotherapy effects

Fraioli

Anzidei

Serra

et al. 2013

BJR

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Objective: To determine whether CT-perfusion (CT-p) can be used to evaluate the effects of chemotherapy and anti-angiogenic treatment in patients with non-small-cell lung carcinoma (NSCLC) and whether CT-p and standard therapeutic response assessment (RECIST) data obtained before and after therapy correlate. Methods: 55 patients with unresectable NSCLC underwent CT-p before the beginning of therapy and 50 of them repeated CT-p 90 days after it. Therapeutic protocol included platinum-based doublets plus bevacizumab for non-squamous carcinoma and platinum-based doublets for squamous carcinoma. RECIST measurements and calculations of blood flow (BF), blood volume (BV), time to peak (TTP) and permeability surface (PS) were performed, and baseline and post-treatment measurements were tested for statistically significant differences. Baseline and follow-up perfusion parameters were also compared based on histopathological subclassification (2004 World Health Organization Classification of Tumours) and therapy response assessed by RECIST. Results: Tumour histology was consistent with large cell carcinoma in 14/50 (28%) cases, adenocarcinoma in 22/50 (44%) cases and squamous cell carcinoma in the remaining 14/50 (28%) cases. BF and PS differences for all tumours between baseline and post-therapy measurements were significant (p50.001); no significant changes were found for BV (p50.3) and TTP (p50.1). The highest increase of BV was demonstrated in adenocarcinoma (5.2634.1%), whereas the highest increase of TTP was shown in large cell carcinoma (6.9622.4%), and the highest decrease of PS was shown in squamous cell carcinoma (221.5618.5%). A significant difference between the three histological subtypes was demonstrated only for BV (p,0.007). On the basis of RECIST criteria, 8 (16%) patients were classified as partial response (PR), 2 (4%) as progressive disease (PD) and the remaining 40 (80%) as stable disease (SD). Among PR, a decrease of both BF (1869.6%) and BV (12.669.2%) were observed; TTP increased in 3 (37.5%) cases, and PS decreased in 6 (75%) cases. SD patients showed an increase of BF, BV, TTP and PS in 6

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mentioning

confidence: 99%

Whole-tumour CT-perfusion of unresectable lung cancer for the monitoring of anti-angiogenetic chemotherapy effects

Fraioli

Anzidei

Serra

et al. 2013

BJR

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“…7,8 The traditional monitoring of therapeutic effects, being based on morphological criteria on computed tomography (CT), may lead to a misinterpretation of antiangiogenic effects. 9,10 Hence, the evolving therapeutic field of vascular-modulating drugs requires new noninvasive methods for assessing tumor vascularity in vivo. [11][12][13][14][15] In 1967, Milne 16 showed that lung tumors may have a dual blood supply by the pulmonary and the aortic system, with a trend toward histological type-specific circulatory pattern.…”

Section: Results: According To Biopsy 37 Patients Had Nsclc (22 Adenmentioning

confidence: 99%

Assessment of Bronchial and Pulmonary Blood Supply in Non-Small Cell Lung Cancer Subtypes Using Computed Tomography Perfusion

Nguyen-Kim¹,

Frauenfelder²,

Strobel³

et al. 2015

Investigative Radiology

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OBJECTIVES: The aim of this study was to investigate the dual blood supply of non-small cell lung cancer (NSCLC) and its association with tumor subtype, size, and stage, using computed tomography perfusion (CTP). MATERIALS AND METHODS: A total of 54 patients (median age, 65 years; range, 42-79 years; 15 women, 39 men) with suspected lung cancer underwent a CTP scan of the lung tumor. Pulmonary and bronchial vasculature regions of interest were used to calculate independently CTP parameters (blood flow [BF], blood volume [BV], and mean transit time [MTT]) of the tumor tissue. The mean and maximum pulmonary and bronchial perfusion indexes (PImean and PImax) were calculated. The tumoral volume and the largest tumoral diameter were assessed. Differences in CTP parameters and indexes among NSCLC subtypes, tumor stages and tumor dimensions were analyzed using non-parametric tests. RESULTS: According to biopsy, 37 patients had NSCLC (22 adenocarcinomas [ACs], 8 squamous cell carcinomas [SCCs], 7 large-cell carcinomas [LCC]). The mean bronchial BF/pulmonary BF, bronchial BV/pulmonary BV, and bronchial MTT/pulmonary MTT was 41.2 ± 30.0/36.9 ± 24.2 mL/100 mL/min, 11.4 ± 9.7/10.4 ± 9.4 mL/100 mL, and 11.4 ± 4.3/14.9 ± 4.4 seconds, respectively. In general, higher bronchial BF than pulmonary BF was observed in NSCLC (P = 0.014). Using a tumoral volume cutoff of 3.5 cm, a significant difference in pulmonary PImax was found (P = 0.028). There was a significantly higher mean pulmonary BF in LCCs and SCCs compared with ACs (P = 0.018 and P = 0.044, respectively), whereas the mean bronchial BF was only significantly higher in LCCs compared with ACs (P = 0.024). Correspondingly, the PImax was significantly higher in LCCs and SCCs than in ACs (P = 0.001 for both). Differences between bronchial and pulmonary PImean and PImax among T stages and Union Internationale Contre le Cancer stages were not statistically significant (P values ranging from 0.691 to 0.753). CONCLUSIONS: The known dual blood supply of NSCLC, which depends on tumor size and histological subtype, is reflected in CTP parameters, with parameters depending both on tumor size and histological subtype. This has to be accounted for when analyzing NSCLC with CTP.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/3.0.

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“…Fraioli et al (56) demonstrated that perfusion CT performed shortly after the initiation of a combined therapy with antiangiogenic drugs may be more helpful for therapeutic planning than the conventional size assessment obtained with RECIST. In some cases, perfusion CT may show a change in tumor perfusion after treatment before observing any significant variations in tumor size (56). Future studies are needed to clarify the utility of CT perfusion as a tool for both prognosis assessment and the evaluation of new drug combinations.…”

Section: Ct Response Assessment After Molecular Targeted Therapymentioning

confidence: 99%

Non-small cell lung cancer after surgery and chemoradiotherapy: follow-up and response assessment

Colombi¹,

Lauro²,

Silva³

et al. 2013

Diagn Interv Radiol

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The imaging techniques in patients treated for lung cancer may be challenging to interpret. Radiologists are often asked to evaluate computed tomography (CT) scans after surgery, and this interpretation requires an understanding of both the timing and type of the surgical procedure. However, follow-up strategies are still not well defined. The assessment of tumor response to chemoradiotherapy relies on a tight integration of CT and clinical findings. Positron emission tomography-computed tomography (PET-CT) with fluorodeoxyglucose may help to exclude tumor recurrence when the sole CT scan is equivocal. More efforts are needed to validate the tools for volumetric tumor measurement in routine practice and to demonstrate their superiority compared to the Response Evaluation Criteria in Solid Tumors (RECIST). Familiarity with the assessment of lung cancer perfusion is also important because of the increasing use of cytostatic therapy. In this review, we outlined the imaging assessment of tumor recurrence after surgery and the role of CT, magnetic resonance imaging, and PET-CT in the follow-up after chemotherapy, radiotherapy, and radiofrequency ablation.

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Whole-Tumor Perfusion CT in Patients with Advanced Lung Adenocarcinoma Treated with Conventional and Antiangiogenetic Chemotherapy: Initial Experience

Abstract: Perfusion CT imaging may allow evaluation of lung cancer angiogenesis demonstrating alterations in vascularity following treatment.

Cited by 76 publications

References 25 publications

Whole-tumour CT-perfusion of unresectable lung cancer for the monitoring of anti-angiogenetic chemotherapy effects

Whole-tumour CT-perfusion of unresectable lung cancer for the monitoring of anti-angiogenetic chemotherapy effects

Assessment of Bronchial and Pulmonary Blood Supply in Non-Small Cell Lung Cancer Subtypes Using Computed Tomography Perfusion

Non-small cell lung cancer after surgery and chemoradiotherapy: follow-up and response assessment

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