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Haag F, Hertel A, Tharmaseelan H, Kuru M, Haselmann V, Brochhausen C, Schönberg SO, Froelich MF. Imaging-based characterization of tumoral heterogeneity for personalized cancer treatment. ROFO-FORTSCHR RONTG 2024; 196:262-272. [PMID: 37944935 DOI: 10.1055/a-2175-4622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
With personalized tumor therapy, understanding and addressing the heterogeneity of malignant tumors is becoming increasingly important. Heterogeneity can be found within one lesion (intralesional) and between several tumor lesions emerging from one primary tumor (interlesional). The heterogeneous tumor cells may show a different response to treatment due to their biology, which in turn influences the outcome of the affected patients and the choice of therapeutic agents. Therefore, both intra- and interlesional heterogeneity should be addressed at the diagnostic stage. While genetic and biological heterogeneity are important parameters in molecular tumor characterization and in histopathology, they are not yet addressed routinely in medical imaging. This article summarizes the recently established markers for tumor heterogeneity in imaging as well as heterogeneous/mixed response to therapy. Furthermore, a look at emerging markers is given. The ultimate goal of this overview is to provide comprehensive understanding of tumor heterogeneity and its implications for radiology and for communication with interdisciplinary teams in oncology. KEY POINTS:: · Tumor heterogeneity can be described within one lesion (intralesional) or between several lesions (interlesional).. · The heterogeneous biology of tumor cells can lead to a mixed therapeutic response and should be addressed in diagnostics and the therapeutic regime.. · Quantitative image diagnostics can be enhanced using AI, improved histopathological methods, and liquid profiling in the future..
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Affiliation(s)
- Florian Haag
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Centre Mannheim, Germany
| | - Alexander Hertel
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Centre Mannheim, Germany
| | - Hishan Tharmaseelan
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Centre Mannheim, Germany
| | - Mustafa Kuru
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Centre Mannheim, Germany
| | - Verena Haselmann
- Institute of Clinical Chemistry, Medical Faculty Mannheim of the University of Heidelberg, University Hospital Mannheim, Germany
| | - Christoph Brochhausen
- Institute of Pathology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefan O Schönberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Centre Mannheim, Germany
| | - Matthias F Froelich
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Centre Mannheim, Germany
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Zhang H, Mu M, He X, Yin Y. Surgical treatment of the metastatic gastrointestinal stromal tumor after resistance to available tyrosine kinase inhibitors: A case report. Asian J Surg 2023; 46:937-938. [PMID: 35963693 DOI: 10.1016/j.asjsur.2022.07.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 07/15/2022] [Indexed: 02/08/2023] Open
Affiliation(s)
- Haidong Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Mingchun Mu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xin He
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yuan Yin
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Radiotherapy in the Management of Gastrointestinal Stromal Tumors: A Systematic Review. Cancers (Basel) 2022; 14:cancers14133169. [PMID: 35804945 PMCID: PMC9265110 DOI: 10.3390/cancers14133169] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/25/2022] [Accepted: 06/26/2022] [Indexed: 01/27/2023] Open
Abstract
Simple Summary Gastrointestinal stromal tumors are considered to be insensitive to radiotherapy. However, with the development of radiation techniques and the accumulation of cases, some studies have indicated that radiotherapy could help achieve objective response in advanced or metastatic gastrointestinal stromal tumors. Therefore, it is necessary to conduct a systematic review to reassess the role of radiotherapy in gastrointestinal stromal tumors. The purpose of this study was to draw the attention of scholars and clinicians to radiotherapy and promote further research on radiotherapy in gastrointestinal stromal tumors. Abstract Gastrointestinal stromal tumors (GISTs) are considered insensitive to radiotherapy. However, a growing number of case reports and case series have shown that some lesions treated by radiotherapy achieved an objective response. The aim of the study was to perform a systematic review of all reported cases, case series, and clinical studies of GISTs treated with radiotherapy to reevaluate the role of radiotherapy in GISTs. A systematic search of the English-written literature was conducted using PubMed, Web of Science, and Embase databases. Overall, 41 articles describing 112 patients were retrieved. The included articles were of low to moderate quality. Bone was the most common site treated by radiotherapy, followed by the abdomen. In order to exclude the influence of effective tyrosine kinase inhibitors (TKIs), a subgroup analysis was conducted on whether and which TKIs were concurrently applied with radiotherapy. Results showed that radiotherapy alone or combined with resistant TKIs could help achieve objective response in selected patients with advanced or metastatic GISTs; however, survival benefits were not observed in the included studies. Pain was the most common symptom in symptomatic GISTs, followed by neurological dysfunction and bleeding. The symptom palliation rate was 78.6% after excluding the influence of effective TKIs. The adverse reactions were mainly graded 1–2. Radiotherapy was generally well-tolerated. Overall, radiotherapy may relieve symptoms for GIST patients with advanced or metastatic lesions and even help achieve objective response in selected patients without significantly reducing the quality of life. In addition to bone metastases, fixed abdominal lesions may be treated by radiotherapy. Publication bias and insufficient quality of included studies were the main limitations in this review. Further clinical studies are needed and justified.
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Walter F, Rottler M, Nierer L, Landry G, Well J, Rogowski P, Mohnike K, Seidensticker M, Ricke J, Belka C, Corradini S. Interstitial High-Dose-Rate Brachytherapy of Liver Metastases in Oligometastatic Patients. Cancers (Basel) 2021; 13:cancers13246250. [PMID: 34944869 PMCID: PMC8699459 DOI: 10.3390/cancers13246250] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/10/2021] [Indexed: 12/22/2022] Open
Abstract
Simple Summary Local ablative treatments have emerged as a promising treatment strategy for patients with oligometastatic disease. Interstitial brachytherapy (iBT) is one of the locally ablative treatment options for unresectable liver metastases in oligometastatic disease. We report the feasibility and oncologic outcome of 141 iBT treatments of 244 oligometastatic liver metastases performed in patients with limited tumor burdens in a high-volume center. iBT was feasible, safe and effective in the treatment of oligometastatic liver metastases with good local control rates and low toxicity. Histology and total tumor volume had an impact on local control rates. Abstract Local ablative treatments have emerged as a promising treatment strategy for patients with oligometastatic disease. Among others, interstitial brachytherapy (iBT) is an upcoming treatment option for unresectable liver metastases. We report the feasibility and oncologic outcome of iBT of oligometastatic liver metastases performed in patients with limited tumor burdens in a high-volume center. Patients undergoing iBT between August 2017and March 2019 were included. A retrospective analysis of patient outcomes and treatment complications was performed. Patients treated for metastatic colorectal carcinoma (CRC) were compared to other histologies. A total of 141 iBT procedures were performed in 106 patients (male:52; female:54) and 244 liver metastases. Overall, 51% (54/106) of patients had a diagnosis of metastatic CRC. The median follow-up was 9 months, and overall survival (OS) was 92.3% at 6 months and 76.3% at 12 months. Local-relapse-free survival (LRFS) was 88.4% at 6 months and 71.5% at 12 months, with a significant difference between patients with CRC (84.1% and 50.6%) versus other histologies (92.4% and 92.4%, p < 0.001). A sub-group analysis showed a significant advantage in patients with CRC receiving a minimal dose (D100) of 20 Gy to the planning target volume. Treatments of smaller total liver-tumor volumes (<18 ccm) resulted in better LRFS rates. iBT is a safe and effective treatment approach for oligometastatic liver disease. A higher treatment dose is needed for patients with CRC. Moreover, lower metastatic burdens may be favorable for LRFS. Prospective studies are needed to assess the role of iBT in the oligometastatic setting as an alternative to other local ablative treatment approaches in patients with liver metastases.
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Affiliation(s)
- Franziska Walter
- Department of Radiation Oncology, University Hospital, Ludwig Maximilian University, 81377 Munich, Germany; (F.W.); (M.R.); (L.N.); (G.L.); (J.W.); (P.R.); (C.B.)
| | - Maya Rottler
- Department of Radiation Oncology, University Hospital, Ludwig Maximilian University, 81377 Munich, Germany; (F.W.); (M.R.); (L.N.); (G.L.); (J.W.); (P.R.); (C.B.)
| | - Lukas Nierer
- Department of Radiation Oncology, University Hospital, Ludwig Maximilian University, 81377 Munich, Germany; (F.W.); (M.R.); (L.N.); (G.L.); (J.W.); (P.R.); (C.B.)
| | - Guillaume Landry
- Department of Radiation Oncology, University Hospital, Ludwig Maximilian University, 81377 Munich, Germany; (F.W.); (M.R.); (L.N.); (G.L.); (J.W.); (P.R.); (C.B.)
| | - Justus Well
- Department of Radiation Oncology, University Hospital, Ludwig Maximilian University, 81377 Munich, Germany; (F.W.); (M.R.); (L.N.); (G.L.); (J.W.); (P.R.); (C.B.)
| | - Paul Rogowski
- Department of Radiation Oncology, University Hospital, Ludwig Maximilian University, 81377 Munich, Germany; (F.W.); (M.R.); (L.N.); (G.L.); (J.W.); (P.R.); (C.B.)
| | - Konrad Mohnike
- Diagnostisch Therapeutisches Zentrum (DTZ), 10243 Berlin, Germany;
| | - Max Seidensticker
- Department of Radiology, University Hospital, Ludwig Maximilian University, 81377 Munich, Germany; (M.S.); (J.R.)
| | - Jens Ricke
- Department of Radiology, University Hospital, Ludwig Maximilian University, 81377 Munich, Germany; (M.S.); (J.R.)
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, Ludwig Maximilian University, 81377 Munich, Germany; (F.W.); (M.R.); (L.N.); (G.L.); (J.W.); (P.R.); (C.B.)
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, Ludwig Maximilian University, 81377 Munich, Germany; (F.W.); (M.R.); (L.N.); (G.L.); (J.W.); (P.R.); (C.B.)
- Correspondence:
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