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Chopra S, Bosse T, Horeweg N, Deodhar K, Menon S, Rafael T, Pai V, Rijstenberg L, van Kemenade F, Kannan S, Mahantshetty U, Segedin B, Huang F, Bruheim K, Perez M, Rai B, Tan LT, Giannakopoulus N, Schmid M, Tanderup K, Pötter R, Nout R. Biomarker expression and impact on clinical outcomes in an international study of chemoradiation and MRI-based image-guided brachytherapy for locally advanced cervical cancer: BIOEMBRACE. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)03141-9. [PMID: 39067486 DOI: 10.1016/j.ijrobp.2024.07.2316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/01/2024] [Accepted: 07/13/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE BIOEMBRACE-I was designed to study the impact of biomarkers in addition to clinic-pathological factors on disease outcomes in patients treated with chemoradiation and MRI-guided brachytherapy (BT) for locally advanced cervical cancer in EMBRACE study. PATIENT AND METHODS Between 2018-2021, eight EMBRACE-I sites contributed tumour tissue for immunohistochemistry of p16, PD-L1 and L1CAM. These biomarkers and clinicopathological factors (FIGO 2009 stage, nodal status, histology, necrosis on MRI) were analysed to predict poor response at brachytherapy (BT) (high-risk clinical target volume [HR-CTV] ≥40cc) at BT), and 5-year local control, pelvic control and disease-free survival (DFS). Interaction between p16, PD-L1, radiotherapy dose (HR-CTV D90) and disease outcomes was investigated. Univariable and multivariable analysis were performed. RESULTS Two-hundred sixty-four patients were included. The median HR-CTV D90 was 89 (86-95) Gy. p16 positive (pos), PD-L1>1% and L1CAM ≥ 10% was noted in 86.6%, 20.1% and 17.8% respectively. P16 negative (neg) status (OR 2.0 (1.0-5.7), p=0.04), necrosis on MRI (OR 2.1 (1.1-4.3), p<0.02) independently predicted for HR-CTV≥40cc, as did FIGO stage and tumour width >5cm. PDL1>1% was associated with reduced local (82% vs. 94%, p=0.02) and pelvic control (79% vs. 89%, p=0.02). HR-CTV D90 <85Gy was associated with inferior 5-year local control in p16+ patients especially if PD-L1 was co-expressed. On multivariable analysis, PD-L1>1% was the only independent factor for 5-year local control (HR 3.3, p=0.04) and L1CAM ≥50% for pelvic control (HR 5.5 (1.3-23.3), p =0.02). CONCLUSIONS P16 neg status and tumor necrosis on MRI are independently associated with poor response to chemoradiation, whereas PD-L1>1% and L1CAM≥50% have an independent impact on local and pelvic control suggesting impact of biomarker expression on outcomes. Further validation is needed.
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Affiliation(s)
- Supriya Chopra
- Department of Radiation Oncology and Medical Physics, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
| | - Tjalling Bosse
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Nanda Horeweg
- Department of Radiation Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Kedar Deodhar
- Department of Pathology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Santosh Menon
- Department of Pathology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Tynisha Rafael
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Venkatesh Pai
- Department of Radiation Oncology and Medical Physics, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Lucia Rijstenberg
- Department of Pathology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Folkert van Kemenade
- Department of Pathology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Sadhana Kannan
- Epidemiology and Clinical Trials Unit, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Umesh Mahantshetty
- Department of Radiation Oncology and Medical Physics, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | | | - Fleur Huang
- Cross Cancer Institute and University of Alberta, Department of Oncology, Edmonton, Canada
| | | | | | - Bhavana Rai
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Li Tee Tan
- Addenbrooke ́s Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Nadia Giannakopoulus
- Cross Cancer Institute and University of Alberta, Department of Oncology, Edmonton, Canada
| | | | - Kari Tanderup
- Aarhus University Hospital, Aarhus, Denmark; Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Richard Pötter
- Department of Radiation Oncology and Medical Physics, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India; Medical University of Vienna, Austria
| | - Remi Nout
- Department of Radiation Oncology, Leiden University Medical Centre, Leiden, The Netherlands; Department of Radiation Oncology, Erasmus University Medical Centre, Rotterdam, The Netherlands.
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Marsilla J, Weiss J, Ye XY, Welch M, Milosevic M, Lyng H, Hompland T, Bruheim K, Tadic T, Haibe-Kains B, Han K. A T2-weighted MRI-based radiomic signature for disease-free survival in locally advanced cervical cancer following chemoradiation: An international, multicentre study. Radiother Oncol 2024; 199:110463. [PMID: 39067707 DOI: 10.1016/j.radonc.2024.110463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 07/22/2024] [Accepted: 07/24/2024] [Indexed: 07/30/2024]
Abstract
INTRODUCTION To develop and validate a T2-weighted magnetic resonance imaging (MRI)-based radiomic signature associated with disease-free survival (DFS) in locally advanced cervical cancer. MATERIALS AND METHODS The study comprised a training dataset of 132 patients (93 Norwegian; 39 The Cancer Imaging Archive (TCIA) and an independent validation Canadian dataset of 199 patients with FIGO stage IB-IVA cervical cancer treated with chemoradiation. Radiomic features were extracted using PyRadiomics. A radiomic signature was developed based on a multivariable radiomic prognostic model for DFS built using the training dataset, with minimal redundancy maximum relevancy feature selection method. Univariate and multivariable Cox regression analyses were then conducted to examine the association of the derived radiomic signature with DFS. RESULTS A radiomic signature was prognostic for DFS in the training cohort (Norwegian hazard ratio [HR] 5.54, p = 0.002; TCIA HR 3.59, p = 0.04). The radiomic signature remained independently associated with DFS (HR 3.70, p = 0.004) when adjusted for stage and tumor volume. The radiomic signature was also prognostic for DFS in the validation cohort, both on univariate analysis (HR 2.22, p = 0.003), and multivariable analysis adjusted for stage and tumor volume (HR 1.84, p = 0.04). The 4-year DFS rates of patients with radiomic signature score > 0 vs ≤ 0 were 48.2 % vs 87.9 %, and 56.4 % vs 80.8 % for training and validation cohorts respectively. CONCLUSION An MRI-based radiomic signature can be used as a prognostic biomarker for DFS in patients with locally advanced cervical cancer undergoing chemoradiation.
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Affiliation(s)
- Joseph Marsilla
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Jessica Weiss
- Department of Biostatistics, University Health Network, Toronto, Ontario, Canada
| | - Xiang Y Ye
- Department of Biostatistics, University Health Network, Toronto, Ontario, Canada
| | - Mattea Welch
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada; Cancer Digital Intelligence Program, University Health Network, Toronto, Ontario, Canada
| | - Michael Milosevic
- Radiation Medicine Program, Princess Margaret Cancer Center, University Health Network, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Heidi Lyng
- Department of Radiation Biology, Oslo University Hospital, Oslo, Norway
| | - Tord Hompland
- Department of Physics, University of Oslo, Oslo, Norway
| | - Kjersti Bruheim
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Tony Tadic
- Radiation Medicine Program, Princess Margaret Cancer Center, University Health Network, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin Haibe-Kains
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada; Cancer Digital Intelligence Program, University Health Network, Toronto, Ontario, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.
| | - Kathy Han
- Radiation Medicine Program, Princess Margaret Cancer Center, University Health Network, Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
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Skingen VE, Hompland T, Fjeldbo CS, Salberg UB, Helgeland H, Ragnum HB, Aarnes EK, Vlatkovic L, Hole KH, Seierstad T, Lyng H. Prostate cancer radiogenomics reveals proliferative gene expression programs associated with distinct MRI-based hypoxia levels. Radiother Oncol 2023; 188:109875. [PMID: 37640161 DOI: 10.1016/j.radonc.2023.109875] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND AND PURPOSE The biology behind individual hypoxia levels in patient tumors is poorly understood. Here, we used radiogenomics to identify associations between magnetic resonance imaging (MRI)-based hypoxia levels and biological processes derived from gene expression data in prostate cancer. MATERIALS AND METHODS For 85 prostate cancer patients, MRI-based hypoxia images were constructed by combining diffusion-weighted images reflecting oxygen consumption and supply. The ability to differentiate hypoxia levels in these images was verified by comparison with matched biopsy sections stained for the hypoxia marker pimonidazole. For MRI-defined hypoxia levels, corresponding hypoxic fractions were calculated and correlated with biopsy gene expression profiles. Biological processes were predicted by gene set enrichment analysis (GSEA) and validated by immunohistochemistry (Ki67 proliferation marker, reactive stroma grade) and RT-PCR (MYC). RESULTS Genes with correlation between expression level and hypoxic fraction were identified for 56 MRI-based hypoxia levels. At all levels, GSEA identified proliferation as the predominant biological process enriched among the correlating genes. Two independent proliferative gene signatures were developed. The Peak1 signature, upregulated at moderate/severe hypoxia, reflected MYC upregulation and high Ki67-proliferation index of cancer cells in pimonidazole-positive regions. The Peak2 signature, upregulated at mild to non-hypoxic levels, was associated with fibroblast gene signature and reactive stroma grade. High scores of both Peak1 and Peak2 indicated elevated risk of biochemical recurrence in multiple cohorts. CONCLUSION Radiogenomics identified two gene expression programs activated at different hypoxia levels, reflecting proliferation of cancer cells and stroma cells. Genes involved in these programs could be candidate targets for intervention.
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Affiliation(s)
- Vilde Eide Skingen
- Department of Radiation Biology, Oslo University Hospital, Oslo, Norway; Department of Physics, University of Oslo, Oslo, Norway
| | - Tord Hompland
- Department of Radiation Biology, Oslo University Hospital, Oslo, Norway
| | | | - Unn Beate Salberg
- Department of Radiation Biology, Oslo University Hospital, Oslo, Norway
| | - Hanna Helgeland
- Department of Radiation Biology, Oslo University Hospital, Oslo, Norway
| | - Harald Bull Ragnum
- Department of Radiation Biology, Oslo University Hospital, Oslo, Norway; Department of Oncology and Hematology, Telemark Hospital Trust, Skien, Norway
| | | | | | - Knut Håkon Hole
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Therese Seierstad
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Heidi Lyng
- Department of Radiation Biology, Oslo University Hospital, Oslo, Norway; Department of Physics, University of Oslo, Oslo, Norway.
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Ma X, Mao M, He J, Liang C, Xie HY. Nanoprobe-based molecular imaging for tumor stratification. Chem Soc Rev 2023; 52:6447-6496. [PMID: 37615588 DOI: 10.1039/d3cs00063j] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
The responses of patients to tumor therapies vary due to tumor heterogeneity. Tumor stratification has been attracting increasing attention for accurately distinguishing between responders to treatment and non-responders. Nanoprobes with unique physical and chemical properties have great potential for patient stratification. This review begins by describing the features and design principles of nanoprobes that can visualize specific cell types and biomarkers and release inflammatory factors during or before tumor treatment. Then, we focus on the recent advancements in using nanoprobes to stratify various therapeutic modalities, including chemotherapy, radiotherapy (RT), photothermal therapy (PTT), photodynamic therapy (PDT), chemodynamic therapy (CDT), ferroptosis, and immunotherapy. The main challenges and perspectives of nanoprobes in cancer stratification are also discussed to facilitate probe development and clinical applications.
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Affiliation(s)
- Xianbin Ma
- School of Medical Technology, Beijing Institute of Technology, Beijing 100081, P. R. China
| | - Mingchuan Mao
- School of Medical Technology, Beijing Institute of Technology, Beijing 100081, P. R. China
| | - Jiaqi He
- School of Life Science, Beijing Institute of Technology, Beijing 100081, P. R. China
| | - Chao Liang
- School of Life Science, Beijing Institute of Technology, Beijing 100081, P. R. China
| | - Hai-Yan Xie
- State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Chemical Biology Center, Peking University, Beijing, 100191, P. R. China.
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Abdul-Latif M, Tharmalingam H, Tsang Y, Hoskin PJ. Functional Magnetic Resonance Imaging in Cervical Cancer Diagnosis and Treatment. Clin Oncol (R Coll Radiol) 2023; 35:598-610. [PMID: 37246040 DOI: 10.1016/j.clon.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 05/12/2023] [Indexed: 05/30/2023]
Abstract
Cervical Cancer is the fourth most common cancer in women worldwide. Treatment with chemoradiotherapy followed by brachytherapy achieves high local control, but recurrence with metastatic disease impacts survival. This highlights the need for predictive and prognostic biomarkers identifying populations at risk of poorer treatment response and survival. Magnetic resonance imaging (MRI) is routinely used in cervical cancer and is a potential source for biomarkers. Functional MRI (fMRI) can characterise tumour beyond anatomical MRI, which is limited to the assessment of morphology. This review summarises fMRI techniques used in cervical cancer and examines the role of fMRI parameters as predictive or prognostic biomarkers. Different techniques characterise different tumour factors, which helps to explain the variation in patient outcomes. These can impact simultaneously on outcomes, making biomarker identification challenging. Most studies are small, focussing on single MRI techniques, which raises the need to investigate combined fMRI approaches for a more holistic characterisation of tumour.
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Affiliation(s)
| | | | - Y Tsang
- Mount Vernon Cancer Centre, Northwood, UK; Radiation Medicine Programme, Princess Margaret Cancer Centre, Toronto, Canada
| | - P J Hoskin
- Mount Vernon Cancer Centre, Northwood, UK; Division of Cancer Sciences, University of Manchester, Manchester, UK
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6
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Boeke S, Winter RM, Leibfarth S, Krueger MA, Bowden G, Cotton J, Pichler BJ, Zips D, Thorwarth D. Machine learning identifies multi-parametric functional PET/MR imaging cluster to predict radiation resistance in preclinical head and neck cancer models. Eur J Nucl Med Mol Imaging 2023; 50:3084-3096. [PMID: 37148296 PMCID: PMC10382355 DOI: 10.1007/s00259-023-06254-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 04/25/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE Tumor hypoxia and other microenvironmental factors are key determinants of treatment resistance. Hypoxia positron emission tomography (PET) and functional magnetic resonance imaging (MRI) are established prognostic imaging modalities to identify radiation resistance in head-and-neck cancer (HNC). The aim of this preclinical study was to develop a multi-parametric imaging parameter specifically for focal radiotherapy (RT) dose escalation using HNC xenografts of different radiation sensitivities. METHODS A total of eight human HNC xenograft models were implanted into 68 immunodeficient mice. Combined PET/MRI using dynamic [18F]-fluoromisonidazole (FMISO) hypoxia PET, diffusion-weighted (DW), and dynamic contrast-enhanced MRI was carried out before and after fractionated RT (10 × 2 Gy). Imaging data were analyzed on voxel-basis using principal component (PC) analysis for dynamic data and apparent diffusion coefficients (ADCs) for DW-MRI. A data- and hypothesis-driven machine learning model was trained to identify clusters of high-risk subvolumes (HRSs) from multi-dimensional (1-5D) pre-clinical imaging data before and after RT. The stratification potential of each 1D to 5D model with respect to radiation sensitivity was evaluated using Cohen's d-score and compared to classical features such as mean/peak/maximum standardized uptake values (SUVmean/peak/max) and tumor-to-muscle-ratios (TMRpeak/max) as well as minimum/valley/maximum/mean ADC. RESULTS Complete 5D imaging data were available for 42 animals. The final preclinical model for HRS identification at baseline yielding the highest stratification potential was defined in 3D imaging space based on ADC and two FMISO PCs ([Formula: see text]). In 1D imaging space, only clusters of ADC revealed significant stratification potential ([Formula: see text]). Among all classical features, only ADCvalley showed significant correlation to radiation resistance ([Formula: see text]). After 2 weeks of RT, FMISO_c1 showed significant correlation to radiation resistance ([Formula: see text]). CONCLUSION A quantitative imaging metric was described in a preclinical study indicating that radiation-resistant subvolumes in HNC may be detected by clusters of ADC and FMISO using combined PET/MRI which are potential targets for future functional image-guided RT dose-painting approaches and require clinical validation.
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Affiliation(s)
- Simon Boeke
- Department of Radiation Oncology, University of Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK), partner site Tübingen, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - René M Winter
- Section for Biomedical Physics, Department of Radiation Oncology, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Sara Leibfarth
- Section for Biomedical Physics, Department of Radiation Oncology, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Marcel A Krueger
- Werner Siemens Imaging Center, Department of Preclinical Imaging and Radiopharmacy, University of Tübingen, Tübingen, Germany
| | - Gregory Bowden
- Werner Siemens Imaging Center, Department of Preclinical Imaging and Radiopharmacy, University of Tübingen, Tübingen, Germany
| | - Jonathan Cotton
- Werner Siemens Imaging Center, Department of Preclinical Imaging and Radiopharmacy, University of Tübingen, Tübingen, Germany
| | - Bernd J Pichler
- Werner Siemens Imaging Center, Department of Preclinical Imaging and Radiopharmacy, University of Tübingen, Tübingen, Germany
- Cluster of Excellence iFIT (EXC 2180) "Image Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany
| | - Daniel Zips
- Department of Radiation Oncology, University of Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK), partner site Tübingen, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniela Thorwarth
- German Cancer Consortium (DKTK), partner site Tübingen, and German Cancer Research Center (DKFZ), Heidelberg, Germany.
- Section for Biomedical Physics, Department of Radiation Oncology, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
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7
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Shi J, Sha R, Yang X. Role of the human solute carrier family 14 member 1 gene in hypoxia-induced renal cell carcinoma occurrence and its enlightenment to cancer nursing. BMC Mol Cell Biol 2023; 24:10. [PMID: 36934247 PMCID: PMC10024409 DOI: 10.1186/s12860-023-00473-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/13/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Hypoxia is considered a critical contributor to renal cell carcinoma progression, including invasion and metastasis. However, the potential mechanisms by which it promotes invasion and metastasis have not yet been clarified. The purpose of this study was to investigate the role and mechanism of hypoxia-induced renal cell carcinoma and provide evidence-based medical proof for improvements to postoperative nursing of renal cell carcinoma patients. A total of 64 patients with renal cell carcinoma were divided into the observation group (nursing based on oxygen administration) and the control group (conventional nursing). Renal function indexes, serum inflammatory factors, and tumor markers were evaluated. The human renal cell carcinoma cell line A498 under hypoxia/normoxia was used as an experimental model in vitro and the biological characteristics and mitochondrial function of the cells were assessed. RESULTS Nursing based on oxygen administration decreased the value of renal function indexes, serum inflammatory factors, and tumor markers in renal cell carcinoma patients. Hypoxia was found to induce A498 cell invasion, migration, and the release of inflammatory cytokines, while repressing human solute carrier family 14 member 1 gene expression. Elevated levels of solute carrier family 14 member 1 expression induced mitochondrial reactive oxygen species accumulation, diminished the intracellular adenosine triphosphate level, and destroyed both mitochondrial membrane potential integrity and mitochondrial morphology. Overexpression of the solute carrier family 14 member 1 gene could abolish hypoxia-induced invasion, reduce the migration of A498 cells, inhibit the hypoxia-induced release of inflammatory cytokines, and arrest the cell cycle at the G1/S checkpoint. CONCLUSIONS These data reveal that nursing based on oxygen administration can improve the clinical efficacy of renal cell carcinoma therapies, being safe and effective. The results elucidate a mechanism wherein the solute carrier family 14 member 1 gene participates in the occurrence and development of hypoxia-induced renal cell carcinoma in a mitochondria-dependent manner.
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Affiliation(s)
- Jing Shi
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Qinhuai District, 68 Changle Road, Nanjing, 210012, China
| | - Ruili Sha
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Qinhuai District, 68 Changle Road, Nanjing, 210012, China
| | - Xilan Yang
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Qinhuai District, 68 Changle Road, Nanjing, 210012, China.
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8
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Gouel P, Decazes P, Vera P, Gardin I, Thureau S, Bohn P. Advances in PET and MRI imaging of tumor hypoxia. Front Med (Lausanne) 2023; 10:1055062. [PMID: 36844199 PMCID: PMC9947663 DOI: 10.3389/fmed.2023.1055062] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
Tumor hypoxia is a complex and evolving phenomenon both in time and space. Molecular imaging allows to approach these variations, but the tracers used have their own limitations. PET imaging has the disadvantage of low resolution and must take into account molecular biodistribution, but has the advantage of high targeting accuracy. The relationship between the signal in MRI imaging and oxygen is complex but hopefully it would lead to the detection of truly oxygen-depleted tissue. Different ways of imaging hypoxia are discussed in this review, with nuclear medicine tracers such as [18F]-FMISO, [18F]-FAZA, or [64Cu]-ATSM but also with MRI techniques such as perfusion imaging, diffusion MRI or oxygen-enhanced MRI. Hypoxia is a pejorative factor regarding aggressiveness, tumor dissemination and resistance to treatments. Therefore, having accurate tools is particularly important.
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Affiliation(s)
- Pierrick Gouel
- Département d’Imagerie, Centre Henri Becquerel, Rouen, France,QuantIF-LITIS, EA 4108, IRIB, Université de Rouen, Rouen, France
| | - Pierre Decazes
- Département d’Imagerie, Centre Henri Becquerel, Rouen, France,QuantIF-LITIS, EA 4108, IRIB, Université de Rouen, Rouen, France
| | - Pierre Vera
- Département d’Imagerie, Centre Henri Becquerel, Rouen, France,QuantIF-LITIS, EA 4108, IRIB, Université de Rouen, Rouen, France
| | - Isabelle Gardin
- Département d’Imagerie, Centre Henri Becquerel, Rouen, France,QuantIF-LITIS, EA 4108, IRIB, Université de Rouen, Rouen, France
| | - Sébastien Thureau
- QuantIF-LITIS, EA 4108, IRIB, Université de Rouen, Rouen, France,Département de Radiothérapie, Centre Henri Becquerel, Rouen, France
| | - Pierre Bohn
- Département d’Imagerie, Centre Henri Becquerel, Rouen, France,QuantIF-LITIS, EA 4108, IRIB, Université de Rouen, Rouen, France,*Correspondence: Pierre Bohn,
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Popat PB, Maheshwari A, Manchanda S, Renganathan R, Sen S, Dhamija E, Thakur M, Deodhar K, Chopra S, Kanteti APK, Ghosh J, Shah S, Sable N, Baheti A, Chauhan S, Gala K, Kulkarni S. Imaging Recommendations for Diagnosis, Staging, and Management of Cervical Cancer. Indian J Med Paediatr Oncol 2023. [DOI: 10.1055/s-0042-1759717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
AbstractCervical cancer is the fourth most common cancer in women globally and the second most common cancer in Indian women, more common in lower socioeconomic strata. Improvement in survival and decrease in morbidity reflect the earlier detection with screening and imaging, as well as multifactorial multimodality therapy integrating surgery, and concurrent chemoradiation therapy providing superior therapeutic benefits. Imaging plays a vital role in assessing the extent of disease and staging of cervical cancer. The appropriateness criteria of a modality are different from its availability based on infrastructure, medical facilities, and resource status. Although in an ideal situation, magnetic resonance imaging (MRI) would be of greatest value in locoregional assessment of extent of disease and fluorodeoxyglucose positron emission tomography-computed tomography for distant staging; often, an ultrasonography, chest radiograph, and bone scans are utilized, with contrast-enhanced computed tomography representing a fair superior diagnostic accuracy, and can be reported as per the RECIST 1.1 criteria. MRI is also of good utility in the assessment of residual disease, predicting response and detecting small volume recurrence. MRI offers the highest diagnostic accuracy in determining parametrial invasion and hence surgical planning; so also, MRI-guided radiation planning helps in more accurate graded radiation dose planning in radiation therapy. Stage and therapy-based surveillance imaging should be encouraged and recommended.
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Affiliation(s)
- Palak Bhavesh Popat
- Department of Radiology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Amita Maheshwari
- Division of Gynaecologic Oncology, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Smita Manchanda
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Rupa Renganathan
- Department of Diagnostic and Interventional Radiology, Kovai Medical Center and Hospitals, Coimbatore, Tamil Nadu, India
| | - Saugata Sen
- Department of Radiology and Imaging Sciences, Tata Medical Centre, Kolkata, West Bengal, India
| | - Ekta Dhamija
- Department of Radiodiagnosis, IRCH, AIIMS, New Delhi, India
| | - Meenakshi Thakur
- Department of Radiology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Kedar Deodhar
- Department of Pathology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Supriya Chopra
- Department of Radiation Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Aditya Pavan Kumar Kanteti
- Department of Medical Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Jaya Ghosh
- Department of Medical Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sneha Shah
- Department of Nuclear Medicine, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Nilesh Sable
- Department of Radiology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Akshay Baheti
- Department of Radiology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sonal Chauhan
- Department of Radiology, H. N. Reliance Hospital, Mumbai, Maharashtra, India
| | - Kunal Gala
- Department of Radiology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Suyash Kulkarni
- Department of Radiology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
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10
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O'Cathail SM, Chalmers AJ. Integrating Novel Cancer Therapies with Radiation - Illuminating the Tunnel. Clin Oncol (R Coll Radiol) 2023; 35:38-41. [PMID: 36333159 DOI: 10.1016/j.clon.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/15/2022] [Accepted: 10/14/2022] [Indexed: 12/31/2022]
Affiliation(s)
- S M O'Cathail
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK.
| | - A J Chalmers
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
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11
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Goodburn RJ, Philippens MEP, Lefebvre TL, Khalifa A, Bruijnen T, Freedman JN, Waddington DEJ, Younus E, Aliotta E, Meliadò G, Stanescu T, Bano W, Fatemi‐Ardekani A, Wetscherek A, Oelfke U, van den Berg N, Mason RP, van Houdt PJ, Balter JM, Gurney‐Champion OJ. The future of MRI in radiation therapy: Challenges and opportunities for the MR community. Magn Reson Med 2022; 88:2592-2608. [PMID: 36128894 PMCID: PMC9529952 DOI: 10.1002/mrm.29450] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 01/11/2023]
Abstract
Radiation therapy is a major component of cancer treatment pathways worldwide. The main aim of this treatment is to achieve tumor control through the delivery of ionizing radiation while preserving healthy tissues for minimal radiation toxicity. Because radiation therapy relies on accurate localization of the target and surrounding tissues, imaging plays a crucial role throughout the treatment chain. In the treatment planning phase, radiological images are essential for defining target volumes and organs-at-risk, as well as providing elemental composition (e.g., electron density) information for radiation dose calculations. At treatment, onboard imaging informs patient setup and could be used to guide radiation dose placement for sites affected by motion. Imaging is also an important tool for treatment response assessment and treatment plan adaptation. MRI, with its excellent soft tissue contrast and capacity to probe functional tissue properties, holds great untapped potential for transforming treatment paradigms in radiation therapy. The MR in Radiation Therapy ISMRM Study Group was established to provide a forum within the MR community to discuss the unmet needs and fuel opportunities for further advancement of MRI for radiation therapy applications. During the summer of 2021, the study group organized its first virtual workshop, attended by a diverse international group of clinicians, scientists, and clinical physicists, to explore our predictions for the future of MRI in radiation therapy for the next 25 years. This article reviews the main findings from the event and considers the opportunities and challenges of reaching our vision for the future in this expanding field.
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Affiliation(s)
- Rosie J. Goodburn
- Joint Department of PhysicsInstitute of Cancer Research and Royal Marsden NHS Foundation TrustLondonUnited Kingdom
| | | | - Thierry L. Lefebvre
- Department of PhysicsUniversity of CambridgeCambridgeUnited Kingdom
- Cancer Research UK Cambridge Research InstituteUniversity of CambridgeCambridgeUnited Kingdom
| | - Aly Khalifa
- Department of Medical BiophysicsUniversity of TorontoTorontoOntarioCanada
| | - Tom Bruijnen
- Department of RadiotherapyUniversity Medical Center UtrechtUtrechtNetherlands
| | | | - David E. J. Waddington
- Faculty of Medicine and Health, Sydney School of Health Sciences, ACRF Image X InstituteThe University of SydneySydneyNew South WalesAustralia
| | - Eyesha Younus
- Department of Medical Physics, Odette Cancer CentreSunnybrook Health Sciences CentreTorontoOntarioCanada
| | - Eric Aliotta
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Gabriele Meliadò
- Unità Operativa Complessa di Fisica SanitariaAzienda Ospedaliera Universitaria Integrata VeronaVeronaItaly
| | - Teo Stanescu
- Department of Radiation Oncology, University of Toronto and Medical Physics, Princess Margaret Cancer CentreUniversity Health NetworkTorontoOntarioCanada
| | - Wajiha Bano
- Joint Department of PhysicsInstitute of Cancer Research and Royal Marsden NHS Foundation TrustLondonUnited Kingdom
| | - Ali Fatemi‐Ardekani
- Department of PhysicsJackson State University (JSU)JacksonMississippiUSA
- SpinTecxJacksonMississippiUSA
- Department of Radiation OncologyCommunity Health Systems (CHS) Cancer NetworkJacksonMississippiUSA
| | - Andreas Wetscherek
- Joint Department of PhysicsInstitute of Cancer Research and Royal Marsden NHS Foundation TrustLondonUnited Kingdom
| | - Uwe Oelfke
- Joint Department of PhysicsInstitute of Cancer Research and Royal Marsden NHS Foundation TrustLondonUnited Kingdom
| | - Nico van den Berg
- Department of RadiotherapyUniversity Medical Center UtrechtUtrechtNetherlands
| | - Ralph P. Mason
- Department of RadiologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Petra J. van Houdt
- Department of Radiation OncologyNetherlands Cancer InstituteAmsterdamNetherlands
| | - James M. Balter
- Department of Radiation OncologyUniversity of MichiganAnn ArborMichiganUSA
| | - Oliver J. Gurney‐Champion
- Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam UMCUniversity of AmsterdamAmsterdamNetherlands
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12
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Makihara K, Yamaguchi M, Ito K, Sakaguchi K, Hori Y, Semba T, Funahashi Y, Fujii H, Terada Y. New Cluster Analysis Method for Quantitative Dynamic Contrast-Enhanced MRI Assessing Tumor Heterogeneity Induced by a Tumor-Microenvironmental Ameliorator (E7130) Treatment to a Breast Cancer Mouse Model. J Magn Reson Imaging 2022; 56:1820-1831. [PMID: 35524730 DOI: 10.1002/jmri.28226] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/23/2022] [Accepted: 04/25/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can provide insight into tumor perfusion. However, a method that can quantitatively measure the intra-tumor distribution of tumor voxel clusters with a distinct range of Ktrans and ve values remains insufficiently explored. HYPOTHESIS Two-dimensional cluster analysis may quantify the distribution of a tumor voxel subregion with a distinct range of Ktrans and ve values in human breast cancer xenografts. STUDY TYPE Prospective longitudinal study. ANIMAL MODEL Twenty-two female athymic nude mice with MCF-7 xenograft, treated with E7130, a tumor-microenvironmental ameliorator, or saline. FIELD STRENGTH/SEQUENCE 9.4 Tesla, turbo rapid acquisition with relaxation enhancement, and spoiled gradient-echo sequences. ASSESSMENT We performed two-dimensional k-means clustering to identify tumor voxel clusters with a distinct range of Ktrans and ve values on Days 0, 2, and 5 after treatment, calculated the ratio of the number of tumor voxels in each cluster to the total number of tumor voxels, and measured the normalized distances defined as the ratio of the distance between each tumor voxel and the nearest tumor margin to a tumor radius. STATISTICAL TESTS Unpaired t-tests, Dunnett's multiple comparison tests, and Chi-squared test were used. RESULTS The largest and second largest clusters constituted 44.4% and 27.5% of all tumor voxels with cluster centroid values of Ktrans at 0.040 min-1 and 0.116 min-1 , and ve at 0.131 and 0.201, respectively. At baseline (Day 0), the average normalized distances for the largest and second largest clusters were 0.33 and 0.24, respectively. E7130-treated group showed the normalized distance of the initial largest cluster decreasing to 0.25, while that of the second largest cluster increasing to 0.31. Saline-treated group showed no change. DATA CONCLUSION A two-dimensional cluster analysis might quantify the spatial distribution of a tumor subregion with a distinct range of Ktrans and ve values. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Kazuyuki Makihara
- Graduate School of Pure and Applied Sciences, University of Tsukuba, Tsukuba, Japan.,Division of Functional Imaging, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Kashiwa, Japan
| | - Masayuki Yamaguchi
- Division of Functional Imaging, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Kashiwa, Japan
| | - Ken Ito
- Division of Functional Imaging, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Kashiwa, Japan.,Oncology Tsukuba Research Development, Discovery, Medicine Creation, Eisai Co., Ltd., Tsukuba-shi, Japan
| | - Kazuya Sakaguchi
- Graduate School of Pure and Applied Sciences, University of Tsukuba, Tsukuba, Japan.,Division of Functional Imaging, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Kashiwa, Japan
| | - Yusaku Hori
- Division of Functional Imaging, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Kashiwa, Japan.,Oncology Tsukuba Research Development, Discovery, Medicine Creation, Eisai Co., Ltd., Tsukuba-shi, Japan
| | - Taro Semba
- Oncology Tsukuba Research Development, Discovery, Medicine Creation, Eisai Co., Ltd., Tsukuba-shi, Japan
| | - Yasuhiro Funahashi
- Lenvima Co-Global Lead, Oncology Business Group, Eisai Co., Ltd., Woodcliff Lake, New Jersey, USA
| | - Hirofumi Fujii
- Division of Functional Imaging, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Kashiwa, Japan
| | - Yasuhiko Terada
- Graduate School of Pure and Applied Sciences, University of Tsukuba, Tsukuba, Japan.,Division of Functional Imaging, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Kashiwa, Japan
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13
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Harris B, Saleem S, Cook N, Searle E. Targeting hypoxia in solid and haematological malignancies. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2022; 41:318. [PMID: 36320041 PMCID: PMC9628170 DOI: 10.1186/s13046-022-02522-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 10/19/2022] [Indexed: 11/07/2022]
Abstract
Tumour hypoxia is a known and extensively researched phenomenon that occurs in both solid and haematological malignancies. As cancer cells proliferate, demand for oxygen can outstrip supply reducing tumour oxygenation. In solid tumours this is contributed to by disorganized blood vessel development. Tumour hypoxia is associated with resistance to treatment, more aggressive disease behaviour and an increased likelihood of metastatic progression. It can be measured using both invasive and non-invasive methods to varying degrees of accuracy. The presence of hypoxia stimulates a complex cellular network of downstream factors including Hypoxia Inducible Factor 1 (HIF1), C-X-C motif chemokine 4 (CXCR4) and Hypoxia‐inducible glycolytic enzyme hexokinase‐2 (HK2) amongst many others. They work by affecting different mechanisms including influencing angiogenesis, treatment resistance, immune surveillance and the ability to metastasize all of which contribute to a more aggressive disease pattern. Tumour hypoxia has been correlated with poorer outcomes and worse prognosis in patients. The correlation between hypoxic microenvironments and poor prognosis has led to an interest in trying to therapeutically target this phenomenon. Various methods have been used to target hypoxic microenvironments. Hypoxia-activated prodrugs (HAPs) are drugs that are only activated within hypoxic environments and these agents have been subject to investigation in several clinical trials. Drugs that target downstream factors of hypoxic environments including HIF inhibitors, mammalian target of rapamycin (mTOR) inhibitors and vascular endothelial growth factor (anti-VEGF) therapies are also in development and being used in combination in clinical trials. Despite promising pre-clinical data, clinical trials of hypoxia targeting strategies have proven challenging. Further understanding of the effect of hypoxia and related molecular mechanisms in human rather than animal models is required to guide novel therapeutic strategies and future trial design. This review will discuss the currently available methods of hypoxia targeting and assessments that may be considered in planning future clinical trials. It will also outline key trials to date in both the solid and haemato-oncology treatment spheres and discuss the limitations that may have impacted on clinical success to date.
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Affiliation(s)
- Bill Harris
- grid.412917.80000 0004 0430 9259Experimental Cancer Medicine Team, Christie NHS Foundation Trust, Manchester, UK
| | - Sana Saleem
- grid.412917.80000 0004 0430 9259Haematology Department, Christie NHS Foundation Trust, Manchester, UK
| | - Natalie Cook
- grid.412917.80000 0004 0430 9259Experimental Cancer Medicine Team, Christie NHS Foundation Trust, Manchester, UK ,grid.5379.80000000121662407Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Emma Searle
- grid.412917.80000 0004 0430 9259Haematology Department, Christie NHS Foundation Trust, Manchester, UK ,grid.5379.80000000121662407Division of Cancer Sciences, University of Manchester, Manchester, UK
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14
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Skipar K, Hompland T, Lund KV, Løndalen A, Malinen E, Kristensen GB, Lindemann K, Nakken ES, Bruheim K, Lyng H. Risk of recurrence after chemoradiotherapy identified by multimodal MRI and 18F-FDG-PET/CT in locally advanced cervical cancer. Radiother Oncol 2022; 176:17-24. [PMID: 36113778 DOI: 10.1016/j.radonc.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 08/24/2022] [Accepted: 09/02/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE MRI, applying dynamic contrast-enhanced (DCE) and diffusion-weighted (DW) sequences, and 18F-fluorodeoxyglucose (18F-FDG) PET/CT provide information about tumor aggressiveness that is unexploited in treatment of locally advanced cervical cancer (LACC). We investigated the potential of a multimodal combination of imaging parameters for classifying patients according to their risk of recurrence. MATERIALS AND METHODS Eighty-two LACC patients with diagnostic MRI and FDG-PET/CT, treated with chemoradiotherapy, were collected. Thirty-eight patients with MRI only were included for validation of MRI results. Endpoints were survival (disease-free, cancer-specific, overall) and tumor control (local, locoregional, distant). Ktrans, reflecting vascular function, apparent diffusion coefficient (ADC), reflecting cellularity, and standardized uptake value (SUV), reflecting glucose uptake, were extracted from DCE-MR, DW-MR and FDG-PET images, respectively. By applying an oxygen consumption and supply-based method, ADC and Ktrans parametric maps were voxel-wise combined into hypoxia images that were used to determine hypoxic fraction (HF). RESULTS HF showed a stronger association with outcome than the single modality parameters. This association was confirmed in the validation cohort. Low HF identified low-risk patients with 95% precision. Based on the 50th SUV-percentile (SUV50), patients with high HF were divided into an intermediate- and high-risk group with high and low SUV50, respectively. This defined a multimodality biomarker, HF/SUV50. HF/SUV50 increased the precision of detecting high-risk patients from 41% (HF alone) to 57% and showed prognostic significance in multivariable analysis for all endpoints. CONCLUSION Multimodal combination of MR- and FDG-PET/CT-images improves classification of LACC patients compared to single modality images and clinical factors.
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Affiliation(s)
- Kjersti Skipar
- Department of Radiation Biology, Oslo University Hospital, Oslo, Norway; Department of Oncology, Telemark Hospital Trust, Skien, Norway; Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Tord Hompland
- Department of Radiation Biology, Oslo University Hospital, Oslo, Norway
| | - Kjersti Vassmo Lund
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Ayca Løndalen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Eirik Malinen
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway; Department of Physics, University of Oslo, Oslo, Norway
| | - Gunnar B Kristensen
- Department of Gynecological Oncology, Oslo University Hospital, Oslo, Norway
| | - Kristina Lindemann
- Department of Gynecological Oncology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Esten S Nakken
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Kjersti Bruheim
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Heidi Lyng
- Department of Radiation Biology, Oslo University Hospital, Oslo, Norway; Department of Physics, University of Oslo, Oslo, Norway.
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15
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Léost F, Delpon G, Garcion E, Gestin JF, Hatt M, Potiron V, Rbah-Vidal L, Supiot S. ["Adaptation of the tumour and its ecosystem to radiotherapies: Mechanisms, imaging and therapeutic approaches" XIVth edition of the workshop organised by the "Vectorisation, Imagerie, Radiothérapies" network of the Cancéropôle Grand-Ouest, 22-25 September 2021, Le Bono, France]. Bull Cancer 2022; 109:1088-1093. [PMID: 35908990 DOI: 10.1016/j.bulcan.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/03/2022] [Accepted: 06/07/2022] [Indexed: 10/16/2022]
Abstract
The fourteenth edition of the workshop covered the latest advances in internal and external radiotherapy obtained through a better understanding of the adaptive capacity of the tumor and its microenvironment, from different disciplinary angles, chemistry, biology, physics, and medicine, paving the way for numerous technological innovations. The biological aspects and the contribution of imaging in monitoring and understanding the adaptation of tumors to radiotherapy were presented, before focusing on innovative radiotherapy strategies and machine learning and data-driven techniques. Finally, the challenges were explored in the radiobiology of targeted radionuclide therapy as well as data science and machine learning in radiomics.
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Affiliation(s)
- Françoise Léost
- Cancéropôle Grand-Ouest, IRS-UN, 8, quai Moncousu, 44007 Nantes cedex 1, France.
| | - Grégory Delpon
- Institut de Cancérologie de l'Ouest, département de physique médicale, boulevard Jacques-Monod, 44800 Nantes Saint-Herblain, France
| | - Emmanuel Garcion
- Université d'Angers, Nantes université, Inserm UMR 1307, CNRS UMR 6075, CRCI2NA, 49000 Angers, France
| | - Jean-François Gestin
- Nantes Université, université d'Angers, Inserm UMR 1307, CNRS UMR 6075, CRCI2NA, 44000 Nantes, France
| | - Mathieu Hatt
- LaTIM, Inserm, UMR 1101, IBSAM, UBO, UBL, 22, rue Camille-Desmoulins, 29238 Brest, France
| | - Vincent Potiron
- Institut de cancérologie de l'Ouest, département de radiothérapie, boulevard Jacques-Monod, 44800 Nantes Saint-Herblain, France
| | - Latifa Rbah-Vidal
- Nantes Université, université d'Angers, Inserm UMR 1307, CNRS UMR 6075, CRCI2NA, 44000 Nantes, France
| | - Stéphane Supiot
- Institut de cancérologie de l'Ouest, département de radiothérapie, boulevard Jacques-Monod, 44800 Nantes Saint-Herblain, France
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16
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Gurney-Champion OJ, Landry G, Redalen KR, Thorwarth D. Potential of Deep Learning in Quantitative Magnetic Resonance Imaging for Personalized Radiotherapy. Semin Radiat Oncol 2022; 32:377-388. [DOI: 10.1016/j.semradonc.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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17
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Quantification of Tumor Hypoxia through Unsupervised Modelling of Consumption and Supply Hypoxia MR Imaging in Breast Cancer. Cancers (Basel) 2022; 14:cancers14051326. [PMID: 35267636 PMCID: PMC8909402 DOI: 10.3390/cancers14051326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/25/2022] [Accepted: 03/02/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Hypoxia in solid tumors is common in most solid cancers and is associated with treatment resistance to both chemo- and radiation-therapy. There is also reason to believe that hypoxia is an important determinant of metastic disease. Identifying hypoxia in solid tumors is important in treatment planning and decision making. In 2018 Hompland et al. proposed a method, based on quantifying consumption and supply of oxygen from diffusion weighted magnetic resonance imaging, to estimate the hypoxic fraction of a solid tumor. The method was based on training model parameters on a known hypoxia state in prostate cancer. In the present study we verified the validity of the consumption and supply concept in breast cancer. Furthermore, we developed and validated a new approach to the concept that does not require a ground truth to train the parameters. Abstract The purpose of the present study is to investigate if consumption and supply hypoxia (CSH) MR-imaging can depict breast cancer hypoxia, using the CSH-method initially developed for prostate cancer. Furthermore, to develop a generalized pan-cancer application of the CSH-method that doesn’t require a hypoxia reference standard for training the CSH-parameters. In a cohort of 69 breast cancer patients, we generated, based on the principles of intravoxel incoherent motion modelling, images reflecting cellular density (apparent diffusion coefficient; ADC) and vascular density (perfusion fraction; fp). Combinations of the information in these images were compared to a molecular hypoxia score made from gene expression data, aiming to identify a way to apply the CSH-methodology in breast cancer. Attempts to adapt previously proposed models for prostate cancer included direct transfers and model parameter rescaling. A novel approach, based on rescaling ADC and fp data to give more nuanced response in the relevant physiologic range, was also introduced. The new CSH-method was validated in a prostate cancer cohort with known hypoxia status. The proposed CSH-method gave estimates of hypoxia that was strongly correlated to the molecular hypoxia score in breast cancer, and hypoxia as measured in pathology slices stained with pimonidazole in prostate cancer. The generalized approach to CSH-imaging depicted hypoxia in both breast and prostate cancers and requires no model training. It is easy to implement using readily available technology and encourages further investigation of CSH-imaging in other cancer entities and in other settings, with the goal being to overcome hypoxia-induced resistance to treatment.
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18
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Lefebvre TL, Brown E, Hacker L, Else T, Oraiopoulou ME, Tomaszewski MR, Jena R, Bohndiek SE. The Potential of Photoacoustic Imaging in Radiation Oncology. Front Oncol 2022; 12:803777. [PMID: 35311156 PMCID: PMC8928467 DOI: 10.3389/fonc.2022.803777] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/07/2022] [Indexed: 12/16/2022] Open
Abstract
Radiotherapy is recognized globally as a mainstay of treatment in most solid tumors and is essential in both curative and palliative settings. Ionizing radiation is frequently combined with surgery, either preoperatively or postoperatively, and with systemic chemotherapy. Recent advances in imaging have enabled precise targeting of solid lesions yet substantial intratumoral heterogeneity means that treatment planning and monitoring remains a clinical challenge as therapy response can take weeks to manifest on conventional imaging and early indications of progression can be misleading. Photoacoustic imaging (PAI) is an emerging modality for molecular imaging of cancer, enabling non-invasive assessment of endogenous tissue chromophores with optical contrast at unprecedented spatio-temporal resolution. Preclinical studies in mouse models have shown that PAI could be used to assess response to radiotherapy and chemoradiotherapy based on changes in the tumor vascular architecture and blood oxygen saturation, which are closely linked to tumor hypoxia. Given the strong relationship between hypoxia and radio-resistance, PAI assessment of the tumor microenvironment has the potential to be applied longitudinally during radiotherapy to detect resistance at much earlier time-points than currently achieved by size measurements and tailor treatments based on tumor oxygen availability and vascular heterogeneity. Here, we review the current state-of-the-art in PAI in the context of radiotherapy research. Based on these studies, we identify promising applications of PAI in radiation oncology and discuss the future potential and outstanding challenges in the development of translational PAI biomarkers of early response to radiotherapy.
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Affiliation(s)
- Thierry L. Lefebvre
- Department of Physics, University of Cambridge, Cambridge, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Emma Brown
- Department of Physics, University of Cambridge, Cambridge, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Lina Hacker
- Department of Physics, University of Cambridge, Cambridge, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Thomas Else
- Department of Physics, University of Cambridge, Cambridge, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Mariam-Eleni Oraiopoulou
- Department of Physics, University of Cambridge, Cambridge, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Michal R. Tomaszewski
- Department of Cancer Physiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - Rajesh Jena
- Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Sarah E. Bohndiek
- Department of Physics, University of Cambridge, Cambridge, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
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Wen H, Guo QH, Zhou XL, Wu XH, Li J. Genomic Profiling of Chinese Cervical Cancer Patients Reveals Prevalence of DNA Damage Repair Gene Alterations and Related Hypoxia Feature. Front Oncol 2022; 11:792003. [PMID: 35071000 PMCID: PMC8782566 DOI: 10.3389/fonc.2021.792003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 12/01/2021] [Indexed: 12/13/2022] Open
Abstract
Background Cervical cancer is responsible for 10–15% of cancer-related deaths in women worldwide. In China, it is the most common cancer in the female genital tract. However, the genomic profiles of Chinese cervical cancer patients remain unclear. Materials and Methods A total of 129 cervical cancer patients were enrolled in this study (113 squamous, 12 adenocarcinoma, 2 adenosquamous, and 2 neuroendocrine carcinoma). To classify the clinical features and molecular characteristics of cervical cancer, the genomic alterations of 618 selected genes were analyzed in the samples of these patients, utilizing target next-generation sequencing (NGS) technology. Furthermore, the findings from the Chinese cohort were then compared with the data of Western patients downloaded from The Cancer Genome Atlas (TCGA) database, in terms of gene expression files, mutation data, and clinical information. Results All studied patients had valid somatic gene alterations, and the most frequently altered genes were PIK3C, TP53, FBXW7, ARID1A, ERBB2, and PTEN. Comparison of genomic profiling showed significantly different prevalence of genes, including TP53, KMT2C, and RET, between the Chinese and the TCGA cohorts. Moreover, 57 patients (44.19%) with 83 actionable alterations were identified in our cohort, especially in PI3K and DNA damage repair (DDR) pathways. After an in-depth analysis of cervical cancer data from the TCGA cohort, DDR alteration was found to be associated with extremely higher tumor mutation burden (TMB) (median mutation count: 149.5 vs 66, p <0.0001), and advanced stages (p <0.05). Additionally, DDR alteration, regardless of its function, was positively correlated with hypoxia feature and score. Moreover, patients with a high hypoxia score were positively correlated with a high abundance of mast cell resting, but lower abundance of CD8+ T cells and activated mast cell. Finally, CDHR5 was identified as the hub gene to be involved in the DDR–hypoxia network, which was negatively correlated with both the DDR alteration and hypoxia score. Conclusions Overall, a unique genomic profiling of Chinese patients with cervical cancer was uncovered. Besides, the prevalent actionable variants, especially in PI3K and DDR pathways, would help promote the clinical management. Moreover, DDR alteration exerted the significant influence on the tumor microenvironment in cervical cancer, which could guide the clinical decisions for the treatment. CDHR5 was the first identified hub gene to be negatively correlated with DDR or hypoxia in cervical cancer, which had potential effects on the treatment of immune checkpoint inhibitors (ICIs).
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Affiliation(s)
- Hao Wen
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Qin-Hao Guo
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Xiao-Lan Zhou
- Hua-Shan Worldwide Medical Center, Hua-Shan Hospital, Fudan University, Shanghai, China
| | - Xiao-Hua Wu
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Jin Li
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China
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Nilsen A, Hillestad T, Skingen VE, Aarnes E, Fjeldbo CS, Hompland T, Evensen TS, Stokke T, Kristensen GB, Grallert B, Lyng H. miR-200a/b/-429 downregulation is a candidate biomarker of tumor radioresistance and independent of hypoxia in locally advanced cervical cancer. Mol Oncol 2022; 16:1402-1419. [PMID: 35064630 PMCID: PMC8936520 DOI: 10.1002/1878-0261.13184] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/21/2021] [Accepted: 01/19/2022] [Indexed: 11/07/2022] Open
Abstract
Many patients with locally advanced cervical cancer experience recurrence within the radiation field after chemoradiotherapy. Biomarkers of tumor radioresistance are required to identify patients in need of intensified treatment. Here, the biomarker potential of miR-200 family members was investigated in this disease. Also, involvement of tumor hypoxia in the radioresistance mechanism was determined, using a previously defined 6-gene hypoxia classifier. miR-200 expression was measured in pre-treatment tumor biopsies of an explorative cohort (n=90) and validation cohort 1 (n=110) by RNA sequencing. Publicly available miR-200 data of 79 patients were included for validation of prognostic significance. A score based on expression of the miR-200a/b/-429 (miR-200a, miR-200b and miR-429) cluster showed prognostic significance in all cohorts. The score was significant in multivariate analysis of central pelvic recurrence. No association with distant recurrence or hypoxia status was found. Potential miRNA target genes were identified from gene expression profiles and showed enrichment of genes in extracellular matrix organization and cell adhesion. miR-200a/b/-429 overexpression had a pronounced radiosensitizing effect in tumor xenografts, whereas the effect was minor in vitro. In conclusion, miR-200a/b/-429 downregulation is a candidate biomarker of central pelvic recurrence and seems to predict cell-adhesion-mediated tumor radioresistance independent of clinical markers and hypoxia.
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Affiliation(s)
- Anja Nilsen
- Department of Radiation BiologyNorwegian Radium HospitalOslo University HospitalNorway
| | - Tiril Hillestad
- Department of Core FacilitiesNorwegian Radium HospitalOslo University HospitalNorway
| | - Vilde E. Skingen
- Department of Radiation BiologyNorwegian Radium HospitalOslo University HospitalNorway
| | - Eva‐Katrine Aarnes
- Department of Radiation BiologyNorwegian Radium HospitalOslo University HospitalNorway
| | - Christina S. Fjeldbo
- Department of Radiation BiologyNorwegian Radium HospitalOslo University HospitalNorway
| | - Tord Hompland
- Department of Radiation BiologyNorwegian Radium HospitalOslo University HospitalNorway
- Department of Core FacilitiesNorwegian Radium HospitalOslo University HospitalNorway
| | - Tina Sandø Evensen
- Department of Core FacilitiesNorwegian Radium HospitalOslo University HospitalNorway
| | - Trond Stokke
- Department of Core FacilitiesNorwegian Radium HospitalOslo University HospitalNorway
| | - Gunnar B. Kristensen
- Department of Gynecological OncologyNorwegian Radium HospitalOslo University HospitalNorway
- Institute of Cancer Genetics and InformaticsOslo University HospitalNorway
| | - Beata Grallert
- Department of Radiation BiologyNorwegian Radium HospitalOslo University HospitalNorway
| | - Heidi Lyng
- Department of Radiation BiologyNorwegian Radium HospitalOslo University HospitalNorway
- Department of PhysicsUniversity of OsloNorway
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21
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Moon EJ, Petersson K, Oleina MM. The importance of hypoxia in radiotherapy for the immune response, metastatic potential and FLASH-RT. Int J Radiat Biol 2022; 98:439-451. [PMID: 34726575 PMCID: PMC7612434 DOI: 10.1080/09553002.2021.1988178] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE Hypoxia (low oxygen) is a common feature of solid tumors that has been intensely studied for more than six decades. Here we review the importance of hypoxia to radiotherapy with a particular focus on the contribution of hypoxia to immune responses, metastatic potential and FLASH radiotherapy, active areas of research by leading women in the field. CONCLUSION Although hypoxia-driven metastasis and immunosuppression can negatively impact clinical outcome, understanding these processes can also provide tumor-specific vulnerabilities that may be therapeutically exploited. The different oxygen tensions present in tumors and normal tissues may underpin the beneficial FLASH sparing effect seen in normal tissue and represents a perfect example of advances in the field that can leverage tumor hypoxia to improve future radiotherapy treatments.
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Affiliation(s)
- Eui Jung Moon
- MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, OX3 7DQ, UK,Equal Contribution and to whom correspondence should be addressed. ; :
| | - Kristoffer Petersson
- MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, OX3 7DQ, UK,Radiation Physics, Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Sweden,Equal Contribution and to whom correspondence should be addressed. ; :
| | - Monica M. Oleina
- MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, OX3 7DQ, UK,Equal Contribution and to whom correspondence should be addressed. ; :
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22
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Datta A, West C, O'Connor JPB, Choudhury A, Hoskin P. Impact of hypoxia on cervical cancer outcomes. Int J Gynecol Cancer 2021; 31:1459-1470. [PMID: 34593564 DOI: 10.1136/ijgc-2021-002806] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/14/2021] [Indexed: 01/22/2023] Open
Abstract
The annual global incidence of cervical cancer is approximately 604 000 cases/342 000 deaths, making it the fourth most common cancer in women. Cervical cancer is a major healthcare problem in low and middle income countries where 85% of new cases and deaths occur. Secondary prevention measures have reduced incidence and mortality in developed countries over the past 30 years, but cervical cancer remains a major cause of cancer deaths in women. For women who present with Fédération Internationale de Gynécologie et d'Obstétrique (FIGO 2018) stages IB3 or upwards, chemoradiation is the established treatment. Despite high rates of local control, overall survival is less than 50%, largely due to distant relapse. Reducing the health burden of cervical cancer requires greater individualization of treatment, identifying those at risk of relapse and progression for modified or intensified treatment. Hypoxia is a well known feature of solid tumors and an established therapeutic target. Low tumorous oxygenation increases the risk of local invasion, metastasis and treatment failure. While meta-analyses show benefit, many individual trials targeting hypoxia failed in part due to not selecting patients most likely to benefit. This review summarizes the available hypoxia-targeted strategies and identifies further research and new treatment paradigms needed to improve patient outcomes. The applications and limitations of hypoxia biomarkers for treatment selection and response monitoring are discussed. Finally, areas of greatest unmet clinical need are identified to measure and target hypoxia and therefore improve cervical cancer outcomes.
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Affiliation(s)
- Anubhav Datta
- Division of Cancer Sciences, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK
- Clinical Radiology, The Christie NHS Foundation Trust, Manchester, UK
| | - Catharine West
- Division of Cancer Sciences, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK
| | - James P B O'Connor
- Division of Cancer Sciences, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK
- Division of Radiotherapy and Imaging, Institute of Cancer Research, London, UK
| | - Ananya Choudhury
- Division of Cancer Sciences, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK
- Clinical Oncology, The Christie Hospital NHS Trust, Manchester, UK
| | - Peter Hoskin
- Division of Cancer Sciences, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK
- Clinical Oncology, Mount Vernon Cancer Centre, Northwood, Middlesex, UK
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23
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Bader SB, Ma TS, Simpson CJ, Liang J, Maezono S, Olcina M, Buffa F, Hammond E. Replication catastrophe induced by cyclic hypoxia leads to increased APOBEC3B activity. Nucleic Acids Res 2021; 49:7492-7506. [PMID: 34197599 PMCID: PMC8287932 DOI: 10.1093/nar/gkab551] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 06/07/2021] [Accepted: 06/11/2021] [Indexed: 11/14/2022] Open
Abstract
Tumor heterogeneity includes variable and fluctuating oxygen concentrations, which result in the accumulation of hypoxic regions in most solid tumors. Tumor hypoxia leads to increased therapy resistance and has been linked to genomic instability. Here, we tested the hypothesis that exposure to levels of hypoxia that cause replication stress could increase APOBEC activity and the accumulation of APOBEC-mediated mutations. APOBEC-dependent mutational signatures have been well-characterized, although the physiological conditions which underpin them have not been described. We demonstrate that fluctuating/cyclic hypoxic conditions which lead to replication catastrophe induce the expression and activity of APOBEC3B. In contrast, stable/chronic hypoxic conditions which induce replication stress in the absence of DNA damage are not sufficient to induce APOBEC3B. Most importantly, the number of APOBEC-mediated mutations in patient tumors correlated with a hypoxia signature. Together, our data support the conclusion that hypoxia-induced replication catastrophe drives genomic instability in tumors, specifically through increasing the activity of APOBEC3B.
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Affiliation(s)
- Samuel B Bader
- Oxford Institute for Radiation Oncology, Department of Oncology, The University of Oxford, Oxford, OX3 7DQ, UK
| | - Tiffany S Ma
- Oxford Institute for Radiation Oncology, Department of Oncology, The University of Oxford, Oxford, OX3 7DQ, UK
| | - Charlotte J Simpson
- Oxford Institute for Radiation Oncology, Department of Oncology, The University of Oxford, Oxford, OX3 7DQ, UK
| | - Jiachen Liang
- Oxford Institute for Radiation Oncology, Department of Oncology, The University of Oxford, Oxford, OX3 7DQ, UK
| | - Sakura Eri B Maezono
- Oxford Institute for Radiation Oncology, Department of Oncology, The University of Oxford, Oxford, OX3 7DQ, UK
| | - Monica M Olcina
- Oxford Institute for Radiation Oncology, Department of Oncology, The University of Oxford, Oxford, OX3 7DQ, UK
| | - Francesca M Buffa
- Oxford Institute for Radiation Oncology, Department of Oncology, The University of Oxford, Oxford, OX3 7DQ, UK
| | - Ester M Hammond
- Oxford Institute for Radiation Oncology, Department of Oncology, The University of Oxford, Oxford, OX3 7DQ, UK
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24
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Wang YF, Tadimalla S, Hayden AJ, Holloway L, Haworth A. Artificial intelligence and imaging biomarkers for prostate radiation therapy during and after treatment. J Med Imaging Radiat Oncol 2021; 65:612-626. [PMID: 34060219 DOI: 10.1111/1754-9485.13242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/18/2021] [Accepted: 05/02/2021] [Indexed: 12/15/2022]
Abstract
Magnetic resonance imaging (MRI) is increasingly used in the management of prostate cancer (PCa). Quantitative MRI (qMRI) parameters, derived from multi-parametric MRI, provide indirect measures of tumour characteristics such as cellularity, angiogenesis and hypoxia. Using Artificial Intelligence (AI), relevant information and patterns can be efficiently identified in these complex data to develop quantitative imaging biomarkers (QIBs) of tumour function and biology. Such QIBs have already demonstrated potential in the diagnosis and staging of PCa. In this review, we explore the role of these QIBs in monitoring treatment response during and after PCa radiotherapy (RT). Recurrence of PCa after RT is not uncommon, and early detection prior to development of metastases provides an opportunity for salvage treatments with curative intent. However, the current method of monitoring treatment response using prostate-specific antigen levels lacks specificity. QIBs, derived from qMRI and developed using AI techniques, can be used to monitor biological changes post-RT providing the potential for accurate and early diagnosis of recurrent disease.
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Affiliation(s)
- Yu-Feng Wang
- Institute of Medical Physics, School of Physics, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Sirisha Tadimalla
- Institute of Medical Physics, School of Physics, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Amy J Hayden
- Sydney West Radiation Oncology, Westmead Hospital, Wentworthville, New South Wales, Australia
- Faculty of Medicine, Western Sydney University, Sydney, New South Wales, Australia
- Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Lois Holloway
- Institute of Medical Physics, School of Physics, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- Liverpool and Macarthur Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Annette Haworth
- Institute of Medical Physics, School of Physics, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
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25
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Gaustad JV, Rofstad EK. Assessment of Hypoxic Tissue Fraction and Prediction of Survival in Cervical Carcinoma by Dynamic Contrast-Enhanced MRI. Front Oncol 2021; 11:668916. [PMID: 34094964 PMCID: PMC8173130 DOI: 10.3389/fonc.2021.668916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/26/2021] [Indexed: 01/11/2023] Open
Abstract
Tumor hypoxia is a major cause of treatment resistance and poor survival in locally-advanced cervical carcinoma (LACC). It has been suggested that Ktrans and ve maps derived by dynamic contrast-enhanced magnetic resonance imaging can provide information on the oxygen supply and oxygen consumption of tumors, but it is not clear whether and how these maps can be combined to identify tumor hypoxia. The aim of the current study was to find the optimal strategy for calculating hypoxic fraction and predicting survival from Ktrans and ve maps in cervical carcinoma. Ktrans and ve maps of 98 tumors of four patient-derived xenograft models of cervical carcinoma as well as 80 patients with LACC were investigated. Hypoxic fraction calculated by using Ktrans maps correlated strongly (P < 0.0001) to hypoxic fraction assessed with immunohistochemistry using pimonidazole as a hypoxia marker and was associated with disease-free and overall survival in LACC patients. Maps of ve did not provide information on hypoxic fraction and patient outcome, and combinations of Ktrans and ve were not superior to Ktrans alone for calculating hypoxic fraction. These observations imply that Ktrans maps reflect oxygen supply and may be used to identify hypoxia and predict outcome in cervical carcinoma, whereas ve is a poor parameter of oxygen consumption and does not provide information on tumor oxygenation status.
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Affiliation(s)
- Jon-Vidar Gaustad
- Group of Radiation Biology and Tumor Physiology, Department of Radiation Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Einar K Rofstad
- Group of Radiation Biology and Tumor Physiology, Department of Radiation Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
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26
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Burchardt E, Burchardt W, Cegła P, Kubiak A, Roszak A, Cholewiński W. Pretreatment [ 18F]FDG PET/CT Prognostic Factors in Patients with Squamous Cell Cervical Carcinoma FIGO IIIC1. Diagnostics (Basel) 2021; 11:diagnostics11040714. [PMID: 33923621 PMCID: PMC8073234 DOI: 10.3390/diagnostics11040714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 11/16/2022] Open
Abstract
PURPOSE This study aims to determine whether semiquantitative parameters obtained from both the primary tumor and metastatic pelvic lymph nodes (PLN) diagnosed in fluoro-18-deoxy-glucose positron emission tomography (FDG-PET-CT) are associated with disease-free survival (DFS), local control (LC), distant metastasis-free survival (DMFS) and overall survival (OS) in patients with locally advanced squamous cervical cancer (LACC) and metastatic pelvic lymph nodes. MATERIALS Retrospective analysis was performed on 93 female patients with FIGO IIIC1. The median age was 53 years (27-75). The PET parameters both in the primary tumor and metastatic pelvic lymph nodes, including SUVmax, SUVmean, TLG, MTV, heterogeneity, along with clinical variables, before radical cisplatin-based radiochemotherapy (RCT) were analyzed. The p-values < 0.05 were considered statistically significant. RESULTS Median follow-up was 38 months (4.5-92.6). Three years and five years OS were 75% and 70% respectively. Patients with SUVmax above 12.6, SUVmean above 7.6 and with TLG in tumors >245.7 lived longer (p < 0.05). The higher SUVmax or SUVmean reduced increased DMFS (HR 0.3 95%CI 0.56-0.96 and 0.59 95%CI 0.37-0.93). The clinical factors and other FDG PET CT parameters were not found to be statistically relevant in terms of OS, DFS, DM and LC. CONCLUSIONS This study is the first report showing that in LACC patient population with PLN involvement treated with definitive RCT, high SUVmean, SUVmax and TLG of the primary tumor in FDG-PET-CT were linked with longer OS. Lower SUVmean and SUVmax were linked with shorter DMFS. None of the clinical factors and the nodal FDG-PET-CT parameters influenced the outcome.
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Affiliation(s)
- Ewa Burchardt
- Department of Radiotherapy and Oncological Gynecology, Greater Poland Cancer Center, 61-866 Poznan, Poland;
- University of Medical Science Poznan, 61-866 Poznan, Poland; (W.B.); (W.C.)
- Correspondence:
| | - Wojciech Burchardt
- University of Medical Science Poznan, 61-866 Poznan, Poland; (W.B.); (W.C.)
- Department of Brachytherapy, Greater Poland Cancer Center, 61-866 Poznan, Poland
| | - Paulina Cegła
- Department of Nuclear Medicine, Greater Poland Cancer Center, 61-866 Poznan, Poland;
| | - Anna Kubiak
- Department of Epidemiology, Greater Poland Cancer Center, 61-866 Poznan, Poland;
| | - Andrzej Roszak
- Department of Radiotherapy and Oncological Gynecology, Greater Poland Cancer Center, 61-866 Poznan, Poland;
- University of Medical Science Poznan, 61-866 Poznan, Poland; (W.B.); (W.C.)
| | - Witold Cholewiński
- University of Medical Science Poznan, 61-866 Poznan, Poland; (W.B.); (W.C.)
- Department of Nuclear Medicine, Greater Poland Cancer Center, 61-866 Poznan, Poland;
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27
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Tumor Hypoxia as a Barrier in Cancer Therapy: Why Levels Matter. Cancers (Basel) 2021; 13:cancers13030499. [PMID: 33525508 PMCID: PMC7866096 DOI: 10.3390/cancers13030499] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Hypoxia is a common feature of solid tumors and associated with poor outcome in most cancer types and treatment modalities, including radiotherapy, chemotherapy, surgery and, most likely, immunotherapy. Emerging strategies, such as proton therapy and combination therapies with radiation and hypoxia targeted drugs, provide new opportunities to overcome the hypoxia barrier and improve therapeutic outcome. Hypoxia is heterogeneously distributed both between and within tumors and shows large variations across patients not only in prevalence, but importantly, also in level. To best exploit the emerging strategies, a better understanding of how individual hypoxia levels from mild to severe affect tumor biology is vital. Here, we discuss our current knowledge on this topic and how we should proceed to gain more insight into the field. Abstract Hypoxia arises in tumor regions with insufficient oxygen supply and is a major barrier in cancer treatment. The distribution of hypoxia levels is highly heterogeneous, ranging from mild, almost non-hypoxic, to severe and anoxic levels. The individual hypoxia levels induce a variety of biological responses that impair the treatment effect. A stronger focus on hypoxia levels rather than the absence or presence of hypoxia in our investigations will help development of improved strategies to treat patients with hypoxic tumors. Current knowledge on how hypoxia levels are sensed by cancer cells and mediate cellular responses that promote treatment resistance is comprehensive. Recently, it has become evident that hypoxia also has an important, more unexplored role in the interaction between cancer cells, stroma and immune cells, influencing the composition and structure of the tumor microenvironment. Establishment of how such processes depend on the hypoxia level requires more advanced tumor models and methodology. In this review, we describe promising model systems and tools for investigations of hypoxia levels in tumors. We further present current knowledge and emerging research on cellular responses to individual levels, and discuss their impact in novel therapeutic approaches to overcome the hypoxia barrier.
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