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Fekete Z, Ignat P, Resiga AC, Todor N, Muntean AS, Resiga L, Curcean S, Lazar G, Gherman A, Eniu D. Unselective Measurement of Tumor-to-Stroma Proportion in Colon Cancer at the Invasion Front-An Elusive Prognostic Factor: Original Patient Data and Review of the Literature. Diagnostics (Basel) 2024; 14:836. [PMID: 38667481 PMCID: PMC11049389 DOI: 10.3390/diagnostics14080836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
The tumor-to-stroma ratio is a highly debated prognostic factor in the management of several solid tumors and there is no universal agreement on its practicality. In our study, we proposed confirming or dismissing the hypothesis that a simple measurement of stroma quantity is an easy-to-use and strong prognostic tool. We have included 74 consecutive patients with colorectal cancer who underwent primary curative abdominal surgery. The tumors have been grouped into stroma-poor (stroma < 10%), medium-stroma (between 10 and 50%) and stroma-rich (over 50%). The proportion of tumor stroma ranged from 5% to 70% with a median of 25%. Very few, only 6.8% of patients, had stroma-rich tumors, 4% had stroma-poor tumors and 89.2% had tumors with a medium quantity of stroma. The proportion of stroma, at any cut-off, had no statistically significant influence on the disease-specific survival. This can be explained by the low proportion of stroma-rich tumors in our patient group and the inverse correlation between stroma proportion and tumor grade. The real-life proportion of stroma-rich tumors and the complex nature of the stroma-tumor interaction has to be further elucidated.
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Affiliation(s)
- Zsolt Fekete
- Department of Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (P.I.); (S.C.); (G.L.); (A.G.); (D.E.)
- “Prof. Dr. I. Chiricuță” Oncology Institute, 400015 Cluj-Napoca, Romania; (N.T.); (A.-S.M.); (L.R.)
| | - Patricia Ignat
- Department of Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (P.I.); (S.C.); (G.L.); (A.G.); (D.E.)
- “Prof. Dr. I. Chiricuță” Oncology Institute, 400015 Cluj-Napoca, Romania; (N.T.); (A.-S.M.); (L.R.)
| | | | - Nicolae Todor
- “Prof. Dr. I. Chiricuță” Oncology Institute, 400015 Cluj-Napoca, Romania; (N.T.); (A.-S.M.); (L.R.)
| | - Alina-Simona Muntean
- “Prof. Dr. I. Chiricuță” Oncology Institute, 400015 Cluj-Napoca, Romania; (N.T.); (A.-S.M.); (L.R.)
| | - Liliana Resiga
- “Prof. Dr. I. Chiricuță” Oncology Institute, 400015 Cluj-Napoca, Romania; (N.T.); (A.-S.M.); (L.R.)
| | - Sebastian Curcean
- Department of Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (P.I.); (S.C.); (G.L.); (A.G.); (D.E.)
- “Prof. Dr. I. Chiricuță” Oncology Institute, 400015 Cluj-Napoca, Romania; (N.T.); (A.-S.M.); (L.R.)
| | - Gabriel Lazar
- Department of Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (P.I.); (S.C.); (G.L.); (A.G.); (D.E.)
| | - Alexandra Gherman
- Department of Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (P.I.); (S.C.); (G.L.); (A.G.); (D.E.)
- “Prof. Dr. I. Chiricuță” Oncology Institute, 400015 Cluj-Napoca, Romania; (N.T.); (A.-S.M.); (L.R.)
| | - Dan Eniu
- Department of Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (P.I.); (S.C.); (G.L.); (A.G.); (D.E.)
- Nicolae Stăncioiu Heart Institute, 400001 Cluj-Napoca, Romania;
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Kalantar R, Curcean S, Winfield JM, Lin G, Messiou C, Blackledge MD, Koh DM. Deep Learning Framework with Multi-Head Dilated Encoders for Enhanced Segmentation of Cervical Cancer on Multiparametric Magnetic Resonance Imaging. Diagnostics (Basel) 2023; 13:3381. [PMID: 37958277 PMCID: PMC10647438 DOI: 10.3390/diagnostics13213381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/29/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023] Open
Abstract
T2-weighted magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) are essential components of cervical cancer diagnosis. However, combining these channels for the training of deep learning models is challenging due to image misalignment. Here, we propose a novel multi-head framework that uses dilated convolutions and shared residual connections for the separate encoding of multiparametric MRI images. We employ a residual U-Net model as a baseline, and perform a series of architectural experiments to evaluate the tumor segmentation performance based on multiparametric input channels and different feature encoding configurations. All experiments were performed on a cohort of 207 patients with locally advanced cervical cancer. Our proposed multi-head model using separate dilated encoding for T2W MRI and combined b1000 DWI and apparent diffusion coefficient (ADC) maps achieved the best median Dice similarity coefficient (DSC) score, 0.823 (confidence interval (CI), 0.595-0.797), outperforming the conventional multi-channel model, DSC 0.788 (95% CI, 0.568-0.776), although the difference was not statistically significant (p > 0.05). We investigated channel sensitivity using 3D GRAD-CAM and channel dropout, and highlighted the critical importance of T2W and ADC channels for accurate tumor segmentation. However, our results showed that b1000 DWI had a minor impact on the overall segmentation performance. We demonstrated that the use of separate dilated feature extractors and independent contextual learning improved the model's ability to reduce the boundary effects and distortion of DWI, leading to improved segmentation performance. Our findings could have significant implications for the development of robust and generalizable models that can extend to other multi-modal segmentation applications.
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Affiliation(s)
- Reza Kalantar
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London SW7 3RP, UK; (R.K.); (J.M.W.); (C.M.); (D.-M.K.)
- Department of Radiology, The Royal Marsden Hospital, London SW3 6JJ, UK
| | - Sebastian Curcean
- Department of Radiation Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania;
| | - Jessica M. Winfield
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London SW7 3RP, UK; (R.K.); (J.M.W.); (C.M.); (D.-M.K.)
- Department of Radiology, The Royal Marsden Hospital, London SW3 6JJ, UK
| | - Gigin Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Guishan, Taoyuan 333, Taiwan;
| | - Christina Messiou
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London SW7 3RP, UK; (R.K.); (J.M.W.); (C.M.); (D.-M.K.)
- Department of Radiology, The Royal Marsden Hospital, London SW3 6JJ, UK
| | - Matthew D. Blackledge
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London SW7 3RP, UK; (R.K.); (J.M.W.); (C.M.); (D.-M.K.)
- Department of Radiology, The Royal Marsden Hospital, London SW3 6JJ, UK
| | - Dow-Mu Koh
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London SW7 3RP, UK; (R.K.); (J.M.W.); (C.M.); (D.-M.K.)
- Department of Radiology, The Royal Marsden Hospital, London SW3 6JJ, UK
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Malicki J, Castro CL, Fundowicz M, Krengli M, Llacer-Moscardo C, Curcean S, Montplet CM, Carvalho L, Konstanty E, Barragan TH, Pisani C, Laszlo I, Garau MM, Kruszyna-Mochalska M, Lencart J, Zwierzchowska D, Serrano AR, Brezae A, Varela EL, Milecki P, Zannetti M, Coza O, Gonzalez E, Beldì D, Guedea F. IROCA-TES: Improving Quality in Radiation Oncology through Clinical Audits - Training and Education for Standardization. Rep Pract Oncol Radiother 2023; 28:429-432. [PMID: 37795403 PMCID: PMC10547405 DOI: 10.5603/rpor.a2023.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/23/2023] [Indexed: 10/06/2023] Open
Abstract
Background Clinical audits are an important tool to objectively assess clinical protocols, procedures, and processes and to detect deviations from good clinical practice. The main aim of this project is to determine adherence to a core set of consensus- based quality indicators and then to compare the institutions in order to identify best practices. Materials and methods We conduct a multicentre, international clinical audit of six comprehensive cancer centres in Poland, Spain, Italy, Portugal, France, and Romania as a part of the project, known as IROCATES (Improving Quality in Radiation Oncology through Clinical Audits - Training and Education for Standardization). Results Radiotherapy practice varies from country to country, in part due to historical, economic, linguistic, and cultural differences. The institutions developed their own processes to suit their existing clinical practice. Conclusions We believe that this study will contribute to establishing the value of routinely performing multi-institutional clinical audits and will lead to improvement of radiotherapy practice at the participating centres.
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Affiliation(s)
- Julian Malicki
- Electroradiology Department, University of Medical Sciences, Poznan, Poland
- Greater Poland Cancer Centre, Poznan, Poland
| | - Carla Lopes Castro
- Department of Radiotherapy, Instituto Português de Oncologia do Porto Francisco Gentil, Portugal
| | | | - Marco Krengli
- Department of Radiation Oncology, University Hospital “Maggiore della Carità”, Novara, Italy
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | | | - Sebastian Curcean
- Department of Radiation Oncology, Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania
| | - Carles Muñoz Montplet
- Department of Medical Physics and Radiation Protection, Catalan Institute of Oncology, Girona, Spain
| | - Luisa Carvalho
- Department of Radiotherapy, Instituto Português de Oncologia do Porto Francisco Gentil, Portugal
| | - Ewelina Konstanty
- Medical Physics Department, The Greater Poland Cancer Centre, Poznan, Poland
| | - Tania Hernandez Barragan
- Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco, Mexico
| | - Carla Pisani
- Department of Radiation Oncology, University Hospital “Maggiore della Carità”, Novara, Italy
| | - Istvan Laszlo
- Department of Radiation Oncology, Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania
| | - Miquel Macià Garau
- Department of Radiation Oncology, Catalan Institute of Oncology, Barcelona, Spain
| | - Marta Kruszyna-Mochalska
- Electroradiology Department, University of Medical Sciences, Poznan, Poland
- Medical Physics Department, The Greater Poland Cancer Centre, Poznan, Poland
| | - Joana Lencart
- Medical Physics Service & Medical Physics, Radiobiology and Radiation Protection Group CI-IPOP, Instituto Português de Oncologia do Porto
| | | | | | | | - Eva Loureiro Varela
- Department of Information Systems, Catalan Institute of Oncology, (ICO) Barcelona, Spain
| | - Piotr Milecki
- Electroradiology Department, University of Medical Sciences, Poznan, Poland
- Radiotherapy Ward I, Greater Poland Cancer Centre, Poznan, Poland
| | - Micol Zannetti
- Department of Radiation Oncology, University Hospital “Maggiore della Carità”, Novara, Italy
| | - Ovidiu Coza
- Department of Radiotherapy with High Energies and Brachytherapy, Oncology Institute “Prof. Dr. Ion Chiricuta”, Cluj-Napoca, Romania
| | - Eva Gonzalez
- Department of Processes & Quality Management, Catalan Institute of Oncology, Barcelona, Spain
| | - Debora Beldì
- Department of Radiation Oncology, University Hospital “Maggiore della Carità”, Novara, Italy
| | - Ferran Guedea
- Department of Radiation Oncology, Catalan Institute of Oncology, Barcelona, Spain
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Curcean S, Cheng L, Picchia S, Tunariu N, Collins D, Blackledge M, Popat S, O'Brien M, Minchom A, Leach MO, Koh DM. Early Response to Chemotherapy in Malignant Pleural Mesothelioma Evaluated Using Diffusion-Weighted Magnetic Resonance Imaging: Initial Observations. JTO Clin Res Rep 2021; 2:100253. [PMID: 34870249 PMCID: PMC8626584 DOI: 10.1016/j.jtocrr.2021.100253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/22/2021] [Accepted: 10/27/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction We compared the magnetic resonance imaging total tumor volume (TTV) and median apparent diffusion coefficient (ADC) of malignant pleural mesothelioma (MPM) before and at 4 weeks after chemotherapy, to evaluate whether these are potential early markers of treatment response. Methods Diffusion-weighted magnetic resonance imaging was performed in 23 patients with MPM before and after 4 weeks of chemotherapy. The TTV was measured by semiautomatic segmentation (GrowCut) and transferred onto ADC maps to record the median ADC. Test-retest repeatability of TTV and ADC was evaluated in eight patients. TTV and median ADC changes were compared between responders and nonresponders, defined using modified Response Evaluation Criteria In Solid Tumors on computed tomography (CT) at 12 weeks after treatment. TTV and median ADC were also correlated with CT size measurement and disease survival. Results The test-retest 95% limits of agreement for TTV were -13.9% to 16.2% and for median ADC -1.2% to 3.3%. A significant increase in median ADC in responders was observed at 4 weeks after treatment (p = 0.02). Correlation was found between CT tumor size change at 12 weeks and median ADC changes at 4 weeks post-treatment (r = -0.560, p = 0.006). An increase in median ADC greater than 5.1% at 4 weeks has 100% sensitivity and 90% specificity for responders (area under the curve = 0.933, p < 0.001). There was also moderate correlation between median tumor ADC at baseline and overall survival (r = 0.45, p = 0.03). Conclusions Diffusion-weighted magnetic resonance imaging measurements of TTV and median ADC in MPM have good measurement repeatability. Increase in ADC at 4 weeks post-treatment has the potential to be an early response biomarker.
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Affiliation(s)
- Sebastian Curcean
- Department of Radiation Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Department of Radiation Oncology, Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania.,Department of Radiology, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Lin Cheng
- Division of Radiotherapy and Imaging, Institute of Cancer Research, London, United Kingdom
| | - Simona Picchia
- Department of Radiology, Bordet Institute, Bruxelles, Belgium
| | - Nina Tunariu
- Department of Radiology, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - David Collins
- Division of Radiotherapy and Imaging, Institute of Cancer Research, London, United Kingdom
| | - Matthew Blackledge
- Division of Radiotherapy and Imaging, Institute of Cancer Research, London, United Kingdom
| | - Sanjay Popat
- Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Mary O'Brien
- Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Anna Minchom
- Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Martin O Leach
- Department of Radiology, Royal Marsden NHS Foundation Trust, London, United Kingdom.,Division of Radiotherapy and Imaging, Institute of Cancer Research, London, United Kingdom
| | - Dow-Mu Koh
- Department of Radiology, Royal Marsden NHS Foundation Trust, London, United Kingdom.,Division of Radiotherapy and Imaging, Institute of Cancer Research, London, United Kingdom
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Zormpas-Petridis K, Tunariu N, Curcean A, Messiou C, Curcean S, Collins DJ, Hughes JC, Jamin Y, Koh DM, Blackledge MD. Accelerating Whole-Body Diffusion-weighted MRI with Deep Learning-based Denoising Image Filters. Radiol Artif Intell 2021; 3:e200279. [PMID: 34617028 PMCID: PMC8489468 DOI: 10.1148/ryai.2021200279] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 05/11/2021] [Accepted: 06/04/2021] [Indexed: 11/23/2022]
Abstract
Purpose To use deep learning to improve the image quality of subsampled images (number of acquisitions = 1 [NOA1]) to reduce whole-body diffusion-weighted MRI (WBDWI) acquisition times. Materials and Methods Both retrospective and prospective patient groups were used to develop a deep learning–based denoising image filter (DNIF) model. For initial model training and validation, 17 patients with metastatic prostate cancer with acquired WBDWI NOA1 and NOA9 images (acquisition period, 2015–2017) were retrospectively included. An additional 22 prospective patients with advanced prostate cancer, myeloma, and advanced breast cancer were used for model testing (2019), and the radiologic quality of DNIF-processed NOA1 (NOA1-DNIF) images were compared with NOA1 images and clinical NOA16 images by using a three-point Likert scale (good, average, or poor; statistical significance was calculated by using a Wilcoxon signed ranked test). The model was also retrained and tested in 28 patients with malignant pleural mesothelioma (MPM) who underwent lung MRI (2015–2017) to demonstrate feasibility in other body regions. Results The model visually improved the quality of NOA1 images in all test patients, with the majority of NOA1-DNIF and NOA16 images being graded as either “average” or “good” across all image-quality criteria. From validation data, the mean apparent diffusion coefficient (ADC) values within NOA1-DNIF images of bone disease deviated from those within NOA9 images by an average of 1.9% (range, 1.1%–2.6%). The model was also successfully applied in the context of MPM; the mean ADCs from NOA1-DNIF images of MPM deviated from those measured by using clinical-standard images (NOA12) by 3.7% (range, 0.2%–10.6%). Conclusion Clinical-standard images were generated from subsampled images by using a DNIF. Keywords: Image Postprocessing, MR-Diffusion-weighted Imaging, Neural Networks, Oncology, Whole-Body Imaging, Supervised Learning, MR-Functional Imaging, Metastases, Prostate, Lung Supplemental material is available for this article. Published under a CC BY 4.0 license.
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Affiliation(s)
- Konstantinos Zormpas-Petridis
- Division of Radiation Therapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Rd, London SW7 3RP, England (K.Z.P., N.T., A.C., C.M., S.C., D.J.C., J.C.H., Y.J., D.M.K., M.D.B.); and Department of Radiology, The Royal Marsden National Health Service Foundation Trust, Surrey, England (N.T., A.C., C.M., S.C., J.C.H., D.M.K.)
| | - Nina Tunariu
- Division of Radiation Therapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Rd, London SW7 3RP, England (K.Z.P., N.T., A.C., C.M., S.C., D.J.C., J.C.H., Y.J., D.M.K., M.D.B.); and Department of Radiology, The Royal Marsden National Health Service Foundation Trust, Surrey, England (N.T., A.C., C.M., S.C., J.C.H., D.M.K.)
| | - Andra Curcean
- Division of Radiation Therapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Rd, London SW7 3RP, England (K.Z.P., N.T., A.C., C.M., S.C., D.J.C., J.C.H., Y.J., D.M.K., M.D.B.); and Department of Radiology, The Royal Marsden National Health Service Foundation Trust, Surrey, England (N.T., A.C., C.M., S.C., J.C.H., D.M.K.)
| | - Christina Messiou
- Division of Radiation Therapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Rd, London SW7 3RP, England (K.Z.P., N.T., A.C., C.M., S.C., D.J.C., J.C.H., Y.J., D.M.K., M.D.B.); and Department of Radiology, The Royal Marsden National Health Service Foundation Trust, Surrey, England (N.T., A.C., C.M., S.C., J.C.H., D.M.K.)
| | - Sebastian Curcean
- Division of Radiation Therapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Rd, London SW7 3RP, England (K.Z.P., N.T., A.C., C.M., S.C., D.J.C., J.C.H., Y.J., D.M.K., M.D.B.); and Department of Radiology, The Royal Marsden National Health Service Foundation Trust, Surrey, England (N.T., A.C., C.M., S.C., J.C.H., D.M.K.)
| | - David J Collins
- Division of Radiation Therapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Rd, London SW7 3RP, England (K.Z.P., N.T., A.C., C.M., S.C., D.J.C., J.C.H., Y.J., D.M.K., M.D.B.); and Department of Radiology, The Royal Marsden National Health Service Foundation Trust, Surrey, England (N.T., A.C., C.M., S.C., J.C.H., D.M.K.)
| | - Julie C Hughes
- Division of Radiation Therapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Rd, London SW7 3RP, England (K.Z.P., N.T., A.C., C.M., S.C., D.J.C., J.C.H., Y.J., D.M.K., M.D.B.); and Department of Radiology, The Royal Marsden National Health Service Foundation Trust, Surrey, England (N.T., A.C., C.M., S.C., J.C.H., D.M.K.)
| | - Yann Jamin
- Division of Radiation Therapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Rd, London SW7 3RP, England (K.Z.P., N.T., A.C., C.M., S.C., D.J.C., J.C.H., Y.J., D.M.K., M.D.B.); and Department of Radiology, The Royal Marsden National Health Service Foundation Trust, Surrey, England (N.T., A.C., C.M., S.C., J.C.H., D.M.K.)
| | - Dow-Mu Koh
- Division of Radiation Therapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Rd, London SW7 3RP, England (K.Z.P., N.T., A.C., C.M., S.C., D.J.C., J.C.H., Y.J., D.M.K., M.D.B.); and Department of Radiology, The Royal Marsden National Health Service Foundation Trust, Surrey, England (N.T., A.C., C.M., S.C., J.C.H., D.M.K.)
| | - Matthew D Blackledge
- Division of Radiation Therapy and Imaging, The Institute of Cancer Research, 123 Old Brompton Rd, London SW7 3RP, England (K.Z.P., N.T., A.C., C.M., S.C., D.J.C., J.C.H., Y.J., D.M.K., M.D.B.); and Department of Radiology, The Royal Marsden National Health Service Foundation Trust, Surrey, England (N.T., A.C., C.M., S.C., J.C.H., D.M.K.)
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Hijab A, Curcean S, Tunariu N, Tovey H, Alonzi R, Staffurth J, Blackledge M, Padhani A, Tree A, Stidwill H, Finch J, Chatfield P, Perry S, Mu Koh D, Hall E, Parker C. Fracture Risk in Men with Metastatic Prostate Cancer Treated With Radium-223. Clin Genitourin Cancer 2021; 19:e299-e305. [PMID: 33958296 PMCID: PMC8514085 DOI: 10.1016/j.clgc.2021.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/17/2021] [Accepted: 03/27/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Radium-223 is a bone-seeking, alpha-emitting radionuclide used in metastatic castration-resistant prostate cancer (mCRPC). Radium-223 increases the risk of fracture when used in combination with abiraterone and prednisolone. The risk of fracture in men receiving radium-223 monotherapy is unclear. PATIENTS AND METHODS This was a prospective, multicenter phase II study of radium-223 in 36 men with mCRPC and a reference cohort (n = 36) matched for fracture risk and not treated with radium-223. Bone fractures were assessed using whole-body magnetic resonance imaging. The primary outcome was risk of new fractures. RESULTS Thirty-six patients were treated with up to six 4-week cycles of radium-223. With a median follow-up of 16.3 months, 74 new fractures were identified in 20 patients. Freedom from fracture was 56% (95% confidence interval, 35.3-71.6) at 12 months. On multivariate analysis, prior corticosteroid use was associated with risk of fracture. In the reference cohort (n = 36), 16 new fractures were identified in 12 patients over a median follow-up of 24 months. Across both cohorts, 67% of all fractures occurred at uninvolved bone. CONCLUSIONS Men with mCRPC, and particularly those treated with radium-223, are at risk of fracture. They should receive a bone health agent to reduce the risk of fragility fractures.
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Affiliation(s)
- Adham Hijab
- The Royal Marsden NHS Foundation Trust, London, UK
| | | | - Nina Tunariu
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - Holly Tovey
- The Institute of Cancer Research, London, UK
| | | | | | | | - Anwar Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK
| | - Alison Tree
- The Royal Marsden NHS Foundation Trust, London, UK
| | | | | | | | | | - Dow Mu Koh
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - Emma Hall
- The Institute of Cancer Research, London, UK
| | - Chris Parker
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK.
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Curcean A, Curcean S, Rescigno P, Dafydd DA, Tree A, Reid A, Koh DM, Sohaib A, Tunariu N, Shur J. Imaging features of the evolving patterns of metastatic prostate cancer. Clin Radiol 2021; 77:88-95. [PMID: 34598790 DOI: 10.1016/j.crad.2021.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 09/02/2021] [Indexed: 12/28/2022]
Abstract
The pattern of metastases in prostate cancer (PC) is evolving. Increased use of imaging, newer imaging techniques with higher sensitivity for disease detection and patients receiving multiple lines of novel therapies with increased life expectancy are likely to be contributory. Awareness of metastatic disease patterns improves early diagnosis, accurate staging, and initiation of appropriate therapy, and can inform prognostic information and anticipate potential disease complications. The aim of this review is to document the spectrum of metastases in PC including emerging and unusual patterns, and to highlight the role of novel imaging including prostate-specific membrane antigen (PSMA)-positron-emission tomography (PET) and whole-body magnetic resonance imaging (WB-MRI) to improve diagnostic and response assessment accuracy.
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Affiliation(s)
- A Curcean
- Department of Radiology, The Royal Marsden NHS Foundation Trust, UK; Institute of Cancer Research, Sutton, Surrey, UK
| | - S Curcean
- Department of Radiology, The Royal Marsden NHS Foundation Trust, UK
| | - P Rescigno
- Department of Radiology, The Royal Marsden NHS Foundation Trust, UK
| | - D Ap Dafydd
- Department of Radiology, The Royal Marsden NHS Foundation Trust, UK
| | - A Tree
- Institute of Cancer Research, Sutton, Surrey, UK; Academic Uro-oncology Unit, The Royal Marsden NHS Foundation Trust, UK
| | - A Reid
- Institute of Cancer Research, Sutton, Surrey, UK; Academic Uro-oncology Unit, The Royal Marsden NHS Foundation Trust, UK
| | - D-M Koh
- Department of Radiology, The Royal Marsden NHS Foundation Trust, UK; Institute of Cancer Research, Sutton, Surrey, UK
| | - A Sohaib
- Department of Radiology, The Royal Marsden NHS Foundation Trust, UK
| | - N Tunariu
- Department of Radiology, The Royal Marsden NHS Foundation Trust, UK; Institute of Cancer Research, Sutton, Surrey, UK
| | - J Shur
- Department of Radiology, The Royal Marsden NHS Foundation Trust, UK.
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Tunariu N, Blackledge M, Messiou C, Petralia G, Padhani A, Curcean S, Curcean A, Koh DM. What's New for Clinical Whole-body MRI (WB-MRI) in the 21st Century. Br J Radiol 2020; 93:20200562. [PMID: 32822545 DOI: 10.1259/bjr.20200562] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Whole-body MRI (WB-MRI) has evolved since its first introduction in the 1970s as an imaging technique to detect and survey disease across multiple sites and organ systems in the body. The development of diffusion-weighted MRI (DWI) has added a new dimension to the implementation of WB-MRI on modern scanners, offering excellent lesion-to-background contrast, while achieving acceptable spatial resolution to detect focal lesions 5 to 10 mm in size. MRI hardware and software advances have reduced acquisition times, with studies taking 40-50 min to complete.The rising awareness of medical radiation exposure coupled with the advantages of MRI has resulted in increased utilization of WB-MRI in oncology, paediatrics, rheumatological and musculoskeletal conditions and more recently in population screening. There is recognition that WB-MRI can be used to track disease evolution and monitor response heterogeneity in patients with cancer. There are also opportunities to combine WB-MRI with molecular imaging on PET-MRI systems to harness the strengths of hybrid imaging. The advent of artificial intelligence and machine learning will shorten image acquisition times and image analyses, making the technique more competitive against other imaging technologies.
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Affiliation(s)
- Nina Tunariu
- Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, London, UK.,Drug Development Unit, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, UK
| | - Matthew Blackledge
- Department of Radiotherapy, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, UK
| | - Christina Messiou
- Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, London, UK
| | - Giuseppe Petralia
- Department of Radiology, European Institute of Oncology, Via Ripamonti, 435 - 20141 Milan, Italy
| | - Anwar Padhani
- Mount Vernon Hospital, The Paul Strickland Scanner Centre, Rickmansworth Road, Northwood, Middlesex, UK
| | - Sebastian Curcean
- Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, London, UK
| | - Andra Curcean
- Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, London, UK.,Drug Development Unit, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, UK
| | - Dow-Mu Koh
- Drug Development Unit, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, UK
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