18F-Fluorocholine to distinguish necrosis from recurrence in brain metastases

18F-氟胆碱可区分脑转移瘤的坏死和复发

• 批准号: 8510050
• 负责人: Kathryn Beal
• 金额: $ 36.69万
• 依托单位: SLOAN-KETTERING INST CAN RESEARCH
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-04-05 至 2015-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8510050
• 关键词: Affect; Brain; Brain Neoplasms; Clinical; Data Set; Disseminated Malignant Neoplasm; Early Diagnosis; Enrollment; Evaluation; Excision; Flowcharts; Funding; Growth; Hospitalization; Image; Incidence; Kinetics; Lead; Lesion; MRI Scans; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Maps; Measures; Memorial Sloan-Kettering Cancer Center; Metastatic Lesion; Metastatic malignant neoplasm to brain; Modality; Modeling; Morbidity - disease rate; Necrosis; Necrotic Lesion; Neoplasm Metastasis; Operative Surgical Procedures; Pathologic; Pathology; Patients; Positron-Emission Tomography; Process; Protocols documentation; Radiation; Radiation necrosis; Radio; Radioactivity; Radiosurgery; Recurrence; Recurrent tumor; Relative (related person); Research; Resected; Sampling; Scanning; Sensitivity and Specificity; Specimen; Spectrum Analysis; Symptoms; Systemic Therapy; Tissue Sample; Toxic effect; base; cohort; common treatment; cost; density; diagnostic accuracy; effective therapy; fluorodeoxyglucose positron emission tomography; imaging modality; improved; in vivo; neoplastic cell; novel; outcome forecast; prevent; public health relevance; standard of care; time interval; treatment strategy; tumor; tumor growth; uptake

DESCRIPTION (provided by applicant): Approximately 180,000 patients per year develop brain metastases in the U.S. and the incidence is rising as patients with metastatic cancer survive longer, due to improved systemic therapies, and highly sensitive MR imaging which can detect small metastatic lesions. Stereotactic radiosurgery (SRS) is a common treatment for patients with a limited number of brain metastases. SRS is logistically convenient and is well tolerated in the short term. However, about 10-20% of treated lesions will eventually develop evolving lesions, and these are evenly split between radiation-induced necrosis and recurrent tumors. Necrosis and recurrence occur within the same time interval after SRS, and are difficult to distinguish on MRI or other standard imaging modalities, such as FDG PET. About 5-10% of cases of suspected necrosis and/or recurrence require neuro-surgical resection in order to alleviate symptoms and to establish the pathology associated with the lesion. The objective of this proposal is to improve the management of patients with evolving lesions following SRS for brain metastases. With a more accurate and earlier diagnosis, based on noninvasive imaging of an evolving lesion, we will be able to offer more appropriate and effective therapies in a more timely and efficient manner. This is particularly important since the treatment of necrotic lesions versus recurrent tumor is quite different. Often the toxicity associated with SRS-induced radio necrosis can be managed conservatively, and thus may reduce the need for surgical intervention and resection, thereby reducing patient morbidity/hospitalization and cost. In contrast, tumor recurrence needs to be managed early and more aggressively, in order to control the lesion, prevent growth, and associated symptoms. Our hypothesis is that 18F-Fluorocholine (18F-FCho) PET imaging will be able to distinguish necrosis from tumor recurrence in lesions that are evolving after SRS. This is a novel study. 18F-FCho has not been extensively or exclusively studied for evaluating evolving brain lesions after SRS. Furthermore, this is the first detailed comparison between the level of 18F-FCho radioactivity in tissue samples resected from the lesion and a detailed pathologic assessment the same tissue samples. This correlative imaging, lesion sampling and pathological study will validate 18F-FCho PET as a clinically useful predictor of post-SRS lesion pathology. We will also acquire dynamic contrast enhancement MRI (DCE-MRI) and magnetic resonance spectroscopy (MRS) pre-operatively in all of the patients as part of standard pre-operative evaluation. These advanced imaging datasets will also be assessed for their ability to distinguish necrosis from recurrence and thereby provide a direct reference within this cohort of patients against which the predictive capability of 18F-FCho may be judged.

描述（由申请人提供）：在美国，每年大约有 180,000 名患者出现脑转移，并且由于全身治疗的改进以及可以检测小转移病灶的高灵敏度 MR 成像，随着转移性癌症患者存活时间的延长，发病率也在上升。立体定向放射外科（SRS）是针对数量有限的脑转移患者的常见治疗方法。 SRS 在后勤上很方便，并且在短期内具有良好的耐受性。然而，大约 10-20% 的治疗病变最终会发展为不断演变的病变，这些病变在辐射引起的坏死和复发性肿瘤之间各占一半。坏死和复发发生在 SRS 后的同一时间间隔内，并且很难通过 MRI 或其他标准成像方式（例如 FDG PET）区分。大约 5-10% 的疑似坏死和/或复发病例需要神经外科切除术，以缓解症状并确定与病变相关的病理学。该提案的目的是改善对脑转移 SRS 后病变进展的患者的管理。通过基于不断变化的病变的无创成像进行更准确、更早的诊断，我们将能够更及时、更有效地提供更合适、更有效的治疗。这一点尤其重要，因为坏死病灶的治疗 与复发性肿瘤有很大不同。通常，与 SRS 引起的放射性坏死相关的毒性可以保守治疗，因此可以减少手术干预和切除的需要，从而降低患者的发病率/住院率和费用。相反，肿瘤复发需要尽早、更积极地进行治疗，以控制病变、防止生长和相关症状。我们的假设是，18F-氟胆碱 (18F-FCho) PET 成像将能够区分 SRS 后病变中的坏死和肿瘤复发。这是一项新颖的研究。 18F-FCh 尚未被广泛或专门研究用于评估 SRS 后演变的脑损伤。此外，这是从病灶切除的组织样本中 18F-Fcho 放射性水平与相同组织样本的详细病理评估之间的首次详细比较。这项相关成像、病变取样和病理学研究将验证 18F-Fcho PET 作为 SRS 后病变病理学的临床有用预测因子。作为标准术前评估的一部分，我们还将在所有患者术前采集动态对比增强 MRI (DCE-MRI) 和磁共振波谱 (MRS)。这些先进的成像数据集还将评估其区分坏死和复发的能力，从而在这组患者中提供直接参考，据此可以判断 18F-FCh 的预测能力。