Improving Pelvic Cancer Patient Chemoradiotherapy Outcomes with FLT PET Imaging

利用 FLT PET 成像改善盆腔癌患者放化疗的效果

• 批准号: 8678708
• 负责人: Sarah McGuire
• 金额: $ 28.13万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-22 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8678708
• 关键词: Acute; Affect; Aftercare; Anus; Area; Biological Markers; Bone Marrow; Cancer Patient; Chronic; Clinical Trials; Combination Drug Therapy; Combined Modality Therapy; Complete Blood Count; Complex; Data; Development; Disorder by Site; Dose; Failure; Financial compensation; Goals; Gynecologic; Image; Imaging Device; Imaging Techniques; Individual; Intensity-Modulated Radiotherapy; Lead; Local Therapy; Malignant neoplasm of anus; Malignant neoplasm of cervix uteri; Malignant neoplasm of prostate; Maps; Measures; Methodology; Methods; Monitor; Organ; Outcome; Patients; Pelvic Cancer; Pelvis; Planning Techniques; Positron-Emission Tomography; Proliferating; Prostate; Public Health; Radiation; Radiation Physics; Radiation therapy; Recovery; Rectal Cancer; Risk; Salvage Therapy; Staging; Structure; Systemic Therapy; Systemic disease; Testing; Time; Toxic effect; base; bone; chemoradiation; chemotherapy; cost; design; direct application; experience; hip bone; improved; innovation; molecular imaging; non-invasive imaging; rectal; response; simulation; therapy design; therapy outcome; tool; treatment planning; tumor; uptake

DESCRIPTION (provided by applicant): Overall survival of pelvic cancer patients depends on control of systemic disease. If local radiation therapy depletes bone marrow function to such an extent that systemic therapies must be withheld, the chances of metastatic failure are significantly increased. Strategies to limit toxicities could benefit a range of pelvic cancer patients including gynecologic, anal, rectal, and prostate. New combinations of chemotherapy and radiation therapy have shown improved outcomes for all of these disease sites, but it has come at the cost of higher levels of toxicity. Our preliminary data demonstrates the unique ability of FLT PET to identify regions of proliferating bone marrow within the pelvis and monitor response to chemoradiation therapy for two cervical cancer patients. This radiation physics treatment planning project proposes to incorporate these features of FLT PET into radiation therapy plan design to determine the optimal strategies for sparing bone marrow in the pelvis to reduce acute and chronic toxicities and improve outcomes for pelvic cancer patients. Initially, a FLT PET image will be taken at the time of simulation for radiation therapy planning. This image will be used to identify active regions of bone marrow in the pelvis as avoidance regions during radiation therapy plan design and optimization. Acute toxicity will be evaluated by monitoring the dose response of bone marrow measured with FLT PET images taken after one and two weeks of chemoradiation therapy correlated to complete blood counts taken at the time of imaging. Additionally, FLT PET images and complete blood counts will be taken 30 days and one year after chemoradiation therapy is complete to evaluate the recovery of bone marrow activity as a function of radiation dose and how this affects chronic toxicity. The dose thresholds critical to bone marrow activity depletion during therapy and the recovery after therapy could then be used to refine planning techniques and optimize therapy design to minimize acute and chronic toxicity. These radiation planning strategies for reducing toxicities may improve compliance with therapy which will lead to better outcomes for pelvic cancer patients. In addition, both reduced acute and chronic toxicities may provide the opportunity for dose escalation for better tumor control or salvage therapies if necessary. It may be that the optimal design of therapy to minimize toxicity and maximize therapy outcomes should consider the interrelationships between patient specific pre-therapy bone marrow activity spatial maps, the response of bone marrow during therapy, and the recovery of bone marrow after therapy.

描述（由申请人提供）：骨盆癌患者的整体存活取决于对全身性疾病的控制。如果局部辐射疗法耗尽了骨髓的功能，以至于必须抑制全身疗法，则转移性衰竭的机会显着增加。限制毒性的策略可以使包括妇科，肛门，直肠和前列腺在内的一系列骨盆癌患者受益。化学疗法和放射疗法的新组合已显示出所有这些疾病部位的结果改善，但它以较高的毒性为代价。我们的初步数据证明了独特的能力 Flt PET的识别骨盆内骨髓增殖的区域，并监测两名宫颈癌患者对化学放疗治疗的反应。该辐射物理治疗计划计划将FLT PET的这些特征纳入放射治疗计划设计中，以确定骨盆中释放骨髓的最佳策略，以降低急性和慢性毒性并改善骨盆癌患者的预后。最初，在放射治疗计划的模拟时将拍摄FLT PET图像。该图像将用于识别骨盆中骨髓的活跃区域，作为放射治疗计划设计和优化期间的回避区域。急性毒性将通过监测在成像时与完全血液计数相关的一和两周化学放疗治疗后拍摄的FLT PET图像测得的骨髓的剂量反应。此外，FLT PET图像和完整的血数将进行30天，并且在化学放疗治疗完成后一年，以评估骨髓活性的恢复，这是放射剂量的函数，以及这如何影响慢性毒性。在治疗过程中，对骨髓活性耗尽至关重要的剂量阈值，然后可以使用治疗后的恢复来完善计划技术并优化治疗设计，以最大程度地减少急性和慢性毒性。这些降低毒性的辐射计划策略可能会提高对疗法的依从性，这将为骨盆癌患者带来更好的结果。此外，急性和慢性毒性降低均可为剂量升级提供更好的机会，以便在必要时更好地控制肿瘤或挽救疗法。可能是最大程度地减少毒性和最大化治疗结果的治疗的最佳设计，应考虑患者特定特定的特定特定治疗前疗法骨髓活性，治疗过程中骨髓的反应以及治疗后骨髓的恢复之间的相互关系。