Using Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI) to Establish Objective Clinical Outcome Measures for Mandibular Osteoradionecrosis

使用动态对比增强磁共振成像 (DCE-MRI) 建立下颌放射性骨坏死的客观临床结果测量

• 批准号: 9247170
• 负责人: STEPHEN Y LAI
• 金额: $ 65.73万
• 依托单位: UNIVERSITY OF TX MD ANDERSON CAN CTR
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-04-01 至 2021-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9247170
• 关键词: Acute; Algorithms; Antibiotics; Blood Vessels; Cancer Patient; Caring; Chronic; Clinical; Clinical Research; Complex; Complication; Contrast Media; Coupled; Data; Data Reporting; Debridement; Development; Diagnosis; Diagnostic Imaging; Dimensions; Disease Management; Disease Progression; Dose; Drug Kinetics; Effectiveness; Ensure; Epidemic; Epidemiology; Event; Excision; External Beam Radiation Therapy; Failure; Goals; Head and Neck Cancer; Head and Neck Neoplasms; Head and neck structure; Human; Human Papillomavirus; Hyperbaric Oxygen; Image; Impaired wound healing; Incidence; Infection; Injection of therapeutic agent; Institution; Intensity-Modulated Radiotherapy; Knowledge; Lead; Life Expectancy; Magnetic Resonance Imaging; Mandible; Maps; Measurement; Measures; Methods; Mission; Monitor; Morbidity - disease rate; Natural History; Necrosis; Operative Surgical Procedures; Opportunistic Infections; Oral cavity; Oropharyngeal Neoplasms; Osteoradionecrosis; Outcome; Outcome Measure; Pathologic; Patient Outcomes Assessments; Patients; Perfusion; Physiology; Populations at Risk; Postoperative Period; Process; Public Health; Radiation; Radiation exposure; Radiation therapy; Reporting; Residual state; Resolution; Resources; Risk; SEER Program; Series; Signal Transduction; Solid Neoplasm; Staging; Staging System; Standardization; Surgical Flaps; Surgical Management; System; Techniques; Testing; Time; Tissues; United States; United States National Institutes of Health; Vascular remodeling; Work; X-Ray Computed Tomography; base; bone; bone healing; bone health; cancer therapy; cohort; contrast enhanced; density; healing; imaging modality; impression; improved; irradiation; lifetime risk; mortality; multimodality; patient population; prospective; public health relevance; quantitative imaging; reconstruction; response; success; treatment response; tumor growth; wound

 DESCRIPTION (provided by applicant): Changes in the epidemiology of head and neck cancers have resulted in an increasing number of younger and healthier patients being treated with definitive external beam radiotherapy (EBRT). The long-term sequelae of radiotherapy in a patient population with good clinical outcomes and extended life expectancy are becoming increasingly relevant in the management of treatment-associated morbidity and mortality. Osteoradionecrosis (ORN) of the mandible is a challenging issue related to irradiation, occurring in up to 16% of patients with various types of head and neck cancers. Altered bone vascularity and opportunistic infections within the oral cavity contribute to the development of ORN, leading to an inexorable process of bone destruction that does not follow the normal sequence of healing events. Early-stage ORN is often managed using antibiotics, local wound care, and hyperbaric oxygen (HBO). Advanced ORN requires surgical resection and reconstruction with healthy non-irradiated tissue. Successful management of this disease process requires an enhanced ability to identify patients at risk for ORN, monitor the effectiveness of conservative management, and improve preoperative planning to ensure clear margins at the time of resection. However, a standardized, objective staging and monitoring system for ORN is not currently available. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is a clinically available quantitative imaging method that is increasingly employed to assess microvascular function in the study of solid tumors of the head and neck. At our institution, DCE-MRI is integrated into a multimodality clinical algorithm aimed at improving the diagnosis, staging, and oncologic surveillance of head and neck tumors. DCE-MRI can detect altered bone vascularity associated with bone healing, necrosis and metastatic involvement, with excellent spatial resolution. We hypothesize that DCE-MRI can be used to detect alterations in bone vascularity following irradiation to monitor ORN clinical progression and response to treatment. To test this hypothesis, we will evaluate the potential of DCE-MRI to identify patients at risk for mandibular ORN, monitor response to conservative management, and determine the extent of advanced mandibular ORN to assist in surgical planning. Successful completion of this proposal has the potential to revolutionize the diagnosis and management of mandibular ORN. For the first time, clinicians will be able to identify patients at risk for ORN and manage post-radiotherapy care appropriately. The effectiveness of currently employed conservative measures could be tested using an objective measure and improved preoperative planning could reduce the rate of surgical failure due to residual compromised bone.

 描述（由申请人提供）：头颈癌流行病学的变化导致越来越多的年轻且健康的患者接受根治性外照射放疗（EBRT）治疗。良好的临床结果和延长的预期寿命在治疗相关的发病率和死亡率方面变得越来越重要，下颌骨放射性骨坏死（ORN）是与照射相关的一个具有挑战性的问题。高达 16% 的各种头颈癌患者中，骨血管分布改变和口腔内机会性感染会导致 ORN 的发生，从而导致骨破坏的不可避免的过程，不遵循正常的愈合顺序。早期 ORN 通常使用抗生素、局部伤口护理和高压氧 (HBO) 进行治疗，晚期 ORN 需要手术切除并用健康的未照射组织进行重建。增强识别 ORN 风险患者、监测保守治疗有效性并改进术前计划以确保切除时清晰切缘的能力。然而，目前尚无标准化、客观的 ORN 分期和监测系统。对比增强磁共振成像 (DCE-MRI) 是一种临床可用的定量成像方法，越来越多地用于评估头颈部实体瘤研究中的微血管功能。在我们的机构，DCE-MRI 已集成到多模态中。临床算法旨在改善头颈部肿瘤的诊断、分期和肿瘤学监测，可以检测与骨愈合、坏死和转移相关的骨血管变化，并且具有出色的空间分辨率。为了检验这一假设，我们将评估 DCE-MRI 识别有风险的患者的潜力。 下颌 ORN，监测保守治疗的反应，并确定晚期下颌 ORN 的范围，以协助手术计划。该提案的成功完成有可能彻底改变下颌 ORN 的诊断和治疗。识别有 ORN 风险的患者并管理放射治疗后护理 可以使用客观措施来测试当前采用的适当保守措施的有效性，并且改进的术前计划可以降低由于残留受损骨而导致的手术失败率。