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- W2040192722 abstract "To develop, refine, and test Dynamic Contrast Enhancement (DCE) Magnetic Resonance Imaging protocols and analysis methodologies for predicting response to preoperative neoadjuvant chemo-radiation therapy (PNT) and resectability in non-small cell lung cancer. Patients with stage IIIA (T1-3 N2 or T3N1) non-small cell lung carcinoma were prospectively studied and received 45 Gy in 25 daily fractions of conformal external beam radiation therapy with 2 courses of cisplatin (50 mg/m2 IV days 1 and 8; 29 and 36) and etoposide (50 mg/m2 IV days 1-5 and 29-33). Three MRI studies (pre-contrast and 3 Tesla DCE MRI) before, during (2 weeks into treatment) and after PNT (study 1, 2, and 3 respectively) were performed for each patient. Five patients have been enrolled to date. One patient progressed and developed pericardial, pulmonary artery branch, and pulmonary vein invasion and did not undergo resection. One patient was found to be unresectable at the time of surgery due to invasion of the descending aorta. Both of the unresectable patients have expired. Three patients were resectable: 2 of 3 had complete pathological response with no evidence of residual tumor at primary site or nodes; one had residual tumor at both the nodes and primary. Among the pharmacokinetic parameters (Amp, kep, and kel), kep of the second MR appeared to differentiate unresectable (n= 2; kep= 4.3 min-1) from resectable tumors (n= 3; kep= 2.3 min-1); and the case with residual tumor (n = 1; kep= 2.6 min-1) from those without residual tumor (n = 2; kep= 2.1 min-1). kep represents the exchange rate constant between blood plasma and extravascular extracellular space, which reflects the wash-in slope of the time-signal intensity curve. This early data shows the feasibility of performing prospective functional tumor imaging timed with the ongoing radiation course, and suggests that therapy responsiveness and resectability may be associated with lower kep. The ability to predict unresectability with the DCE-MRI's, would not only spare patients the morbidity of unsuccessful surgery, but also eliminate the detrimental treatment gap in the patient's therapy, which results when patients are found to be unresectable after preoperative therapy and require completion of the radiation therapy course. Supported by NCI R21 CA121582 and NCI P30 CA16058." @default.
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- W2040192722 date "2012-11-01" @default.
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- W2040192722 title "MR-Predictive Assay in Preoperative Lung Cancer Therapy" @default.
- W2040192722 doi "https://doi.org/10.1016/j.ijrobp.2012.07.1612" @default.
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