The Promise of Dynamic Contrast-Enhanced Imaging in Radiation Therapy

doi:10.1016/j.semradonc.2010.11.001

Seminars in Radiation Oncology

Volume 21, Issue 2, April 2011, Pages 147-156

https://doi.org/10.1016/j.semradonc.2010.11.001 Get rights and content

Dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) and computed tomography (CT) scanning are emerging as valuable tools to quantitatively map the spatial distribution of vascular parameters, such as perfusion, vascular permeability, blood volume, and mean transit time in tumors and normal organs. DCE MRI/CT have shown prognostic and predictive value for response of certain cancers to chemotherapy and radiation therapy. DCE MRI/CT offer the promise of early assessment of tumor response to radiation therapy, opening a window for adaptively optimizing radiation therapy based upon functional alterations that occur earlier than morphologic changes. DCE MRI/CT has also shown the potential of mapping dose responses in normal organs and tissue for evaluation of individual sensitivity to radiation, providing additional opportunities to minimize risks of radiation injury. The evidence for potentially applying DCE MRI and CT for selection and delineation of radiation boost targets is growing. The clinical use of DCE MRI and CT scanning as a biomarker or even a surrogate endpoint for radiation therapy assessment of tumor and normal organs must consider technical validation issues, including standardization, reproducibility, accuracy and robustness, and clinical validation of the sensitivity and specificity for each specific problem of interest. Although holding great promise, to date, DCE MRI and CT scanning have not been qualified as a surrogate endpoint for radiation therapy assessment or for treatment modification in any prospective phase III clinical trial for any tumor site.

Section snippets

Prognostic and Predictive Indicators for Tumor Response Assessment

Malignant gliomas, particularly GBM, exhibit neovascularity characterized as abnormally rapid growth of vasculature with high density, great vessel leakage, abnormal perfusion, and prolonged mean transit time, which is possibly mediated by angiogenesis and has become the target of antiangiogenic therapy.32, 33 Cerebral blood volume (CBV), cerebral blood flow (CBF), and vascular permeability in gliomas mapped by DCE or DSc MRI before radiation have been shown to be prognostic factors for

DCE Imaging for Assessment of Normal Tissue and Organ Response to Radiation Dose

Radiation-induced vascular injury in normal tissue and organs can pose a risk for organ function. Radiation can cause vascular damage, such as vessel dilation, endothelial cell death and apoptosis, microvessel hemorrhage, and eventually vessel occlusion.51, 52, 53, 54, 55 Vascular damage can subsequently affect organ function (eg, in the brain, liver, and rectum).56, 57, 58, 59 This risk hinders the attempt to increase radiation dose to achieve a better tumor control or even cure the cancer.

DCE MRI for Radiation Target Selection and Delineation

Because technological dose delivery has changed dramatically, target volume definition based on CT scanning is increasingly becoming an obvious limiting factor in advanced precision treatment. The role of functional imaging for target volume definition has been discussed by several authors.1, 76 It has been suggested that a tumor target volume could be defined and segmented as multiple biological target subvolumes, which could be defined based on multiple functional imaging examinations, each

Issues Related to DCE Imaging in Radiation Therapy

Issues related to the use of DCE imaging in radiation oncology perhaps depend on the attempted usage. There are some common issues related to all types of cancer therapy but others uniquely to radiation therapy. These common issues include the standardization of imaging protocols; the PK models; and quantitative metrics derived from the DCE imaging data, quality control/assurance of imaging acquisition, and reproducibility and accuracy of the method as a whole. Currently, there are several

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: Supported in part by NIH P01 CA59827, NCI RO1 CA132834, RO1 NS064973 and R21 CA126137.

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