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NAPOVEDNA VREDNOST MR DIFUZIJE IN PERFUZIJE ZA SPREMLJANJE ODGOVORA LOKALNO IN/ ALI PODROČNO NAPREDOVALEGA PLOŠČATOCELIČNEGA KARCINOMA GLAVE IN VRATU NA ZDRAVLJENJE S SOČASNO RADIOKEMOTERAPIJO
Garbajs, Manca (Author), Šurlan Popovič, Katarina (Mentor) More about this mentor... This link opens in a new window, Strojan, Primož (Co-mentor)

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Abstract
UVOD. Zdravljenje s sočasno radiokemoterapijo s cisplatinom (RT-KT) je nekirurška metoda izbora za bolnike z lokalno in/ali področno napredovalim ploščatoceličnim karcinomom glave in vratu (PCKGV). Z radiološkimi metodami, s katerimi bi že pred ali zgodaj med zdravljenjem napovedali, kako učinkovito bo to, bi lahko v primeru neodzivnih tumorjev spremenili zdravljenje. Namen naše raziskave je bil oceniti, ali izhodiščne vrednosti parametrov, pridobljenih z MR difuzijskim in perfuzijskim slikanjem, in njihove spremembe med zdravljenjem lahko napovedo odgovor bolnikov s PCKGV na zdravljenje z RT-KT s cisplatinom. METODE. Pri 20 bolnikih z napredovalimi PCKGV smo naredili MR difuzijsko in perfuzijsko slikanje pred zdravljenjem, po 1 tednu (t.j. po prejetih 10 Gy) in po 4 tednih (po prejetih 40 Gy) RT-KT ter 2,5 do 3 mesece po zaključenem zdravljenju. V vsaki časovni točki smo v primarnem tumorju z MR difuzijsko preiskavo merili vrednosti navideznega difuzijskega koeficienta [ADC] in vrednosti treh MR perfuzijskih parametrov (konstanta prostorninskega prenosa med zunajceličnim zunajžilnim prostorom [ZZP] in krvno plazmo [Ktrans], prostornino ZZP na enoto prostornine tkiva [Ve] in prostornino krvne plazme na enoto prostornine tkiva [Vp]). Da bi določili dejavnike, ki napovedujejo odgovor na zdravljenje, smo izhodiščne vrednosti in relativne spremembe vseh parametrov po 10 Gy oz. po 40 Gy (glede na izhodišče) analizirali s Firthovim regresijskim modelom. Korelacijo med prostornino tumorja in MR funkcionalnimi parametri smo izračunali s Spearmanovim koeficientom korelacije. REZULTATI. Relativna sprememba (glede na izhodiščno vrednost) Ktrans po 10 Gy se je pokazala kot statistično značilen dejavnik, ki napoveduje, ali bodo bolniki odgovorili na zdravljenje z RT-KT (p = 0,047; 95% interval zaupanja (IZ), 0,99 – 0,87; srednja relativna sprememba Ktrans glede na izhodiščno vrednost, 50,2 %; razpon, od 25,1% do 90,9 %). Pri bolnikih, ki so odgovorili na zdravljenje, se je Ve po10 Gy statistično mejno značilno zmanjšal (p = 0,066; 26,9 %, od 76,7 % do 126,8 %). Prav tako se je mejno statistično značilno po 40 Gy povečal ADC (p = 0,079; 73,4 %; od 17,8 % do 121,6%). Nobeden izmed parametrov, izmerjenih pred zdravljenjem, se ni izkazal za statistično značilnega. Analiza korelacij ni pokazala statistično značilne povezave med prostornino tumorja in izmerjenimi MR parametri, ne glede na čas meritve. ZAKLJUČKI. Spremembe Ktrans, Ve in ADC, ugotovljene že zgodaj med zdravljenjem, bi lahko pomagale pri napovedi odgovora PCKGV na zdravljenje s sočasno RT-KT s cisplatinom. MR perfuzijski in difuzijski parametri niso korelirali s spremembo prostornine tumorja, izmerjeno z MR volumetrijo.  

Language:Slovenian
Keywords:MR difuzijsko slikanje, MR perfuzijsko slikanje, Odgovor na zdravljenje, Ploščatocelični karcinom glave in vratu, Sočasna radiokemoterapija
Work type:Doctoral dissertation (mb31)
Organization:MF - Faculty of Medicine
Year:2019
Views:725
Downloads:225
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Secondary language

Language:English
Title:THE ROLE OF MR DIFFUSION AND PERFUSION TO PREDICT TREATMENT RESPONSE OF LOCOREGIONALLY ADVANCED SQUAMOUS CELL HEAD AND NECK CARCINOMA TREATED WITH CONCOMITANT CHEMORADIOTHERAPY
Abstract:
INTRODUCTION. Concomitant chemoradiotherapy (CRT) with cisplatin is a non-surgical method of choice for treatment of loco-regionally advanced head and neck squamous cell carcinoma (HNSCC). Radiologic imaging with capacity to predict treatment efficacy before or early during therapy would assisst in changing the therapy in case of non-responsive tumors. The role of our study was to assess wheater MR diffusion and perfusion parameters, measured before treatment or their changes early during treatment could predict treatment response in patients with HNSCC, treated with cisplatin based CRT. METHODS. MR diffusion and perfusion imaging was performed in 20 patients with loco-regionally advanced HNSCC before treatment, after 1 week (e.g. after 10 Gy) and after 4 weeks (e.g. after 40 Gy) of CRT, and 2,5 - 3 months after treatment completion. At each time point, apparent diffusion coefficient [ADC] was measured in the primary tumor with MR diffusion examination, as well as three MR perfusion parameters (volume transfer constant between extracellular extravascular space (EES) and blood plasma [Ktrans], EES volume per unit tissue volume [Ve] and blood plasma volume per unit tissue volume [Vp]). Baseline values and relative changes of all parameters after 10 Gy and 40 Gy (from baseline) were analysed by Firth logistic regression in order to determine predictive factors for treatment response. Spearman's rank correlation coefficient was used to asses the association between tumour volume and MR functional parametrs. RESULTS. Relative change (from baseline) of Ktrans after 10 Gy was found to be a significant factor for prediction whether patients would response to treatment with CRT (p = 0,047; 95% confidence interval (CI), 0,99 – 0,87; median relative change of Ktrans after 10 Gy from baseline, 50,2 %; range, 25,1 % to 90,9 %). In patients with complete response to treatment, there was a borderline sginificant decrease of Ve after 10 Gy (p = 0,066; 26,9 %, from 76,7 % to 126,8 %). In addition, ADC after 40 Gy increased with a borderline significance (p = 0,079; 73,4 %; from 17,8 % to 121,6 %). None of the parameters measured before treatment appeared to be of statistical significance. Correlation canalysis showed no statistically significant association between tumour volume and measured MR parametrs at any time point during treatment. CONCLUSIONS. Changes of Ktrans, Ve and ADC recognized early during treatment could potentionally help in prediction what would be a response of HNSCC to CRT treatment with cisplatin. MR diffusion and perfusion parametrs did not correlate with changes in volume of volume as measured with MR volumetry.

Keywords:MR Diffusion-Weighted imaging, Dynamic contrast-enhanced MRI, Treatment response, Squamous cell head and neck cancer, Concomitant chemoradiotherapy

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