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INTRA-TUMORAL METABOLIC HETEROGENEITY OF CERVICAL CANCER

INTRA-TUMORAL METABOLIC HETEROGENEITY OF CERVICAL CANCER. Perry Grigsby. Tumor Heterogeneity. Definition. Pre-Treatment. Heterogeniety = d (V)/ d (T). Chemo-IMRT Timeline 7-8 weeks (~55 days). 4 days IMRT 1 day HDR. 4 days IMRT 1 day HDR. 4 days IMRT 1 day HDR. 4 days IMRT

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INTRA-TUMORAL METABOLIC HETEROGENEITY OF CERVICAL CANCER

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  1. INTRA-TUMORAL METABOLIC HETEROGENEITY OF CERVICAL CANCER Perry Grigsby

  2. Tumor Heterogeneity Definition

  3. Pre-Treatment

  4. Heterogeniety = d(V)/d(T)

  5. Chemo-IMRT Timeline7-8 weeks (~55 days) 4 days IMRT 1 day HDR 4 days IMRT 1 day HDR 4 days IMRT 1 day HDR 4 days IMRT 1 day HDR 4 days IMRT 1 day HDR 4 days IMRT 1 day HDR IMRT Post-tx FDG-PET & MR Evaluate response Pre-tx FDG-PET & MR Plan IMRT ADC-MR to guide brachytherapy

  6. Change in Heterogeneity During Treatment

  7. Cu-ATSMHypoxia

  8. Axial Coronal Sagittal A B C

  9. Fraction of 64Cu-ATSM Threshold Volume Within the FDG Defined Tumor Volume

  10. 64Cu-ATSM Heterogeneity 1 0.8 p=0.04 0.6 Hetero > -1.7 Progression Free Survival Hetero ≤ -1.7 0.4 0.2 0 0 5 10 15 20 25 30 35 40 45 Time (Months)

  11. Non-Spatial

  12. Other Measures of Heterogeneity Texture & Shape of Metabolism

  13. Texture Features • Energy • Contrast • Local Homogeneity • Entropy

  14. Shape-based Features • Eccentricity • Euler Number • Solidity • Extent

  15. Volumetric run length type texture

  16. Volumetric run length type texture

  17. Volumetric zone length type texture

  18. Volumetric zone length type texture

  19. Chemo-IMRT Timeline7-8 weeks (~55 days) 4 days IMRT 1 day HDR 4 days IMRT 1 day HDR 4 days IMRT 1 day HDR 4 days IMRT 1 day HDR 4 days IMRT 1 day HDR 4 days IMRT 1 day HDR IMRT Post-tx FDG-PET & MR Evaluate response Pre-tx FDG-PET & MR Plan IMRT ADC-MR to guide brachytherapy

  20. T2W ADC Diffusion Weighted Imaging

  21. Week 1 Week 3 Week 5 Patient 1 Patient 2 Olsen JR, et al. ASTRO 2011.

  22. Tumor Volume Comparison

  23. Tumor Sub-Volume Comparison

  24. Tumor Sub-Volume Comparison

  25. Diffusion Weighted Imaging ADC

  26. Segmentation

  27. DTI

  28. DTI

  29. Goals • Identify Biologic Targets • Improve Image Guided Therapy

  30. Improve Survival with IMRT/IGRTExternal RT & Brachytherapy

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