Hutterer Markus, Hattingen Elke, Palm Christoph, Proescholdt Martin Andreas, Hau Peter
Department of Neurology and Wilhelm-Sander Neuro-Oncology Unit, University Hospital and Medical School, Regensburg, Germany (M.H., P.H.); Neuroradiology, Department of Radiology, University Hospital Bonn, Bonn, Germany (E.H.); Regensburg Medical Image Computing, Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany (C.P.); Department of Neurosurgery, University Hospital and Medical School, Regensburg, Germany (M.P.).
Neuro Oncol. 2015 Jun;17(6):784-800. doi: 10.1093/neuonc/nou322. Epub 2014 Dec 27.
Despite multimodal treatment, the prognosis of high-grade gliomas is grim. As tumor growth is critically dependent on new blood vessel formation, antiangiogenic treatment approaches offer an innovative treatment strategy. Bevacizumab, a humanized monoclonal antibody, has been in the spotlight of antiangiogenic approaches for several years. Currently, MRI including contrast-enhanced T1-weighted and T2/fluid-attenuated inversion recovery (FLAIR) images is routinely used to evaluate antiangiogenic treatment response (Response Assessment in Neuro-Oncology criteria). However, by restoring the blood-brain barrier, bevacizumab may reduce T1 contrast enhancement and T2/FLAIR hyperintensity, thereby obscuring the imaging-based detection of progression. The aim of this review is to highlight the recent role of imaging biomarkers from MR and PET imaging on measurement of disease progression and treatment effectiveness in antiangiogenic therapies. Based on the reviewed studies, multimodal imaging combining standard MRI with new physiological MRI techniques and metabolic PET imaging, in particular amino acid tracers, may have the ability to detect antiangiogenic drug susceptibility or resistance prior to morphological changes. As advances occur in the development of therapies that target specific biochemical or molecular pathways and alter tumor physiology in potentially predictable ways, the validation of physiological and metabolic imaging biomarkers will become increasingly important in the near future.
尽管采用了多模式治疗，但高级别胶质瘤的预后仍然严峻。由于肿瘤生长严重依赖新血管形成，抗血管生成治疗方法提供了一种创新的治疗策略。贝伐单抗，一种人源化单克隆抗体，多年来一直是抗血管生成方法的焦点。目前，包括对比增强T1加权和T2/液体衰减反转恢复（FLAIR）图像的MRI常规用于评估抗血管生成治疗反应（神经肿瘤学反应评估标准）。然而，通过恢复血脑屏障，贝伐单抗可能会降低T1对比增强和T2/FLAIR高信号，从而掩盖基于成像的进展检测。本综述的目的是强调来自MR和PET成像的成像生物标志物在抗血管生成治疗中疾病进展测量和治疗效果方面的最新作用。基于所综述的研究，将标准MRI与新的生理MRI技术和代谢PET成像（特别是氨基酸示踪剂）相结合的多模式成像，可能有能力在形态学变化之前检测抗血管生成药物的敏感性或耐药性。随着针对特定生化或分子途径并以潜在可预测方式改变肿瘤生理学的治疗方法的发展，生理和代谢成像生物标志物的验证在不久的将来将变得越来越重要。
