Paterson C, Allwood-Spiers S, McCrea I, Foster J, McJury M, Thomson M, Sankaralingam M, Grose D, James A, Rizwanullah M, McLoone P, Chalmers A, Duffton A
Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow G12 0YN, UK.
Department of Clinical Physics and Bioengineering, NHS Greater Glasgow and Clyde, Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow G12 0YN, UK.
Clin Transl Radiat Oncol. 2017 Jan 10;2:13-18. doi: 10.1016/j.ctro.2016.12.003. eCollection 2017 Feb.
A significant proportion of patients with intermediate and high risk squamous cell cancer of the oropharynx (OPSCC) continue to relapse locally despite radical chemoradiotherapy (CRT). The toxicity of the current combination of intensified dose per fraction radiotherapy and platinum based chemotherapy limits further uniform intensification. If a predictive biomarker for outcomes from CRT can be identified during treatment then individualised and adaptive treatment strategies may be employed.
METHODS/DESIGN: The MeRInO study is a prospective observational imaging study of patients with intermediate and high risk, locally advanced OPSCC receiving radical RT or concurrent CRT Patients undergo diffusion weighted MRI prior to treatment (MRI_1) and during the third week of RT (MRI_2). Apparent diffusion coefficient (ADC) measurements will be made on each scan for previously specified target lesions (primary and lymph nodes) and change in ADC calculated. Patients will be followed up and disease status for each target lesion noted. The primary aim of the MeRInO study is to determine the threshold change in ADC from baseline to week 3 of RT that may identify the sub-group of non-responders during treatment.
The use of DW-MRI as a predictive biomarker during RT for SCC H&N is in its infancy but studies to date have found that response to treatment may indeed be predicted by comparison of DW-MRI carried out before and during treatment. However, previous studies have included all sub-sites and biological sub-types. Establishing ADC thresholds that predict for local failure is an essential step towards using DW-MRI to improve the therapeutic ratio in treating SCC H&N. This would be done most robustly in a specific H&N sub-site and in sub-types with similar biological behaviour. The MeRInO study will help establish these thresholds in OPSCC.
相当一部分口咽鳞状细胞癌（OPSCC）中高危患者尽管接受了根治性放化疗（CRT），仍会出现局部复发。当前每分次剂量强化放疗与铂类化疗联合方案的毒性限制了进一步统一强化治疗。如果在治疗期间能够识别出CRT疗效的预测生物标志物，那么就可以采用个体化和适应性治疗策略。
方法/设计：MeRInO研究是一项对接受根治性放疗或同步CRT的中高危、局部晚期OPSCC患者进行的前瞻性观察性影像学研究。患者在治疗前（MRI_1）和放疗第三周期间（MRI_2）接受扩散加权磁共振成像（DW-MRI）检查。将对每次扫描中预先指定的靶病变（原发灶和淋巴结）进行表观扩散系数（ADC）测量，并计算ADC的变化。对患者进行随访并记录每个靶病变的疾病状态。MeRInO研究的主要目的是确定放疗第3周时ADC相对于基线的阈值变化，该变化可能识别出治疗期间无反应的亚组患者。
在头颈部鳞状细胞癌（SCC H&N）放疗期间使用DW-MRI作为预测生物标志物尚处于起步阶段，但迄今为止的研究发现，通过比较治疗前和治疗期间进行的DW-MRI，确实可以预测治疗反应。然而，先前的研究涵盖了所有亚部位和生物学亚型。确定预测局部失败的ADC阈值是使用DW-MRI提高SCC H&N治疗疗效比的关键一步。这在特定的头颈部亚部位和具有相似生物学行为的亚型中进行最为可靠。MeRInO研究将有助于在OPSCC中确定这些阈值。
