Tran William T, Childs Charmaine, Probst Heidi, Farhat Golnaz, Czarnota Gregory J
Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada; Physical Sciences, Sunnybrook Research Institute, Toronto, Canada; Facutly of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK.
Facutly of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK.
J Med Imaging Radiat Sci. 2018 Dec;49(4):342-351. doi: 10.1016/j.jmir.2017.09.006. Epub 2018 Apr 1.
Guidelines from the American National Comprehensive Cancer Network recommend neoadjuvant chemotherapy to patients with locally advanced breast cancer (LABC) to downstage tumours before surgery. However, only a small fraction (15%-17%) of LABC patients achieve pathological complete response (pCR); that is, no residual tumour in the breast, after treatment. Measuring tumour response during neoadjuvant chemotherapy can potentially help physicians adapt treatment, thus potentially improving the pCR rate. Recently, imaging biomarkers that are used to measure the tumour's functional and biological features have been studied as pretreatment markers for pCR or as an indicator for intratreatment tumour response. Also, imaging biomarkers have been the focus of intense research to characterise tumour heterogeneity as well as to advance our understanding of the principle mechanisms behind chemoresistance. Advances in investigational radiology are moving rapidly to high-resolution imaging, capturing metabolic data, and performing tissue characterisation and statistical modelling of imaging biomarkers, with an end point of personalised medicine in breast cancer treatment. In this commentary, we present studies within the framework of imaging biomarkers used to measure breast tumour response to chemotherapy. Current studies are showing that significant progress has been made in the accuracy of measuring tumour response either before or during chemotherapy, yet the challenges at the forefront of these works include translational gaps such as needing large-scale clinical trials for validation and standardisation of imaging methods. However, the ongoing research is showing that imaging biomarkers may play an important role in personalised treatments for LABC.
美国国立综合癌症网络的指南建议，对局部晚期乳腺癌（LABC）患者进行新辅助化疗，以便在手术前使肿瘤降期。然而，只有一小部分（15%-17%）的LABC患者在治疗后达到病理完全缓解（pCR），即乳房中无残留肿瘤。在新辅助化疗期间测量肿瘤反应可能有助于医生调整治疗方案，从而有可能提高pCR率。最近，用于测量肿瘤功能和生物学特征的成像生物标志物已被研究作为pCR的预处理标志物或作为治疗期间肿瘤反应的指标。此外，成像生物标志物一直是深入研究的焦点，用于表征肿瘤异质性以及增进我们对化疗耐药背后主要机制的理解。研究性放射学正在迅速向高分辨率成像、获取代谢数据、进行组织表征以及成像生物标志物的统计建模发展，最终目标是实现乳腺癌治疗的个性化医疗。在这篇评论中，我们介绍了在用于测量乳腺肿瘤对化疗反应的成像生物标志物框架内的研究。目前的研究表明，在化疗前或化疗期间测量肿瘤反应的准确性方面已经取得了重大进展，但这些工作面临的首要挑战包括转化差距，例如需要大规模临床试验来验证和标准化成像方法。然而，正在进行的研究表明，成像生物标志物可能在LABC的个性化治疗中发挥重要作用。
