South West Sydney Clinical School, Faculty of Medicine and Health, University of New South Wales, Liverpool, Australia.
Department of Radiation Oncology, Liverpool Cancer Therapy Centre, Liverpool Hospital, Liverpool, Australia.
Expert Rev Anticancer Ther. 2022 Oct;22(10):1081-1098. doi: 10.1080/14737140.2022.2114457. Epub 2022 Oct 10.
Noninvasive predictive quantitative biomarkers are required to guide treatment individualization in patients with locally advanced rectal cancer (LARC) in order to maximize therapeutic outcomes and minimize treatment toxicity. Magnetic resonance imaging (MRI), positron emission tomography (PET), and blood biomarkers have the potential to predict chemoradiotherapy (CRT) response in LARC.
This review examines the value of functional imaging (MRI and PET) and liquid biomarkers (circulating tumor cells (CTCs) and circulating tumor nucleic acid (ctNA)) in the prediction of CRT response in LARC. Selected imaging and liquid biomarker studies are presented and the current status of the most promising imaging (apparent diffusion coefficient (ADC), K, SUV, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) and liquid biomarkers (CTCs, ctNA) is discussed. The potential applications of imaging and liquid biomarkers for treatment stratification and a pathway to clinical translation are presented.
Functional imaging and liquid biomarkers provide novel ways of predicting CRT response. The clinical and technical validation of the most promising imaging and liquid biopsy biomarkers in multicenter studies with harmonized acquisition techniques is required. This will enable clinical trials to investigate treatment escalation or de-escalation pathways in rectal cancer.
为了最大限度地提高治疗效果并最小化治疗毒性，需要无创预测性定量生物标志物来指导局部晚期直肠癌（LARC）患者的个体化治疗。磁共振成像（MRI）、正电子发射断层扫描（PET）和血液生物标志物有可能预测 LARC 的放化疗（CRT）反应。
本综述探讨了功能成像（MRI 和 PET）和液体生物标志物（循环肿瘤细胞（CTC）和循环肿瘤核酸（ctNA））在预测 LARC 的 CRT 反应中的价值。介绍了选定的成像和液体生物标志物研究，并讨论了最有前途的成像（表观扩散系数（ADC）、K、SUV、代谢肿瘤体积（MTV）和总肿瘤糖酵解（TLG）和液体生物标志物（CTC、ctNA）的现状。还提出了影像学和液体生物标志物在治疗分层中的潜在应用以及向临床转化的途径。
功能成像和液体生物标志物为预测 CRT 反应提供了新的方法。需要在具有协调采集技术的多中心研究中对最有前途的成像和液体活检生物标志物进行临床和技术验证。这将使临床试验能够研究直肠癌的治疗升级或降级途径。
