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https://doi.org/10.2478/raon-2022-0046
Title: | Quantifying the changes in the tumour vascular micro-environment in spinal metastases treated with stereotactic body radiotherapy-a single arm prospective study | Authors: | Vellayappan, Balamurugan Cheong, Dennis Singbal, Salil Tey, Jeremy Soon, Yu Yang Leong, Cheng Nang Wong, Alvin Lwin, Sein Lee, Chau Hung Periasamy, Pravin Lo, Simon Kumar, Naresh |
Keywords: | Science & Technology Life Sciences & Biomedicine Oncology Radiology, Nuclear Medicine & Medical Imaging spine metastases stereotactic body radiotherapy DCE-MRI endothelial apoptosis RADIATION-THERAPY RADIOSURGERY PERFUSION CERAMIDE DISEASE TRACER MRI |
Issue Date: | 13-Dec-2022 | Publisher: | WALTER DE GRUYTER GMBH | Citation: | Vellayappan, Balamurugan, Cheong, Dennis, Singbal, Salil, Tey, Jeremy, Soon, Yu Yang, Leong, Cheng Nang, Wong, Alvin, Lwin, Sein, Lee, Chau Hung, Periasamy, Pravin, Lo, Simon, Kumar, Naresh (2022-12-13). Quantifying the changes in the tumour vascular micro-environment in spinal metastases treated with stereotactic body radiotherapy-a single arm prospective study. RADIOLOGY AND ONCOLOGY 56 (4) : 525-534. ScholarBank@NUS Repository. https://doi.org/10.2478/raon-2022-0046 | Abstract: | Background: The primary objective was to quantify changes in vascular micro-environment in spinal metastases (SM) patients treated with stereotactic body radiotherapy (SBRT) with multi-parametric dynamic contrast enhanced (DCE) magnetic resonance imaging (MRI). The secondary objective was to study plasma biomarkers related to endothelial apoptosis. Patients and methods: Patients were imaged with DCE-MRI at baseline/1-week/12-weeks post-SBRT. Metrics including normalised time-dependent leakage (Ktrans), permeability surface product (PS), fractional plasma volume (Vp), extracellular volume (Ve) and perfusion (F) were estimated using distributed parameter model. Serum acid sphingomyelinase (ASM) and sphingosine-1-phosphate (S1P) were quantified using ELISA. Clinical outcomes including physician-scored and patient-reported toxicity were collected. Results: Twelve patients (with varying primary histology) were recruited, of whom 10 underwent SBRT. Nine patients (with 10 lesions) completed all 3 imaging assessment timepoints. One patient died due to pneumonia (unrelated) before follow-up scans were performed. Median SBRT dose was 27 Gy (range: 24-27) over 3 fractions (range: 2-3). Median follow-up for alive patients was 42-months (range: 22.3-54.3), with local control rate of 90% and one grade 2 or higher toxicity (vertebral compression fracture). In general, we found an overall trend of reduction at 12-weeks in all parameters (Ktrans/PS/Vp/Ve/F). Ktrans and PS showed a reduction as early as 1-week. Ve/Vp/F exhibited a slight rise 1-week post-SBRT before reducing below the baseline value. There were no significant changes, post-SBRT, in plasma biomarkers (ASM/S1P). Conclusions: Tumour vascular micro-environment (measured by various metrics) showed a general trend towards downregulation post-SBRT. It is likely that vascular-mediated cell killing contributes to excellent local control rates seen with SBRT. Future studies should evaluate the effect of SBRT on primary-specific spinal metastases (e.g., renal cell carcinoma). | Source Title: | RADIOLOGY AND ONCOLOGY | URI: | https://scholarbank.nus.edu.sg/handle/10635/237800 | ISSN: | 1318-2099 1581-3207 |
DOI: | 10.2478/raon-2022-0046 |
Appears in Collections: | Staff Publications Elements |
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