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Perfusion CT: noninvasive surrogate marker for stratification of pancreatic cancer response to concurrent chemo- and radiation therapy

 Mi-Suk Park  ;  Ernst Klotz  ;  Myeong-Jin Kim  ;  Si Young Song  ;  Seung Woo Park  ;  Seung-Whan Cha  ;  Joon Soek Lim  ;  Jinsil Seong  ;  Jae Bok Chung  ;  Ki Whang Kim 
 RADIOLOGY, Vol.250(1) : 110-117, 2009 
Journal Title
Issue Date
Aged ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Blood Volume/physiology ; Combined Modality Therapy ; Contrast Media ; Deoxycytidine/administration & dosage ; Deoxycytidine/analogs & derivatives ; Extracellular Fluid/metabolism ; Female ; Fluid Shifts/physiology ; Follow-Up Studies ; Humans ; Iopamidol ; Male ; Middle Aged ; Pancreatic Neoplasms/blood supply ; Pancreatic Neoplasms/diagnostic imaging ; Pancreatic Neoplasms/drug therapy* ; Pancreatic Neoplasms/radiotherapy* ; Plasma Volume/physiology ; Portography/methods* ; Prospective Studies ; ROC Curve ; Radiotherapy Dosage ; Tomography, Spiral Computed/methods* ; Treatment Outcome
PURPOSE: To prospectively determine whether perfusion computed tomography (CT) parameters, such as volume transfer constant (K(trans)) between blood plasma and extracellular extravascular space (EES) and blood volume calculated from dynamic CT data, can be used to predict response of pancreatic cancer to concurrent chemotherapy and radiation therapy (CCRT). MATERIALS AND METHODS: This prospective study was institutional review board approved, and written informed consent was obtained. Thirty patients with pancreatic cancer underwent perfusion CT with 64-detector row CT before gemcitabine-based CCRT. Two perfusion parameters (K(trans) and blood volume) measured before treatment were compared between patients who responded to treatment and those who did not, as determined with World Health Organization criteria from first and second posttherapeutic follow-up CT examinations, which were performed at 3- and 6-month follow-up. Statistical analysis was performed with the two-sample t test. A receiver operating characteristic curve was used to determine the best cutoff value of perfusion parameters for differentiation of responders from nonresponders. RESULTS: Twenty of 30 patients examined at 3-month follow-up responded to therapy. Their pretreatment K(trans) value was significantly higher than that of nonresponders (50.8 mL/100 mL/min +/- 30.5 [standard deviation] vs 19.0 mL/100 mL/min +/- 10.8, P = .001). The best cutoff value for differentiating between responders and nonresponders was 31.8 mL/100 mL/min, which yielded 75.0% sensitivity and 90.0% specificity. Ten of 18 patients examined at 6-month follow-up responded to therapy. Their pretreatment K(trans) value was significantly higher than that of nonresponders (58.6 mL/100 mL/min +/- 43.2 vs 19.8 mL/100 mL/min +/- 10.9, P = .002). Responders also had higher blood volume values, but this difference was not significant. CONCLUSION: Tumors with a high pretreatment K(trans) value tended to respond better to CCRT than did tumors with a low pretreatment K(trans) value. Perfusion CT may be used to predict tumor response to CCRT in patients with pancreatic cancer. This might aid in development of a tailored approach to therapy in these patients.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Ki Whang(김기황)
Kim, Myeong Jin(김명진) ORCID logo https://orcid.org/0000-0001-7949-5402
Park, Mi-Suk(박미숙) ORCID logo https://orcid.org/0000-0001-5817-2444
Park, Seung Woo(박승우) ORCID logo https://orcid.org/0000-0001-8230-964X
Seong, Jin Sil(성진실) ORCID logo https://orcid.org/0000-0003-1794-5951
Song, Si Young(송시영) ORCID logo https://orcid.org/0000-0002-1417-4314
Lim, Joon Seok(임준석) ORCID logo https://orcid.org/0000-0002-0334-5042
Chung, Jae Bock(정재복)
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