RESUMEN
PURPOSE: Aim of the study was to evaluate the impact of parenchymal blood volume (PBV) C-arm CT in transarterial radioembolization (TARE) planning procedure regarding the appropriateness of segmental blood supply from selective catheter positions defined by angiographic images compared to PBV mapsto determine the influence of changed target volumes on dose calculation. MATERIAL AND METHODS: A total of 22 consecutive patients (median age, 62 years) underwent a TARE planning procedure were included in this retrospective study. Selective angiograms and selective PBV C-arm CT (right and left liver lobe) were evaluated in a blinded fashion, regarding segmental hepatic artery variants. Volumetry of target volume and dosimetry of glass and resin microspheres were performed. RESULTS: Classification of segment IV and segment I to the corresponding target vascular bed supply was correct in 91.0% (20/22) and 86.4% (19/22) for angiography and C-arm CT, respectively. Except one case, all other liver segments were classified properly to the left and right hepatic arterial supply. Based on the mismatch of the angiographic and the C-arm CT approach, changes of target volume were evident in 27.3% of patients, resulting in a mean mismatch volume of 90±54ml (range, 51-198ml) and a percentage of dose differences of 14.2±11.8% and 12.6±10.6% for the right and 12.5±8.5% and 11.1±7.8% for the left liver lobe in glass and resin microspheres, respectively. CONCLUSION: The C-arm CT approach is superior to the angiographic determination of vascular supply of specific liver segments for dosimetry before radioembolization. Especially for unexperienced interventional radiologists or for a complex anatomy, C-arm CT improves individualized dosimetry concepts.
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Volumen Sanguíneo/efectos de la radiación , Embolización Terapéutica/métodos , Arteria Hepática/diagnóstico por imagen , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/fisiopatología , Tomografía Computarizada por Rayos X/métodos , Anciano , Volumen Sanguíneo/fisiología , Femenino , Arteria Hepática/fisiopatología , Humanos , Hígado/irrigación sanguínea , Hígado/diagnóstico por imagen , Hígado/fisiopatología , Neoplasias Hepáticas/irrigación sanguínea , Masculino , Microesferas , Persona de Mediana Edad , Dosificación Radioterapéutica , Estudios RetrospectivosRESUMEN
PURPOSE: To assess the feasibility of hyperpolarized (HP) (129)Xe MRI for detection of early stage radiation-induced lung injury (RILI) in a rat model involving unilateral irradiation by assessing differences in gas exchange dynamics between irradiated and unirradiated lungs. METHODS: The dynamics of gas exchange between alveolar air space and pulmonary tissue (PT), PT and red blood cells (RBCs) was measured using single-shot spiral iterative decomposition of water and fat with echo asymmetry and least-squares estimation images of the right and left lungs of two age-matched cohorts of Sprague Dawley rats. The first cohort (n = 5) received 18 Gy irradiation to the right lung using a (60)Co source and the second cohort (n = 5) was not irradiated and served as the healthy control. Both groups were imaged two weeks following irradiation when radiation pneumonitis (RP) was expected to be present. The gas exchange data were fit to a theoretical gas exchange model to extract measurements of pulmonary tissue thickness (LPT) and relative blood volume (VRBC) from each of the right and left lungs of both cohorts. Following imaging, lung specimens were retrieved and percent tissue area (PTA) was assessed histologically to confirm RP and correlate with MRI measurements. RESULTS: Statistically significant differences in LPT and VRBC were observed between the irradiated and non-irradiated cohorts. In particular, LPT of the right and left lungs was increased approximately 8.2% and 5.0% respectively in the irradiated cohort. Additionally, VRBC of the right and left lungs was decreased approximately 36.1% and 11.7% respectively for the irradiated cohort compared to the non-irradiated cohort. PTA measurements in both right and left lungs were increased in the irradiated group compared to the non-irradiated cohort for both the left (P < 0.05) and right lungs (P < 0.01) confirming the presence of RP. PTA measurements also correlated with the MRI measurements for both the non-irradiated (r = 0.79, P < 0.01) and irradiated groups (r = 0.91, P < 0.01). CONCLUSIONS: Regional RILI can be detected two weeks post-irradiation using HP (129)Xe MRI and analysis of gas exchange curves. This approach correlates well with histology and can potentially be used clinically to assess radiation pneumonitis associated with early RILI to improve radiation therapy outcomes.
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Medios de Contraste , Pulmón/diagnóstico por imagen , Pulmón/efectos de la radiación , Imagen por Resonancia Magnética/métodos , Intercambio Gaseoso Pulmonar/efectos de la radiación , Traumatismos Experimentales por Radiación/diagnóstico por imagen , Neumonitis por Radiación/fisiopatología , Isótopos de Xenón , Animales , Volumen Sanguíneo/efectos de la radiación , Estudios de Cohortes , Estudios de Factibilidad , Pulmón/patología , Pulmón/fisiopatología , Modelos Biológicos , Traumatismos Experimentales por Radiación/fisiopatología , Neumonitis por Radiación/patología , Ratas Sprague-DawleyRESUMEN
PURPOSE: To investigate whether early relative cerebral blood volume (rCBV), relative cerebral blood flow (rCBF) and permeability (Ktrans(2)) measurements may serve as magnetic resonance imaging (MRI) biomarkers of radiation response or progression for brain metastases. MATERIALS AND METHODS: Seventy brain metastases in 44 patients treated with either stereotactic radiosurgery or whole brain radiotherapy were imaged with dynamic susceptibility and dynamic contrast enhancement MRI at baseline, 1 week and 1 month after treatment. The final response status was determined according to volume criteria derived from a 1 year post-treatment MRI or last available follow-up MRI. Tumours were characterised as responders, non-responders, progressors and non-progressors and compared for Ktrans(2), rCBF and rCBV differences. Uni- and multivariate analysis evaluated factors associated with tumour response and progression at 1 week and 1 month. A generalised estimating equations (GEE) model accounted for multiple tumours per subject. Receiver operator characteristic (ROC) analysis identified optimal cut-off values, sensitivity and specificity for response or progression. RESULTS: Tumour responders showed lower Ktrans(2) and reduced rCBF at 1 week (P < 0.05 each). Progressive disease showed lower rCBF and reduced rCBV at 1 month (P < 0.05 each). GEE and multivariate analysis revealed lower Ktrans(2) at 1 week, an absence of prior radiation predicted response. At 1 month only lower rCBV predicted progressive disease on GEE and multivariate analysis. Optimal cut-off points for Ktrans(2) and rCBV were 1.37 and 2.03 with sensitivity and specificity of 61.5 and 81.1% and 73.9 and 81.8%, respectively. CONCLUSION: Lower Ktrans(2) at 1 week and rCBV at 1 month discriminated responders and progressive disease, respectively.
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Biomarcadores/análisis , Volumen Sanguíneo/efectos de la radiación , Neoplasias Encefálicas/radioterapia , Circulación Cerebrovascular/efectos de la radiación , Imagen por Resonancia Magnética/métodos , Radiocirugia/efectos adversos , Radioterapia/efectos adversos , Anciano , Neoplasias Encefálicas/irrigación sanguínea , Neoplasias Encefálicas/secundario , Neoplasias Encefálicas/cirugía , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Perfusión , Pronóstico , Estudios Prospectivos , Traumatismos por Radiación/diagnóstico , Traumatismos por Radiación/etiologíaRESUMEN
BACKGROUND AND PURPOSE: DIPG is among the most devastating brain tumors in children, necessitating the development of novel treatment strategies and advanced imaging markers such as perfusion to adequately monitor clinical trials. This study investigated tumor perfusion and 3D segmented tumor volume as predictive markers for outcome in children with newly diagnosed DIPG. METHODS: Imaging data were assessed at baseline, during, and after RT, and every other month thereafter until tumor progression for 35 patients (ages 2-16 years) with newly diagnosed DIPG enrolled in the phase I clinical study, NCT00472017. Patients were treated with conformal RT and vandetanib, a vascular endothelial growth factor receptor 2 inhibitor. RESULTS: Tumor perfusion increased and tumor volume decreased during combined RT and vandetanib therapy. These changes slowly diminished in follow-up scans until tumor progression. However, increased tumor perfusion and decreased tumor volume during combined therapy were associated with longer PFS. Apart from a longer OS for patients who showed elevated tumor perfusion after RT, there was no association for tumor volume and other perfusion variables with OS. CONCLUSIONS: Our results suggest that tumor perfusion may be a useful predictive marker for the assessment of treatment response and tumor progression in children with DIPG treated with both RT and vandetanib. The assessment of tumor perfusion yields valuable information about tumor microvascular status and its response to therapy, which may help better understand the biology of DIPGs and monitor novel treatment strategies in future clinical trials.
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Neoplasias del Tronco Encefálico/diagnóstico , Glioma/diagnóstico , Imagenología Tridimensional/métodos , Imagen por Resonancia Magnética/métodos , Neuroimagen/métodos , Adolescente , Antineoplásicos/uso terapéutico , Volumen Sanguíneo/efectos de los fármacos , Volumen Sanguíneo/efectos de la radiación , Neoplasias del Tronco Encefálico/fisiopatología , Neoplasias del Tronco Encefálico/radioterapia , Niño , Preescolar , Estudios de Cohortes , Progresión de la Enfermedad , Imagen Eco-Planar/métodos , Femenino , Estudios de Seguimiento , Glioma/fisiopatología , Glioma/radioterapia , Humanos , Aumento de la Imagen/métodos , Procesamiento de Imagen Asistido por Computador/métodos , Masculino , Terapia Neoadyuvante , Piperidinas/uso terapéutico , Estudios Prospectivos , Quinazolinas/uso terapéutico , Radioterapia Conformacional/métodos , Receptores de Factores de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
PURPOSE: To develop an image analysis framework to delineate the physiological imaging-defined subvolumes of a tumor in relating to treatment response and outcome. METHODS AND MATERIALS: Our proposed approach delineates the subvolumes of a tumor based on its heterogeneous distributions of physiological imaging parameters. The method assigns each voxel a probabilistic membership function belonging to the physiological parameter classes defined in a sample of tumors, and then calculates the related subvolumes in each tumor. We applied our approach to regional cerebral blood volume (rCBV) and Gd-DTPA transfer constant (K(trans)) images of patients who had brain metastases and were treated by whole-brain radiation therapy (WBRT). A total of 45 lesions were included in the analysis. Changes in the rCBV (or K(trans))-defined subvolumes of the tumors from pre-RT to 2 weeks after the start of WBRT (2W) were evaluated for differentiation of responsive, stable, and progressive tumors using the Mann-Whitney U test. Performance of the newly developed metrics for predicting tumor response to WBRT was evaluated by receiver operating characteristic (ROC) curve analysis. RESULTS: The percentage decrease in the high-CBV-defined subvolumes of the tumors from pre-RT to 2W was significantly greater in the group of responsive tumors than in the group of stable and progressive tumors (P<.007). The change in the high-CBV-defined subvolumes of the tumors from pre-RT to 2W was a predictor for post-RT response significantly better than change in the gross tumor volume observed during the same time interval (P=.012), suggesting that the physiological change occurs before the volumetric change. Also, K(trans) did not add significant discriminatory information for assessing response with respect to rCBV. CONCLUSION: The physiological imaging-defined subvolumes of the tumors delineated by our method could be candidates for boost target, for which further development and evaluation is warranted.
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Volumen Sanguíneo/efectos de la radiación , Neoplasias Encefálicas/radioterapia , Circulación Cerebrovascular , Radioterapia de Intensidad Modulada/métodos , Carga Tumoral/efectos de la radiación , Adulto , Anciano , Algoritmos , Volumen Sanguíneo/fisiología , Neoplasias Encefálicas/irrigación sanguínea , Neoplasias Encefálicas/metabolismo , Neoplasias Encefálicas/patología , Neoplasias Encefálicas/secundario , Irradiación Craneana/métodos , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Modelos Estadísticos , Estudios Prospectivos , Dosificación Radioterapéutica , Estadísticas no Paramétricas , Resultado del TratamientoRESUMEN
PURPOSE: To evaluate the effects of radiation therapy on primary tumor vasculature using dual-energy (DE) micro-computed tomography (micro-CT). METHODS AND MATERIALS: Primary sarcomas were generated with mutant Kras and p53. Unirradiated tumors were compared with tumors irradiated with 20 Gy. A liposomal-iodinated contrast agent was administered 1 day after treatment, and mice were imaged immediately after injection (day 1) and 3 days later (day 4) with DE micro-CT. CT-derived tumor sizes were used to assess tumor growth. After DE decomposition, iodine maps were used to assess tumor fractional blood volume (FBV) at day 1 and tumor vascular permeability at day 4. For comparison, tumor vascularity and vascular permeability were also evaluated histologically by use of CD31 immunofluorescence and fluorescently-labeled dextrans. RESULTS: Radiation treatment significantly decreased tumor growth from day 1 to day 4 (P<.05). There was a positive correlation between CT measurement of tumor FBV on day 1 and extravasated iodine on day 4 with microvascular density (MVD) on day 4 (R(2)=0.53) and dextran accumulation (R(2)=0.63) on day 4, respectively. Despite no change in MVD measured by histology, tumor FBV significantly increased after irradiation as measured by DE micro-CT (0.070 vs 0.091, P<.05). Both dextran and liposomal-iodine accumulation in tumors increased significantly after irradiation, with dextran fractional area increasing 5.2-fold and liposomal-iodine concentration increasing 4.0-fold. CONCLUSIONS: DE micro-CT is an effective tool for noninvasive assessment of vascular changes in primary tumors. Tumor blood volume and vascular permeability increased after a single therapeutic dose of radiation treatment.
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Volumen Sanguíneo/efectos de la radiación , Permeabilidad Capilar/efectos de la radiación , Sarcoma/irrigación sanguínea , Sarcoma/radioterapia , Microtomografía por Rayos X/métodos , Animales , Volumen Sanguíneo/fisiología , Permeabilidad Capilar/fisiología , Medios de Contraste , Técnica del Anticuerpo Fluorescente/métodos , Yodo , Liposomas/administración & dosificación , Ratones , Nanopartículas/administración & dosificación , Imagen de Perfusión/métodos , Molécula-1 de Adhesión Celular Endotelial de Plaqueta , Dosis de Radiación , Sarcoma/patología , Carga TumoralRESUMEN
PURPOSE: The purpose of this study was to evaluate high-dose single fraction delivered with monochromatic X-rays minibeams for the radiotherapy of primary brain tumors in rats. METHODS AND MATERIALS: Two groups of healthy rats were irradiated with one anteroposterior minibeam incidence (four minibeams, 123 Gy prescribed dose at 1 cm depth in the brain) or two interleaved incidences (54 Gy prescribed dose in a 5 × 5 × 4.8 mm(3) volume centered in the right hemisphere), respectively. Magnetic resonance imaging (MRI) follow-up was performed over 1 year. T2-weighted (T2w) images, apparent diffusion coefficient (ADC), and blood vessel permeability maps were acquired. F98 tumor bearing rats were also irradiated with interleaved minibeams to achieve a homogeneous dose of 54 Gy delivered to an 8 × 8 × 7.8 mm(3) volume centered on the tumor. Anatomic and functional MRI follow-up was performed every 10 days after irradiation. T2w images, ADC, and perfusion maps were acquired. RESULTS: All healthy rats were euthanized 1 year after irradiation without any clinical alteration visible by simple examination. T2w and ADC measurements remain stable for the single incidence irradiation group. Localized Gd-DOTA permeability, however, was observed 9 months after irradiation for the interleaved incidences group. The survival time of irradiated glioma bearing rats was significantly longer than that of untreated animals (49 ± 12.5 days versus 23.3 ± 2 days, p < 0.001). The tumoral cerebral blood flow and blood volume tend to decrease after irradiation. CONCLUSIONS: This study demonstrates the sparing effect of minibeams on healthy tissue. The increased life span achieved for irradiated glioma bearing rats was similar to the one obtained with other radiotherapy techniques. This experimental tumor therapy study shows the feasibility of using X-ray minibeams with high doses in brain tumor radiotherapy.
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Neoplasias Encefálicas/radioterapia , Irradiación Craneana/métodos , Glioma/radioterapia , Tratamientos Conservadores del Órgano/métodos , Animales , Volumen Sanguíneo/efectos de la radiación , Neoplasias Encefálicas/irrigación sanguínea , Neoplasias Encefálicas/mortalidad , Neoplasias Encefálicas/patología , Irradiación Craneana/instrumentación , Estudios de Factibilidad , Glioma/irrigación sanguínea , Glioma/mortalidad , Glioma/patología , Imagen por Resonancia Magnética , Masculino , Modelos Animales , Tratamientos Conservadores del Órgano/instrumentación , Órganos en Riesgo , Radioterapia/métodos , Dosificación Radioterapéutica , Ratas , Ratas Endogámicas F344 , Análisis de Supervivencia , Sincrotrones/instrumentaciónRESUMEN
Terrestrial Trunked Radio (TETRA) technology ("Airwave") has led to public concern because of its potential interference with electrical activity in the brain. The present study is the first to examine whether acute exposure to a TETRA base station signal has an impact on cognitive functioning and physiological responses. Participants were exposed to a 420 MHz TETRA signal at a power flux density of 10 mW/m(2) as well as sham (no signal) under double-blind conditions. Fifty-one people who reported a perceived sensitivity to electromagnetic fields as well as 132 controls participated in a double-blind provocation study. Forty-eight sensitive and 132 control participants completed all three sessions. Measures of short-term memory, working memory, and attention were administered while physiological responses (blood volume pulse, heart rate, skin conductance) were monitored. After applying exclusion criteria based on task performance for each aforementioned cognitive measure, data were analyzed for 36, 43, and 48 sensitive participants for these respective tasks and, likewise, 107,125, and 129 controls. We observed no differences in cognitive performance between sham and TETRA exposure in either group; physiological response also did not differ between the exposure conditions. These findings are similar to previous double-blind studies with other mobile phone signals (900-2100 MHz), which could not establish any clear evidence that mobile phone signals affect health or cognitive function.
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Cognición/efectos de la radiación , Campos Electromagnéticos/efectos adversos , Exposición a Riesgos Ambientales/efectos adversos , Fenómenos Fisiológicos/efectos de la radiación , Ondas de Radio/efectos adversos , Telecomunicaciones/instrumentación , Adulto , Volumen Sanguíneo/efectos de la radiación , Femenino , Respuesta Galvánica de la Piel/efectos de la radiación , Frecuencia Cardíaca/efectos de la radiación , Humanos , Masculino , Memoria/efectos de la radiación , Tolerancia a RadiaciónRESUMEN
PURPOSE: To measure changes in perfusion of the pharyngeal constrictor muscles (PCM) using CT perfusion (CTP) imaging during a course of definitive radiotherapy (RT) in head-and-neck cancer (HNC) patients and correlate with dysphagia outcome after RT. METHODS AND MATERIALS: Fifteen HNC patients underwent CTP imaging of the PCM at baseline and Weeks 2, 4, and 6 during RT and 6 weeks after RT. Blood flow and blood volume were measured in the PCM, and percentage change from baseline scan was determined. A single physician-based assessment of dysphagia was performed every 3 months after RT using the Common Terminology Criteria for Adverse Events, version 3.0 grading system. RESULTS: With a median follow-up of 28 months (range, 6-44 months), Grade 3 dysphagia was present in 7 of 15 patients, and 8 patients experienced Grade 0-2 dysphagia. The CTP parameters at Week 2 of RT demonstrated an increase in mean PCM blood flow of 161.9% vs. 12.3% (p = 0.007) and an increase in mean PCM blood volume of 96.6% vs. 8.7% (p = 0.039) in patients with 6-month post-RT Grade 3 dysphagia and Grade 0-2 dysphagia, respectively. On multivariate analysis, when adjusting for smoking history, tumor volume, and baseline dysphagia status, an increase in blood flow in the second week of RT was significant for 3- and 6-month Grade 3 dysphagia (p < 0.05). CONCLUSIONS: Perfusion changes in the PCM during Week 2 of RT in the PCM may predict the severity of dysphagia after HNC RT.
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Trastornos de Deglución/etiología , Neoplasias de Cabeza y Cuello/radioterapia , Músculos Faríngeos/efectos de la radiación , Anciano , Volumen Sanguíneo/fisiología , Volumen Sanguíneo/efectos de la radiación , Quimioradioterapia , Trastornos de Deglución/diagnóstico por imagen , Trastornos de Deglución/fisiopatología , Femenino , Estudios de Seguimiento , Neoplasias de Cabeza y Cuello/tratamiento farmacológico , Neoplasias de Cabeza y Cuello/patología , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada Multidetector , Análisis Multivariante , Músculos Faríngeos/irrigación sanguínea , Músculos Faríngeos/diagnóstico por imagen , Estudios Prospectivos , Radioterapia de Intensidad Modulada , Flujo Sanguíneo Regional/fisiología , Flujo Sanguíneo Regional/efectos de la radiación , Fumar , Factores de Tiempo , Carga TumoralRESUMEN
This study tests whether the nitric oxide synthase (NOS) inhibitor, N(G)-nitro-L-arginine (L-NNA), combines favorably with ionizing radiation (IR) in controlling squamous carcinoma tumor growth. Animals bearing FaDu and A431 xenografts were treated with L-NNA in the drinking water. IR exposure was 10 Gy for tumor growth and survival studies and 4 Gy for ex vivo clonogenic assays. Cryosections were examined immunohistochemically for markers of apoptosis and hypoxia. Blood flow was assayed by fluorescent microscopy of tissue cryosections after i.v. injection of fluorospheres. Orally administered L-NNA for 24 hrs reduces tumor blood flow by 80% (p<0.01). Within 24 hrs L-NNA treatment stopped tumor growth for at least 10 days before tumor growth again ensued. The growth arrest was in part due to increased cell killing since a combination of L-NNA and a single 4 Gy IR caused 82% tumor cell killing measured by an ex vivo clonogenic assay compared to 49% by L-NNA or 29% by IR alone. A Kaplan-Meyer analysis of animal survival revealed a distinct survival advantage for the combined treatment. Combining L-NNA and IR was also found to be at least as effective as a single i.p. dose of cisplatin plus IR. In contrast to the in vivo studies, exposure of cells to L-NNA in vitro was without effect on clonogenicity with or without IR. Western and immunochemical analysis of expression of a number of proteins involved in NO signaling indicated that L-NNA treatment enhanced arginase-2 expression and that this may represent vasculature remodeling and escape from NOS inhibition. For tumors such as head and neck squamous carcinomas that show only modest responses to inhibitors of specific angiogenic pathways, targeting NO-dependent pro-survival and angiogenic mechanisms in both tumor and supporting stromal cells may present a potential new strategy for tumor control.
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Antineoplásicos/farmacología , Carcinoma de Células Escamosas/tratamiento farmacológico , Carcinoma de Células Escamosas/radioterapia , Inhibidores Enzimáticos/farmacología , Óxido Nítrico Sintasa/antagonistas & inhibidores , Nitroarginina/farmacología , Ensayos Antitumor por Modelo de Xenoinjerto , Animales , Antineoplásicos/uso terapéutico , Apoptosis/efectos de los fármacos , Apoptosis/efectos de la radiación , Volumen Sanguíneo/efectos de los fármacos , Volumen Sanguíneo/efectos de la radiación , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/fisiopatología , Línea Celular Tumoral , Proliferación Celular/efectos de los fármacos , Proliferación Celular/efectos de la radiación , Cisplatino/farmacología , Inhibidores Enzimáticos/uso terapéutico , Regulación Neoplásica de la Expresión Génica/efectos de los fármacos , Regulación Neoplásica de la Expresión Génica/efectos de la radiación , Humanos , Masculino , Ratones , Óxido Nítrico Sintasa/metabolismo , Nitroarginina/uso terapéutico , Dosis de Radiación , Análisis de SupervivenciaRESUMEN
For the last two decades, a large number of studies have investigated the effects of mobile phone radiation on the human brain and cognition using behavioral or neurophysiological measurements. This review evaluated previous findings with respect to study design and data analysis. Provocation studies found no evidence of subjective symptoms attributed to mobile phone radiation, suggesting psychological reasons for inducing such symptoms in hypersensitive people. Behavioral studies previously reported improved cognitive performance under exposure, but it was likely to have occurred by chance due to multiple comparisons. Recent behavioral studies and replication studies with more conservative statistics found no significant effects compared with original studies. Neurophysiological studies found no significant effects on cochlear and brainstem auditory processing, but only inconsistent results on spontaneous and evoked brain electrical activity. The inconsistent findings suggest possible false positives due to multiple comparisons and thus replication is needed. Other approaches such as brain hemodynamic response measurements are promising but the findings are few and not yet conclusive. Rigorous study design and data analysis considering multiple comparisons and effect size are required to reduce controversy in this important field of research.
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Conducta/efectos de la radiación , Teléfono Celular , Campos Electromagnéticos/efectos adversos , Fenómenos Fisiológicos del Sistema Nervioso/efectos de la radiación , Animales , Conducta/fisiología , Volumen Sanguíneo/efectos de la radiación , Circulación Cerebrovascular/efectos de la radiación , HumanosRESUMEN
PURPOSE: We used computed tomography (CT) perfusion to evaluate the acute and late effect of radiation therapy (RT) on spinal cord (SC) hemodynamics in patients without symptoms of myelopathy. We hypothesized that SC perfusion could be acutely altered during RT. METHODS AND MATERIALS: We analyzed neck CT perfusion studies of 36 head-and-neck cancer patients (N1), 16 of whom had previously undergone RT. In a separate group of 6 patients (N2), CT perfusion studies were obtained before RT, after 40 Gy, and after treatment completion. RESULTS: In the N1 group, SC blood flow (BF), blood volume (BV), mean transit time (MTT), and capillary permeability (CP) maps were not significantly different between RT-treated and RT-naive patients. In the N2 group, BF and CP were significantly increased during treatment compared with the baseline and post-RT studies. CONCLUSIONS: Radiation therapy of the head and neck may cause transient perturbations of SC perfusion that seem to reverse after treatment. There are no definite chronic effects of RT on SC perfusion observeable at the typical doses administered during treatment of head and neck malignancies.
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Neoplasias de Cabeza y Cuello/radioterapia , Médula Espinal/irrigación sanguínea , Médula Espinal/efectos de la radiación , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Anciano de 80 o más Años , Velocidad del Flujo Sanguíneo/fisiología , Velocidad del Flujo Sanguíneo/efectos de la radiación , Volumen Sanguíneo/fisiología , Volumen Sanguíneo/efectos de la radiación , Permeabilidad Capilar/fisiología , Permeabilidad Capilar/efectos de la radiación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Flujo Sanguíneo Regional/fisiología , Flujo Sanguíneo Regional/efectos de la radiaciónRESUMEN
Radiation therapy does not only target tumour cells but also affects tumour vascularity. In the present study, changes in tumour vascularity and blood volume were investigated in five grade 1 oral fibrosarcomas, eight other sarcomas (non-oral soft tissue and bone sarcomas) and 12 squamous cell carcinomas in dogs during fractionated radiation therapy (total dose, 45-56 Gy). Contrast-enhanced power Doppler ultrasound was performed before fraction 1, 3, 6, 8, 10, 12, 14 and 15 or 16 (sarcomas) or 17 (squamous cell carcinomas). Prior to treatment, median vascularity and blood volume were significantly higher in squamous cell carcinomas (P=0.0005 and 0.001), whereas measurements did not differ between oral fibrosarcomas and other sarcomas (P=0.88 and 0.999). During the course of radiation therapy, only small, non-significant changes in vascularity and blood volume were observed in all three tumour histology groups (P=0.08 and P=0.213), whereas median tumour volume significantly decreased until the end of treatment (P=0.04 for fibrosarcomas and other sarcomas, P=0.008 for squamous cell carcinomas). It appeared that there was a proportional decrease in tumour volume, vascularity and blood volume. Doppler measurements did not predict progression free interval or survival in any of the three tumour groups (P=0.06-0.86). However, the number of tumours investigated was small and therefore, the results can only be considered preliminary.
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Carcinoma de Células Escamosas/veterinaria , Enfermedades de los Perros/radioterapia , Neoplasias de la Boca/veterinaria , Sarcoma/veterinaria , Ultrasonografía Doppler en Color/veterinaria , Animales , Volumen Sanguíneo/efectos de la radiación , Volumen Sanguíneo/veterinaria , Neoplasias Óseas/irrigación sanguínea , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/radioterapia , Neoplasias Óseas/veterinaria , Carcinoma de Células Escamosas/irrigación sanguínea , Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/radioterapia , Medios de Contraste , Enfermedades de los Perros/diagnóstico por imagen , Perros , Femenino , Fibrosarcoma/irrigación sanguínea , Fibrosarcoma/diagnóstico por imagen , Fibrosarcoma/radioterapia , Fibrosarcoma/veterinaria , Aumento de la Imagen , Masculino , Neoplasias de la Boca/irrigación sanguínea , Neoplasias de la Boca/diagnóstico por imagen , Neoplasias de la Boca/radioterapia , Flujo Sanguíneo Regional/efectos de la radiación , Sarcoma/irrigación sanguínea , Sarcoma/diagnóstico por imagen , Sarcoma/radioterapia , Resultado del Tratamiento , Ultrasonografía Doppler en Color/métodosRESUMEN
PURPOSE: To assess whether alterations in tumor blood volume (BV) and blood flow (BF) during the early course of chemo-radiotherapy (chemo-RT) for head-and-neck cancer (HNC) predict treatment outcome. METHODS AND MATERIALS: Fourteen patients receiving concomitant chemo-RT for nonresectable, locally advanced HNC underwent dynamic contrast-enhanced (DCE) MRI scans before therapy and 2 weeks after initiation of chemo-RT. The BV and BF were quantified from DCE MRI. Preradiotherapy BV and BF, as well as their changes during RT, were evaluated separately in the primary gross tumor volume (GTV) and nodal GTV for association with outcomes. RESULTS: At a median follow-up of 10 months (range, 5-27 months), 9 patients had local-regional controlled disease. One patient had regional failure, 3 had local failures, and 1 had local-regional failure. Reduction in tumor volume after 2 weeks of chemo-RT did not predict for local control. In contrast, the BV in the primary GTV after 2 weeks of chemo-RT was increased significantly in the local control patients compared with the local failure patients (p < 0.03). CONCLUSIONS: Our data suggest that an increase in available primary tumor blood for oxygen extraction during the early course of RT is associated with local control, thus yielding a predictor with potential to modify treatment. These findings require validation in larger studies.
Asunto(s)
Volumen Sanguíneo , Neoplasias de Cabeza y Cuello/irrigación sanguínea , Neoplasias de Cabeza y Cuello/radioterapia , Adulto , Anciano de 80 o más Años , Anticuerpos Monoclonales/administración & dosificación , Anticuerpos Monoclonales Humanizados , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Volumen Sanguíneo/efectos de la radiación , Carboplatino/administración & dosificación , Cetuximab , Terapia Combinada , Femenino , Estudios de Seguimiento , Neoplasias de Cabeza y Cuello/tratamiento farmacológico , Neoplasias de Cabeza y Cuello/mortalidad , Neoplasias de Cabeza y Cuello/patología , Humanos , Masculino , Persona de Mediana Edad , Paclitaxel/administración & dosificación , Paclitaxel/uso terapéutico , Valor Predictivo de las Pruebas , Dosificación Radioterapéutica , Factores de Tiempo , Insuficiencia del Tratamiento , Resultado del TratamientoRESUMEN
PURPOSE: The tumor vascular effects of radiotherapy and subsequent administration of the vascular disrupting agent combretastatin A4 phosphate (CA4P) were studied in patients with advanced non-small-cell lung cancer using volumetric dynamic contrast-enhanced computed tomography (CT). PATIENTS AND METHODS: Following ethical committee approval and informed consent, 8 patients receiving palliative radiotherapy (27 Gy in six fractions, twice weekly) also received CA4P (50 mg/m(2)) after the second fraction of radiotherapy. Changes in dynamic CT parameters of tumor blood volume (BV) and permeability surface area product (PS) were measured for the whole tumor volume, tumor rim, and center after radiotherapy alone and after radiotherapy in combination with CA4P. RESULTS: After the second fraction of radiotherapy, 6 of the 8 patients showed increases in tumor PS (23.6%, p = 0.011). Four hours after CA4P, a reduction in tumor BV (22.9%, p < 0.001) was demonstrated in the same 6 patients. Increase in PS after radiotherapy correlated with reduction in BV after CA4P (r = 0.77, p = 0.026). At 72 h after CA4P, there was a sustained reduction in tumor BV of 29.4% (p < 0.001). Both increase in PS after radiotherapy and reduction in BV after CA4P were greater at the rim of the tumor. The BV reduction at the rim was sustained to 72 h (51.4%, p = 0.014). CONCLUSION: Radiotherapy enhances the tumor antivascular activity of CA4P in human non-small-cell lung cancer, resulting in sustained tumor vascular shutdown.
Asunto(s)
Antineoplásicos Fitogénicos/uso terapéutico , Carcinoma de Pulmón de Células no Pequeñas , Neoplasias Pulmonares , Estilbenos/uso terapéutico , Volumen Sanguíneo/efectos de los fármacos , Volumen Sanguíneo/efectos de la radiación , Permeabilidad Capilar/efectos de los fármacos , Permeabilidad Capilar/efectos de la radiación , Carcinoma de Pulmón de Células no Pequeñas/irrigación sanguínea , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Terapia Combinada , Medios de Contraste , Femenino , Humanos , Neoplasias Pulmonares/irrigación sanguínea , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/radioterapia , Masculino , Tomografía Computarizada por Rayos X/métodosRESUMEN
PURPOSE: To quantitatively assess the in vivo acute vascular effects of fractionated radiotherapy for human non-small-cell lung cancer using volumetric perfusion computed tomography (CT). METHODS AND MATERIALS: Sixteen patients with advanced non-small-cell lung cancer, undergoing palliative radiotherapy delivering 27 Gy in 6 fractions over 3 weeks, were scanned before treatment, and after the second (9 Gy), fourth (18 Gy), and sixth (27 Gy) radiation fraction. Using 16-detector CT, multiple sequential volumetric acquisitions were acquired after intravenous contrast agent injection. Measurements of vascular blood volume and permeability for the whole tumor volume were obtained. Vascular changes at the tumor periphery and center were also measured. RESULTS: At baseline, lung tumor vascularity was spatially heterogeneous with the tumor rim showing a higher vascular blood volume and permeability than the center. After the second, fourth, and sixth fractions of radiotherapy, vascular blood volume increased by 31.6% (paired t test, p = 0.10), 49.3% (p = 0.034), and 44.6% (p = 0.0012) respectively at the tumor rim, and 16.4% (p = 0.29), 19.9% (p = 0.029), and 4.0% (p = 0.0050) respectively at the center of the tumor. After the second, fourth, and sixth fractions of radiotherapy, vessel permeability increased by 18.4% (p = 0.022), 44.8% (p = 0.0048), and 20.5% (p = 0.25) at the tumor rim. The increase in permeability at the tumor center was not significant after radiotherapy. CONCLUSION: Fractionated radiotherapy increases tumor vascular blood volume and permeability in human non-small-cell lung cancer. We have established the spatial distribution of vascular changes after radiotherapy; greater vascular changes were demonstrated at the tumor rim compared with the center.
Asunto(s)
Volumen Sanguíneo/efectos de la radiación , Carcinoma de Pulmón de Células no Pequeñas/irrigación sanguínea , Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Neoplasias Pulmonares/irrigación sanguínea , Neoplasias Pulmonares/radioterapia , Volumen Sanguíneo/fisiología , Permeabilidad Capilar/fisiología , Permeabilidad Capilar/efectos de la radiación , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico por imagen , Femenino , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Masculino , Cuidados Paliativos , Estudios Prospectivos , Dosificación Radioterapéutica , Reproducibilidad de los Resultados , Tomografía Computarizada por Rayos X/métodosRESUMEN
The aim of this preliminary investigation was to assess the probable effects of microwave exposure on Hematological parameters of RBC (Red Blood Cell), PCV (Packed Cell Volume) and Hb (Hemoglobin) in rats. For this study 80 Sprague Dawley rats were exposed to 2450 MHZ microwave field for a period of one year. The experiment groups were divided to 5 groups, each 16 (8 males and 8 female), 4 for treatment and one, for control (D, E, F, G and H). The incident power density of the first two experiment groups was 1 mW m(-2) and for next two groups, was 10 mW cm(-2). The daily exposure time was 5 min for groups F and G and 30 min for groups, D and F. The animals in control group (H) were under normal condition without any microwave exposure. In the end of the study the blood samples were taken from the heart of animals under ether anesthesia and determination of blood parameters were performed by cell counter auto analyzer. According to the statistical results, the level of RBC in male groups of F and G and percentage of PCV in female and male groups of F and content of Hb, in female groups of F, were significantly increased in comparison to the control group and variation of results in other groups were not significant.
Asunto(s)
Volumen Sanguíneo/efectos de la radiación , Eritrocitos/efectos de la radiación , Hemoglobinas/efectos de la radiación , Microondas/efectos adversos , Animales , Campos Electromagnéticos , Femenino , Masculino , Ratas , Ratas Sprague-DawleyRESUMEN
Optical imaging slit spectroscopy is a powerful method for estimating quantitative changes in cerebral haemodynamics, such as deoxyhaemoglobin, oxyhaemoglobin and blood volume (Hbr, HbO2 and Hbt, respectively). Its disadvantage is that there is a large loss of spatial data as one image dimension is used to encode spectral wavelength information. Single wavelength optical imaging, on the other hand, produces high-resolution spatiotemporal maps of brain activity, but yields only indirect measures of Hbr, HbO2 and Hbt. In this study we perform two-dimensional optical imaging spectroscopy (2D-OIS) in rat barrel cortex during contralateral whisker stimulation to obtain two-dimensional maps over time of Hbr, HbO2 and Hbt. The 2D-OIS was performed by illuminating the cortex with four wavelengths of light (575, 559, 495 and 587 nm), which were presented sequentially at a high frame rate (32 Hz). The contralateral whisker pad was stimulated using two different durations: 1 and 16 s (5 Hz, 1.2 mA). Control experiments used a hypercapnic (5% CO2) challenge to manipulate baseline blood flow and volume in the absence of corresponding neural activation. The 2D-OIS method allowed separation of artery, vein and parenchyma regions. The magnitude of the haemodynamic response elicited varied considerably between different vascular compartments; the largest responses in Hbt were in the arteries and the smallest in the veins. Phase lags in the HbO2 response between arteries and veins suggest that a process of upstream signalling maybe responsible for dilating the arteries. There was also a consistent increase in Hbr from arterial regions after whisker stimulation.
Asunto(s)
Circulación Cerebrovascular/fisiología , Energía Filtrada en la Transmisión por Microscopía Electrónica , Flujo Sanguíneo Regional/fisiología , Corteza Somatosensorial/fisiología , Vibrisas/inervación , Algoritmos , Animales , Vasos Sanguíneos/fisiología , Volumen Sanguíneo/fisiología , Volumen Sanguíneo/efectos de la radiación , Mapeo Encefálico , Relación Dosis-Respuesta en la Radiación , Estimulación Eléctrica/métodos , Potenciales Evocados Somatosensoriales/fisiología , Potenciales Evocados Somatosensoriales/efectos de la radiación , Lateralidad Funcional/fisiología , Hemoglobinas/metabolismo , Procesamiento de Imagen Asistido por Computador/métodos , Técnicas In Vitro , Ratas , Flujo Sanguíneo Regional/efectos de la radiación , Factores de TiempoRESUMEN
PURPOSE: To identify radiation-induced changes in the cerebral vasculature of healthy tissue in the first four months following radiotherapy through the analysis of dynamic-susceptibility contrast perfusion imaging. MATERIALS AND METHODS: Dynamic gradient-echo imaging was performed on 22 patients during injection of a bolus of Gd-DTPA contrast. The relative cerebral blood volume (rCBV), maximum DeltaR2* of the first passage of the bolus, and a recirculation parameter were derived from gamma-variate fits of the dynamic data. The white matter (WM) rCBV and peak heights were estimated through correlation with segmented T1-weighted images. A percent recovery to baseline was also computed to further describe the recirculation phase. RESULTS: A significant elevation of the recirculation phase was observed at doses>15 Gy at two months following radiotherapy. This was reflected in an increased recirculation parameter in the fitted curves in the 15-30, 30-45, and >45 Gy dose groups to 2.8%, 3.8%, and 2.4% above the <15 Gy voxels, as well as in a decline in percent recovery to baseline. A trend toward lower rCBV and peak heights was observed at that same time point. CONCLUSION: The observed results suggest a dose-dependent decline in vessel density and increase in vascular permeability and/or tortuosity in irradiated normal-appearing brain tissue at two months following radiotherapy.
Asunto(s)
Volumen Sanguíneo/efectos de la radiación , Neoplasias Encefálicas/radioterapia , Encéfalo/efectos de la radiación , Circulación Cerebrovascular , Glioma/radioterapia , Adulto , Anciano , Encéfalo/irrigación sanguínea , Neoplasias Encefálicas/fisiopatología , Medios de Contraste , Relación Dosis-Respuesta en la Radiación , Femenino , Gadolinio DTPA , Glioma/fisiopatología , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Persona de Mediana Edad , Método de Montecarlo , Estadísticas no ParamétricasRESUMEN
The objective of the present study was to reveal an interaction between choroidal blood flow (ChBF) and light-induced photoreceptor activity, a physiological coupling that has been already demonstrated for retinal blood flow but rejected for ChBF. Ten healthy adults volunteered for this study. A real-time recording near-infrared laser-Doppler flowmeter was used to quantify the subfoveal ChBF while the luminance of blue flicker between 1 and 64 Hz was first increased and then decreased by 4.0 log units in 1.0-log unit steps between 0.0375 and 375 cd/m2. In separate testing, flash electroretinograms (ERGs) provided electrophysiological indexes of the relative response of short-wave cones (s-cones) and rods to blue light stimulation. Group-averaged, normalized ChBF measurements revealed that it was modulated by approximately 9% by flicker frequency. Increasing the blue flicker luminance from low to high attenuated the subfoveal ChBF, volume, and velocity by approximately 32%, approximately 30%, and approximately 5%, respectively. Decreasing the luminance from high to low over the same range had no effect on the subfoveal choroidal hemodynamics. The markedly different effects of reversed directions of change in blue flicker luminance on the subfoveal ChBF were linked to transitions between rod-dominated and s-cone-dominated retinal responses. Collectively, these findings indicate that the blue light-induced photoreceptor response is associated with a differential distribution of the ChBF across the ocular fundus according to the degree and type of retinal photoreceptor stimulated.