Cervical Cancer Clinical Trial
Official title:
Radiation Therapy Planning by Multi-parametric PET/MRI Imaging in Patients With Cervical Cancer
The main goal of this project is to evaluate the potential and feasibility of hybrid PET/MRI functional imaging to non-invasively measure tumor characteristics for radiation therapy planning (RT) for cervical cancer. It will be assessed how the complementary information of tumor characteristics can contributed to better understanding of tumor delineation. Another endpoint of this study is to evaluate a new PET-tracer (68Ga-NODAGA- E[c(RGDyK)]2) enabling imaging of tumor-angiogenesis.
The standard treatment for patients with locally advanced cervical cancer includes a
combination of external beam radiotherapy (EBRT) and brachytherapy (BT) with concurrent
cisplatin-based chemotherapy. During the last decade, the utilization of MRI for planning of
EBRT and BT has grown based on the GEC ESTRO recommendations and the cervix is among the
first cancer sites where response-adaptive radiotherapy has been successfully implemented in
clinical practice. This approach has changed patterns of clinical practice with regard to
dose administration, and significant improvements in clinical outcome have been reported.
However further development of both BT and EBRT is still demanded to improve tumor
delineation and consequently local control.
Recent developments in advanced image guidance for both EBRT and BT have potential to improve
local as well as nodal and also systemic control. Multi-parametric PET/MR imaging potentially
offers new possibilities for RT planning, whereas a complete replacement of the planning MRI
with combined PET/MRI for EBRT and BT, alters target volume delineation due to superior soft
tissue contrast provided by MRI and combined with the information of tumor heterogeneity,
perfusion characteristics, and hypoxia provided by PET, DW-MRI, and DCE-MRI. However combined
use of PET/MRI for treatment planning still remains challenging due to several aspects.
Therefore, investigators intend to encounter the technical challenges regarding dose planning
and attenuation correction of MRI hardware and immobilization devices by generating
Pseudo-CT, using methods based on ultra-short echo time (UTE) MR sequence. Additionally,
investigators desire to assess how the complementary information provided by multi-parametric
PET/MRI can affect the planning of EBRT and BT and contribute to better understanding of the
pathology of cervical cancer during chemo-radiotherapy and improve radiation treatment.
The PET/MR will be performed with a new PET-tracer "RGD" (68Ga-NODAGA- E[c(RGDyK)]2) enabling
imaging of tumor-angiogenesis. This is to show the angiogenesis within the tumor and changes
during external radiotherapy. The study of angiogenesis will be supported by examination of
tissues from the tumor.
Investigators expect the angiogenesis to correlate to the aggression and thereby the
prognosis of the individual tumor.
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