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Early prediction of response
Functional imaging
Microarrays
Proteomics
FDG SUVmax
0
10
20
30
Before RT During RT After RT
FMISO/FDG SUVmax
0
10
20
30
Before RT During RT After RT
SU
V m
ax
FDG/FLT SUVmax
0
10
20
30
SU
V m
ax
N=15 N=10 N=5
Before RT
During RT
After RT
Before RT During RT After RT Before RT During RT After RT
FDG 17 10 5 18 11,5 4,5 14 8 3
FMISO 5 3 3
FLT 8 3 1,5
tumour evolution: SUVmax
RECTUMGELATINE
Rectum resection
Styrofoam boxOrientation sticks
-20°C
Formol
scan
4 mm slices
Validation of tumor delineation
Validation of Tumor Delineation
T
T
T
MR CT FDG PET FLT PET
Resection specimen Pathology
metabolism tracer proliferation tracer
before therapy
during therapy
after therapy
MR FDG FMISO FLT Pathology
cc cc cc cc cc
P1 7,76 3,54 1,45 1,37
P2 5,77 0,53 3,09 0,05
P3 20,36 12,95 8,98 11,19
P4 8,79 1,02 1,38 0,77
P5 7,15 3,61 0 pCR
P6 3,59 0 0 0,55
P7 6,99 2,92 0 0,43
P8 3,2 0 0 pCR
P9 18,29 3,18 1,87 2,25
P10 3,45 2,05 0,52 pCR
P11 2 7,09 3,05 0,32
P12 4,08 0 5,14 pCR
P13 0,48 0,35 2,26 pCR
P14 1,32 0 0 pCR
P15 8 5,4 0 0,13 T
P
Validation tumour volume MR-FDG with APO
FDG-PET TVs delineated with the gradient-based method matched closer with the pathological TV than MR-based TV
Translational research in rectal cancer
SSURGERY
W 12-13
T0 T1 T2
Blood/ tissue samples
Pathological response according to tumor regression grading
Chemoradiation Cetuximab* + capecitabine
(n=37)
Oxaliplatin* + capecitabine
(n=36)
5-FU alone (n=35)
pCR
2 (5%)
5 (14%)
4 (11%)
> 2 mm mesorectal margin
27 (73%)
30 (83%)
Translational research in rectal cancer
Micro-arraysImmunohistochemistr
y
FISH
GENES PROTEINS
ELISA
Phase II study with cetuximab in rectal cancer
TGF-α
EGFR
Fibro-inflammatory
changes
Ki67
Debucquoy et al, unpublished results
Effect of Bevacizumab on tumour responseMarked response in all 6 patients
Only microscopic disease in 5 patients
Willett et al. J Clin Oncol 2005
Effect of bevacizumab on tumour vasculature
Pretreatment
Day 12
Patient
IFP (
mm
Hg
)
0
4.5
9.0
13.5
18.0
22.5
3 4 5 6IFP = interstitial fluid pressure
Willett et al. Nat Med 2004