ACRIN Gynecologic
Committee
Fall Meeting 2010
ACRIN Abdominal Committee
ACRIN Gynecologic Committee
ACRIN 6695
Perfusion CT (DCE-CT) as an early predictor of
response to combined cytotoxic and antiangiogenic chemotherapy and as a surrogate
marker of long-term outcome for patients
with advanced stage epithelial ovarian,
peritoneal and fallopian tube cancer:
A companion study to GOG 262
Chaan Ng
ACRIN Gynecologic Committee
BACKGROUND: Biomarkers
•Overall survival
•Response
•Biomarkers in oncology
-Assessment of tumor response
-Predictors of response
-Prognostic markers
•CEA, PSA, Ca125
•TNM
•RECIST
ACRIN Gynecologic Committee
BACKGROUND: CT Perfusion
• CT Perfusion
– Tissue viability
• Angiogenesis
– Functional evaluation
• Tumor blood flow, volume, permeability
– Combined with routine CT staging
ACRIN Gynecologic Committee
BACKGROUND:
“THE QUESTION”
• Utility of CT perfusion in oncology
• Translatability of CT perfusion into clinical
environment
ACRIN Gynecologic Committee
BACKGROUND:
THE STUDY
• ACRIN 6695
• GOG 262
ACRIN Gynecologic Committee
PROTOCOL SCHEMA
ACRIN Gynecologic Committee
ACRIN Gynecologic Committee
“Conventional”
“Dose-dense”
•Primary Endpoint:
-Progression-free survival (PFS)
•Secondary Endpoints:
-Overall Survival (OS)
-Response Rate (RR)
-Toxicity
-Translational Research -Quality of Life
ACRIN Gynecologic Committee
ACRIN Gynecologic Committee
ACRIN Gynecologic Committee
IMAGING OBJECTIVES:
Primary
• Whether larger changes in tumor perfusion
parameters (T2 - T0) are predictive of better
progression-free-survival rate at 6 months
(PFS6m)
– [Early predictor of response?]
– [Prior to first routine CT restaging]
ACRIN Gynecologic Committee
ACRIN Gynecologic Committee
Contrast body CT
ACRIN Gynecologic Committee
TARGET LESION
• Precontrast
– >1cm short axis
– > 10 HU on pre-contrast (50% of lesion)
• Postcontrast
– > 5 HU enhancement (in 50% of lesion)
ACRIN Gynecologic Committee
CT CONTRAST
• Oral contrast
– Negative or positive contrast
• IV contrast
– >300 mgI2/mL
– 3-4 mL/s
– 0.8 mL/kg body weight (max. 70 mL volume)
ACRIN Gynecologic Committee
TARGET LESION: examples
ACRIN Gynecologic Committee
TARGET LESION: examples
ACRIN Gynecologic Committee
TARGET LESION
• > 2cm
• Round or oval
– Not plaques
• Avoid motion
– Retroperitoneum
– Pelvis
• Enhancement
– Cyst, ascites, hematoma
• Postop changes
ACRIN Gynecologic Committee
ELIGIBILITY
•
•
•
•
Eligible for GOG
Adequate renal function
No contraindication to IV contrast medium
Diabetics on Metformin
• Consent process
– Correlative within Consent Form of participating
GOG sites, with “opt-out”
ACRIN Gynecologic Committee
ANALYSES
• Central perfusion CT data analysis
– Ting Lee
– ACRIN HQ
• Data available for alternative analyses
– GE model
– Other vendors
ACRIN Gynecologic Committee
ACCRUAL
• ACRIN = 70 evaluable
– GOG = 625
• Attrition
– In practice we need 25-30% of GOG accrual
ACRIN Gynecologic Committee
CHALLENGES
• Accrual
– Sites
– GOG
– Target lesions
• Radiation dose
ACRIN Gynecologic Committee
SITES
• Looking for collaborating sites
ACRIN Gynecologic Committee
ACRIN Gynecologic Committee
CONTACT DETAILS
• Chaan Ng
Department of Radiology
MD Anderson Cancer Center
Houston, TX 77030-4009
Phone: 713-792-6759
Email: cng@mdanderson.org
• Ting-Yim Lee
Imaging Research Labs,
Robarts Research Institute
London, Ontario, Canada
Phone: 519-663-5777 ext. 24131
Email: tlee@imaging.robarts.ca
ACRIN Abdominal Committee
ACRIN Gynecologic Committee