Vrednost multidetektorske kompjuterizovane tomografije u proceni i predviđanju odgovora karcinoma jednjaka na neoadjuvantnu hemoradioterapiju
Value of the multidetector computed tomography in evaluation and prediction of response of esophageal cancer to the neoadjuvant chemo radiotherapy
Докторанд
Đurić Stefanović, AleksandraМентор
Šaranović, ĐorđijeЧланови комисије
Peško, PredragMašulović, Dragan
Micev, Marjan
Метаподаци
Приказ свих података о дисертацијиСажетак
Cilj: Neoadjuvantna (preoperativna) hemoradioterapija (HRT) je široko prihvaćena
terapijska opcija u multimodalnom tretmanu uznapredovalog, lokorgionalno ograničenog
karcinoma jednjaka, a multidetektorska kompjuterizovana tomografija (MDCT) danas
predstavlja standard u radiološkom dijagnostičkom algoritmu bolesnika sa karcinomom
jednjaka, jer omogućava istovremenu procenu lokoregionalne proširenosti maligne bolesti
(T i N stadijum) i detekciju udaljenih metastaza (M stadijum). Glavni ciljevi rada su: 1)
utvrđivanje dijagnostičke pouzdanosti MDCT sa CT perfuzijom u proceni odgovora
karcinoma jednjaka na neoadjuvantnu HRT i 2) identifikacija morfoloških i perfuzionih
karakteristika karcinoma jednjaka koje mogu da predstavljaju prediktivne markere
potencijalnog odgovora na HRT, a koje je moguće detektovati inicijalnim MDCT
pregledom sa CT perfuzijom.
Metodologija: Prospektivnom kohortnom kliničkom studijom obuhvaćeno je 65 bolesnika
sa lokalno uznapredovalim skvamocelularnim karcinomom je...dnjaka, lečenih
neoadjuvantnom HRT, kojima je u inicijalnoj dijagnostičkoj obradi, kao i 4-8 nedelja po
sprovedenoj HRT, urađen MDCT pregled vrata, grudnog koša i abdomena sa CT
perfuzionom studijom, radi (inicijalne i post-HRT) procene stadijuma maligne bolesti
jednjaka. Istraživanje je sprovedeno u Centru za radiologiju i magnetnu rezonancu
Kliničkog centra Srbije (Odsek digestivne radiologije- Prva hirurška klinika i Odsek za
multidetektorsku kompjuterizovanu tomografiju) i Centru za hirurgiju jednjaka Prve
hirurške klinike Kliničkog centra Srbije, u periodu od januara 2007. do jula 2013. Patološka
analiza je rađena u Službi za patohistologiju Kliničkog centra Srbije (Odeljenje za
digestivnu patologiju)...
Objective: Neoadjuvant (preoperative) chemo radiotherapy (CRT) is widely accepted
therapeutic option in the multimodal treatment of loco regional advanced esophageal
cancer, while multidetector-computed tomography (MDCT) is now the standard in
diagnostic algorithm of patients with esophageal cancer, because it allows the
simultaneous assessment of loco regional spread of malignancy (T and N stage) and the
detection of distant metastases (M stage). The main objectives of this study were: 1) to
estimate the diagnostic accuracy of MDCT together with the CT perfusion study in
assessment of response of esophageal cancer to the neoadjuvant CRT, and 2) to identify
the morphological and perfusion characteristics of the esophageal carcinoma, which
could be the potential predictive markers of response to CRT, and those could be
detected by initial MDCT examination with CT perfusion study.
Methodology: 65 patients with loco regional advanced squamous cell carcinoma of the
esophagus, who were trea...ted with neoadjuvant CRT, were included in this prospective
cohort clinical study. In all patients, MDCT examination of the neck, thorax and
abdomen with CT perfusion study was performed in the initial diagnostic process, and
repeated on the same way 4-8 weeks after completion of the CRT, due to staging and restaging
purposes. The research was performed at the Center of Radiology and MRI of
Clinical Center of Serbia (Unit of Digestive Radiology - First Surgical Clinic and
Department of Multidetector Computed Tomography), and the Center of Esophageal
Surgery, First Surgical Clinic, Clinical Center of Serbia, from January 2007 until July
2013. Pathological analysis was performed in the Department of histopathology
(Department of Digestive Pathology), Clinical Center of Serbia. The study was
approved by the Ethics Committee of the Medical Faculty in Belgrade...