背景:功能精准医学(FPM)代表了治疗恶性肿瘤的个性化和有效方式。然而,获取足够的活组织进行FPM分析是复杂的成像和辐射坏死的难以识别,特别是在复发的情况下。作者描述了在复发性高级别神经胶质瘤患者中计划FPM测定的活检轨迹的情况。
方法:一名25岁男性,有复发性高级别神经胶质瘤病史,在随访成像确定潜在复发区域后,计划进行激光消融和化疗活检。该区域的术前磁共振(MR)波谱显示,放射性坏死病灶内胆碱/肌酸比率较高的区域,这有助于规划活检轨迹,以选择性地针对FPM分析的恶性肿瘤。化疗结果显示肿瘤对洛莫司汀的敏感性高,作为辅助治疗。
结论:FPM治疗在复发的情况下并发放射性坏死,在影像学上可能表现为恶性肿瘤,并在活检或切除期间干扰组织采集。因此,手术入路应在MR波谱成像等成像方式的帮助下仔细规划,以更好地确保有效的组织采集,从而进行准确的FPM分析,并促进对复发的更明确治疗.
BACKGROUND: Functional precision medicine (FPM) represents a personalized and efficacious modality for treating malignant neoplasms. However, acquiring sufficient live tissue to perform FPM analyses is complicated by both difficult identification on imaging and radiation necrosis, particularly in cases of recurrence. The authors describe a
case of planning biopsy trajectories for an FPM assay in a patient with recurrent high-grade glioma.
METHODS: A 25-year-old male with a history of recurrent high-grade glioma was scheduled for laser ablation and biopsy with ChemoID assaying after regions of potential recurrence were identified on follow-up imaging. Preoperative magnetic resonance (MR)
spectroscopy of the regions showed areas of high choline/creatine ratios within lesions of radiation necrosis, which helped in planning the biopsy trajectories to selectively target malignancies for FPM analysis. ChemoID results showed high tumor susceptibility to lomustine, which was implemented as adjuvant therapy.
CONCLUSIONS: FPM therapy in the setting of recurrence is complicated by radiation necrosis, which can present as malignancy on imaging and interfere with tissue acquisition during biopsy or resection. Thus, operative approaches should be carefully planned with the assistance of imaging modalities such as MR
spectroscopy to better ensure effective tissue acquisition for accurate FPM analysis and to promote more definitive treatment of recurrence.