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Abstract #0839

Pre-treatment hyperpolarized 13C-lactate to 13C-bicarbonate ratio predicts response of brain metastases to stereotactic radiosurgery

Nicole I.C. Cappelletto1, Hany Soliman2, Casey Y. Lee1, Nadia D. Bragagnolo3, Biranavan Uthayakumar1, Arjun Sahgal2, Albert P. Chen4, Ruby Endre3, Nathan Ma5, William J. Perks5, Jay S. Detsky2, Chris Heyn6, and Charles H. Cunningham1,3
1Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada, 2Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada, 3Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada, 4GE Healthcare, Toronto, ON, Canada, 5Pharmacy, Sunnybrook Health Sciences Centre, Toronto, ON, Canada, 6Radiology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

Synopsis

Keywords: Hyperpolarized MR (Non-Gas), Cancer, Treatment Response Prediction, Radiotherapy, Brain Metastases, MetabolismBrain metastases are increasingly being treated with stereotactic radiosurgery; however, 20-30% of treated tumors locally recure post treatment. Hyperpolarized [1-13C]pyruvate magnetic resonance imaging (HP 13C MRI) is an emerging metabolic imaging modality that measures key metabolic phenotypes indicative of aggressive tumor phenotypes. Here we show that the pre-treatment tumor 13C-lactate to 13C-bicarbonate ratio – a marker of glycolysis and (indirectly) oxidative phosphorylation – measured via HP [1-13C]pyruvate MRI is a robust predictor of local recurrence (AUCROC=0.95, p=0.0008; AUCPRC=0.92) and can inform treatment decisions should the model predict a non-response to SRS.

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