Imaging Biomarkers And Their Implications For Tumor Heterogeneity

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Babak Saboury, MD, MPH; Sepideh Panahi, MD; Robert Morales MD; Eliot Siegel, MD Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, MD, USA Reprint permissions are pending. Radiomics and Personalized Medicine: Imaging Biomarkers and their Implications for Tumor Heterogeneity Introduction Cancer is the cause of death in one out of four people in the United States.{Cronin, 2014 #124;Ward, 2014 #128} The mortality rate has been almost constant in spite of all new discoveries to cure cancer in the past few decades{Cronin, 2014 #124}. This shows that several contributing factors play major roles. The practice of clinical oncology focuses on the diversity on cancer cells.…show more content…
Regional intratumoral heterogeneity manifests at the cellular level as subgroups of cells with different genetic and phenotypic characteristics. Many newer tools (e.g., laser capture microdessection) have been developed and used to help study this phenomenon on a cellular basis in tumors previously considered to be homogeneous,.{Johann, 2009 #131} Regional phenotypic evolution is driven by tremendous temporal and spatial variation in the environment (and, therefore, environmental selection forces), mostly as a result of variability of vascular density and blood flow. The prognostic significance of tumor heterogeneity has been highlighted in several malignancies, and in fact, this characteristic has been included in the grading systems for certain tumors {Yip, 2015 #242;Stahl, 2015 #136;Skibinski, 2015 #160;Singh, 2015 #230;Robertson-Tessi, 2015 #148;Supernat, 2014 #204;Longo, 2012 #339;Polyak, 2014 #223}. (Figure 1 - Permission Pending) Figure 1. Collisson, E. A. et al. (2012) What are we learning from the cancer genome? Nat. Rev. Clin. Oncol. doi:10.1038/nrclinonc.2012.159 The importance of tumor heterogeneity The most important utility of tumor heterogeneity quantification lies in its implications for determining and defining therapeutic outcome in cancer. Onco-therapeutic interventions fail for two general reasons: 1) cellular resistance, in which the cell is unresponsive to a treatment because of its intrinsic properties (such as activation of xenobiotic
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