MR Metabolic Biomarkers for Cervical Cancer
MR Metabolic Biomarkers for Cervical Cancer
The purposes of this study are: (1) to develop magnetic resonance (MR) imaging and
 spectroscopy as surrogate biomarkers for altered cancer metabolism in cervical cancer; (2) to
 understand the function of human papillomavirus (HPV) infection and autophagy (a cellular
 catabolic degradation response to stress) in the metabolic alterations in cervical cancer.
In the first part of this project, we aim to identify the differences in cancer metabolism
 between normal and cervical cancer. Conventional MR study plus magnetic resonance
 spectroscopy (MRS) and diffusion weighted imaging (DWI) sequences will be carried out on 30
 eligible surgical candidates for pretreatment clinical assessment. Metabolites in cancer
 tissue will be collected during operation and analyzed using high resolution MRS, and
 compared with control group comprising 30 patients with normal cervical tissue. The primary
 endpoint of this part is to identify different MRS profiles between normal and cancer
 subjects. We will investigate the underlying biological mechanism between these two groups by
 evaluating status of HPV infection and autophagy. In the second part, we aim to understand
 cancer metabolism in cervical cancers infected by different types of HPV. We plan to enroll
 another 30 surgical candidates and complete the data regarding clinical MRS/DWI and tissue
 high resolution MRS. Together with the 30 cancer subjects in part one there will be in total
 60 cancer subjects for analysis. The primary endpoint of this part is to compare MRS profiles
 from cancer tissue infected with different HPV genotypes, particularly HPV type 16 and HPV
 type 18. The secondary endpoint is to correlate the tissue MRS profiles with the in vivo
 MRS/DWI measured by clinical MR scanner. In the third part of this project, we aim to
 investigate cancer metabolism under combined chemoradiation therapy (CCRT). We plan to enroll
 60 patients primarily treated with CCRT and collect the data using clinical MR and tissue
 high-resolution MRS. Tissue MRS profiles will be correlated with the HPV, E6/E7 and
 autophagy.

 The advance in knowledge of this project is to unwire the complex relationship among cancer
 metabolism, HPV infection and autophagy in cervical cancer. The clinical impact is the
 development of MR biomarkers for cancer metabolism and autophagy, both play important roles
 in the resistance to cancer therapy. The inherited non-invasiveness and non-radiation nature
 makes MR technique an ideal platform for clinical usage.
Inclusion Criteria:

 -  be able to give informed consent.

 -  female patients between 20 and 80 years of age.

 -  biopsy proven newly diagnosed cervical cancer clinical stage International Federation
 of Gynecology and Obstetrics (FIGO) Ib and above.

 -  patients must be willing to undergo standard treatment such as surgery or
 chemo-radiation therapy.

 Exclusion Criteria:

 -  patients who are judged to be noncompliant to treatment or not accessible for follow
 up.

 -  patients with contraindications to magnetic resonance imaging (MRI) scanning, such as
 claustrophobia, cardiac pacemaker, metal implants in field of view, or unable to
 cooperate for MRI study due to mental status.