title: In vivo 31P NMR spectroscopy of human musculoskeletal tumors as a measure of response to chemotherapy.
abstract: The value of in vivo 31P NMR spectroscopy to provide indicators of response to cytostatic chemotherapy was studied in patients with malignant musculoskeletal tumors. Characteristics of untreated cancers were strong signals of PME and PDE, moderately increased Pi and low PCr. The intracellular pH was slightly alkaline. The intracellular concentration of free magnesium was 70% of that in muscle. Spectroscopic findings at different times of therapy were compared with the percentage of tumor necrosis after surgical resection in 28 patients. In follow-up studies, energy-rich phosphates declined in nonresponders, while PME, Pi and frequently PDE increased. Treatment response appeared to involve the reversal of these trends. In five responders, a biphasic pattern was observed, i.e. initially the spectrum changed into that of severely ischemic cell injury followed by a successive phase of apparent 'tumor activation'. Pretreatment levels of (PCr+Pi)/total phosphate > or = 0.35 and PCr/ alpha-NTP > or = 1.5, an accelerated increase in total low-energy phosphates/total high-energy phosphates (> or = 3.0%/day) after the initial drug application, and a long-term decrease (< or = -0.4%/day) during later therapy were highly indicative of tumor response to chemotherapy. Such spectroscopic predictors for treatment response proved to be superior to currently used indices such as tumor size.
authors.affiliation: Westfälische Wilhelms-Universität Münster, Institut für Physikalische Chemie, Germany.
authors.forename: H E
authors.initials: HE
authors.lastname: Möller
authors.forename: P
authors.initials: P
authors.lastname: Vermathen
authors.forename: E
authors.initials: E
authors.lastname: Rummeny
authors.forename: K
authors.initials: K
authors.lastname: Wörtler
authors.forename: P
authors.initials: P
authors.lastname: Wuisman
authors.forename: A
authors.initials: A
authors.lastname: Rössner
authors.forename: B
authors.initials: B
authors.lastname: Wörmann
authors.forename: J
authors.initials: J
authors.lastname: Ritter
authors.forename: P E
authors.initials: PE
authors.lastname: Peters
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001706:Biopsy; D001859:Bone Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D002648:Child; D005260:Female; D005682:Gadolinium; D019786:Gadolinium DTPA; D006801:Humans; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D019042:Muscle Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D009942:Organometallic Compounds; D004369:Pentetic Acid / Q000031:analogs & derivatives; D010758:Phosphorus; D012983:Soft Tissue Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery
chemical_list: D009942:Organometallic Compounds; D010758:Phosphorus; D004369:Pentetic Acid; D005682:Gadolinium; D019786:Gadolinium DTPA