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  • Cervical Cancer – Tumor Heterogeneity: Serial Functional and Molecular Imaging Across the Radiation Therapy Course in Advanced Cervical Cancer (CC-Tumor-Heterogeneity)

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Background: The functional and biological properties of the tumor microenvironment are fundamentally important determinants of tumor response and therapy outcome in cancer.  Oxygenation status and vascularity are known to influence radiation response, and molecular energy metabolism and proliferation, modulate risk of disease recurrence and metastatic progression.  However, with the current standard clinical diagnostic approaches, such as biopsy or anatomic/morphologic tumor imaging, assessment of the known intra-tumoral heterogeneity of functional and biological tumor properties is limited.  Specifically, the functional characteristics within the microenvironment throughout the entire tumor have been challenging to assess spatially for tumor heterogeneity and temporally for clinical correlation before and during treatment.  While histologic tissue sampling is widely used clinically, sampling of the entire tumor with extensive biopsies, and biopsies at various time points during therapy for intra-treatment assessment are impractical and generally pose unacceptable clinical risk.