<b>Background:</b> Systemic chemotherapy and radiotherapy play an important role in the treatment of colorectal cancer. Tumour perfusion and oxygenation is known to influence radiosensitivity and chemosensitivity. In this thesis, I propose that the evaluation of changes in tumour perfusion using perfusion CT (pCT) and dynamic contrast-enhanced (Dce) MRI can guide the rational sequencing of drugs and radiation. <b>Methods:</b> Dce-MRI and pCT scans were incorporated into a clinical trial of hypofractionated pelvic radiotherapy and nelfinavir in 10 patients with rectal cancer. Toxicity and tissue biomarkers (tumour cell density, microvessel density, CAIX, HIF1-alpha, phospho-Akt and phospho-PRAS40) were evaluated. pCT liver scans were incorporated into an imaging study in patients with colorectal liver metastases randomised to receive either oxaliplatin/ 5FU chemotherapy or oxaliplatin/ 5FU chemotherapy plus selective internal radiotherapy. <b>Results:</b> After 7 days of nelfinavir concurrent with hypo-fractionated pelvic radiotherapy, there was a mean 42&percnt; increase in median K^trans (P=0.03, paired t test) on Dce-MRI and a median 30&percnt; increase in mean blood flow on pCT (P=0.028, Wilcoxon Rank Sum), although no statistically significant changes in perfusion parameters were demonstrated after 7 days of nelfinavir prior to radiotherapy. The feasibility of evaluating tumour cell density in rectal biopsies before and after radiotherapy and a radiosensitising drug as an early endpoint of response was demonstrated. In patients with colorectal liver metastases who received oxaliplatin and modified de Gramont chemotherapy alone, after 4 cycles of chemotherapy, a 28&percnt; decrease in the mean hepatic arterial fraction was observed (P=0.018, paired t test). Between pCT scans 2 days before SIRT and 39-47 days following SIRT and continued 2-weekly chemotherapy, there was a mean 62&percnt; (P=0.009) reduction in Blood Flow and 61&percnt; (P=0.006) reduction in Blood Volume (paired t test). <b>Conclusions</b> This research does not support the hypothesis that nelfinavir before radiotherapy improves blood flow to human rectal cancer. Increases in rectal tumour perfusion during radiotherapy and concurrent nelfinavir are likely to be primarily explained by the acute biological effects of radiation. Four or more cycles of oxaliplatin and modified de Gramont chemotherapy may result in changes in tumour perfusion of colorectal liver metastases which would be detrimental to subsequent radiotherapy. Selective internal radiotherapy resulted in substantial reductions in tumour perfusion 39-47 days after the treatment. Perfusion imaging can be used to detect changes in tumour perfusion in response to radiotherapy and systemic therapy which have implications for the sequencing of therapies.

Une nouvelle stratégie oncologique, basée sur l’intégration de la radiothérapie nanovectorisée et l’administration loco-régionale, a été évaluée pour le traitement et l’imagerie du glioblastome, le type le plus commun des tumeurs cérébrales primaires. Les dendrimères Gallic Acid-Triethylène Glycol (GATG) sont des nanovecteurs de choix pour délivrer simultanément l’agent thérapeutique (le radioisotope 188Re par son rayonnement béta a été retenu) et l’agent diagnostique (le gadolinium est un agent paramagnétique utilisé en Imagerie par Résonance Magnétique (IRM)). Leur évaluation a été réalisée par administration locorégionale par stéréotaxie sur un modèle de rat F 98. Les données pharmaco-cinétiques ont été également obtenues après injection intraveineuse permettant d’apprécier les propriétés des différents dendrimères synthétisés. Leur apport en terme de confinement au site d’injection représente un avantage majeur de ce nouveau type de radiopharmaceutiques. / A new oncologic strategy, based on the integration of nanovectorized radiotherapy and locoregional delivery, was evaluated for the treatment and imaging of glioblastomas, the most common and lethal type of primary brain tumors. Gallic acidtriethylene glycol (GATG) dendrimers were the nanovectors of choice to deliver the radiotherapeutic 188Re and paramagnetic nuclei Gd3+, with a minimally invasive stereotactic injection, directly depositing the radiotherapeutic dose to the tumor site in a F98 rat glioma model. Intravenous injection was used to further investigate the pharmacokinetics, throughout body distribution and clearance profiles of these dendrimers. Molecular weight and architecture had an important role on the in vivo behavior of the dendrimers. Their use as nanovectors prevented the fast brain clearance of the radionuclide alone, and prolonged the confinement of the internal radiation at the tumor site.