TITLE

Prognostic Significance of Serial Magnetic Resonance Spectroscopies over the Course of Radiation Therapy for Patients with Malignant Glioma

AUTHOR(S)
Alexander, A.; Murtha, A.; Abdulkarim, B.; Mehta, V.; Wheatley, M.; Murray, B.; Riauka, T.; Hanson, J.; Fulton, D.; Urtasun, R.; McEwan, A.; Roa, W.
PUB. DATE
October 2006
SOURCE
Clinical & Investigative Medicine;Oct2006, Vol. 29 Issue 5, p301
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: The standard treatment of high grade gliomas (HGG) involves maximal neuro-surgical debulking, followed by post-operative radiotherapy, with or without concurrent chemotherapy, depending on histologic grade. Despite this aggressive strategy, there are few long-term survivors. Proton magnetic resonance spectroscopy (MRS) is a non-invasive imaging method that can monitor metabolic changes in brain tumours. To date there is little data concerning the prognostic significance of the evolving spectral alterations during a course of radiotherapy. Materials: We report herein a prospective study of patients with HGGs undergoing post-operative radiotherapy. Fourteen consecutively eligible patients with a confirmed histologic diagnosis of malignant glioma and completion of all required MRS imaging were included in this study. All patients had MRS imaging prior to radiotherapy, at week 4 of radiotherapy, and 2 months post-treatment. T1 and T2 weighted images as well as post-gadolinium multi-voxel proton MRS images were obtained. Normalized (tumour metabolite/normal brain metabolite) levels of choline, NAA, creatine, lipid and lactate were calculated. Kaplan-Meier (KM) curves of progression-free and overall survival were constructed based on the evolving patterns of metabolite changes over the course of the images. Results: The mean tumour choline/NAA ratio decreased over the course of therapy, with a reduction observed between the baseline and post-radiotherapy studies (1.91 vs. 1.29, P=0.049). A similar decrease was identified with the mean normalized choline ratio, with a highly significant difference observed between the baseline and post-radiation images (1.61 vs. 0.96, P=0.001). Patients who exhibited more than 40% decrease in normalized choline between the week 4 and post-radiotherapy studies were associated with unfavourable survival (logrank test, P=0.003) and disease progression (logrank test, P=0.012). The Lactate/NAA ratio and the 4th week of radiotherapy and the change in normalized choline/creatine between baseline and week 4 of radiotherapy were also predictive of outcome suggesting the possibility of adaptive, response-based radiation treatment. Patients with two or more poor prognostic MRS indices had a significantly shorter progression-free survival compared with those with zero or one poor indices, with 15% and 68% at 1 year, respectively (logrank test, P=0.045). Conclusion: The evolving pattern of spectral changes over the course of radiotherapy, in particular those associated with choline-containing compounds, appears to be prognostic of tumour response and outcome. Based on our data, a decision point may exist in the mid course of radical radiotherapy, at which time consideration of the choline levels could indicate the extent of radiotherapeutic response, thus allowing for individualized treatment modification.
ACCESSION #
22955041

 

Related Articles

  • The Metabolic Epicenter of Supratentorial Gliomas: A 1H-MRSI Study. Sankar, Tejas; Kuznetsov, Yevgeniy E.; Ryan, Robert W.; Caramanos, Zografos; Antel, Samson B.; Arnold, Douglas L.; Preul, Mark C. // Canadian Journal of Neurological Sciences;Nov2009, Vol. 36 Issue 6, p696 

    Background: Assessing the impact of glioma location on prognosis remains elusive. We approached the problem using multivoxel proton magnetic resonance spectroscopic imaging (1H-MRSI) to define a tumor "metabolic epicenter", and examined the relationship of metabolic epicenter location to...

  • Oligodendrogliomas in the CT/MR-Era. Leonardi, M. A.; Lumenta, Ch. B. // Acta Neurochirurgica;Dec2001, Vol. 143 Issue 12, p1195 

    Summary.Background: The aim of this study was to investigate survival times and 4 prognostic factors of oligodendrogliomas in the CT/MR-era, since most previous studies result from the pre-CT-era, where modern histopathological classification, diagnostic and therapeutic tools were not used....

  • Erratum to: Tumour and tumour-like lesions of the patella - a multicentre experience. Singh, J.; James, S. L.; Kroon, H. M.; Woertler, K.; Anderson, S. E.; Jundt, G.; Davies, A. M. // European Radiology;Mar2010, Vol. 20 Issue 3, p763 

    A correction to the article "Tumour and tumour-like lesions of the patella: A multicentre experience," that was published in the previous issue is presented.

  • Hypothalamic glioma masquerading as craniopharyngioma. Vyas, Sameer; Prabhakar, Nidhi; Kumar Tewari, Manoj; Radotra, Bishan Dass; Khandelwal, Niranjan // Journal of Neurosciences in Rural Practice;Jul-Sep2013, Vol. 4 Issue 3, p323 

    Hypothalamic glioma account for 10-15% of supratentorial tumors in children. They usually present earlier (first 5 years of age) than craniopharyngioma. Hypothalamic glioma poses a diagnostic dilemma with craniopharyngioma and other hypothalamic region tumors, when they present with atypical...

  • Distinct supratentorial lesions mimicking cerebral gliomas. Wurm, G.; Parsaei, B.; Silye, R.; Fellner, F. A. // Acta Neurochirurgica;Jan2004, Vol. 146 Issue 1, p19 

    Summary Background. Various supratentorial pathological conditions can mimic neoplastic cerebral lesions clinically as well as radiologically. Analysis of the neuroradiological findings, the clinical history, laboratory and other paraclinical data mostly help to narrow down the diagnosis of...

  • A report of a desmoplastic non-infantile ganglioglioma in a 6-year-old boy with review of the literature. Per, Hüseyin; Kontaş, Olgun; Kumandaş, Sefer; Kurtsoy, Ali // Neurosurgical Review;Jul2009, Vol. 32 Issue 3, p369 

    Desmoplastic infantile gangliogliomas (DIG) are uncommon supratentorial brain tumors with a usually good prognosis despite an aggressive radiological appearance that typically occurs in infants below the age of 24 months. DIGs are exclusively supratentorial, generally have a voluminous size, and...

  • Intensity-modulated radiation to spare neural stem cells in brain tumors: A computational platform for evaluation of physical and biological dose metrics. Jaganathan, Arun; Tiwari, Meena; Phansekar, Rahul; Panta, Rajkumar; Huilgol, Nagraj // Journal of Cancer Research & Therapeutics;Jan-Mar2011, Vol. 7 Issue 1, p58 

    Background: Neurocognitive effects following whole-brain and partial-brain irradiation can cause considerable morbidity. Sparing of neural stem cells (NSCs) is proposed as an avenue for reducing the long-term radiation-induced defects in learning, memory, and intelligence. We performed an...

  • Implications of contrast-enhanced CT-based and MRI-based target volume delineations in radiotherapy treatment planning for brain tumors. Datta, Niloy R.; David, Rajasekar; Gupta, Raltesh K.; Lal, Punita // Journal of Cancer Research & Therapeutics;Jan2008, Vol. 4 Issue 1, p9 

    Delineation of various target volumes using contrast-enhanced magnetic resonance imaging (MRI) and/or computed tomography (CT) constitutes the primary step for radiation therapy planning (IRTP) in brain tumors. This study presents a quantification and comparative evaluation of the various...

  • H-MRS is useful to reinforce the suspicion of primary central nervous system lymphoma prior to surgery. Mora, Paloma; Majós, Carles; Castañer, Sara; Sánchez, Juan; Gabarrós, Andreu; Muntané, Amadeo; Aguilera, Carles; Arús, Carles // European Radiology;Nov2014, Vol. 24 Issue 11, p2895 

    Objectives: To assess whether H-MRS may be useful to reinforce the radiological suspicion of PCNSL. Methods: In this retrospective study, we included 546 patients with untreated brain tumours in which single-voxel spectroscopy at TE 30 ms and 136 ms had been performed. The patients were split...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics