Changes in Relative Cerebral Blood Volume 1 Month after Radiation-Temozolomide Therapy Can Help Predict Overall Survival in Patients with Glioblastoma1
ABSTRACT To evaluate perfusion parameter changes in patients with glioblastoma multiforme by comparing the perfusion magnetic resonance (MR) imaging measurements obtained before combined radiation and temozolomide therapy (RT-TMZ) with the follow-up MR imaging measurements obtained 1 month after completion of this treatment.
Institutional review board approval was obtained, and HIPAA guidelines were followed. The data of 36 patients (24 male [median age, 63 years]; 12 female [median age, 59 years]) with glioblastoma multiforme who were treated with RT-TMZ were retrospectively reviewed. The hypothesis was that a change in relative cerebral blood volume (rCBV) 1 month after RT-TMZ is predictive of overall survival. Linear regression analysis was performed to correlate changes in tumor size and perfusion parameters with overall survival. Receiver operating characteristic (ROC) curves were evaluated for 1-year survival. Overall survival was assessed with Kaplan-Meir survival curves and log-rank testing.
Percentage change in rCBV at 1 month after RT-TMZ correlated with overall survival. Increased rCBV after treatment was a strong predictor of poor survival (median survival, 235 days versus 529 days with decreased rCBV) (P < .008, log-rank test). The ROC curves for 1-year survival showed a greater area under the curve (0.806; 95% confidence interval [CI]: 0.698, 0.970) (P = .005) with rCBV than with tumor size (0.556; 95% CI: 0.342, 0.729) (P = .382). The overall survival for patients with increased tumor size, based on Macdonald criteria, was shorter than that for patients who showed no progression (stable or partial response), but the difference was not significant (median survival, 442 days versus 598 days) (P = .761, log-rank test).
Change in rCBV after RT-TMZ appears to correlate with overall survival.
- SourceAvailable from: Benjamin Lemasson
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- "The conventional approach for analyzing MRI parameters is to determine the percentage change in a summary statistic over the tumor VOI, which may be delineated using qualitative imaging such as T1-Gd and FLAIR images. These summary statistics may include the histogram mean, median, or even percentile of the parameter  . We have proposed a physiologically based approach where relative tumor volumes are determined from the segmentation of the tumor histogram based on known physiological values. "
ABSTRACT: Studies investigating dynamic susceptibility contrast magnetic resonance imaging-determined relative cerebral blood volume (rCBV) maps as a metric of treatment response assessment have generated conflicting results. We evaluated the potential of various analytical techniques to predict survival of patients with glioma treated with chemoradiation. rCBV maps were acquired in patients with high-grade gliomas at 0, 1, and 3 weeks into chemoradiation therapy. Various analytical techniques were applied to the same cohort of serial rCBV data for early assessment of survival. Three different methodologies were investigated: 1) percentage change of whole tumor statistics (i.e., mean, median, and percentiles), 2) physiological segmentation (low rCBV, medium rCBV, or high rCBV), and 3) a voxel-based approach, parametric response mapping (PRM). All analyses were performed using the same tumor contours, which were determined using contrast-enhanced T1-weighted and fluid attenuated inversion recovery images. The predictive potential of each response metric was assessed at 1-year and overall survival. PRM was the only analytical approach found to generate a response metric significantly predictive of patient 1-year survival. Time of acquisition and contour volume were not found to alter the sensitivity of the PRM approach for predicting overall survival. We have demonstrated the importance of the analytical approach in early response assessment using serial rCBV maps. The PRM analysis shows promise as a unified early and robust imaging biomarker of treatment response in patients diagnosed with high-grade gliomas.Translational oncology 12/2013; 6(6):766-74. DOI:10.1593/tlo.13670 · 3.40 Impact Factor
Current Topics in Ionizing Radiation Research, 02/2012; , ISBN: 978-953-51-0196-3
- "As to the tumor vasculature, several studies have been proposed using two different techniques -quantified power Doppler sonography or Dynamic contrast-enhanced MRI (DCE-MRI). And both showed promising results (Hormigo et al., 2007; Kim et al., 2006; Mangla et al., 2010). "
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ABSTRACT: Novel therapies of central nervous system (CNS) malignancies have evoked the demand to increasingly integrate dedicated imaging techniques into the diagnostic work-up and treatment evaluation in neuro-oncology. In primary and secondary malignancies of the CNS, advanced neuroimaging techniques enable non-invasive assessment of tissue microstructure, cellular and vascular proliferation and capillary permeability. Furthermore, eloquent cortical areas in the vicinity of tumours and the course of white matter pathways are rendered visible to facilitate surgical therapy. The armamentarium of magnetic resonance (MR) imaging techniques includes diffusion-weighted imaging (DWI), perfusion-weighted imaging (PWI), diffusion-tensor imaging (DTI), functional MRI (f-MRI) and MR spectroscopy (MRS). Computed tomography perfusion (perfusion CT) may serve as an alternative to magnetic resonance perfusion (perfusion MR). These new imaging techniques lend support to distinguish the primary brain neoplasms from the secondary brain neoplasms, aid in grading of gliomas, delineate infiltration beyond visible boundaries on contrast-enhanced images and thus support guidance for biopsies and surgical resection. Surveillance and treatment monitoring of neoplasms may shift from almost exclusive reliance on contrast enhancement to an imaging approach that combines traditional morphology with advanced “functional” techniques. Validation of these new developments is ongoing based on the observations in clinical neuro-oncology, radiation oncology, histopathology and neurosurgery. Application of advanced imaging protocols may promise to improve diagnosis, to stratify patients to an increasing diversity of treatment options and potentially individualise therapy.memo - Magazine of European Medical Oncology 09/2012; 5(3). DOI:10.1007/s12254-012-0046-8