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Acharya S, Robinson CG, Michalski JM, Mullen D, DeWees TA, Campian JL, Chundury A, Bottani B, Hallahan DE, Bradley JD, Huang J. Association of 1p/19q Codeletion and Radiation Necrosis in Adult Cranial Gliomas After Proton or Photon Therapy. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.01.099] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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102
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Thust SC, van den Bent MJ, Smits M. Pseudoprogression of brain tumors. J Magn Reson Imaging 2018; 48:571-589. [PMID: 29734497 PMCID: PMC6175399 DOI: 10.1002/jmri.26171] [Citation(s) in RCA: 178] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 04/07/2018] [Indexed: 12/11/2022] Open
Abstract
This review describes the definition, incidence, clinical implications, and magnetic resonance imaging (MRI) findings of pseudoprogression of brain tumors, in particular, but not limited to, high-grade glioma. Pseudoprogression is an important clinical problem after brain tumor treatment, interfering not only with day-to-day patient care but also the execution and interpretation of clinical trials. Radiologically, pseudoprogression is defined as a new or enlarging area(s) of contrast agent enhancement, in the absence of true tumor growth, which subsides or stabilizes without a change in therapy. The clinical definitions of pseudoprogression have been quite variable, which may explain some of the differences in reported incidences, which range from 9-30%. Conventional structural MRI is insufficient for distinguishing pseudoprogression from true progressive disease, and advanced imaging is needed to obtain higher levels of diagnostic certainty. Perfusion MRI is the most widely used imaging technique to diagnose pseudoprogression and has high reported diagnostic accuracy. Diagnostic performance of MR spectroscopy (MRS) appears to be somewhat higher, but MRS is less suitable for the routine and universal application in brain tumor follow-up. The combination of MRS and diffusion-weighted imaging and/or perfusion MRI seems to be particularly powerful, with diagnostic accuracy reaching up to or even greater than 90%. While diagnostic performance can be high with appropriate implementation and interpretation, even a combination of techniques, however, does not provide 100% accuracy. It should also be noted that most studies to date are small, heterogeneous, and retrospective in nature. Future improvements in diagnostic accuracy can be expected with harmonization of acquisition and postprocessing, quantitative MRI and computer-aided diagnostic technology, and meticulous evaluation with clinical and pathological data. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018.
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Affiliation(s)
- Stefanie C. Thust
- Lysholm Neuroradiology DepartmentNational Hospital for Neurology and NeurosurgeryLondonUK
- Department of Brain Rehabilitation and RepairUCL Institute of NeurologyLondonUK
- Imaging DepartmentUniversity College London HospitalLondonUK
| | - Martin J. van den Bent
- Department of NeurologyThe Brain Tumor Centre at Erasmus MC Cancer InstituteRotterdamThe Netherlands
| | - Marion Smits
- Department of Radiology and Nuclear Medicine, Erasmus MCUniversity Medical Centre RotterdamRotterdamThe Netherlands
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103
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Sharma A, Low J, Mrugala MM. Neuro-oncologists have spoken - the role of bevacizumab in the inpatient setting. A clinical and economic conundrum. Neurooncol Pract 2018; 6:30-36. [PMID: 31385984 DOI: 10.1093/nop/npy011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Bevacizumab is a monoclonal antibody targeting vascular endothelial growth factor (VEGF), a key player in tumor angiogenesis. The drug can halt tumor progression, treat radiation necrosis, and reduce peritumoral edema. Although it does not increase overall survival, bevacizumab can improve progression-free survival and quality of life. In many countries, bevacizumab use in the inpatient setting is restricted due to its significant cost. Here, we explore attitudes towards the use of bevacizumab amidst practitioners treating brain tumors and assess ease of accessing the drug in the inpatient setting. Design/Methods A 10-question survey querying practitioners' opinions of inpatient bevacizumab utility and its availability was distributed to the membership of the Society of Neuro-Oncology in July 2016. Results Eighty-seven percent felt that there was a role for bevacizumab in the inpatient setting, and 69% reported favorable experiences with bevacizumab use. However, 40% encountered difficulty in obtaining approval for inpatient use. We present two contrasting clinical cases that highlight favorable and unfavorable outcomes when bevacizumab use was and was not permitted, respectively. Conclusions In this sample of neuro-oncology practitioners, there is general consensus that bevacizumab plays an important role in the inpatient treatment of brain tumors. In light of ongoing barriers to inpatient bevacizumab use due to cost concerns, these data motivate the creation of standardized policies for inpatient bevacizumab use that balances its important role in improving quality of life with financial considerations.
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Affiliation(s)
| | - Justin Low
- Department of Neurology, University of Washington, Seattle, WA
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104
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Meneghelli P, Pasqualin A, Zampieri P, Longhi M, Foroni R, Sini A, Tommasi N, Nicolato A. Surgical Management of Adverse Radiation Effects After Gamma Knife Radiosurgery for Cerebral Arteriovenous Malformations: A Population-Based Cohort Study. World Neurosurg 2018; 114:e840-e850. [PMID: 29572169 DOI: 10.1016/j.wneu.2018.03.097] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 03/12/2018] [Accepted: 03/14/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The goal of this study is to report our experience in the surgical treatment of cerebral arteriovenous malformations (cAVMs) related permanent symptomatic adverse radiation effects (PSAREs), to clarify an appropriate surgical management and to identify the risk factors related to their development. METHODS We evaluated 549 patients treated with Gamma Knife radiosurgery (GKRS) for cAVMs with a follow-up of at least 8 years. Univariate and multivariate analyses were used to test different risk factors related to the development of PSARE. We retrospectively reviewed the records of these patients to analyze the clinical outcome. RESULTS Fourteen patients (2.5%) developed PSARE and were submitted to surgery. Higher average treated volume represents a significant risk factors for the development of PSARE (P < 0.05); on the other hand, older age and higher average dose reduce the risk of PSARE (P < 0.05). A favorable clinical outcome was achieved in 13 patients (93%) after surgery; in 1 patient, the unfavorable outcome was due to hemorrhage that occurred months after GKRS. Serial MRI scans following either surgical removal of the nodule or Ommaya reservoir positioning showed progressive reduction of brain edema in all cases. CONCLUSIONS The management of PSARE is controversial, especially for cAVMs treated with SRS. Surgical removal is rarely needed, but-if unavoidable-it can be a valuable option in experienced hands. A careful preoperative planning is always necessary to detect pathologic blood flow through the PSARE.
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Affiliation(s)
- Pietro Meneghelli
- Institute of Neurosurgery, University and City Hospital, Verona, Italy.
| | - Alberto Pasqualin
- Section of Vascular Neurosurgery, Institute of Neurological Surgery, University and City Hospital, Verona, Italy
| | - Piergiuseppe Zampieri
- Section of Neuroradiology, Department of Diagnosis and Pathology, University and City Hospital, Verona, Italy
| | - Michele Longhi
- Section of Radiosurgery and Stereotactic Neurosurgery, Institute of Neurosurgery, University and City Hospital, Verona, Italy
| | - Roberto Foroni
- Section of Radiosurgery and Stereotactic Neurosurgery, Institute of Neurosurgery, University and City Hospital, Verona, Italy
| | - Antonio Sini
- Institute of Neurosurgery, University and City Hospital, Verona, Italy
| | - Nicola Tommasi
- Centro interdipartimentale di documentazione economica, University of Verona, Verona, Italy
| | - Antonio Nicolato
- Section of Radiosurgery and Stereotactic Neurosurgery, Institute of Neurosurgery, University and City Hospital, Verona, Italy
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105
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van West SE, de Bruin HG, van de Langerijt B, Swaak-Kragten AT, van den Bent MJ, Taal W. Incidence of pseudoprogression in low-grade gliomas treated with radiotherapy. Neuro Oncol 2018; 19:719-725. [PMID: 28453748 DOI: 10.1093/neuonc/now194] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 08/01/2016] [Indexed: 11/14/2022] Open
Abstract
Background As the incidence of pseudo-progressive disease (psPD), or pseudoprogression, in low-grade glioma (LGG) is unknown, we retrospectively investigated this phenomenon in a cohort of LGG patients given radiotherapy (RT). Methods All MRI scans and clinical data from patients with histologically proven LGG treated with radiation between 2000 and 2011 were reviewed. PsPD was scored when a new enhancing lesion occurred after RT and subsequently disappeared or remained stable for at least a year without therapy, including dexamethasone. Results Sixty-three out of 71 patients who received RT for LGG were deemed eligible for evaluation of psPD. The median follow-up was 5 years (range 1‒10 y). PsPD was seen in 13 patients (20.6%). PsPD occurred after a median of 12 months with a range of 3-78 months. The median duration of psPD was 6 months, with a range of 2-26 months and always occurred within the RT high dose fields of at least 45 Gy. The area of the enhancement at the time of psPD was significantly smaller compared with the area of enhancement during "true" progression (median size 54mm2 [range 12-340mm2] vs 270mm2 [range 30-3420mm2], respectively; P = .009). Conclusions PsPD occurs frequently in LGG patients receiving RT. This supports the policy to postpone a new line of treatment until progression is evident, especially when patients have small contrast enhancing lesions within the RT field.
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Affiliation(s)
- Sophie E van West
- Department of Neuro-oncology/Neurology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Hein G de Bruin
- Department of Radiology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Bart van de Langerijt
- Department of Neuro-oncology/Neurology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Annemarie T Swaak-Kragten
- Department of Radiation Oncology, Erasmus MC/Daniel den Hoed Cancer Centre, Rotterdam, The Netherlands
| | - Martin J van den Bent
- Department of Neuro-oncology/Neurology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Walter Taal
- Department of Neuro-oncology/Neurology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
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106
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Zhuang H, Yuan X, Chang JY, Song Y, Wang J, Yuan Z, Wang X, Wang P. Exploration of the recurrence in radiation brain necrosis after bevacizumab discontinuation. Oncotarget 2018; 7:48842-48849. [PMID: 26934327 PMCID: PMC5217054 DOI: 10.18632/oncotarget.7768] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 02/08/2016] [Indexed: 11/25/2022] Open
Abstract
Objective: The aim of the paper was to investigate the recurrence and its causes of radiation brain necrosis following bevacizumab discontinuation. Methods: This study included 14 patients with radiation brain necrosis (confirmed through imaging) after stereotactic radiotherapy for a primary or metastatic brain tumor and who received bevacizumab treatment from June 2011 through December 2014. The patients received bevacizumab at 5 mg/kg, q3-4w, for at least 3 cycles. The T1 signal intensity from enhanced MRI images was used as the evaluation criteria for the brain necrosis treatment efficacy. Results: brain necrosis improved in 13 of the 14 cases (92.9%). However, during follow-up, 10 of the 13 responsive patients (76.9%) exhibited a recurrence in brain necrosis, and a multiple linear regression analysis shows that brain necrosis recurrence was related to the follow-up time after the initial bevacizumab treatment discontinuation. Conclusion: bevacizumab produced good short-term effects for radiation brain necrosis; however, most of the patients would recurrence after bevacizumab is discontinued. Thus, brain necrosis was irreversible.
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Affiliation(s)
- Hongqing Zhuang
- Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Xiangkun Yuan
- Department of Radiotherapy, Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine (Cangzhou No. 2 Hospital), Hebei, China
| | - Joe Y Chang
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Yongchun Song
- Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Junjie Wang
- Department of Radiotherapy, Peking University 3rd Hospital, Beijing, China
| | - Zhiyong Yuan
- Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Xiaoguang Wang
- Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Ping Wang
- Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
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Abstract
PURPOSE OF REVIEW This article reviews key principles in the identification of tumors of the central nervous system (CNS) using standard and advanced imaging modalities. This article highlights the pitfalls and pearls of the imaging evaluation of patients with cancer at time of diagnosis and during cancer therapy and discusses the challenges of the imaging evaluation of treatment-related toxicities. RECENT FINDINGS Treatment of CNS tumors with surgery, chemotherapy, or radiation alters the imaging appearance of the tumor and can be associated with a variety of treatment-related toxicities. The clinician must be familiar with how to assess response to treatment and how to differentiate tumor progression from treatment-related effects. SUMMARY Management and follow-up of neuro-oncology patients is optimized by a comprehensive radiologic approach to CNS tumors and recognition of the challenges in the assessment of response to treatments.
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108
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Mehta S, Shah A, Jung H. Diagnosis and treatment options for sequelae following radiation treatment of brain tumors. Clin Neurol Neurosurg 2017; 163:1-8. [DOI: 10.1016/j.clineuro.2017.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 10/18/2022]
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109
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Singh AK, Tantiwongkosi B, Moise AM, Altmeyer WB. Stroke-like migraine attacks after radiation therapy syndrome: Case report and review of the literature. Neuroradiol J 2017; 30:568-573. [PMID: 28643603 PMCID: PMC5703131 DOI: 10.1177/1971400917690009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 26-year-old female presented with vision loss accompanied by migraine-like headaches. A contrast-enhanced magnetic resonance imaging of the brain was performed which revealed findings suggestive of stroke-like migraine attacks after radiation therapy (SMART) syndrome. SMART syndrome is a delayed complication of brain radiation characterized by neurologic symptoms including migraine-like headaches, seizures, and hemispheric impairment. The purpose of this article is to make the readers aware of this rare complication of brain irradiation. Appropriate diagnosis of SMART syndrome is essential to avoid invasive tests.
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Affiliation(s)
- Achint K Singh
- Department of Radiology, University of Texas Health Science Center, San Antonio, USA
| | - Bundhit Tantiwongkosi
- Department of Radiology, University of Texas Health Science Center, San Antonio, USA
| | | | - Wilson B Altmeyer
- Department of Radiology, University of Texas Health Science Center, San Antonio, USA
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110
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Quantitative Volumetric Analysis Following Magnetic Resonance-Guided Laser Interstitial Thermal Ablation of Cerebellar Metastases. World Neurosurg 2017; 110:e755-e765. [PMID: 29180082 DOI: 10.1016/j.wneu.2017.11.098] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/16/2017] [Accepted: 11/18/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Treating recurrent posterior fossa metastases after previous radiation therapy and surgical resection remains challenging. Magnetic resonance laser-induced thermal therapy (MR-LITT) is a promising treatment for recurrent lesions, but data on safety, efficacy, and postablation volume change in the posterior fossa are lacking. METHODS All patients with recurrent posterior fossa metastatic lesions treated with MR-LITT by the senior neurosurgeon were included in the study. Preoperative and postoperative follow-up magnetic resonance imaging (MRI) studies were used to measure lesional and perilesional edema volume. These measurements were compared to calculate percent ablation volume. All patients' clinical examinations were followed closely. RESULTS Four patients with recurrent cerebellar metastases were treated with MR-LITT. The average percent lesion ablated was 97.1% (range, 88.2%-100%). The average preoperative lesion volume was 3.3 cm3 (range, 1.1-7.2 cm3), and the average final postoperative volume was 3.8 cm3 (range, 0.5-7.6 cm3). Lesion volume increased to maximum volume on postoperative day 1, with an average increase of 486.9%. The extrapolated average time for the lesion to shrink to below the initial size was 294.5 days. There was a trend toward a decrease in average edema volume from the preoperative MRI of 17.8 cm3 to final postoperative follow-up MRI of 3.4 cm3 (P = 0.0952). No postoperative hydrocephalus or complications occurred. CONCLUSIONS This pilot study shows that LITT appears to be a safe and promising treatment for recurrent posterior fossa metastatic lesions up to 7.2 cm3. Further randomized controlled studies are warranted to further characterize the long-term efficacy of this therapy.
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111
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Ilyas A, Chen CJ, Ding D, Buell TJ, Raper DMS, Lee CC, Xu Z, Sheehan JP. Radiation-Induced Changes After Stereotactic Radiosurgery for Brain Arteriovenous Malformations: A Systematic Review and Meta-Analysis. Neurosurgery 2017; 83:365-376. [DOI: 10.1093/neuros/nyx502] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 09/11/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Adeel Ilyas
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Ching-Jen Chen
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Dale Ding
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
- Department of Neurosurgery, Barrow Neurologic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Thomas J Buell
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Daniel M S Raper
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Cheng-Chia Lee
- Department of Neurological Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Zhiyuan Xu
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
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112
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Belliveau JG, Bauman GS, Tay KY, Ho D, Menon RS. Initial Investigation into Microbleeds and White Matter Signal Changes following Radiotherapy for Low-Grade and Benign Brain Tumors Using Ultra-High-Field MRI Techniques. AJNR Am J Neuroradiol 2017; 38:2251-2256. [PMID: 28970242 DOI: 10.3174/ajnr.a5395] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 07/24/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE External beam radiation therapy is a common treatment for many brain neoplasms. While external beam radiation therapy adheres to dose limits to protect the uninvolved brain, areas of high dose to normal tissue still occur. Patients treated with chemoradiotherapy can have adverse effects such as microbleeds and radiation necrosis, but few studies exist of patients treated without chemotherapy. MATERIALS AND METHODS Ten patients were treated for low-grade or benign neoplasms with external beam radiation therapy only and scanned within 12-36 months following treatment with a 7T MR imaging scanner. A multiecho gradient-echo sequence was acquired and postprocessed into SWI, quantitative susceptibility mapping, and apparent transverse relaxation maps. Six patients returned for follow-up imaging approximately 18 months following their first research scan and were imaged with the same techniques. RESULTS At the first visit, 7/10 patients had microbleeds evident on SWI, quantitative susceptibility mapping, and apparent transverse relaxation. All microbleeds were within a dose region of >45 Gy. Additionally, 4/10 patients had asymptomatic WM signal changes evident on standard imaging. Further analysis with our technique revealed that these lesions were venocentric, suggestive of a neuroinflammatory process. CONCLUSIONS There exists a potential for microbleeds in patients treated with external beam radiation therapy without chemotherapy. This finding is of clinical relevance because it could be a precursor of future neurovascular disease and indicates that additional care should be taken when using therapies such as anticoagulants. Additionally, the appearance of venocentric WM lesions could be suggestive of a neuroinflammatory mechanism that has been suggested in diseases such as MS. Both findings merit further investigation in a larger population set.
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Affiliation(s)
- J-G Belliveau
- From the Departments of Medical Biophysics (J.-G.B., G.S.B., R.S.M.).,Centre for Functional and Metabolic Mapping (J.-G.B., R.S.M.), Robarts Research Institute, London, Ontario, Canada
| | - G S Bauman
- From the Departments of Medical Biophysics (J.-G.B., G.S.B., R.S.M.).,Oncology (G.S.B.).,London Regional Cancer Program (G.S.B.), London, Ontario, Canada
| | - K Y Tay
- Medical Imaging (K.Y.T.), University of Western Ontario, London, Ontario, Canada
| | - D Ho
- Department of Radiology (D.H.), Woodstock General Hospital, Woodstock, Ontario, Canada
| | - R S Menon
- From the Departments of Medical Biophysics (J.-G.B., G.S.B., R.S.M.) .,Centre for Functional and Metabolic Mapping (J.-G.B., R.S.M.), Robarts Research Institute, London, Ontario, Canada
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113
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Silva D, Sharma M, Juthani R, Meola A, Barnett GH. Magnetic Resonance Thermometry and Laser Interstitial Thermal Therapy for Brain Tumors. Neurosurg Clin N Am 2017; 28:525-533. [PMID: 28917281 DOI: 10.1016/j.nec.2017.05.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Recent technological advancements in intraoperative imaging are shaping the way for a new era in brain tumor surgery. Magnetic resonance thermometry has provided intraoperative real-time imaging feedback for safe and effective application of laser interstitial thermal therapy (LITT) in neuro-oncology. Thermal ablation has also established itself as a surgical option in epilepsy surgery and is currently used in spine oncology with promising results. This article reviews the principles and rationale as well as the clinical application of LITT for brain tumors. It also discusses the technical nuances of the current commercially available systems.
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Affiliation(s)
- Danilo Silva
- Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Mayur Sharma
- Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Rupa Juthani
- Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Antonio Meola
- Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Gene H Barnett
- Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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114
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Keller A, Doré M, Antoni D, Menoux I, Thillays F, Clavier JB, Delpon G, Jarnet D, Bourrier C, Lefebvre F, Chibbaro S, Darié I, Proust F, Noël G. [Risk of radionecrosis after hypofractionated stereotactic radiotherapy targeting the postoperative resection cavity of brain metastases]. Cancer Radiother 2017; 21:377-388. [PMID: 28551018 DOI: 10.1016/j.canrad.2017.01.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 01/02/2017] [Accepted: 01/31/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To investigate the factors that potentially lead to brain radionecrosis after hypofractionated stereotactic radiotherapy targeting the postoperative resection cavity of brain metastases. METHODS AND MATERIALS A retrospective analysis conducted in two French centres, was performed in patients treated with trifractionated stereotactic radiotherapy (3×7.7Gy prescribed to the 70% isodose line) for resected brain metastases. Patients with previous whole-brain irradiation were excluded of the analysis. Radionecrosis was diagnosed according to a combination of criteria including clinical, serial imaging or, in some cases, histology. Univariate and multivariate analyses were performed to determine the predictive factors of radionecrosis including clinical and dosimetric variables such as volume of brain receiving a specific dose (V8Gy-V22Gy). RESULTS One hundred eighty-one patients, with a total of 189 cavities were treated between March 2008 and February 2015. Thirty-five patients (18.5%) developed radionecrosis after a median follow-up of 15 months (range: 3-38 months) after hypofractionated stereotactic radiotherapy. One third of patients with radionecrosis were symptomatic. Multivariate analysis showed that infra-tentorial location was predictive of radionecrosis (hazard ratio [HR]: 2.97; 95% confidence interval [95% CI]: 1.47-6.01; P=0.0025). None V8Gy-V22Gy was associated with appearance of radionecrosis, even if V14Gy trended toward significance (P=0.059). CONCLUSION Analysis of patients and treatment variables revealed that infratentorial location of brain metastases was predictive for radionecrosis after hypofractionated stereotactic radiotherapy for postoperative resection cavities.
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Affiliation(s)
- A Keller
- Département universitaire de radiothérapie, centre Paul-Strauss, Unicancer, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France
| | - M Doré
- Département de radiothérapie, institut de cancérologie de l'Ouest, boulevard Jacques-Monod, 44805 Saint-Herblain, France
| | - D Antoni
- Département universitaire de radiothérapie, centre Paul-Strauss, Unicancer, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France; Laboratoire EA 3430, fédération de médecine translationnelle de Strasbourg, université de Strasbourg, 67000 Strasbourg, France
| | - I Menoux
- Département universitaire de radiothérapie, centre Paul-Strauss, Unicancer, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France
| | - F Thillays
- Département de radiothérapie, institut de cancérologie de l'Ouest, boulevard Jacques-Monod, 44805 Saint-Herblain, France
| | - J B Clavier
- Département universitaire de radiothérapie, centre Paul-Strauss, Unicancer, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France
| | - G Delpon
- Département de radiothérapie, institut de cancérologie de l'Ouest, boulevard Jacques-Monod, 44805 Saint-Herblain, France
| | - D Jarnet
- Département universitaire de radiothérapie, centre Paul-Strauss, Unicancer, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France
| | - C Bourrier
- Département universitaire de radiothérapie, centre Paul-Strauss, Unicancer, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France
| | - F Lefebvre
- Laboratoire de biostatistiques, faculté de médecine, 4, rue Kirschleger, 67085 Strasbourg cedex, France
| | - S Chibbaro
- Département de neurochirurgie, hôpital de Hautepierre, avenue Molière, 67200 Strasbourg, France
| | - I Darié
- Service de neurochirurgie, centre hospitalier régional d'Orléans, 1, rue Porte-Madeleine, 45000 Orléans, France
| | - F Proust
- Département de neurochirurgie, hôpital de Hautepierre, avenue Molière, 67200 Strasbourg, France
| | - G Noël
- Département universitaire de radiothérapie, centre Paul-Strauss, Unicancer, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France; Laboratoire EA 3430, fédération de médecine translationnelle de Strasbourg, université de Strasbourg, 67000 Strasbourg, France.
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Fahrenholtz SJ, Madankan R, Danish S, Hazle JD, Stafford RJ, Fuentes D. Theoretical model for laser ablation outcome predictions in brain: calibration and validation on clinical MR thermometry images. Int J Hyperthermia 2017; 34:101-111. [PMID: 28540820 DOI: 10.1080/02656736.2017.1319974] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Neurosurgical laser ablation is experiencing a renaissance. Computational tools for ablation planning aim to further improve the intervention. Here, global optimisation and inverse problems are demonstrated to train a model that predicts maximum laser ablation extent. METHODS A closed-form steady state model is trained on and then subsequently compared to N = 20 retrospective clinical MR thermometry datasets. Dice similarity coefficient (DSC) is calculated to provide a measure of region overlap between the 57 °C isotherms of the thermometry data and the model-predicted ablation regions; 57 °C is a tissue death surrogate at thermal steady state. A global optimisation scheme samples the dominant model parameter sensitivities, blood perfusion (ω) and optical parameter (μeff) values, throughout a parameter space totalling 11 440 value-pairs. This represents a lookup table of μeff-ω pairs with the corresponding DSC value for each patient dataset. The μeff-ω pair with the maximum DSC calibrates the model parameters, maximising predictive value for each patient. Finally, leave-one-out cross-validation with global optimisation information trains the model on the entire clinical dataset, and compares against the model naïvely using literature values for ω and μeff. RESULTS When using naïve literature values, the model's mean DSC is 0.67 whereas the calibrated model produces 0.82 during cross-validation, an improvement of 0.15 in overlap with the patient data. The 95% confidence interval of the mean difference is 0.083-0.23 (p < 0.001). CONCLUSIONS During cross-validation, the calibrated model is superior to the naïve model as measured by DSC, with +22% mean prediction accuracy. Calibration empowers a relatively simple model to become more predictive.
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Affiliation(s)
- Samuel John Fahrenholtz
- a Department of Imaging Physics , University of Texas MD Anderson Cancer Center , Houston , TX , USA.,b Department of Medical Physics , UTHealth Graduate School of Biomedical Sciences , Houston , TX , USA
| | - Reza Madankan
- a Department of Imaging Physics , University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Shabbar Danish
- c Section of Neurosurgery , Rutgers Cancer Institute of New Jersey , New Brunswick , NJ , USA
| | - John D Hazle
- a Department of Imaging Physics , University of Texas MD Anderson Cancer Center , Houston , TX , USA.,b Department of Medical Physics , UTHealth Graduate School of Biomedical Sciences , Houston , TX , USA
| | - R Jason Stafford
- a Department of Imaging Physics , University of Texas MD Anderson Cancer Center , Houston , TX , USA.,b Department of Medical Physics , UTHealth Graduate School of Biomedical Sciences , Houston , TX , USA
| | - David Fuentes
- a Department of Imaging Physics , University of Texas MD Anderson Cancer Center , Houston , TX , USA.,b Department of Medical Physics , UTHealth Graduate School of Biomedical Sciences , Houston , TX , USA
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Duan C, Perez-Torres CJ, Yuan L, Engelbach JA, Beeman SC, Tsien CI, Rich KM, Schmidt RE, Ackerman JJH, Garbow JR. Can anti-vascular endothelial growth factor antibody reverse radiation necrosis? A preclinical investigation. J Neurooncol 2017; 133:9-16. [PMID: 28425047 PMCID: PMC5548457 DOI: 10.1007/s11060-017-2410-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 04/03/2017] [Indexed: 01/16/2023]
Abstract
Anti-vascular endothelial growth factor (anti-VEGF) antibodies are a promising new treatment for late time-to-onset radiation-induced necrosis (RN). We sought to evaluate and validate the response to anti-VEGF antibody in a mouse model of RN. Mice were irradiated with the Leksell Gamma Knife Perfexion™ and then treated with anti-VEGF antibody, beginning at post-irradiation (PIR) week 8. RN progression was monitored via anatomic and diffusion MRI from weeks 4-12 PIR. Standard histology, using haematoxylin and eosin (H&E), and immunohistochemistry staining were used to validate the response to treatment. After treatment, both post-contrast T1-weighted and T2-weighted image-derived lesion volumes decreased (P < 0.001), while the lesion volumes for the control group increased. The abnormally high apparent diffusion coefficient (ADC) for RN also returned to the ADC range for normal brain following treatment (P < 0.001). However, typical RN pathology was still present histologically. Large areas of focal calcification were observed in ~50% of treated mouse brains. Additionally, VEGF and hypoxia-inducible factor 1-alpha (HIF-1α) were continually upregulated in both the anti-VEGF and control groups. Despite improvements observed radiographically following anti-VEGF treatment, lesions were not completely resolved histologically. The subsequent calcification and the continued upregulation of VEGF and HIF-1α merit further preclinical/clinical investigation.
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Affiliation(s)
- Chong Duan
- Department of Chemistry, Washington University, Saint Louis, MO, USA
| | - Carlos J Perez-Torres
- Department of Radiology, Washington University, Saint Louis, MO, USA
- School of Health Sciences, Purdue University, West Lafayette, IN, 47907, USA
| | - Liya Yuan
- Department of Neurosurgery, Washington University, Saint Louis, MO, USA
| | - John A Engelbach
- Department of Radiology, Washington University, Saint Louis, MO, USA
| | - Scott C Beeman
- Department of Radiology, Washington University, Saint Louis, MO, USA
| | - Christina I Tsien
- Department of Radiation Oncology, Washington University, Saint Louis, MO, USA
| | - Keith M Rich
- Department of Neurosurgery, Washington University, Saint Louis, MO, USA
- Department of Radiation Oncology, Washington University, Saint Louis, MO, USA
| | - Robert E Schmidt
- Department of Pathology and Immunology, Washington University, Saint Louis, MO, USA
| | - Joseph J H Ackerman
- Department of Chemistry, Washington University, Saint Louis, MO, USA
- Department of Radiology, Washington University, Saint Louis, MO, USA
- Department of Medicine, Washington University, Saint Louis, MO, USA
- Alvin J Siteman Cancer Center, Washington University, Saint Louis, MO, USA
| | - Joel R Garbow
- Department of Radiology, Washington University, Saint Louis, MO, USA.
- Alvin J Siteman Cancer Center, Washington University, Saint Louis, MO, USA.
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Kim HM, Hong BY, Lee JI, Kim JS, Lim SH. Pontine Necrosis Related with Radiation Therapy, Complicated with Spontaneous Hemorrhage. BRAIN & NEUROREHABILITATION 2017. [DOI: 10.12786/bn.2017.10.e1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Ha Min Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Bo Young Hong
- Department of Rehabilitation Medicine, The Catholic University of Korea, Suwon St. Vincent Hospital, Suwon, Korea
| | - Jong In Lee
- Department of Rehabilitation Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Joon Sung Kim
- Department of Rehabilitation Medicine, The Catholic University of Korea, Suwon St. Vincent Hospital, Suwon, Korea
| | - Seong Hoon Lim
- Department of Rehabilitation Medicine, The Catholic University of Korea, Suwon St. Vincent Hospital, Suwon, Korea
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118
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Furuuchi K, Nishiyama A, Yoshioka H, Yokoyama T, Ishida T. Reenlargement of radiation necrosis after stereotactic radiotherapy for brain metastasis from lung cancer during bevacizumab treatment. Respir Investig 2016; 55:184-187. [PMID: 28274537 DOI: 10.1016/j.resinv.2016.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 11/10/2016] [Accepted: 11/15/2016] [Indexed: 10/20/2022]
Abstract
We describe a 55-year-old man who received stereotactic radiotherapy (SRT) for the treatment of brain metastasis from lung adenocarcinoma. Fourteen months after SRT, right-sided hemiparesis developed, and magnetic resonance imaging revealed progression of perifocal edema and an enhanced lesion. Cerebral radiation necrosis was diagnosed, and treatment with bevacizumab was initiated. The lesion clearly responded to bevacizumab therapy, but reenlarged 8 months later and was surgically resected. Histopathological analysis of the resected specimen revealed large areas of necrosis; however, viable tumor cells were detected in the necrotic areas. Reenlargement of the necrotic lesion was attributed to the recurrence of lung cancer.
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Affiliation(s)
- Koji Furuuchi
- Department of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Japan.
| | - Akihiro Nishiyama
- Division of Medical Oncology Cancer Research Institute, Kanazawa University, Kanazawa, Japan
| | - Hiroshige Yoshioka
- Department of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Toshihide Yokoyama
- Department of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Tadashi Ishida
- Department of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Japan
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119
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Constanzo J, Masson-Côté L, Tremblay L, Fouquet JP, Sarret P, Geha S, Whittingstall K, Paquette B, Lepage M. Understanding the continuum of radionecrosis and vascular disorders in the brain following gamma knife irradiation: An MRI study. Magn Reson Med 2016; 78:1420-1431. [PMID: 27851877 DOI: 10.1002/mrm.26546] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/17/2016] [Accepted: 10/17/2016] [Indexed: 01/10/2023]
Abstract
PURPOSE The radiation dose delivered to brain tumors is limited by the possibility to induce vascular damage and necrosis in surrounding healthy tissue. In the present study, we assessed the ability of MRI to monitor the cascade of events occurring in the healthy rat brain after stereotactic radiosurgery, which could be used to optimize the radiation treatment planning. METHODS The primary somatosensory forelimb area (S1FL) and the primary motor cortex in the right hemisphere of Fischer rats (n = 6) were irradiated with a single dose of Gamma Knife radiation (Leksell Perfexion, Elekta AG, Stockholm, Sweden). Rats were scanned with a small-animal 7 Tesla MRI scanner before treatment and 16, 21, 54, 82, and 110 days following irradiation. At every imaging session, T2 -weighted (T2 w), Gd-DTPA dynamic contrast-enhanced MRI (DCE-MRI), and T2*-weighted ( T2* w) images were acquired to measure changes in fluid content, blood vessel permeability, and structure, respectively. At days 10, 110, and 140, histopathology was performed on brain sections. Locomotion and spatial memory ability were assessed longitudinally by behavioral tests. RESULTS No vascular changes were initially observed. After 54 days, a small necrotic volume in the white matter below the S1FL, surrounded by an area presenting significant vascular permeability, was revealed. Between 54 and 110 days, the necrotic volume increased and was accompanied by the formation of a ring-like region, where a mixture of necrosis and permeable blood vessels were observed, as confirmed by histology. Behavioral changes were only observed after day 82. CONCLUSION Together, DCE-MRI and T2* w images supported by histology provided a coherent picture of the phenomena involved in the formation of new, leaky blood vessels, which was followed by the detection of radionecrosis in a preclinical model of brain irradiation. Magn Reson Med 78:1420-1431, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Julie Constanzo
- Center for Research in Radiotherapy, Department of Nuclear Medicine and Radiobiology, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Laurence Masson-Côté
- Center for Research in Radiotherapy, Department of Nuclear Medicine and Radiobiology, Université de Sherbrooke, Sherbrooke, Québec, Canada.,Service of Radiation Oncology, Department of Nuclear Medicine and Radiobiology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Luc Tremblay
- Sherbrooke Molecular Imaging Center, Department of Nuclear Medicine and Radiobiology, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Jérémie P Fouquet
- Sherbrooke Molecular Imaging Center, Department of Nuclear Medicine and Radiobiology, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Philippe Sarret
- Department of Pharmacology and Physiology, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Sameh Geha
- Department of Pathology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Kevin Whittingstall
- Sherbrooke Molecular Imaging Center, Department of Nuclear Medicine and Radiobiology, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Benoit Paquette
- Center for Research in Radiotherapy, Department of Nuclear Medicine and Radiobiology, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Martin Lepage
- Sherbrooke Molecular Imaging Center, Department of Nuclear Medicine and Radiobiology, Université de Sherbrooke, Sherbrooke, Québec, Canada
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Bolcaen J, Lybaert K, Moerman L, Descamps B, Deblaere K, Boterberg T, Kalala JP, Van den Broecke C, De Vos F, Vanhove C, Goethals I. Kinetic Modeling and Graphical Analysis of 18F-Fluoromethylcholine (FCho), 18F-Fluoroethyltyrosine (FET) and 18F-Fluorodeoxyglucose (FDG) PET for the Fiscrimination between High-Grade Glioma and Radiation Necrosis in Rats. PLoS One 2016; 11:e0161845. [PMID: 27559736 PMCID: PMC4999092 DOI: 10.1371/journal.pone.0161845] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 08/12/2016] [Indexed: 02/07/2023] Open
Abstract
Background Discrimination between glioblastoma (GB) and radiation necrosis (RN) post-irradiation remains challenging but has a large impact on further treatment and prognosis. In this study, the uptake mechanisms of 18F-fluorodeoxyglucose (18F-FDG), 18F-fluoroethyltyrosine (18F-FET) and 18F-fluoromethylcholine (18F-FCho) positron emission tomography (PET) tracers were investigated in a F98 GB and RN rat model applying kinetic modeling (KM) and graphical analysis (GA) to clarify our previous results. Methods Dynamic 18F-FDG (GB n = 6 and RN n = 5), 18F-FET (GB n = 5 and RN n = 5) and 18F-FCho PET (GB n = 5 and RN n = 5) were acquired with continuous arterial blood sampling. Arterial input function (AIF) corrections, KM and GA were performed. Results The influx rate (Ki) of 18F-FDG uptake described by a 2-compartmental model (CM) or using Patlak GA, showed more trapping (k3) in GB (0.07 min-1) compared to RN (0.04 min-1) (p = 0.017). K1 of 18F-FET was significantly higher in GB (0.06 ml/ccm/min) compared to RN (0.02 ml/ccm/min), quantified using a 1-CM and Logan GA (p = 0.036). 18F-FCho was rapidly oxidized complicating data interpretation. Using a 1-CM and Logan GA no clear differences were found to discriminate GB from RN. Conclusions Based on our results we concluded that using KM and GA both 18F-FDG and 18F-FET were able to discriminate GB from RN. Using a 2-CM model more trapping of 18F-FDG was found in GB compared to RN. Secondly, the influx of 18F-FET was higher in GB compared to RN using a 1-CM model. Important correlations were found between SUV and kinetic or graphical measures for 18F-FDG and 18F-FET. 18F-FCho PET did not allow discrimination between GB and RN.
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Affiliation(s)
- Julie Bolcaen
- Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
- * E-mail:
| | - Kelly Lybaert
- Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Lieselotte Moerman
- Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Benedicte Descamps
- iMinds-IBiTech-MEDISIP, Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
| | - Karel Deblaere
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Tom Boterberg
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | | | | | - Filip De Vos
- Department of Radiopharmacy, Ghent University, Ghent, Belgium
| | - Christian Vanhove
- iMinds-IBiTech-MEDISIP, Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
| | - Ingeborg Goethals
- Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
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121
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Pruitt R, Gamble A, Black K, Schulder M, Mehta AD. Complication avoidance in laser interstitial thermal therapy: lessons learned. J Neurosurg 2016; 126:1238-1245. [PMID: 27257839 DOI: 10.3171/2016.3.jns152147] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Complications of laser interstitial thermal therapy (LITT) are underreported. The authors discuss how they have modified their technique in the context of technical and treatment-related adverse events. METHODS The Medtronic Visualase system was used in 49 procedures in 46 patients. Between 1 and 3 cooling catheters/laser fiber assemblies were placed, for a total of 62 implanted devices. Devices were placed using frameless stereotaxy (n = 3), frameless stereotaxy with intraoperative MRI (iMRI) (n = 9), iMRI under direct vision (n = 2), MRI alone (n = 1), or frame-based (n = 47) techniques. LITT was performed while monitoring MRI thermometry. Indications included brain tumors (n = 12), radiation necrosis (n = 2), filum terminale ependymoma (n = 1), mesial temporal lobe epilepsy (n = 21), corpus callosotomy for bifrontal epilepsy (n = 3), cavernoma (n = 1), and hypothalamic hamartomas (n = 6). RESULTS Some form of adverse event occurred in 11 (22.4%) of 49 procedures. These included 4 catheter malpositions, 3 intracranial hemorrhages, 3 cases of neurological deficit related to thermal injury, and 1 technical malfunction resulting in an aborted procedure. Of these, direct thermal injury was the only cause of prolonged neurological morbidity and occurred in 3 of 49 procedures. Use of frameless stereotaxy and increased numbers of devices were associated with significantly increased complication rates (p < 0.05). A number of procedural modifications were made to avoid complications, including the use of 1) frame-based catheter placement, a 1.8-mm alignment rod to create a track and titanium skull anchors for long trajectories to improve accuracy; 2) a narrow-gauge instrument for dural puncture and coregistration of contrast MRI with CT angiography to reduce intracranial hemorrhage; 3) general endotracheal anesthesia for posterior-placed skull anchors to reduce the likelihood of damage to the cooling catheter; 4) use of as few probes as possible to reduce complications overall; and 5) dose modification of thermal treatment and use of short (3-mm) diffusing tips to limit treatment when structures to be spared do not have intervening CSF spaces to act as heat sinks. CONCLUSIONS Laser ablation treatment may be used for a variety of neurosurgical procedures for patients with tumors and epilepsy. While catheter placement and thermal treatment may be associated with a range of suboptimal operative and postoperative courses, permanent neurological morbidity is less common. The authors' institutional experience illustrates a number of measures that may be taken to improve outcomes using this important new tool in the neurosurgical arsenal.
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Affiliation(s)
- Rachel Pruitt
- Hofstra Northwell School of Medicine, Hempstead; and
| | | | - Karen Black
- Hofstra Northwell School of Medicine, Hempstead; and.,Radiology, North Shore University Hospital, Manhasset, New York
| | - Michael Schulder
- Hofstra Northwell School of Medicine, Hempstead; and.,Departments of 2 Neurosurgery and
| | - Ashesh D Mehta
- Hofstra Northwell School of Medicine, Hempstead; and.,Departments of 2 Neurosurgery and
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122
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Abstract
Abnormal tumor vasculature is a potent mediator of treatment resistance because it results in heterogeneous perfusion, hypoxia, increased interstitial fluid pressure, and incomplete penetration of cytotoxic chemotherapies. Targeting this abnormal tumor vasculature is a promising therapeutic strategy, but results with antiangiogenic drugs in brain cancer have been mixed. Vasculature's response to treatment is a dynamic physiological process that can change rapidly throughout treatment, so it requires noninvasive techniques to serially monitor these changes in order to improve outcome. We review the role of vascular magnetic resonance imaging to measure tumor response to treatment and highlight opportunities and future avenues for expanding these promising techniques.
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123
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Masch WR, Wang PI, Chenevert TL, Junck L, Tsien C, Heth JA, Sundgren PC. Comparison of Diffusion Tensor Imaging and Magnetic Resonance Perfusion Imaging in Differentiating Recurrent Brain Neoplasm From Radiation Necrosis. Acad Radiol 2016; 23:569-76. [PMID: 26916251 DOI: 10.1016/j.acra.2015.11.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 09/26/2015] [Accepted: 11/03/2015] [Indexed: 10/22/2022]
Abstract
RATIONALE AND OBJECTIVES To compare differences in diffusion tensor imaging (DTI) and dynamic susceptibility-weighted contrast-enhanced (DSC) magnetic resonance (MR) perfusion imaging characteristics of recurrent neoplasm and radiation necrosis in patients with brain tumors previously treated with radiotherapy with or without surgery and chemotherapy. MATERIALS AND METHODS Patients with a history of brain neoplasm previously treated with radiotherapy with or without chemotherapy and surgery who developed a new enhancing lesion on posttreatment surveillance MRI were enrolled. DSC perfusion MRI and DTI were performed. Region of interest cursors were manually drawn in the contrast-enhancing lesions, in the perilesional white matter edema, and in the contralateral normal-appearing frontal lobe white matter. DTI and DSC perfusion MR indices were compared in recurrent tumor versus radiation necrosis. RESULTS Twenty-two patients with 24 lesions were included. Sixteen (67%) lesions were placed into the recurrent neoplasm group and eight (33%) lesions were placed into the radiation necrosis group using biopsy results as the gold standard in all but three patients. Mean apparent diffusion coefficient values, mean parallel eigenvalues, and mean perpendicular eigenvalues in the contrast-enhancing lesion were significantly lower, and relative cerebral blood volume was significantly higher for the recurrent neoplasm group compared to the radiation necrosis group (P < 0.01, P = 0.03, P < 0.01, and P < 0.01, respectively). CONCLUSIONS The combined assessment of DTI and DSC MR perfusion properties of new contrast-enhancing lesions is helpful in distinguishing recurrent neoplasm from radiation necrosis in patients with a history of brain neoplasm previously treated with radiotherapy with or without surgery and chemotherapy.
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Abstract
BACKGROUND Discrimination between radiation necrosis and tumor progression after radiation therapy represents a radiologic challenge. The aim of our investigation is to identify patterns of radiation necrosis on brain magnetic resonance imaging (MRI) and positron emission tomography (PET) with Fluoroethyltyrosin (FET) after proton beam therapy (PBT) for skull base tumors. MATERIAL AND METHODS Five consecutive patients with extra-axial neoplasms were included, presenting a total of eight radiation necrosis lesions (three clival chordomas; two petroclival chondrosarcomas; two women; mean age: 49 ± 18.2 years). Radiation necrosis was defined as the appearance of abnormal enhancement on MRI after PBT decreasing over time, and additional histopathologic confirmation in one patient. MRI and PET imaging were retrospectively analyzed by two experienced radiologists in consensus. RESULTS All lesions were localized close to the primary tumor in the field of irradiation. Three patients showed bilateral symmetrical lesions. All lesions showed T2 hyperintensity and T1 hypointensity. Cerebral blood volume (CBV) was reduced in all available studies. None of the lesions showed a restricted diffusion. FET-PET (three patients) showed a higher uptake in four out of five lesions; three of which had a mean tumor-to-background (TBRmean) uptake lower than 1.95 and FET uptake increasing over time and were correctly classified into radiation necrosis. CONCLUSIONS Most radiation necroses were in direct continuity with the primary tumor mimicking tumor progression. The most consistent imaging findings for PBT radiation necrosis are low CBV without restricted diffusion and FET-PET TBRmean lower than 1.95 or increasing uptake over time. Bilateral symmetric involvement may be another indicator of radiation necrosis. Critères radiologiques de la nécrose après protonthérapie des tumeurs de la base du crâne.
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125
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Zhuang H, Yuan X, Zheng Y, Li X, Chang JY, Wang J, Wang X, Yuan Z, Wang P. A study on the evaluation method and recent clinical efficacy of bevacizumab on the treatment of radiation cerebral necrosis. Sci Rep 2016; 6:24364. [PMID: 27067388 PMCID: PMC4828710 DOI: 10.1038/srep24364] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 03/21/2016] [Indexed: 12/13/2022] Open
Abstract
In order to investigate the efficacy of bevacizumab on the treatment of radiation cerebral necrosis, patients who were diagnosed with radiation cerebral necrosis by imaging after stereotactic radiotherapy were collected. Bevacizumab was applied at a dose of 5 mg/kg once every three weeks at least three times. The changes in cerebral necrosis symptoms before and after treatment, the cerebral edema volume, the cerebral necrosis volume, and the changes in magnetic resonance imaging (MRI) strengthening phase signals of cerebral necrosis were used as the first observation point. The side effects of bevacizumab were used as the second observation point. Total of 14 radiation cerebral necrosis patients were treated with bevacizumab between June 2011 and February 2013 were collected. There were 12 symptomatic patients, of whom 10 patients (83.3%) had reduced symptoms. The edema index grades of nine patients (64.29%) improved. The cerebral necrosis volumes of 13 patients (92.86%) decreased. The T1 phase signal strengths of the intracranial enhanced MRIs of 12 patients (85.71%) significantly decreased. The clinical side effects of bevacizumab were mild. In conclusion, Preliminary results showed that treatment of radiation cerebral necrosis using bevacizumab was safe and effective. This treatment measure is worthy of further study.
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Affiliation(s)
- Hongqing Zhuang
- Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, and Tianjin Lung Cancer Center, Tianjin, China
| | - Xiangkun Yuan
- Department of Radiotherapy, Hebei Province Cangzhou Hospital of integrated traditional and western medicine (Cangzhou No. 2 Hospital), Hebei, China
| | - Yi Zheng
- Daqing Oilfield General Hospital, Heilongjiang, China
| | - Xubin Li
- Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, and Tianjin Lung Cancer Center, Tianjin, China
| | - Joe Y Chang
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Junjie Wang
- Department of Radiotherapy, Peking University 3rd Hospital, Beijing, China
| | - Xiaoguang Wang
- Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, and Tianjin Lung Cancer Center, Tianjin, China
| | - Zhiyong Yuan
- Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, and Tianjin Lung Cancer Center, Tianjin, China
| | - Ping Wang
- Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, and Tianjin Lung Cancer Center, Tianjin, China
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Hatzoglou V, Yang TJ, Omuro A, Gavrilovic I, Ulaner G, Rubel J, Schneider T, Woo KM, Zhang Z, Peck KK, Beal K, Young RJ. A prospective trial of dynamic contrast-enhanced MRI perfusion and fluorine-18 FDG PET-CT in differentiating brain tumor progression from radiation injury after cranial irradiation. Neuro Oncol 2015; 18:873-80. [PMID: 26688076 DOI: 10.1093/neuonc/nov301] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 11/06/2015] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the effectiveness of fluorine-18 fluorodeoxyglucose (FDG) PET-CT and dynamic contrast-enhanced (DCE) MRI in differentiating tumor progression and radiation injury in patients with indeterminate enhancing lesions after radiation therapy (RT) for brain malignancies. METHODS Patients with indeterminate enhancing brain lesions on conventional MRI after RT underwent brain DCE-MRI and PET-CT in a prospective trial. Informed consent was obtained. Lesion outcomes were determined by histopathology and/or clinical and imaging follow-up. Metrics obtained included plasma volume (Vp) and volume transfer coefficient (K(trans)) from DCE-MRI, and maximum standardized uptake value (SUVmax) from PET-CT; lesion-to-normal brain ratios of all metrics were calculated. The Wilcoxon rank sum test and receiver operating characteristic analysis were performed. RESULTS The study included 53 patients (29 treated for 29 gliomas and 24 treated for 26 brain metastases). Progression was determined in 38/55 (69%) indeterminate lesions and radiation injury in 17 (31%). Vpratio (VP lesion/VP normal brain, P < .001), K(trans) ratio (P = .002), and SUVratio (P = .002) correlated significantly with diagnosis of progression versus radiation injury. Progressing lesions exhibited higher values of all 3 metrics compared with radiation injury. Vpratio had the highest accuracy in determining progression (area under the curve = 0.87), with 92% sensitivity and 77% specificity using the optimal, retrospectively determined threshold of 2.1. When Vpratio was combined with K(trans) ratio (optimal threshold 3.6), accuracy increased to 94%. CONCLUSIONS Vpratio was the most effective metric for distinguishing progression from radiation injury. Adding K(trans) ratio to Vpratio further improved accuracy. DCE-MRI is an effective imaging technique for evaluating nonspecific enhancing intracranial lesions after RT.
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Affiliation(s)
- Vaios Hatzoglou
- Department of Radiology, Neuroradiology Service, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., J.R., T.S., K.K.P., R.J.Y.); Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (T.J.Y., K.B.); Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York (G.U.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (A.O., I.G.); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (K.M.W., Z.Z.); Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York (K.K.P.); Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., A.O., I.G., K.B., R.J.Y.)
| | - T Jonathan Yang
- Department of Radiology, Neuroradiology Service, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., J.R., T.S., K.K.P., R.J.Y.); Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (T.J.Y., K.B.); Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York (G.U.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (A.O., I.G.); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (K.M.W., Z.Z.); Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York (K.K.P.); Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., A.O., I.G., K.B., R.J.Y.)
| | - Antonio Omuro
- Department of Radiology, Neuroradiology Service, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., J.R., T.S., K.K.P., R.J.Y.); Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (T.J.Y., K.B.); Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York (G.U.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (A.O., I.G.); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (K.M.W., Z.Z.); Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York (K.K.P.); Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., A.O., I.G., K.B., R.J.Y.)
| | - Igor Gavrilovic
- Department of Radiology, Neuroradiology Service, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., J.R., T.S., K.K.P., R.J.Y.); Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (T.J.Y., K.B.); Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York (G.U.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (A.O., I.G.); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (K.M.W., Z.Z.); Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York (K.K.P.); Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., A.O., I.G., K.B., R.J.Y.)
| | - Gary Ulaner
- Department of Radiology, Neuroradiology Service, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., J.R., T.S., K.K.P., R.J.Y.); Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (T.J.Y., K.B.); Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York (G.U.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (A.O., I.G.); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (K.M.W., Z.Z.); Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York (K.K.P.); Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., A.O., I.G., K.B., R.J.Y.)
| | - Jennifer Rubel
- Department of Radiology, Neuroradiology Service, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., J.R., T.S., K.K.P., R.J.Y.); Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (T.J.Y., K.B.); Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York (G.U.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (A.O., I.G.); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (K.M.W., Z.Z.); Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York (K.K.P.); Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., A.O., I.G., K.B., R.J.Y.)
| | - Taylor Schneider
- Department of Radiology, Neuroradiology Service, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., J.R., T.S., K.K.P., R.J.Y.); Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (T.J.Y., K.B.); Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York (G.U.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (A.O., I.G.); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (K.M.W., Z.Z.); Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York (K.K.P.); Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., A.O., I.G., K.B., R.J.Y.)
| | - Kaitlin M Woo
- Department of Radiology, Neuroradiology Service, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., J.R., T.S., K.K.P., R.J.Y.); Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (T.J.Y., K.B.); Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York (G.U.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (A.O., I.G.); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (K.M.W., Z.Z.); Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York (K.K.P.); Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., A.O., I.G., K.B., R.J.Y.)
| | - Zhigang Zhang
- Department of Radiology, Neuroradiology Service, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., J.R., T.S., K.K.P., R.J.Y.); Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (T.J.Y., K.B.); Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York (G.U.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (A.O., I.G.); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (K.M.W., Z.Z.); Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York (K.K.P.); Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., A.O., I.G., K.B., R.J.Y.)
| | - Kyung K Peck
- Department of Radiology, Neuroradiology Service, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., J.R., T.S., K.K.P., R.J.Y.); Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (T.J.Y., K.B.); Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York (G.U.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (A.O., I.G.); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (K.M.W., Z.Z.); Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York (K.K.P.); Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., A.O., I.G., K.B., R.J.Y.)
| | - Kathryn Beal
- Department of Radiology, Neuroradiology Service, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., J.R., T.S., K.K.P., R.J.Y.); Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (T.J.Y., K.B.); Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York (G.U.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (A.O., I.G.); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (K.M.W., Z.Z.); Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York (K.K.P.); Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., A.O., I.G., K.B., R.J.Y.)
| | - Robert J Young
- Department of Radiology, Neuroradiology Service, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., J.R., T.S., K.K.P., R.J.Y.); Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (T.J.Y., K.B.); Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York (G.U.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (A.O., I.G.); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (K.M.W., Z.Z.); Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York (K.K.P.); Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York (V.H., A.O., I.G., K.B., R.J.Y.)
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Lai G, Mahadevan A, Hackney D, Warnke PC, Nigim F, Kasper E, Wong ET, Carter BS, Chen CC. Diagnostic Accuracy of PET, SPECT, and Arterial Spin-Labeling in Differentiating Tumor Recurrence from Necrosis in Cerebral Metastasis after Stereotactic Radiosurgery. AJNR Am J Neuroradiol 2015; 36:2250-5. [PMID: 26427832 DOI: 10.3174/ajnr.a4475] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 05/03/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE Radiographic assessment of cerebral metastasis after stereotactic radiosurgery remains a major challenge in neuro-oncology. It is often difficult to distinguish tumor progression from radiation necrosis in this setting using conventional MR imaging. The objective of this study was to compare the diagnostic sensitivity and specificity of different functional imaging modalities for detecting tumor recurrence after stereotactic radiosurgery. MATERIALS AND METHODS We retrospectively reviewed patients treated between 2007 and 2010 and identified 14 patients with cerebral metastasis who had clinical or radiographic progression following stereotactic radiosurgery and were imaged with arterial spin-labeling, FDG-PET, and thallium SPECT before stereotactic biopsy. Diagnostic accuracy, specificity, sensitivity, positive predictive value, and negative predictive value were calculated for each imaging technique by using the pathologic diagnosis as the criterion standard. RESULTS Six patients (42%) had tumor progression, while 8 (58%) developed radiation necrosis. FDG-PET and arterial spin-labeling were equally sensitive in detecting tumor progression (83%). However, the specificity of arterial spin-labeling was superior to that of the other modalities (100%, 75%, and 50%, respectively). A combination of modalities did not augment the sensitivity, specificity, positive predictive value, or negative predictive value of arterial spin-labeling. CONCLUSIONS In our series, arterial spin-labeling positivity was closely associated with the pathologic diagnosis of tumor progression after stereotactic radiosurgery. Validation of this finding in a large series is warranted.
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Affiliation(s)
- G Lai
- From the School of Medicine (G.L., B.S.C., C.C.C.), University of California, San Diego, La Jolla, California
| | | | | | - P C Warnke
- Division of Neurosurgery (P.C.W.), University of Chicago, Chicago, Illinois
| | - F Nigim
- Division of Neurosurgery (F.N., E.K.)
| | - E Kasper
- Division of Neurosurgery (F.N., E.K.)
| | - E T Wong
- Department of Neurology (E.T.W.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - B S Carter
- From the School of Medicine (G.L., B.S.C., C.C.C.), University of California, San Diego, La Jolla, California
| | - C C Chen
- From the School of Medicine (G.L., B.S.C., C.C.C.), University of California, San Diego, La Jolla, California
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128
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Delayed cerebrospinal fluid rhinorrhea four years after gamma knife surgery for juvenile angiofibroma. J Craniofac Surg 2015; 25:e565-7. [PMID: 25377982 DOI: 10.1097/scs.0000000000001164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Juvenile angiofibroma (JA) is a highly vascularized tumor that often recurs or regrows. Recently, gamma knife surgery (GKS) was attempted on unresectable or remnant JA. We experienced a JA case that developed cerebrospinal fluid (CSF) rhinorrhea 4 years after GKS. Two surgical excisions using midfacial degloving approach were performed before GKS. After radiosurgery, the tumor was controlled, and no early complications were observed. However, 4 years after, intractable CSF leakage developed as a late complication, and we thus performed 4 subsequent endoscopic surgical repairs. The CSF leakage is very rare but can occur as a late complication of GKS and should be treated aggressively.
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129
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Medvid R, Ruiz A, Komotar RJ, Jagid JR, Ivan ME, Quencer RM, Desai MB. Current Applications of MRI-Guided Laser Interstitial Thermal Therapy in the Treatment of Brain Neoplasms and Epilepsy: A Radiologic and Neurosurgical Overview. AJNR Am J Neuroradiol 2015; 36:1998-2006. [PMID: 26113069 DOI: 10.3174/ajnr.a4362] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Minimally invasive stereotactic tumor ablation is a viable option for the treatment of benign and malignant intracranial lesions. Although surgical excision constitutes first-line therapy for various brain pathologies, it can cause irreversible neurologic deficits. Additionally, many patients who may benefit from surgery do not qualify as surgical candidates due to multiple comorbidities. Recent advancements in laser interstitial thermal therapy, namely the ability to monitor ablation in real-time under MR imaging, have improved the safety and efficacy of the procedure. MRI-guided laser interstitial thermal therapy is currently used as a minimally invasive treatment for brain metastases, radiation necrosis, glioma, and epilepsy. This article will discuss the principles, suggested indications, complications, and imaging characteristics of MRI-guided laser interstitial thermal therapy as they pertain to the treatment of brain pathology.
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Affiliation(s)
- R Medvid
- From the Department of Radiology (R.M., A.R., R.M.Q., M.B.D.), Division of Neuroradiology
| | - A Ruiz
- From the Department of Radiology (R.M., A.R., R.M.Q., M.B.D.), Division of Neuroradiology
| | - R J Komotar
- Department of Neurological Surgery (J.R.J., R.J.K., M.E.I.), Jackson Memorial Hospital/University of Miami Hospital, Miami, Florida
| | - J R Jagid
- Department of Neurological Surgery (J.R.J., R.J.K., M.E.I.), Jackson Memorial Hospital/University of Miami Hospital, Miami, Florida
| | - M E Ivan
- Department of Neurological Surgery (J.R.J., R.J.K., M.E.I.), Jackson Memorial Hospital/University of Miami Hospital, Miami, Florida
| | - R M Quencer
- From the Department of Radiology (R.M., A.R., R.M.Q., M.B.D.), Division of Neuroradiology
| | - M B Desai
- From the Department of Radiology (R.M., A.R., R.M.Q., M.B.D.), Division of Neuroradiology
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Santiago-Dieppa DR, Steinberg J, Gonda D, Cheung VJ, Carter BS, Chen CC. Extracellular vesicles as a platform for 'liquid biopsy' in glioblastoma patients. Expert Rev Mol Diagn 2015; 14:819-25. [PMID: 25136839 DOI: 10.1586/14737159.2014.943193] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Extracellular vesicles (EVs) are cell-secreted vesicles that range from 30-2000 nm in size. These vesicles are secreted by both normal and neoplastic cells. Physiologically, EVs serve multiple critical biologic functions, including cellular remodeling, intracellular communication, modulation of the tumor microenvironment and regulation of immune function. Because EVs contain genetic and proteomic contents that reflect the cell of origin, it is possible to detect tumor-specific material in EVs secreted by cancer cells. Importantly, EVs secreted by cancer cells transgress anatomic compartments and can be detected in the blood, cerebrospinal fluid, and other biofluids of cancer patients. In this context, there is a growing interest in analyzing EVs from the biofluid of cancer patients as a means of disease diagnosis and therapeutic monitoring. In this article, we review the development of EVs as a diagnostic platform for the most common form of brain cancer, glioblastoma, discuss potential clinical translational opportunities and identify the central challenges associated with future clinical applications.
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Affiliation(s)
- David R Santiago-Dieppa
- Division of Neurosurgery, University of California, 3855 Health Science Drive #0987 La Jolla, San Diego, CA 92093-0987, USA
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Doré M, Lefebvre L, Delpon G, Thillays F. Radionécrose cérébrale après irradiation en conditions stéréotaxiques des berges opératoires : analyse de la littérature à partir de quatre cas. Cancer Radiother 2015; 19:111-9. [DOI: 10.1016/j.canrad.2014.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 10/14/2014] [Accepted: 10/15/2014] [Indexed: 11/16/2022]
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Gómez-Río M, Testart Dardel N, Santiago Chinchilla A, Rodríguez-Fernández A, Olivares Granados G, Luque Caro R, Zurita Herrera M, Chamorro Santos CE, Lardelli-Claret P, Llamas-Elvira JM. 18F-Fluorocholine PET/CT as a complementary tool in the follow-up of low-grade glioma: diagnostic accuracy and clinical utility. Eur J Nucl Med Mol Imaging 2015; 42:886-95. [DOI: 10.1007/s00259-015-2997-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 01/14/2015] [Indexed: 11/30/2022]
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Pathological characteristics of cyst formation following gamma knife surgery for arteriovenous malformation. Acta Neurochir (Wien) 2015; 157:293-8. [PMID: 25503297 DOI: 10.1007/s00701-014-2298-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 11/28/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The pathological characteristics of cyst development after gamma knife surgery (GKS) for arteriovenous malformation (AVM) were analysed. METHOD Sixteen male and 12 female patients aged 17-67 years (mean 31.3 years) were retrospectively identified among 868 patients who underwent GKS for AVM at our hospital. The pathological characteristics of the reddish nodular lesion and chronic encapsulated expanding haematoma associated with cyst following GKS for AVM were examined. RESULTS Cyst was associated with chronic encapsulated expanding haematoma in 13, and with nodular lesion in 12 patients. The nidus volume at GKS was 0.1-36 ml (median 6.0 ml), and the prescription dose at the nidus margin was 18-25 Gy (median 20 Gy). Cyst formation was detected from 1.1 to 16 years (mean 7.3 years) after GKS. Seven of the 12 patients with nodular lesion underwent surgery. Ten of the 13 patients with expanding haematoma underwent surgical removal of expanding haematoma. Histological examination was possible in 17 cases. Dilated capillary vessels with wall damage such as hyalinisation and fibrinoid necrosis, marked protein exudation and haemorrhage were the most common findings. Brain parenchyma was observed among the dilated vessels in some cases. Structureless necrotic tissue was not evident. CONCLUSIONS The present study suggests that enhanced nodular lesion on magnetic resonance imaging and chronic encapsulated expanding haematoma associated with cyst may have common aetiopathology caused by late radiation effects, mainly consisting of dilated capillary vessels with wall damage. Massive protein exudation from such damaged capillary vessels is important in cyst development.
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Radiation-induced neurotoxicity: clinical and radiological improvement after hyperbaric oxygen therapy. Neurol Sci 2015; 36:1057-9. [PMID: 25630455 DOI: 10.1007/s10072-015-2091-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 01/21/2015] [Indexed: 10/24/2022]
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Bolcaen J, Descamps B, Deblaere K, Boterberg T, De Vos Pharm F, Kalala JP, Van den Broecke C, Decrock E, Leybaert L, Vanhove C, Goethals I. (18)F-fluoromethylcholine (FCho), (18)F-fluoroethyltyrosine (FET), and (18)F-fluorodeoxyglucose (FDG) for the discrimination between high-grade glioma and radiation necrosis in rats: a PET study. Nucl Med Biol 2014; 42:38-45. [PMID: 25218024 DOI: 10.1016/j.nucmedbio.2014.07.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 07/04/2014] [Accepted: 07/21/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Discrimination between (high-grade) brain tumor recurrence and radiation necrosis (RN) remains a diagnostic challenge because both entities have similar imaging characteristics on conventional magnetic resonance imaging (MRI). Metabolic imaging, such as positron emission tomography (PET) could overcome this diagnostic dilemma. In this study, we investigated the potential of 2-[(18)F]-fluoro-2-deoxy-D-glucose ((18)F-FDG), O-(2-[(18)F]-fluoroethyl)-L-tyrosine ((18)F-FET), and [(18)F]-Fluoromethyl-dimethyl-2-hydroxyethylammonium ((18)F-fluoromethylcholine, (18)F-FCho) PET in discriminating high-grade tumor from RN. METHODS We developed a glioblastoma (GB) rat model by inoculating F98 GB cells into the right frontal region. Induction of RN was achieved by irradiating the right frontal region with 60 Gy using three arcs with a beam aperture of 3×3 mm (n=3). Dynamic PET imaging with (18)F-FDG, (18)F-FET, and (18)F-FCho, as well as (18)F-FDG PET at a delayed time interval (240 min postinjection), was acquired. RESULTS MRI revealed contrast-enhancing tumors at 15 days after inoculation (n=4) and contrast-enhancing RN lesions 5-6 months postirradiation (n=3). On (18)F-FDG PET, the mean lesion-to-normal ratio (LNRmean) was significantly higher in GB than in RN (p=0.034). The difference in the LNRmean between tumors and RN was higher on the late (18)F-FDG PET images than on the PET images reconstructed from the last time frame of the dynamic acquisition (this is at a conventional time interval). LNRs obtained from (18)F-FCho PET were not significantly different between GB and RN (p=1.000). On (18)F-FET PET, the LNRmean was significantly higher in GB compared to RN (p=0.034). CONCLUSIONS Unlike (18)F-FCho, (18)F-FDG and (18)F-FET PET were effective in discriminating GB from RN. Interestingly, in the case of (18)F-FDG, delayed PET seems particularly useful. ADVANCES IN KNOWLEDGE AND IMPLICATIONS FOR PATIENT CARE Our results suggest that (delayed) (18)F-FDG and (18)F-FET PET can be used to discriminate GB (recurrence) from RN. Confirmation of these results in clinical studies is needed.
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Affiliation(s)
- Julie Bolcaen
- Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Benedicte Descamps
- iMinds Medical IT - MEDISIP - Infinity lab, Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
| | - Karel Deblaere
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Tom Boterberg
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | | | | | | | - Elke Decrock
- Department of Basic Medical Sciences-Physiology group, Ghent University, Ghent, Belgium
| | - Luc Leybaert
- Department of Basic Medical Sciences-Physiology group, Ghent University, Ghent, Belgium
| | - Christian Vanhove
- iMinds Medical IT - MEDISIP - Infinity lab, Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
| | - Ingeborg Goethals
- Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium.
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Perez-Torres CJ, Engelbach JA, Cates J, Thotala D, Yuan L, Schmidt RE, Rich KM, Drzymala RE, Ackerman JJH, Garbow JR. Toward distinguishing recurrent tumor from radiation necrosis: DWI and MTC in a Gamma Knife--irradiated mouse glioma model. Int J Radiat Oncol Biol Phys 2014; 90:446-53. [PMID: 25104071 DOI: 10.1016/j.ijrobp.2014.06.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 05/05/2014] [Accepted: 06/04/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE Accurate noninvasive diagnosis is vital for effective treatment planning. Presently, standard anatomical magnetic resonance imaging (MRI) is incapable of differentiating recurring tumor from delayed radiation injury, as both lesions are hyperintense in both postcontrast T1- and T2-weighted images. Further studies are therefore necessary to identify an MRI paradigm that can differentially diagnose these pathologies. Mouse glioma and radiation injury models provide a powerful platform for this purpose. METHODS AND MATERIALS Two MRI contrasts that are widely used in the clinic were chosen for application to a glioma/radiation-injury model: diffusion weighted imaging, from which the apparent diffusion coefficient (ADC) is obtained, and magnetization transfer contrast, from which the magnetization transfer ratio (MTR) is obtained. These metrics were evaluated longitudinally, first in each lesion type alone-glioma versus irradiation - and then in a combined irradiated glioma model. RESULTS MTR was found to be consistently decreased in all lesions compared to nonlesion brain tissue (contralateral hemisphere), with limited specificity between lesion types. In contrast, ADC, though less sensitive to the presence of pathology, was increased in radiation injury and decreased in tumors. In the irradiated glioma model, ADC also increased immediately after irradiation, but decreased as the tumor regrew. CONCLUSIONS ADC is a better metric than MTR for differentiating glioma from radiation injury. However, MTR was more sensitive to both tumor and radiation injury than ADC, suggesting a possible role in detecting lesions that do not enhance strongly on T1-weighted images.
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Affiliation(s)
| | - John A Engelbach
- Department of Radiology, Washington University, St. Louis, Missouri
| | - Jeremy Cates
- Department of Radiation Oncology, Washington University, St. Louis, Missouri
| | - Dinesh Thotala
- Department of Radiation Oncology, Washington University, St. Louis, Missouri
| | - Liya Yuan
- Department of Neurosurgery, Washington University, St. Louis, Missouri
| | - Robert E Schmidt
- Department of Neuropathology, Washington University, St. Louis, Missouri
| | - Keith M Rich
- Department of Radiation Oncology, Washington University, St. Louis, Missouri; Department of Neurosurgery, Washington University, St. Louis, Missouri
| | - Robert E Drzymala
- Department of Radiation Oncology, Washington University, St. Louis, Missouri
| | - Joseph J H Ackerman
- Department of Chemistry, Washington University, St. Louis, Missouri; Department of Radiology, Washington University, St. Louis, Missouri; Department of Internal Medicine, Washington University, St. Louis, Missouri
| | - Joel R Garbow
- Department of Radiology, Washington University, St. Louis, Missouri.
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137
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Jiang X, Perez-Torres CJ, Thotala D, Engelbach JA, Yuan L, Cates J, Gao F, Drzymala RE, Rich KM, Schmidt RE, Ackerman JJH, Hallahan DE, Garbow JR. A GSK-3β inhibitor protects against radiation necrosis in mouse brain. Int J Radiat Oncol Biol Phys 2014; 89:714-21. [PMID: 24969790 PMCID: PMC4307920 DOI: 10.1016/j.ijrobp.2014.04.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 04/07/2014] [Accepted: 04/08/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE To quantify the effectiveness of SB415286, a specific inhibitor of GSK-3β, as a neuroprotectant against radiation-induced central nervous system (brain) necrosis in a mouse model. METHODS AND MATERIALS Cohorts of mice were treated with SB415286 or dimethyl sulfoxide (DMSO) prior to irradiation with a single 45-Gy fraction targeted to the left hemisphere (brain) using a gamma knife machine. The onset and progression of radiation necrosis (RN) were monitored longitudinally by noninvasive in vivo small-animal magnetic resonance imaging (MRI) beginning 13 weeks postirradiation. MRI-derived necrotic volumes for SB415286- and DMSO-treated mice were compared. MRI results were supported by correlative histology. RESULTS Mice treated with SB415286 showed significant protection from radiation-induced necrosis, as determined by in vivo MRI with histologic validation. MRI-derived necrotic volumes were significantly smaller at all postirradiation time points in SB415286-treated animals. Although the irradiated hemispheres of the DMSO-treated mice demonstrated many of the classic histologic features of RN, including fibrinoid vascular necrosis, vascular telangiectasia, hemorrhage, and tissue loss, the irradiated hemispheres of the SB415286-treated mice consistently showed only minimal tissue damage. These studies confirmed that treatment with a GSK-3β inhibitor dramatically reduced delayed time-to-onset necrosis in irradiated brain. CONCLUSIONS The unilateral cerebral hemispheric stereotactic radiation surgery mouse model in concert with longitudinal MRI monitoring provided a powerful platform for studying the onset and progression of RN and for developing and testing new neuroprotectants. Effectiveness of SB415286 as a neuroprotectant against necrosis motivates potential clinical trials of it or other GSK-3β inhibitors.
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Affiliation(s)
- Xiaoyu Jiang
- Department of Chemistry, Washington University, St. Louis, Missouri
| | | | - Dinesh Thotala
- Department of Radiation Oncology, Washington University, St. Louis, Missouri
| | - John A Engelbach
- Department of Radiology, Washington University, St. Louis, Missouri
| | - Liya Yuan
- Department of Neurosurgery, Washington University, St. Louis, Missouri
| | - Jeremy Cates
- Department of Radiation Oncology, Washington University, St. Louis, Missouri
| | - Feng Gao
- Division of Biostatistics, Washington University, St. Louis, Missouri; Alvin J. Siteman Cancer Center, Washington University, St. Louis, Missouri
| | - Robert E Drzymala
- Department of Radiation Oncology, Washington University, St. Louis, Missouri; Department of Neurosurgery, Washington University, St. Louis, Missouri
| | - Keith M Rich
- Department of Radiation Oncology, Washington University, St. Louis, Missouri; Department of Neurosurgery, Washington University, St. Louis, Missouri
| | - Robert E Schmidt
- Department of Neuropathology, Washington University, St. Louis, Missouri
| | - Joseph J H Ackerman
- Department of Chemistry, Washington University, St. Louis, Missouri; Department of Radiology, Washington University, St. Louis, Missouri; Department of Internal Medicine, Washington University, St. Louis, Missouri; Alvin J. Siteman Cancer Center, Washington University, St. Louis, Missouri
| | - Dennis E Hallahan
- Department of Radiation Oncology, Washington University, St. Louis, Missouri; Alvin J. Siteman Cancer Center, Washington University, St. Louis, Missouri
| | - Joel R Garbow
- Department of Radiology, Washington University, St. Louis, Missouri; Alvin J. Siteman Cancer Center, Washington University, St. Louis, Missouri.
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138
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Linear Accelerator-Based Radiosurgery Alone for Arteriovenous Malformation: More Than 12 Years of Observation. Int J Radiat Oncol Biol Phys 2014; 89:576-83. [DOI: 10.1016/j.ijrobp.2014.03.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 01/31/2014] [Accepted: 03/11/2014] [Indexed: 11/20/2022]
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139
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Jiang X, Engelbach JA, Yuan L, Cates J, Gao F, Drzymala RE, Hallahan DE, Rich KM, Schmidt RE, Ackerman JJH, Garbow JR. Anti-VEGF antibodies mitigate the development of radiation necrosis in mouse brain. Clin Cancer Res 2014; 20:2695-702. [PMID: 24647570 PMCID: PMC4135174 DOI: 10.1158/1078-0432.ccr-13-1941] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To quantify the effectiveness of anti-VEGF antibodies (bevacizumab and B20-4.1.1) as mitigators of radiation-induced, central nervous system (brain) necrosis in a mouse model. EXPERIMENTAL DESIGN Cohorts of mice were irradiated with single-fraction 50- or 60-Gy doses of radiation targeted to the left hemisphere (brain) using the Leksell Perfexion Gamma Knife. The onset and progression of radiation necrosis were monitored longitudinally by in vivo, small-animal MRI, beginning 4 weeks after irradiation. MRI-derived necrotic volumes for antibody (Ab)-treated and untreated mice were compared. MRI results were supported by correlative histology. RESULTS Hematoxylin and eosin-stained sections of brains from irradiated, non-Ab-treated mice confirmed profound tissue damage, including regions of fibrinoid vascular necrosis, vascular telangiectasia, hemorrhage, loss of neurons, and edema. Treatment with the murine anti-VEGF antibody B20-4.1.1 mitigated radiation-induced changes in an extraordinary, highly statistically significant manner. The development of radiation necrosis in mice under treatment with bevacizumab (a humanized anti-VEGF antibody) was intermediate between that for B20-4.1.1-treated and non-Ab-treated animals. MRI findings were validated by histologic assessment, which confirmed that anti-VEGF antibody treatment dramatically reduced late-onset necrosis in irradiated brain. CONCLUSIONS The single-hemispheric irradiation mouse model, with longitudinal MRI monitoring, provides a powerful platform for studying the onset and progression of radiation necrosis and for developing and testing new therapies. The observation that anti-VEGF antibodies are effective mitigants of necrosis in our mouse model will enable a wide variety of studies aimed at dose optimization and timing and mechanism of action with direct relevance to ongoing clinical trials of bevacizumab as a treatment for radiation necrosis.
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Affiliation(s)
- Xiaoyu Jiang
- Authors' Affiliations: Departments of Chemistry, Radiology, Neurosurgery, Radiation Oncology, Neuropathology, and Internal Medicine; Division of Biostatistics; and the Alvin J. Siteman Cancer Center, Washington University, St. Louis, Missouri
| | - John A Engelbach
- Authors' Affiliations: Departments of Chemistry, Radiology, Neurosurgery, Radiation Oncology, Neuropathology, and Internal Medicine; Division of Biostatistics; and the Alvin J. Siteman Cancer Center, Washington University, St. Louis, Missouri
| | - Liya Yuan
- Authors' Affiliations: Departments of Chemistry, Radiology, Neurosurgery, Radiation Oncology, Neuropathology, and Internal Medicine; Division of Biostatistics; and the Alvin J. Siteman Cancer Center, Washington University, St. Louis, Missouri
| | - Jeremy Cates
- Authors' Affiliations: Departments of Chemistry, Radiology, Neurosurgery, Radiation Oncology, Neuropathology, and Internal Medicine; Division of Biostatistics; and the Alvin J. Siteman Cancer Center, Washington University, St. Louis, Missouri
| | - Feng Gao
- Authors' Affiliations: Departments of Chemistry, Radiology, Neurosurgery, Radiation Oncology, Neuropathology, and Internal Medicine; Division of Biostatistics; and the Alvin J. Siteman Cancer Center, Washington University, St. Louis, MissouriAuthors' Affiliations: Departments of Chemistry, Radiology, Neurosurgery, Radiation Oncology, Neuropathology, and Internal Medicine; Division of Biostatistics; and the Alvin J. Siteman Cancer Center, Washington University, St. Louis, Missouri
| | - Robert E Drzymala
- Authors' Affiliations: Departments of Chemistry, Radiology, Neurosurgery, Radiation Oncology, Neuropathology, and Internal Medicine; Division of Biostatistics; and the Alvin J. Siteman Cancer Center, Washington University, St. Louis, MissouriAuthors' Affiliations: Departments of Chemistry, Radiology, Neurosurgery, Radiation Oncology, Neuropathology, and Internal Medicine; Division of Biostatistics; and the Alvin J. Siteman Cancer Center, Washington University, St. Louis, Missouri
| | - Dennis E Hallahan
- Authors' Affiliations: Departments of Chemistry, Radiology, Neurosurgery, Radiation Oncology, Neuropathology, and Internal Medicine; Division of Biostatistics; and the Alvin J. Siteman Cancer Center, Washington University, St. Louis, MissouriAuthors' Affiliations: Departments of Chemistry, Radiology, Neurosurgery, Radiation Oncology, Neuropathology, and Internal Medicine; Division of Biostatistics; and the Alvin J. Siteman Cancer Center, Washington University, St. Louis, Missouri
| | - Keith M Rich
- Authors' Affiliations: Departments of Chemistry, Radiology, Neurosurgery, Radiation Oncology, Neuropathology, and Internal Medicine; Division of Biostatistics; and the Alvin J. Siteman Cancer Center, Washington University, St. Louis, MissouriAuthors' Affiliations: Departments of Chemistry, Radiology, Neurosurgery, Radiation Oncology, Neuropathology, and Internal Medicine; Division of Biostatistics; and the Alvin J. Siteman Cancer Center, Washington University, St. Louis, Missouri
| | - Robert E Schmidt
- Authors' Affiliations: Departments of Chemistry, Radiology, Neurosurgery, Radiation Oncology, Neuropathology, and Internal Medicine; Division of Biostatistics; and the Alvin J. Siteman Cancer Center, Washington University, St. Louis, Missouri
| | - Joseph J H Ackerman
- Authors' Affiliations: Departments of Chemistry, Radiology, Neurosurgery, Radiation Oncology, Neuropathology, and Internal Medicine; Division of Biostatistics; and the Alvin J. Siteman Cancer Center, Washington University, St. Louis, MissouriAuthors' Affiliations: Departments of Chemistry, Radiology, Neurosurgery, Radiation Oncology, Neuropathology, and Internal Medicine; Division of Biostatistics; and the Alvin J. Siteman Cancer Center, Washington University, St. Louis, MissouriAuthors' Affiliations: Departments of Chemistry, Radiology, Neurosurgery, Radiation Oncology, Neuropathology, and Internal Medicine; Division of Biostatistics; and the Alvin J. Siteman Cancer Center, Washington University, St. Louis, MissouriAuthors' Affiliations: Departments of Chemistry, Radiology, Neurosurgery, Radiation Oncology, Neuropathology, and Internal Medicine; Division of Biostatistics; and the Alvin J. Siteman Cancer Center, Washington University, St. Louis, Missouri
| | - Joel R Garbow
- Authors' Affiliations: Departments of Chemistry, Radiology, Neurosurgery, Radiation Oncology, Neuropathology, and Internal Medicine; Division of Biostatistics; and the Alvin J. Siteman Cancer Center, Washington University, St. Louis, MissouriAuthors' Affiliations: Departments of Chemistry, Radiology, Neurosurgery, Radiation Oncology, Neuropathology, and Internal Medicine; Division of Biostatistics; and the Alvin J. Siteman Cancer Center, Washington University, St. Louis, Missouri
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140
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Rao MS, Hargreaves EL, Khan AJ, Haffty BG, Danish SF. Magnetic Resonance-Guided Laser Ablation Improves Local Control for Postradiosurgery Recurrence and/or Radiation Necrosis. Neurosurgery 2014; 74:658-67; discussion 667. [DOI: 10.1227/neu.0000000000000332] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
ABSTRACT
BACKGROUND:
Enhancing lesions that progress after stereotactic radiosurgery are often tumor recurrence or radiation necrosis. Magnetic resonance-guided laser-induced thermal therapy (LITT) is currently being explored for minimally invasive treatment of intracranial neoplasms.
OBJECTIVE:
To report the largest series to date of local control with LITT for the treatment of recurrent enhancing lesions after stereotactic radiosurgery for brain metastases.
METHODS:
Patients with recurrent metastatic intracranial tumors or radiation necrosis who had previously undergone radiosurgery and had a Karnofsky performance status of >70 were eligible for LITT. Sixteen patients underwent a total of 17 procedures. The primary end point was local control using magnetic resonance imaging scans at intervals of >4 weeks. Radiographic outcomes were followed up prospectively until death or local recurrence (defined as >25% increase in volume compared with the 24-hour postprocedural scan).
RESULTS:
Fifteen patients (age, 46-82 years) were available for follow-up. Primary tumor histology was non–small-cell lung cancer (n = 12) and adenocarcinoma (n = 3). On average, the lesion size measured 3.66 cm3 (range, 0.46-25.45 cm3); there were 3.3 ablations per treatment (range, 2-6), with 7.73-cm depth to target (range, 5.5-14.1 cm), ablation dose of 9.85 W (range, 8.2-12.0 W), and total ablation time of 7.43 minutes (range, 2-15 minutes). At a median follow-up of 24 weeks (range, 4-84 weeks), local control was 75.8% (13 of 15 lesions), median progression-free survival was 37 weeks, and overall survival was 57% (8 of 14 patients). Two patients experience recurrence at 6 and 18 weeks after the procedure. Five patients died of extracranial disease progression; 1 patient died of neurological progression elsewhere in the brain.
CONCLUSION:
Magnetic resonance imaging-guided LITT is a well-tolerated procedure and may be effective in treating tumor recurrence/radiation necrosis.
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Affiliation(s)
- Malay S. Rao
- Department of Radiation Oncology and Neurosurgery, Rutgers University-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Eric L. Hargreaves
- Neurosurgery, Rutgers University-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Atif J. Khan
- Department of Radiation Oncology and Neurosurgery, Rutgers University-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Bruce G. Haffty
- Department of Radiation Oncology and Neurosurgery, Rutgers University-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Shabbar F. Danish
- Neurosurgery, Rutgers University-Robert Wood Johnson Medical School, New Brunswick, New Jersey
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141
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Tye K, Engelhard HH, Slavin KV, Nicholas MK, Chmura SJ, Kwok Y, Ho DS, Weichselbaum RR, Koshy M. An analysis of radiation necrosis of the central nervous system treated with bevacizumab. J Neurooncol 2014; 117:321-7. [PMID: 24504500 DOI: 10.1007/s11060-014-1391-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 01/26/2014] [Indexed: 11/30/2022]
Abstract
Radiation necrosis is a devastating complication following radiation to the central nervous system. The purpose of this study was to perform a comprehensive analysis of cases in the literature using bevacizumab, a monoclonal antibody against vascular endothelial growth factor, as treatment for radiation necrosis. A MEDLINE/PubMed search of articles about the use of bevacizumab for radionecrosis treatment yielded 16 studies published between 2007 and 2012. Data was summarized according to patient characteristics, treatment received and outcomes measured. A total of 71 unique cases were identified that met the inclusion criteria. The median age at the time of treatment with bevacizumab was 47 years. The most common tumors treated were glioblastoma (31 %), anaplastic glioma (14 %), and metastatic brain tumors (15 %). The median time from ending radiotherapy to starting treatment with bevacizumab was 11 months and the median follow up time after bevacizumab treatment was 8 months. The median number of cycles of bevacizumab was administered was 4, and the median dosage of bevacizumab was 7.5 mg/kg. The median time elapsed between cycles of bevacizumab was 2 weeks. Overall, pre and post treatment imaging revealed a median decrease in T1 contrast enhancement of 63 %, and a 59 % median decrease in T2/FLAIR signal abnormality. Treatment with bevacizumab resulted in a significant radiographic response for patients with radionecrosis. The median dosage of bevacizumab of 7.5 mg/kg for four cycles every 2 weeks should be considered as a treatment option in this patient population.
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Affiliation(s)
- Karen Tye
- Department of Radiation Oncology, University of Illinois at Chicago, 1801 West Taylor Street, Chicago, IL, 60612, USA
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142
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Dietrich J, Klein JP. Imaging of Cancer Therapy–Induced Central Nervous System Toxicity. Neurol Clin 2014; 32:147-57. [DOI: 10.1016/j.ncl.2013.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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143
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Rahmathulla G, Recinos PF, Kamian K, Mohammadi AM, Ahluwalia MS, Barnett GH. MRI-Guided Laser Interstitial Thermal Therapy in Neuro-Oncology: A Review of Its Current Clinical Applications. Oncology 2014; 87:67-82. [DOI: 10.1159/000362817] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 04/08/2014] [Indexed: 11/19/2022]
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144
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Diagnostic Challenges of Radiation Necrosis. Can J Neurol Sci 2013; 40:763-4. [DOI: 10.1017/s0317167100015845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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145
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Rooney JW, Laack NN. Pharmacological interventions to treat or prevent neurocognitive decline after brain radiation. CNS Oncol 2013; 2:531-41. [PMID: 25054823 PMCID: PMC6136103 DOI: 10.2217/cns.13.60] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
After surgery, radiation is the most effective treatment for the majority of brain tumors in both children and adults. Although improvements in radiotherapy delivery and targeting have resulted in reduction in neurologic morbidity, radiotherapy is still associated with acute and late toxicities that are dependent on a variety of treatment- and patient-specific variables. Variables of treatment include radiation dose, fractionation, volume, technique, photons or protons, and concomitant or adjuvant chemotherapy. Patient- and tumor-specific variables include tumor type, location and patient age. Side effects of treatment are also variable and can range from mild fatigue to significant memory difficulties and even death. This review will focus on the hypothesized mechanisms of cognitive dysfunction after radiation therapy and will discuss possible intervention strategies including behavioral and pharmacological prevention and treatment.
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Affiliation(s)
- Jessica W Rooney
- Mayo Clinic Department of Radiation Oncology, 200 First Street SW, Rochester, MN 55905, USA
| | - Nadia N Laack
- Mayo Clinic Department of Radiation Oncology, 200 First Street SW, Rochester, MN 55905, USA
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