1
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Sheehan JP, Lee CC, Fadul CE. Progression versus pseudoprogression: radiological differentiation with contrast clearance analysis on brain MRI. J Neurooncol 2024; 169:695-696. [PMID: 39042301 DOI: 10.1007/s11060-024-04770-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Accepted: 07/05/2024] [Indexed: 07/24/2024]
Affiliation(s)
- Jason P Sheehan
- Department of Neurological Surgery, University of Virginia Health System, Box 800212, Charlottesville, VA, 22908, USA.
| | - Cheng-Chia Lee
- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Camilo E Fadul
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
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2
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Hung JSE, Su YH, Chen CJ, Chiang CL, Shen CI, Yang HC, Shiau CY, Luo YH, Wu HM, Hu YS, Lin CJ, Liu KD, Chung WY, Guo WY, Lee CC. Is it advisable to perform radiosurgery for EGFR-TKI-controlled brain metastases? A retrospective study of the role of radiosurgery in lung cancer treatment. J Neurooncol 2023; 164:413-422. [PMID: 37656378 DOI: 10.1007/s11060-023-04425-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 08/15/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE Given the availability of TKIs with high central nervous system efficacy, the question arises as to whether upfront SRS provides additional clinical benefits. The goal of this study was to characterize the clinical outcomes of SRS as salvage therapy for TKI-uncontrolled BMs. METHODS This retrospective study included EGFR-mutant NSCLC patients presenting BMs at the time of primary tumor diagnosis. BMs were categorized into three subgroups, referred to as "Nature of TKI-treated BMs", "TKI-controlled brain metastases ± SRS", and "SRS salvage therapy". The first subgroup analysis characterized the effects of TKIs on tumor behavior. In the second subgroup, we compared outcomes of TKI-controlled BMs treated with TKI alone versus those treated with combined TKI-SRS therapy. The third subgroup characterized the outcomes of TKI-uncontrolled BMs treated with SRS as salvage therapy Clinical outcomes include local and distant tumor control. RESULTS This study included 106 patients with a total of 683 BMs. TKI treatment achieved control in 63% of local tumors at 24 months. Among the TKI-controlled BMs, local tumor control was significantly higher in the combined TKI-SRS group (93%) than in the TKI-alone group (65%) at 24 months (p < 0.001). No differences were observed between the two groups in terms of distant tumor control (p = 0.832). In dealing with TKI-uncontrolled BMs, salvage SRS achieved local tumor control in 58% of BMs at 24 months. CONCLUSIONS While upfront TKI alone proved highly effective in BM control, this study also demonstrated the outcomes of SRS when implemented concurrently with TKI or as salvage therapy for TKI-uncontrolled BMs. This study also presents a strategy of the precise timing and targeting of SRS to lesions in progression.
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Affiliation(s)
- Joseph Shang-En Hung
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yan-Hua Su
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ching-Jen Chen
- Department of Neurological Surgery, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Chi-Lu Chiang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chia-I Shen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Huai-Che Yang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Cheng-Ying Shiau
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yung-Hung Luo
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsiu-Mei Wu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yong-Sin Hu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chung-Jung Lin
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kang-Du Liu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wen-Yuh Chung
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wan-Yuo Guo
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Chia Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Eraky AM. Radiological Biomarkers for Brain Metastases Prognosis: Quantitative Magnetic Resonance Imaging (MRI) Modalities As Non-invasive Biomarkers for the Effect of Radiotherapy. Cureus 2023; 15:e38353. [PMID: 37266043 PMCID: PMC10229388 DOI: 10.7759/cureus.38353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 06/03/2023] Open
Abstract
Radiotherapy effect is achieved by its ability to cause DNA damage and induce apoptosis. In contrast, radiation can induce tumor cells' proliferation, invasiveness, and epithelial-mesenchymal transition (EMT). Besides developing radioresistance, this paradoxical effect of radiotherapy is considered a challenging problem in the field of radiotherapy. This highlights the importance of developing new modalities to diagnose radioresistance early to avoid any unnecessary exposure to radiation and differentiate between metastases recurrence versus post-radiation changes. Quantitative magnetic resonance imaging (MRI) techniques including diffusion-weighted imaging (DWI), dynamic susceptibility contrast (DSC), arterial spin labeling (ASL), and dynamic contrast-enhanced (DCE) represent potential biomarkers to diagnose metastases recurrence and radioresistance. In this review, we will focus on recent studies discussing the possibility of using DWI, DSC, ASL, and DCE to diagnose radioresistance and recurrence in patients with brain metastases.
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Affiliation(s)
- Akram M Eraky
- Neurological Surgery, Medical College of Wisconsin, Milwaukee, USA
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Huang YH, Yang HC, Chiang CL, Wu HM, Luo YH, Hu YS, Lin CJ, Chung WY, Shiau CY, Guo WY, Lee CC. Gamma Knife Radiosurgery Irradiation of Surgical Cavity of Brain Metastases: Factor Analysis and Gene Mutations. LIFE (BASEL, SWITZERLAND) 2023; 13:life13010236. [PMID: 36676186 PMCID: PMC9864800 DOI: 10.3390/life13010236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/07/2023] [Accepted: 01/10/2023] [Indexed: 01/19/2023]
Abstract
(1) Background: Surgical resection for the removal of brain metastases often fails to prevent tumor recurrence within the surgical cavity; hence, researchers are divided as to the benefits of radiation treatment following surgical resection. This retrospective study assessed the effects of post-operative stereotactic radiosurgery (SRS) on local tumor control and overall survival. (2) Methods: This study examined the demographics, original tumor characteristics, and surgical outcomes of 97 patients who underwent Gamma Knife Radiosurgery (GKRS) treatment (103 brain metastases). Kaplan-Meier plots and Cox regression were used to correlate clinical features to tumor control and overall survival. (3) Results: The overall tumor control rate was 75.0% and overall 12-month survival was 89.6%. Tumor control rates in the radiation group versus the non-radiation group were as follows: 12 months (83.1% vs. 57.7%) and 24 months (66.1% vs. 50.5%). During the 2-year follow-up period after SRS, the intracranial response rate was higher in the post-craniotomy radiation group than in the non-radiation group (p = 0.027). Cox regression multivariate analysis determined that post-craniotomy irradiation of the surgical cavity is predictive of tumor control (p = 0.035). However, EGFR mutation was not predictive of overall survival or tumor control. (4) Conclusions: Irradiating the surgical cavity after surgery can enhance local tumor control; however, it does not have a significant effect on overall survival.
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Affiliation(s)
- Yi-Han Huang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Huai-Che Yang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei 112, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Chi-Lu Chiang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Hsiu-Mei Wu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Department of Radiology, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Yung-Hung Luo
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Yong-Sin Hu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Department of Radiology, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Chung-Jung Lin
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Department of Radiology, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Wen-Yuh Chung
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei 112, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Cheng-Ying Shiau
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Cancer Center, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Wan-Yuo Guo
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Department of Radiology, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Cheng-Chia Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei 112, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Correspondence: ; Tel.: +886-2-28712121
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Natural history of lung squamous cell brain metastases in patients treated with radiosurgery: a thirty-year experience at a tertiary medical center. J Neurooncol 2023; 161:135-146. [PMID: 36469189 DOI: 10.1007/s11060-022-04153-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 09/29/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE In this study we report our 30-year experience in stereotactic radiosurgery (SRS) treatment of lung squamous cell carcinoma (LUSC) brain metastases (BMs). It will serve to provide detailed longitudinal outcomes and predictors of efficacy in treating LUSC-BMs with SRS. METHOD We retrospectively reviewed 51 patients and 109 tumors treated with SRS at our center between 1993 and 2022. Patient demographics, PDL1 genotype, immunotherapy use and mortality cause were recorded. Radiological and clinical outcomes were followed at 1-3-month intervals post-SRS. Cox-regression analysis and Kaplan-Meier survival curves were performed in statistical analysis. RESULTS We included 37 male and 14 female patients (median age 62.7 years at BM diagnosis). Median overall survival (OS) time was 6.9 months, 6-month OS rate was 62.1%, and Karnofsky performance scale (KPS) was the only independent predictor. Median time for local control maintenance was 7.6 months, 6-month local control rate was 69.1%, with TKI as the only independent predictor. Median time to distant failure was 5.13 months, 6-month distant failure rate was 51.1%, and factors with significant impact included gender (p = 0.002), presence of extracranial metastases (p < 0.001), use of immunotherapy(p < 0.001), PDL1 genotype (p = 0.034), and total intracranial metastases number (p = 0.008). However, no definitive benefits of immunotherapy were identified in patients with higher PDL1 mutational tumors. CONCLUSION In this study we defined the natural history of disease progression and outcomes in SRS-treated LUSC-BM patients. We also identified predictors of OS and tumor control among these patients. The findings of this study will serve as a guide when counseling these patients for SRS.
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Gao F, Li JJ, Liu JY, Li YJ, Cong XY, Talifu Z, Zhang X. Association between brain N-acetylaspartate levels and sensory and motor dysfunction in patients who have spinal cord injury with spasticity: an observational case-control study. Neural Regen Res 2023; 18:582-586. [DOI: 10.4103/1673-5374.350216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kim B, Yang JU, Chang Y, Choi HJ, Jang K, Yoon SY, Park SH. Development of an Animal Stereotactic Device for Preclinical Research on Tumor Response After Stereotactic Radiosurgery. World Neurosurg 2022; 166:220-224. [PMID: 35953040 DOI: 10.1016/j.wneu.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 08/01/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND In gamma knife radiosurgery, the tumor response to radiation is an important predictor of clinical treatment results. Since brain tumors have different characteristics and growth patterns, depending on the type, the tumors' response to radiation are also different. Compared with various other clinical treatments, there is a dearth of research on the development of gamma knife-magnetic resonance imaging (MRI) preclinical experimental equipment. Hence, the identification of preclinical equipment necessity for experimental animals will provide meaningful data for the provision of clinical assistance to humans. OBJECTIVES A device for stereotactic radiosurgery capable of MRI in small animals was developed. The feasibility of creating a preplan by means of small animal images was then assessed. METHODS A device for stereotaxic surgery of small animals using a 48-channel MRI coil was developed using a 3 dimensional printer. Rat brain-MRI images were obtained with a 3.0 T MRI scanner using a multi-channel coil. The acquired MRI images were transferred to a GammaPlan workstation to establish a preplan. RESULTS To gamma rays to the targeted site on animals, a positioning device combined with a G-frame was mounted on a gamma knife. Planning of radiosurgery based on MRI images became possible with GammaPlan workstations. CONCLUSIONS Preclinical experiments using small animals are possible with the use of stereotactic devices. In clinical treatment, preclinical experimental results will provide meaningful information.
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Affiliation(s)
- Byungmok Kim
- Department of Medical & Biological Engineering, Kyungpook National University, Daegu, Republic of Korea; Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Ji-Ung Yang
- Department of Medical & Biological Engineering, Kyungpook National University, Daegu, Republic of Korea; Division of Applied RI, Korea Institute of Radiological & Medical Sciences (KIRAMS), Seoul, Republic of Korea
| | - Yongmin Chang
- Department of Molecular Medicine, Kyungpook National University School of Medicine, Daegu, Republic of Korea; Department of Radiology, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Hea Jung Choi
- Department of Medical & Biological Engineering, Kyungpook National University, Daegu, Republic of Korea; Department of Radiation Oncology, Asan Medical Center, Seoul, Republic of Korea
| | - Kyungeun Jang
- Department of Medical & Biological Engineering, Kyungpook National University, Daegu, Republic of Korea; AIRS Medical, Seoul, Republic of Korea
| | - Sang-Youl Yoon
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Seong-Hyun Park
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Republic of Korea; Department of Neurosurgery, Kyungpook National University School of Medicine, Daegu, Republic of Korea.
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8
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Chiou GY, Chiang CL, Yang HC, Shen CI, Wu HM, Chen YW, Chen CJ, Luo YH, Hu YS, Lin CJ, Chung WY, Shiau CY, Guo WY, Pan DHC, Lee CC. Combined stereotactic radiosurgery and tyrosine kinase inhibitor therapy versus tyrosine kinase inhibitor therapy alone for the treatment of non-small cell lung cancer patients with brain metastases. J Neurosurg 2022; 137:563-570. [PMID: 34920439 DOI: 10.3171/2021.9.jns211373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/23/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Whether combined radiation and tyrosine kinase inhibitor (TKI) therapy in non-small cell lung cancer (NSCLC) patients with brain metastases (BMs) and epidermal growth factor receptor (EGFR) mutations confers additional benefits over TKI therapy alone remains a matter of debate. The goal of this study was to compare outcomes between combined TKI therapy with stereotactic radiosurgery (SRS) versus TKI therapy alone in NSCLC patients with BMs and EGFR mutations. METHODS Consecutive cases of NSCLC patients with EGFR mutations and BMs treated with TKIs were selected for inclusion in this study. Patients were categorized into two groups based on SRS: TKI therapy alone (group I) and combined SRS and TKI therapy (group II). Patients who had SRS or TKI as salvage therapy and those with prior radiation treatment for BMs were excluded. Tumor control (< 10% increase in tumor volume) and overall survival (OS) rates were compared using Kaplan-Meier analyses. Independent predictors of tumor control and OS were identified using multivariable Cox regression analyses. RESULTS The study cohort comprised 280 patients (n = 90 in group I and n = 190 in group II). Cumulative tumor control rates were higher in group II than in group I (79.8% vs 31.2% at 36 months, p < 0.0001). Cumulative OS rates were comparable between groups I and II (43.8% vs 59.4% at 36 months, p = 0.3203). Independent predictors of tumor control were older age (p < 0.01, HR 1.03), fewer BMs (p < 0.01, HR 1.09), lack of extracranial metastasis (p < 0.02, HR 0.70), and combined SRS and TKI therapy (p < 0.01, HR 0.25). Independent predictors of OS were fewer BMs (p < 0.01, HR 1.04) and a higher Karnofsky Performance Status score (p < 0.01, HR 0.97). CONCLUSIONS Although the OS rate did not differ between TKI therapy with and without SRS, the addition of SRS to TKI therapy resulted in improvement of intracranial tumor control. The lack of effect on survival rate with the addition of SRS may be attributable to extracranial disease progression. The addition of SRS to TKI therapy is recommended for intracranial disease control in NSCLC patients with BMs and EGFR mutations. Potential benefits may include prevention of neurological deficits and seizures. Future prospective studies may help clarify the clinical outcome benefits of SRS in these patients.
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Affiliation(s)
- Guan-Ying Chiou
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei
| | - Chi-Lu Chiang
- 3School of Medicine, National Yang Ming Chiao Tung University, Taipei
- 5Department of Chest Medicine, Taipei Veterans General Hospital, Taipei
- 8Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; and
| | - Huai-Che Yang
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei
- 3School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Chia-I Shen
- 3School of Medicine, National Yang Ming Chiao Tung University, Taipei
- 5Department of Chest Medicine, Taipei Veterans General Hospital, Taipei
- 8Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; and
| | - Hsiu-Mei Wu
- 2Department of Radiology, Taipei Veterans General Hospital, Taipei
- 3School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Yu-Wei Chen
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei
- 2Department of Radiology, Taipei Veterans General Hospital, Taipei
| | - Ching-Jen Chen
- 9Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Yung-Hung Luo
- 3School of Medicine, National Yang Ming Chiao Tung University, Taipei
- 5Department of Chest Medicine, Taipei Veterans General Hospital, Taipei
- 8Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; and
| | - Yong-Sin Hu
- 2Department of Radiology, Taipei Veterans General Hospital, Taipei
- 3School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Chung-Jung Lin
- 2Department of Radiology, Taipei Veterans General Hospital, Taipei
- 3School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Wen-Yuh Chung
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei
- 3School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Cheng-Ying Shiau
- 3School of Medicine, National Yang Ming Chiao Tung University, Taipei
- 4Cancer Center, Taipei Veterans General Hospital, Taipei
| | - Wan-Yuo Guo
- 2Department of Radiology, Taipei Veterans General Hospital, Taipei
- 3School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - David Hung-Chi Pan
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei
- 7Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, Taipei
| | - Cheng-Chia Lee
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei
- 3School of Medicine, National Yang Ming Chiao Tung University, Taipei
- 6Brain Research Center, National Yang Ming Chiao Tung University, Taipei
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ADC textural features in patients with single brain metastases improve clinical risk models. Clin Exp Metastasis 2022; 39:459-466. [PMID: 35394585 PMCID: PMC9117356 DOI: 10.1007/s10585-022-10160-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 02/28/2022] [Indexed: 11/03/2022]
Abstract
AIMS In this retrospective study we performed a quantitative textural analysis of apparant diffusion coefficient (ADC) images derived from diffusion weighted MRI (DW-MRI) of single brain metastases (BM) patients from different primary tumors and tested whether these imaging parameters may improve established clinical risk models. METHODS We identified 87 patients with single BM who had a DW-MRI at initial diagnosis. Applying image segmentation, volumes of contrast-enhanced lesions in T1 sequences, hyperintense T2 lesions (peritumoral border zone (T2PZ)) and tumor-free gray and white matter compartment (GMWMC) were generated and registered to corresponding ADC maps. ADC textural parameters were generated and a linear backward regression model was applied selecting imaging features in association with survival. A cox proportional hazard model with backward regression was fitted for the clinical prognostic models (diagnosis-specific graded prognostic assessment score (DS-GPA) and the recursive partitioning analysis (RPA)) including these imaging features. RESULTS Thirty ADC textural parameters were generated and linear backward regression identified eight independent imaging parameters which in combination predicted survival. Five ADC texture features derived from T2PZ, the volume of the T2PZ, the normalized mean ADC of the GMWMC as well as the mean ADC slope of T2PZ. A cox backward regression including the DS-GPA, RPA and these eight parameters identified two MRI features which improved the two risk scores (HR = 1.14 [1.05;1.24] for normalized mean ADC GMWMC and HR = 0.87 [0.77;0.97]) for ADC 3D kurtosis of the T2PZ.) CONCLUSIONS: Textural analysis of ADC maps in patients with single brain metastases improved established clinical risk models. These findings may aid to better understand the pathogenesis of BM and may allow selection of patients for new treatment options.
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Madamesila J, Ploquin N, Faruqi S, Tchistiakova E. Investigating diffusion patterns of brain metastases pre- and post-stereotactic radiosurgery: a feasibility study. Biomed Phys Eng Express 2021; 7. [PMID: 34388735 DOI: 10.1088/2057-1976/ac1d89] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/13/2021] [Indexed: 11/12/2022]
Abstract
Purpose.Metastatic complications are responsible for 90% of cancer-associated mortality. Magnetic resonance imaging (MRI) can be used to observe the brain's microstructure and potentially correlate changes with metastasis occurrence. Diffusion weighted imaging (DWI) is an MRI technique that utilizes the kinetics of water molecules within the body. The aim of this study is to use DWI to characterize diffusion changes within brain metastases in cancer patients pre- and post-stereotactic radiosurgery (SRS).Methods.We retrospectively analyzed 113 metastases from 13 patients who underwent SRS for brain metastasis recurrence. Longitudinal apparent diffusion coefficient (ADC) maps were registered to Gd-T1 images and CT, and clinical metastasis ROIs from all SRS treatments were retrospectively transferred onto these ADC maps for analysis. Metastases were characterized based on pre-SRS diffusion pattern, primary cancer site, and post-SRS outcome. ADC values were calculated pre- and post-SRS.Results.ADC values were significantly elevated (980.2 × 10-6mm2s-1and 1040.3 × 10-6mm2s-1pre- and post-SRS, respectively) when compared to healthy brain tissue (826.8 × 10-6mm2s-1) for all metastases. Three identified pre-SRS patterns were significantly different before SRS and within 6 months post-SRS. No significant differences were observed between different primaries pre-SRS. Post-SRS, Lung metastases ADC decreased by 86.2 × 10-6mm2s-1, breast metastases increased by 116.7 × 10-6mm2s-1, and genitourinary metastases showed no significant ADC change. SRS outcomes showed ADC variability pre-treatment but no significant differences pre- and post-SRS, except at 6-9 months post-SRS where progressing metastases were elevated when compared to other response groups.Conclusion. This study provided a unique opportunity to characterize diffusion changes in brain metastases before their manifestation on standard Gd-T1 images and post-SRS. Identified patterns may improve early detection of brain metastases as well as predict their response to treatment.
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Affiliation(s)
| | - Nicolas Ploquin
- Department of Physics and Astronomy, University of Calgary, Canada.,Department of Oncology, Division of Medical Physics, University of Calgary, Canada
| | - Salman Faruqi
- Department of Oncology, Division of Radiation Oncology, University of Calgary, Canada
| | - Ekaterina Tchistiakova
- Department of Physics and Astronomy, University of Calgary, Canada.,Department of Oncology, Division of Medical Physics, University of Calgary, Canada
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Zheng Y, Geng D, Yu T, Xia W, She D, Liu L, Yin B. Prognostic value of pretreatment MRI texture features in breast cancer brain metastasis treated with Gamma Knife radiosurgery. Acta Radiol 2021; 62:1208-1216. [PMID: 32910684 DOI: 10.1177/0284185120956296] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Gamma Knife radiosurgery (GKS) was recommended for treating patients with breast cancer brain metastasis (BCBM), but predictions of the existing prognostic models for therapeutic responsiveness vary substantially. PURPOSE To investigate the prognostic value of pretreatment clinical, MRI radiologic, and texture features in patients with BCBM undergoing GKS. MATERIAL AND METHODS The data of 81 BCBMs in 44 patients were retrospectively reviewed. Progressive disease was defined as an increase of at least 20% in the longest diameter of the target lesion or the presence of new intracranial lesions on contrast-enhanced T1-weighted (CE-T1W) imaging. Radiomic features were extracted from pretreatment CE-T1W images, T2-weighted (T2W) images, and ADC maps. Cox proportional hazard analyses were performed to identify independent predictors associated with BCBM-specific progression-free survival (PFS). A nomogram was constructed and its calibration ability was assessed. RESULTS The cumulative BCBM-specific PFS was 52.27% at six months and 11.36% at one year, respectively. Age (hazard ratio [HR] 1.04; 95% confidence interval [CI] 1.01-1.06; P = 0.004) and CE-T1W-based kurtosis (HR 0.72; 95% CI 0.57-0.92; P = 0.008) were the independent predictors. The combination of CE-T1W-based kurtosis and age displayed a higher C-index (C-index 0.70; 95% CI 0.63-0.77) than did CE-T1W-based kurtosis (C-index 0.65; 95% CI 0.57-0.73) or age (C-index 0.63; 95% CI 0.56-0.70) alone. The nomogram based on the combinative model provided a better performance over age (P < 0.05). The calibration curves elucidated good agreement between prediction and observation for the probability of 7- and 12-month BCBM-specific PFS. CONCLUSION Pretreatment CE-T1W-based kurtosis combined with age could improve prognostic ability in patients with BCBM undergoing GKS.
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Affiliation(s)
- Yingyan Zheng
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Daoying Geng
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, PR China
- Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, PR China
| | - Tonggang Yu
- Department of Radiology, Shanghai Gamma Hospital, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Wei Xia
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, PR China
- Academy for Engineering and Technology, Fudan University, Shanghai, PR China
- Department of Medical Imaging, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, PR China
| | - Dejun She
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Li Liu
- Department of Radiology, Shanghai Cancer Center, Fudan University, Shanghai, PR China
| | - Bo Yin
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, PR China
- Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, PR China
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12
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Tumor habitat analysis by magnetic resonance imaging distinguishes tumor progression from radiation necrosis in brain metastases after stereotactic radiosurgery. Eur Radiol 2021; 32:497-507. [PMID: 34357451 DOI: 10.1007/s00330-021-08204-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/22/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The identification of viable tumor after stereotactic radiosurgery (SRS) is important for future targeted therapy. This study aimed to determine whether tumor habitat on structural and physiologic MRI can distinguish viable tumor from radiation necrosis of brain metastases after SRS. METHOD Multiparametric contrast-enhanced T1- and T2-weighted imaging, apparent diffusion coefficient (ADC), and cerebral blood volume (CBV) were obtained from 52 patients with 69 metastases, showing enlarging enhancing masses after SRS. Voxel-wise clustering identified three structural MRI habitats (enhancing, solid low-enhancing, and nonviable) and three physiologic MRI habitats (hypervascular cellular, hypovascular cellular, and nonviable). Habitat-based predictors for viable tumor or radiation necrosis were identified by logistic regression. Performance was validated using the area under the curve (AUC) of the receiver operating characteristics curve in an independent dataset with 24 patients. RESULTS None of the physiologic MRI habitats was indicative of viable tumor. Viable tumor was predicted by a high-volume fraction of solid low-enhancing habitat (low T2-weighted and low CE-T1-weighted values; odds ratio [OR] 1.74, p <.001) and a low-volume fraction of nonviable tissue habitat (high T2-weighted and low CE-T1-weighted values; OR 0.55, p <.001). Combined structural MRI habitats yielded good discriminatory ability in both development (AUC 0.85, 95% confidence interval [CI]: 0.77-0.94) and validation sets (AUC 0.86, 95% CI:0.70-0.99), outperforming single ADC (AUC 0.64) and CBV (AUC 0.58) values. The site of progression matched with the solid low-enhancing habitat (72%, 8/11). CONCLUSION Solid low-enhancing and nonviable tissue habitats on structural MRI can help to localize viable tumor in patients with brain metastases after SRS. KEY POINTS • Structural MRI habitats helped to differentiate viable tumor from radiation necrosis. • Solid low-enhancing habitat was most helpful to find viable tumor. • Providing spatial information, the site of progression matched with solid low-enhancing habitat.
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13
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Azar M, Mohsenian Sisakht A, Kazemi Gazik F, Shahrokhi P, Rastegar K, Karamzade-Ziarati N. PET-guided gamma knife radiosurgery in brain tumors: a brief review. Clin Transl Imaging 2021. [DOI: 10.1007/s40336-021-00447-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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14
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Kaufmann TJ, Smits M, Boxerman J, Huang R, Barboriak DP, Weller M, Chung C, Tsien C, Brown PD, Shankar L, Galanis E, Gerstner E, van den Bent MJ, Burns TC, Parney IF, Dunn G, Brastianos PK, Lin NU, Wen PY, Ellingson BM. Consensus recommendations for a standardized brain tumor imaging protocol for clinical trials in brain metastases. Neuro Oncol 2021; 22:757-772. [PMID: 32048719 PMCID: PMC7283031 DOI: 10.1093/neuonc/noaa030] [Citation(s) in RCA: 121] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
A recent meeting was held on March 22, 2019, among the FDA, clinical scientists, pharmaceutical and biotech companies, clinical trials cooperative groups, and patient advocacy groups to discuss challenges and potential solutions for increasing development of therapeutics for central nervous system metastases. A key issue identified at this meeting was the need for consistent tumor measurement for reliable tumor response assessment, including the first step of standardized image acquisition with an MRI protocol that could be implemented in multicenter studies aimed at testing new therapeutics. This document builds upon previous consensus recommendations for a standardized brain tumor imaging protocol (BTIP) in high-grade gliomas and defines a protocol for brain metastases (BTIP-BM) that addresses unique challenges associated with assessment of CNS metastases. The "minimum standard" recommended pulse sequences include: (i) parameter matched pre- and post-contrast inversion recovery (IR)-prepared, isotropic 3D T1-weighted gradient echo (IR-GRE); (ii) axial 2D T2-weighted turbo spin echo acquired after injection of gadolinium-based contrast agent and before post-contrast 3D T1-weighted images; (iii) axial 2D or 3D T2-weighted fluid attenuated inversion recovery; (iv) axial 2D, 3-directional diffusion-weighted images; and (v) post-contrast 2D T1-weighted spin echo images for increased lesion conspicuity. Recommended sequence parameters are provided for both 1.5T and 3T MR systems. An "ideal" protocol is also provided, which replaces IR-GRE with 3D TSE T1-weighted imaging pre- and post-gadolinium, and is best performed at 3T, for which dynamic susceptibility contrast perfusion is included. Recommended perfusion parameters are given.
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Affiliation(s)
| | - Marion Smits
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jerrold Boxerman
- Department of Diagnostic Imaging, Rhode Island Hospital and Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Raymond Huang
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Daniel P Barboriak
- Department of Radiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Michael Weller
- Department of Neurology & Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Caroline Chung
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Christina Tsien
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Lalitha Shankar
- Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), Bethesda, Maryland, USA
| | - Evanthia Galanis
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Elizabeth Gerstner
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Terry C Burns
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ian F Parney
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Gavin Dunn
- Department of Neurological Surgery, Washington University, St Louis, Missouri, USA
| | - Priscilla K Brastianos
- Departments of Medicine and Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nancy U Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Benjamin M Ellingson
- UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.,Departments of Radiological Sciences and Psychiatry, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
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15
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Galldiks N, Kocher M, Ceccon G, Werner JM, Brunn A, Deckert M, Pope WB, Soffietti R, Le Rhun E, Weller M, Tonn JC, Fink GR, Langen KJ. Imaging challenges of immunotherapy and targeted therapy in patients with brain metastases: response, progression, and pseudoprogression. Neuro Oncol 2021; 22:17-30. [PMID: 31437274 DOI: 10.1093/neuonc/noz147] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The advent of immunotherapy using immune checkpoint inhibitors (ICIs) and targeted therapy (TT) has dramatically improved the prognosis of various cancer types. However, following ICI therapy or TT-either alone (especially ICI) or in combination with radiotherapy-imaging findings on anatomical contrast-enhanced MRI can be unpredictable and highly variable, and are often difficult to interpret regarding treatment response and outcome. This review aims at summarizing the imaging challenges related to TT and ICI monotherapy as well as combined with radiotherapy in patients with brain metastases, and to give an overview on advanced imaging techniques which potentially overcome some of these imaging challenges. Currently, major evidence suggests that imaging parameters especially derived from amino acid PET, perfusion-/diffusion-weighted MRI, or MR spectroscopy may provide valuable additional information for the differentiation of treatment-induced changes from brain metastases recurrence and the evaluation of treatment response.
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Affiliation(s)
- Norbert Galldiks
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany.,Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Düsseldorf, Germany
| | - Martin Kocher
- Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany.,Department of Stereotaxy and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Garry Ceccon
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jan-Michael Werner
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anna Brunn
- Institute of Neuropathology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Martina Deckert
- Institute of Neuropathology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Whitney B Pope
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Riccardo Soffietti
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
| | - Emilie Le Rhun
- Neuro-Oncology, General and Stereotaxic Neurosurgery Service, University Hospital Lille, Lille, France.,Breast Cancer Department, Oscar Lambret Center, Lille, France.,Department of Neurology & Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Michael Weller
- Department of Neurology & Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Jörg C Tonn
- Department of Neurosurgery, Ludwig Maximilians University of Munich, Munich, Germany.,German Cancer Consortium, partner site Munich, Germany
| | - Gereon R Fink
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany.,Department of Nuclear Medicine, University Hospital Aachen, Aachen, Germany
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16
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Imaging of Response to Radiosurgery and Immunotherapy in Brain Metastases: Quo Vadis? Curr Treat Options Neurol 2021. [DOI: 10.1007/s11940-021-00664-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Abstract
Purpose of Review
This review presents an overview of how advanced imaging techniques may help to overcome shortcomings of anatomical MRI for response assessment in patients with brain metastases who are undergoing stereotactic radiosurgery, immunotherapy, or combinations thereof.
Recent Findings
Study results suggest that parameters derived from amino acid PET, diffusion- and perfusion-weighted MRI, MR spectroscopy, and newer MRI methods are particularly helpful for the evaluation of the response to radiosurgery or checkpoint inhibitor immunotherapy and provide valuable information for the differentiation of radiotherapy-induced changes such as radiation necrosis from brain metastases. The evaluation of these imaging modalities is also of great interest in the light of emerging high-throughput analysis methods such as radiomics, which allow the acquisition of additional data at a low cost.
Summary
Preliminary results are promising and should be further evaluated. Shortcomings are different levels of PET and MRI standardization, the number of patients enrolled in studies, and the monocentric and retrospective character of most studies.
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17
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Zhao L, Zhao M, Liu J, Yang H, Zhou X, Wen C, Li G, Duan Y. Mean apparent diffusion coefficient in a single slice may predict tumor response to whole-brain radiation therapy in non-small-cell lung cancer patients with brain metastases. Eur Radiol 2021; 31:5565-5575. [PMID: 33452628 DOI: 10.1007/s00330-020-07584-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/09/2020] [Accepted: 12/01/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES This study aimed to access the performance of apparent diffusion coefficient (ADC) as a predictor for treatment response to whole-brain radiotherapy (WBRT) in patients with brain metastases (BMs) from non-small-cell lung cancer (NSCLC). METHODS A retrospective analysis was conducted of 102 NSCLC patients with BMs who underwent WBRT between 2012 and 2016. Diffusion-weighted MRI were performed pre-WBRT and within 12 weeks after WBRT started. Mean single-plane ADC value of ROIs was evaluated by two radiologists blinded to results of each other. The treatment response rate, intracranial progression-free survival (PFS), and overall survival (OS) were analyzed based on the ADC value and ΔADC respectively. At last, we used COX and logistic regression to do the multivariate analysis. RESULTS There was good inter-observer agreement of mean ADC value pre-WBRT, post-WBRT, and ΔADC between the 2 radiologists (Pearson correlation 0.915 [pre-WBRT], 0.950 [post-WBRT], 0.937 [ΔADC], p < 0.001, for each one). High mean ADC value were related with better response rate (72.2% vs 37.5%, p = 0.001) and iPFS (7.6 vs 6.4 months, p = 0.031). High ΔADC were related with better response rate (73.6% vs 36.7%, p < 0.001). Multivariate analysis shows that histopathology, BMs number, high ADC value pre-WBRT, and high ΔADC post-WBRT were related to better treatment response of WBRT, and KPS, BMs number, and low ADC value pre-WBRT increased the risk of developing intracranial relapse. CONCLUSIONS The mean single-plane ADC value pre-WBRT and ΔADC post-WBRT were potential predictor for intracranial tumor response to WBRT in NSCLC patients with brain metastases. KEY POINTS • ADC value is a potential predictor of intracranial treatment response to WBRT in NSCLC patients with brain metastases. • Higher mean ADC value pre-WBRT and ΔADC post-WBRT of brain metastases were related to better intracranial tumor response. • Prediction of response before WBRT using ADC value can help oncologists to make better therapy plans and avoid missing opportunities for rescue therapy.
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Affiliation(s)
- Lihao Zhao
- Department of Chemoradiation Oncology, The First Affiliated Hospital of Wenzhou Medical University, No. 2 Fuxue Lane, Wenzhou, 325000, People's Republic of China
| | - Mengjing Zhao
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, South Baixiang Street, Wenzhou, 325000, People's Republic of China
| | - Jinjin Liu
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, South Baixiang Street, Wenzhou, 325000, People's Republic of China
| | - Han Yang
- Department of Chemoradiation Oncology, The First Affiliated Hospital of Wenzhou Medical University, No. 2 Fuxue Lane, Wenzhou, 325000, People's Republic of China
| | - Xiaojun Zhou
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, South Baixiang Street, Wenzhou, 325000, People's Republic of China
| | - Caiyun Wen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, South Baixiang Street, Wenzhou, 325000, People's Republic of China
| | - Gang Li
- Department of Chemoradiation Oncology, The First Affiliated Hospital of Wenzhou Medical University, No. 2 Fuxue Lane, Wenzhou, 325000, People's Republic of China.
| | - Yuxia Duan
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, South Baixiang Street, Wenzhou, 325000, People's Republic of China.
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18
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Whole body diffusion-weighted MRI in detection of metastasis and lymphoma: a prospective longitudinal clinical study. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00231-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Abstract
Background
Whole-body diffusion-weighted magnetic resonance imaging (WB-DWI-MRI) is an emerging tool that has an increasing role in the diagnosis of metastasis and lymphoma. This is a longitudinal study in actual clinical settings designed to assess WB-DWI-MRI in detection of tumor spread. The study included all patients who were referred to Radiology Department, during the period from June 2016 till May 2018, with either a known primary tumor (either laboratory, radiologically, or histologically proven, of any type, affecting any organ) or with biopsy-proven lymphoma of any subtype, affecting any organ. All patients underwent WB coronal T1-weighted, STIR, axial T2-weighted, and DWI-MRI examinations before commencing any treatment with curative intent. The body was divided into lymph nodes (LNs), skeletal system, and organs (brain, lung, and liver). Patients were followed up till the nature of the lesion(s) was confirmed (clinically, radiologically, or histologically).
Results
The study included 46 patients; 27 patients had metastases and 19 had lymphomas. Sensitivities, specificities, and accuracies for LN detection were 77%, 85%, and 83%; for skeletal metastasis were 88%, 94%, and 92%; for brain lesions were 78%, 95%, and 91%; and for lung lesion were 64%, 88%, and 76%, respectively. As for the liver, all lesions were correctly identified and did not miss any lesion with accuracy of 100%. Overall, 1739 lesions were discovered in 1271 regions out of 3818 examined regions with overall sensitivity, specificity, and accuracy of 86%, 92%, and 90% respectively.
Conclusion
The diagnostic performance of WB-DWI-MRI is variable among different anatomical sites. It has good performance in diagnosis of some organs as liver, bone marrow, and some LNs regions as porta-hepatis. It has a less diagnostic performance in the lung, and LNs located in cervical, mediastinum, supraclavicular, and mesenteric regions.
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19
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Zakaria R, Chen YJ, Hughes DM, Wang S, Chawla S, Poptani H, Berghoff AS, Preusser M, Jenkinson MD, Mohan S. Does the application of diffusion weighted imaging improve the prediction of survival in patients with resected brain metastases? A retrospective multicenter study. Cancer Imaging 2020; 20:16. [PMID: 32028999 PMCID: PMC7006156 DOI: 10.1186/s40644-020-0295-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 01/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Brain metastases are common in clinical practice. Many clinical scales exist for predicting survival and hence deciding on best treatment but none are individualised and none use quantitative imaging parameters. A multicenter study was carried out to evaluate the prognostic utility of a simple diffusion weighted MRI parameter, tumor apparent diffusion coefficient (ADC). METHODS A retrospective analysis of imaging and clinical data was performed on a cohort of 223 adult patients over a ten-year period 2002-2012 pooled from three institutions. All patients underwent surgical resection with histologically confirmed brain metastases and received adjuvant whole brain radiotherapy and/or chemotherapy. Survival was modelled using standard clinical variables and statistically compared with and without the addition of tumor ADC. RESULTS The median overall survival was 9.6 months (95% CI 7.5-11.7) for this cohort. Greater age (p = 0.002), worse performance status (p < 0.0001) and uncontrolled extracranial disease (p < 0.0001) were all significantly associated with shorter survival in univariate analysis. Adjuvant whole brain radiotherapy (p = 0.007) and higher tumor ADC (p < 0.001) were associated with prolonged survival. Combining values of tumor ADC with conventional clinical scoring systems such as the Graded Prognostic Assessment (GPA) score significantly improved the modelling of survival (e.g. concordance increased from 0.5956 to 0.6277 with Akaike's Information Criterion reduced from 1335 to 1324). CONCLUSIONS Combining advanced MRI readings such as tumor ADC with clinical scoring systems is a potentially simple method for improving and individualising the estimation of survival in patients having surgery for brain metastases.
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Affiliation(s)
- Rasheed Zakaria
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK. .,Institute of Integrative Biology, University of Liverpool, Liverpool, UK.
| | - Yin Jie Chen
- Division of Neuroradiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | | | - Sumei Wang
- Division of Neuroradiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Sanjeev Chawla
- Division of Neuroradiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Harish Poptani
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Anna S Berghoff
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Matthias Preusser
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Michael D Jenkinson
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK.,Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Suyash Mohan
- Division of Neuroradiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
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20
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Huang CY, Lee CC, Yang HC, Lin CJ, Wu HM, Chung WY, Shiau CY, Guo WY, Pan DHC, Peng SJ. Radiomics as prognostic factor in brain metastases treated with Gamma Knife radiosurgery. J Neurooncol 2020; 146:439-449. [PMID: 32020474 DOI: 10.1007/s11060-019-03343-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 11/12/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Gamma Knife radiosurgery (GKRS) is a non-invasive procedure for the treatment of brain metastases. This study sought to determine whether radiomic features of brain metastases derived from pre-GKRS magnetic resonance imaging (MRI) could be used in conjunction with clinical variables to predict the effectiveness of GKRS in achieving local tumor control. METHODS We retrospectively analyzed 161 patients with non-small cell lung cancer (576 brain metastases) who underwent GKRS for brain metastases. The database included clinical data and pre-GKRS MRI. Brain metastases were demarcated by experienced neurosurgeons, and radiomic features of each brain metastasis were extracted. Consensus clustering was used for feature selection. Cox proportional hazards models and cause-specific proportional hazards models were used to correlate clinical variables and radiomic features with local control of brain metastases after GKRS. RESULTS Multivariate Cox proportional hazards model revealed that higher zone percentage (hazard ratio, HR 0.712; P = .022) was independently associated with superior local tumor control. Similarly, multivariate cause-specific proportional hazards model revealed that higher zone percentage (HR 0.699; P = .014) was independently associated with superior local tumor control. CONCLUSIONS The zone percentage of brain metastases, a radiomic feature derived from pre-GKRS contrast-enhanced T1-weighted MRIs, was found to be an independent prognostic factor of local tumor control following GKRS in patients with non-small cell lung cancer and brain metastases. Radiomic features indicate the biological basis and characteristics of tumors and could potentially be used as surrogate biomarkers for predicting tumor prognosis following GKRS.
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Affiliation(s)
- Chih-Ying Huang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-Chia Lee
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Huai-Che Yang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chung-Jung Lin
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsiu-Mei Wu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Yuh Chung
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Ying Shiau
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wan-Yuo Guo
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - David Hung-Chi Pan
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Syu-Jyun Peng
- Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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21
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Byvaltsev VA, Stepanov IA, Kichigin AI. THE ROLE OF DIFFUSION-WEIGHTED MRI OF PATIENTS WITH SPINE METASTASES. COLUNA/COLUMNA 2019. [DOI: 10.1590/s1808-185120191804225382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: The role of diffusion-weighted MRI in differential diagnostics and predicting the survival of patients with spine metastases was studied. Methods: The study included data from MRI and morphological studies of 23 patients with spine metastases. Results: The values obtained for the apparent diffusion coefficient (ADC) of tumors were compared with their histological type, cell density and Ki-67 proliferation index. The effect of ADC values on overall patient survival was also assessed. A reliable inverse correlation was established between ADC values and Ki-67 proliferation index for various types of spine metastases (r=-0.753, p=0.017). The dependence of ADC values and overall survival of patients with metastases in the spine is shown. Conclusion: The technique of diffusion-weighted MRI can be used as part of a comprehensive assessment in the preoperative planning of surgical treatment, and as a prognostic factor of overall survival for this group of patients. Level of Evidence II. Prognostic retrospective study,
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Affiliation(s)
- Vadim Anatol'evich Byvaltsev
- Irkutsk State Medical University, Russia; Railway Clinical Hospital, Russia; Irkutsk Scientific Center of Surgery and Traumatology, Russia; Irkutsk State Medical Academy of Continuing Education, Russia
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22
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Borghei-Razavi H, Sharma M, Emch T, Krivosheya D, Lee B, Muhsen B, Prayson R, Obuchowski N, Barnett GH, Vogelbaum MA, Chao ST, Suh JH, Mohammadi AM, Angelov L. Pathologic Correlation of Cellular Imaging Using Apparent Diffusion Coefficient Quantification in Patients with Brain Metastases After Gamma Knife Radiosurgery. World Neurosurg 2019; 134:e903-e912. [PMID: 31733389 DOI: 10.1016/j.wneu.2019.11.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 11/05/2019] [Accepted: 11/06/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate the role of apparent diffusion coefficient (ADC) in differentiating radiation necrosis (RN) from recurrent tumor after Gamma Knife radiosurgery (GKRS) for brain metastases (BMs). METHODS Forty-one patients with BM who underwent surgical intervention after GKRS at Cleveland Clinic (2006-2017) were included in this retrospective study. The ADC values of the growing lesions and the contralateral hemisphere were calculated using picture archiving and communication system. These values were correlated to the percentage of RN identified on pathologic evaluation of the surgical specimen. RESULTS The median age of the patients was 59 years (range, 25-86 years), and lung cancer (63.4%) was the most common malignancy. Median initial (pre-GKRS) target volume of the lesions was 5.4 cc (range, 0.135-45.6 cc), and median GKRS dose was 18.0 Gy. Surgical resection or biopsy was performed at a median of 176 days after GKRS. Two variables were statistically significant predictors of predominate RN (75%-100%) in the surgical specimen: 1) ADC of the lesion on the preresection magnetic resonance imaging (MRI) and 2) initial pre-GKRS target volume. ADC >1.5 × 10-3 mm2/s within the lesion on MRI predicted significant RN on pathologic evaluation of the lesion (P < 0.05). Similarly, when the target volume before GKRS was large (>10 cc), the risk of identifying significant necrosis in the pathologic specimen was elevated (P < 0.05). CONCLUSIONS Our data suggest that the combination of lesion ADC on MRI prior to surgical intervention and the initial target volume can predict RN with reasonable accuracy.
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Affiliation(s)
- Hamid Borghei-Razavi
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA; Rose Ella Burkhart Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mayur Sharma
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA; Rose Ella Burkhart Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Todd Emch
- Department of Neuroradiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daria Krivosheya
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA; Rose Ella Burkhart Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bryan Lee
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA; Rose Ella Burkhart Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Baha'eddin Muhsen
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA; Rose Ella Burkhart Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Richard Prayson
- Department of Neuropathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nancy Obuchowski
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gene H Barnett
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael A Vogelbaum
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA; Rose Ella Burkhart Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Samuel T Chao
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio, USA; Rose Ella Burkhart Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - John H Suh
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio, USA; Rose Ella Burkhart Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Alireza M Mohammadi
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA; Rose Ella Burkhart Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lilyana Angelov
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA; Rose Ella Burkhart Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA.
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23
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Sinclair G, Benmakhlouf H, Martin H, Maeurer M, Dodoo E. Adaptive hypofractionated gamma knife radiosurgery in the acute management of brainstem metastases. Surg Neurol Int 2019; 10:14. [PMID: 30783544 PMCID: PMC6367951 DOI: 10.4103/sni.sni_53_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 10/29/2018] [Indexed: 12/15/2022] Open
Abstract
Background: Intrinsic brainstem metastases are life-threatening neoplasms requiring rapid, effective intervention. Microsurgery is considered not feasible in most cases and systemic treatment seldom provides a successful outcome. In this context, radiation therapy remains the best option but adverse radiation effects (ARE) remain a major concern. A dose-adaptive gamma knife procedure coined as Rapid Rescue Radiosurgery (3R) offers the possibility to treat these lesions whilst reducing the risk of ARE evolvement. We report the results of 3R applied to a group of patients with brainstem metastases. Methods: Eight patients with nine brainstem metastases, having undergone three separate, dose-adapted gamma knife radiosurgery (GKRS) procedures over 7 days, were retrospectively analyzed in terms of tumor volume reduction, local control rates, and ARE-development under the period of treatment and at least 6 months after treatment completion. Results: Mean peripheral doses at GKRS 1, GKRS 2, and GKRS 3 were 7.4, 7.7, and 8.2 Gy (range 6–9 Gy) set at the 35–50% isodose lines. Mean tumor volume reduction between GKRS 1 and GKRS 3 was −15% and −56% at first follow-up. Four patients developed radiologic signs of ARE but remained clinically asymptomatic. One patient developed a local recurrence at 34 months. Mean survival from GKRS 1 was 13 months. Two patients were still alive at the time of paper submission (10 and 23 months from GKRS 1). Conclusions: In this study, 3R proved effective in terms of tumor volume reduction, rescue/preservation of neurological function, and limited ARE evolvement.
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Affiliation(s)
- Georges Sinclair
- Department of Neurosurgery, Karolinska University Hospital, Solna, Sweden
| | - Hamza Benmakhlouf
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Solna, Sweden
| | - Heather Martin
- Department of Neuroradiology, Karolinska University Hospital, Solna, Sweden
| | - Markus Maeurer
- Department of Laboratory Medicine (LABMED), Therapeutic Immunology Unit (TIM), Karolinska Institutet, Stockholm, Sweden.,Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institute, Centre for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Solna, Sweden
| | - Ernest Dodoo
- Department of Neurosurgery, Karolinska University Hospital, Solna, Sweden
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24
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Winter JD, Moraes FY, Chung C, Coolens C. Detectability of radiation-induced changes in magnetic resonance biomarkers following stereotactic radiosurgery: A pilot study. PLoS One 2018; 13:e0207933. [PMID: 30475887 PMCID: PMC6258119 DOI: 10.1371/journal.pone.0207933] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 11/05/2018] [Indexed: 11/18/2022] Open
Abstract
Our objective was to investigate direct voxel-wise relationship between dose and early MR biomarker changes both within and in the high-dose region surrounding brain metastases following stereotactic radiosurgery (SRS). Specifically, we examined the apparent diffusion coefficient (ADC) from diffusion-weighted imaging and the contrast transfer coefficient (Ktrans) and volume of extracellular extravascular space (ve) derived from dynamic contrast-enhanced (DCE) MRI data. We investigated 29 brain metastases in 18 patients using 3 T MRI to collect imaging data at day 0, day 3 and day 20 following SRS. The ADC maps were generated by the scanner and Ktrans and ve maps were generated using in-house software for dynamic tracer-kinetic analysis. To enable spatially-correlated voxel-wise analysis, we developed a registration pipeline to register all ADC, Ktrans and ve maps to the planning MRI scan. To interrogate longitudinal changes, we computed absolute ΔADC, ΔKtrans and Δve for day 3 and 20 post-SRS relative to day 0. We performed a Kruskall-Wallice test on each biomarker between time points and investigated dose correlations within the gross tumour volume (GTV) and surrounding high dose region > 12 Gy via Spearman’s rho. Only ve exhibited significant differences between day 0 and 20 (p < 0.005) and day 3 and 20 (p < 0.05) within the GTV following SRS. Strongest dose correlations were observed for ADC within the GTV (rho = 0.17 to 0.20) and weak correlations were observed for ADC and Ktrans in the surrounding > 12 Gy region. Both ΔKtrans and Δve showed a trend with dose at day 20 within the GTV and > 12 Gy region (rho = -0.04 to -0.16). Weak dose-related decreases in Ktrans and ve within the GTV and high dose region at day 20 most likely reflect underlying vascular responses to radiation. Our study also provides a voxel-wise analysis schema for future MR biomarker studies with the goal of elucidating surrogates for radionecrosis.
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Affiliation(s)
- Jeff D. Winter
- Radiation Medicine Program, Princess Margaret Cancer Center and University Health Network, Toronto, Ontario, Canada
| | - Fabio Y. Moraes
- Radiation Medicine Program, Princess Margaret Cancer Center and University Health Network, Toronto, Ontario, Canada
| | - Caroline Chung
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
- TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Catherine Coolens
- Radiation Medicine Program, Princess Margaret Cancer Center and University Health Network, Toronto, Ontario, Canada
- TECHNA Institute, University Health Network, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Ontario, Canada
- * E-mail:
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25
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Loganadane G, Dhermain F, Louvel G, Kauv P, Deutsch E, Le Péchoux C, Levy A. Brain Radiation Necrosis: Current Management With a Focus on Non-small Cell Lung Cancer Patients. Front Oncol 2018; 8:336. [PMID: 30234011 PMCID: PMC6134016 DOI: 10.3389/fonc.2018.00336] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 08/02/2018] [Indexed: 12/25/2022] Open
Abstract
As the prognosis of metastatic non-small cell lung cancer (NSCLC) patients is constantly improving with advances in systemic therapies (immune checkpoint blockers and new generation of targeted molecular compounds), more attention should be paid to the diagnosis and management of treatments-related long-term secondary effects. Brain metastases (BM) occur frequently in the natural history of NSCLC and stereotactic radiation therapy (SRT) is one of the main efficient local non-invasive therapeutic methods. However, SRT may have some disabling side effects. Brain radiation necrosis (RN) represents one of the main limiting toxicities, generally occurring from 6 months to several years after treatment. The diagnosis of RN itself may be quite challenging, as conventional imaging is frequently not able to differentiate RN from BM recurrence. Retrospective studies have suggested increased incidence rates of RN in NSCLC patients with oncogenic driver mutations [epidermal growth factor receptor (EGFR) mutated or anaplastic lymphoma kinase (ALK) positive] or receiving tyrosine kinase inhibitors. The risk of immune checkpoint inhibitors in contributing to RN remains controversial. Treatment modalities for RN have not been prospectively compared. Those include surveillance, corticosteroids, bevacizumab and local interventions (minimally invasive laser interstitial thermal ablation or surgery). The aim of this review is to describe and discuss possible RN management options in the light of the newly available literature, with a particular focus on NSCLC patients.
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Affiliation(s)
| | - Frédéric Dhermain
- Department of Radiation Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Guillaume Louvel
- Department of Radiation Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Paul Kauv
- Department of Neuroradiology, AP-HP, CHU Henri Mondor, University of Paris-Est, Créteil, France
| | - Eric Deutsch
- Department of Radiation Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France.,INSERM U1030, Molecular Radiotherapy, Gustave Roussy, Université Paris-Saclay, Villejuif, France.,Université Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Cécile Le Péchoux
- Department of Radiation Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Antonin Levy
- Department of Radiation Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France.,INSERM U1030, Molecular Radiotherapy, Gustave Roussy, Université Paris-Saclay, Villejuif, France.,Université Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
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26
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Interval Change in Diffusion and Perfusion MRI Parameters for the Assessment of Pseudoprogression in Cerebral Metastases Treated With Stereotactic Radiation. AJR Am J Roentgenol 2018; 211:168-175. [DOI: 10.2214/ajr.17.18890] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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27
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Chen BB, Lu YS, Yu CW, Lin CH, Chen TWW, Wei SY, Cheng AL, Shih TTF. Imaging biomarkers from multiparametric magnetic resonance imaging are associated with survival outcomes in patients with brain metastases from breast cancer. Eur Radiol 2018; 28:4860-4870. [PMID: 29770848 DOI: 10.1007/s00330-018-5448-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 03/02/2018] [Accepted: 03/23/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVES The aim of this study is to investigate the correlation of survival outcomes with imaging biomarkers from multiparametric magnetic resonance imaging (MRI) in patients with brain metastases from breast cancer (BMBC). METHODS This study was approved by the institutional review board. Twenty-two patients with BMBC who underwent treatment involving bevacizumab on day 1, etoposide on days 2-4, and cisplatin on day 2 in 21-day cycles were prospectively enrolled for a phase II study. Three brain MRIs were performed: before the treatment, on day 1, and on day 21. Eight imaging biomarkers were derived from dynamic contrast-enhanced MRI (Peak, IAUC60, Ktrans, kep, ve), diffusion-weighted imaging [apparent diffusion coefficient (ADC)], and MR spectroscopy (choline/N-acetylaspartate and choline/creatine ratios). The relative changes (Δ) in these biomarkers were correlated with the central nervous system (CNS)-specific progression-free survival (PFS) and overall survival (OS) using the Kaplan-Meier and Cox proportional hazard models. RESULTS There were no significant differences in the survival outcomes as per the changes in the biomarkers on day 1. On day 21, those with a low ΔKtrans (p = 0.024) or ΔADC (p = 0.053) reduction had shorter CNS-specific PFS; further, those with a low ΔPeak (p = 0.012) or ΔIAUC60 (p = 0.04) reduction had shorter OS compared with those with high reductions. In multivariate analyses, ΔKtrans and ΔPeak were independent prognostic factors for CNS-specific PFS and OS, respectively, after controlling for age, size, hormone receptors, and performance status. CONCLUSIONS Multiparametric MRI may help predict the survival outcomes in patients with BMBC. KEY POINTS • Decreased angiogenesis after chemotherapy on day 21 indicated good survival outcome. • ΔK trans was an independent prognostic factors for CNS-specific PFS. • ΔPeak was an independent prognostic factors for OS. • Multiparametric MRI helps clinicians to assess patients with BMBC. • High-risk patients may benefit from more intensive follow-up or treatment strategies.
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Affiliation(s)
- Bang-Bin Chen
- Department of Radiology, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Medical Imaging, National Taiwan University Hospital, No. 7, Chung-Shan South Rd, Taipei, 10016, Taiwan
| | - Yen-Shen Lu
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Wei Yu
- Department of Radiology, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Medical Imaging, National Taiwan University Hospital, No. 7, Chung-Shan South Rd, Taipei, 10016, Taiwan
| | - Ching-Hung Lin
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tom Wei-Wu Chen
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shwu-Yuan Wei
- Department of Radiology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ann-Lii Cheng
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tiffany Ting-Fang Shih
- Department of Radiology, College of Medicine, National Taiwan University, Taipei, Taiwan.
- Department of Medical Imaging, National Taiwan University Hospital, No. 7, Chung-Shan South Rd, Taipei, 10016, Taiwan.
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Abstract
Magnetic resonance imaging (MRI) is the cornerstone for evaluating patients with brain masses such as primary and metastatic tumors. Important challenges in effectively detecting and diagnosing brain metastases and in accurately characterizing their subsequent response to treatment remain. These difficulties include discriminating metastases from potential mimics such as primary brain tumors and infection, detecting small metastases, and differentiating treatment response from tumor recurrence and progression. Optimal patient management could be benefited by improved and well-validated prognostic and predictive imaging markers, as well as early response markers to identify successful treatment prior to changes in tumor size. To address these fundamental needs, newer MRI techniques including diffusion and perfusion imaging, MR spectroscopy, and positron emission tomography (PET) tracers beyond traditionally used 18-fluorodeoxyglucose are the subject of extensive ongoing investigations, with several promising avenues of added value already identified. These newer techniques provide a wealth of physiologic and metabolic information that may supplement standard MR evaluation, by providing the ability to monitor and characterize cellularity, angiogenesis, perfusion, pH, hypoxia, metabolite concentrations, and other critical features of malignancy. This chapter reviews standard and advanced imaging of brain metastases provided by computed tomography, MRI, and amino acid PET, focusing on potential biomarkers that can serve as problem-solving tools in the clinical management of patients with brain metastases.
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Affiliation(s)
- Whitney B Pope
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, United States.
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29
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Abstract
Stereotactic radiosurgery has revolutionized the management of brain metastases. It delivers focused, highly conformal, ionizing radiation to a tumor delineated using high-resolution imaging, with low toxicity to adjacent brain structures. Randomized controlled and prospective trials have demonstrated a survival advantage and high local control rates after stereotactic radiosurgery for metastatic disease to the central nervous system, including for up to 10 brain metastases. Its minimal-access nature makes it an attractive alternative to surgical resection. Furthermore, in addition to chemotherapy, newer targeted therapies and immunotherapies with improved side-effect profiles allow for the concurrent delivery of systemic therapy with radiosurgery, with possible additive or synergistic effects, expediting the treatment of both extracranial and intracranial disease. The modern management of brain metastasis patients should include consideration of routine staging and surveillance magnetic resonance imaging scans in patients with higher-stage cancer to detect intracranial metastases earlier and treat promptly with radiosurgery in order to prevent the development of neurologic symptoms and the need for surgical resection.
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Affiliation(s)
- Amparo Wolf
- Department of Neurosurgery, Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York University, New York, NY, United States
| | - Douglas Kondziolka
- Department of Neurosurgery, Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York University, New York, NY, United States.
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30
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Wu CC, Guo WY, Chung WY, Wu HM, Lin CJ, Lee CC, Liu KD, Yang HC. Magnetic resonance imaging characteristics and the prediction of outcome of vestibular schwannomas following Gamma Knife radiosurgery. J Neurosurg 2017; 127:1384-1391. [PMID: 28186452 DOI: 10.3171/2016.9.jns161510] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEGamma Knife surgery (GKS) is a promising treatment modality for patients with vestibular schwannomas (VSs), but a small percentage of patients have persistent postradiosurgical tumor growth. The aim of this study was to determine the clinical and quantitative MRI features of VS as predictors of long-term tumor control after GKS.METHODSThe authors performed a retrospective study of all patients with VS treated with GKS using the Leksell Gamma Knife Unit between 2005 and 2013 at their institution. A total of 187 patients who had a minimum of 24 months of clinical and radiological assessment after radiosurgery were included in this study. Those who underwent a craniotomy with tumor removal before and after GKS were excluded. Study patients comprised 85 (45.5%) males and 102 (54.5%) females, with a median age of 52.2 years (range 20.4–82.3 years). Tumor volumes, enhancing patterns, and apparent diffusion coefficient (ADC) values were measured by region of interest (ROI) analysis of the whole tumor by serial MRI before and after GKS.RESULTSThe median follow-up period was 60.8 months (range 24–128.9 months), and the median treated tumor volume was 3.54 cm3 (0.1–16.2 cm3). At last follow-up, imaging studies indicated that 150 tumors (80.2%) showed decreased tumor volume, 20 (10.7%) had stabilized, and 17 (9.1%) continued to grow following radiosurgery. The postradiosurgical outcome was not significantly correlated with pretreatment volumes or postradiosurgical enhancing patterns. Tumors that showed regression within the initial 12 months following radiosurgery were more likely to have a larger volume reduction ratio at last follow-up than those that did not (volume reduction ratio 55% vs 23.6%, respectively; p < 0.001). Compared with solid VSs, cystic VSs were more likely to regress or stabilize in the initial postradiosurgical 6–12-month period and during extended follow-up. Cystic VSs exhibited a greater volume reduction ratio at last follow-up (cystic vs solid: 67.6% ± 24.1% vs 31.8% ± 51.9%; p < 0.001). The mean preradiosurgical maximum ADC (ADCmax) values of all VSs were significantly higher for those with tumor regression or stabilization at last follow-up compared with those with progression (2.391 vs 1.826 × 10−3 mm2/sec; p = 0.010).CONCLUSIONSLoss of central enhancement after radiosurgery was a common phenomenon, but it did not correlate with tumor volume outcome. Preradiosurgical MRI features including cystic components and ADCmax values can be helpful as predictors of treatment outcome.
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Affiliation(s)
- Chih-Chun Wu
- 1Department of Radiology and
- 2School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - Wan-Yuo Guo
- 1Department of Radiology and
- 2School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - Wen-Yuh Chung
- 2School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
- 3Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital; and
| | - Hisu-Mei Wu
- 1Department of Radiology and
- 2School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - Chung-Jung Lin
- 1Department of Radiology and
- 2School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - Cheng-Chia Lee
- 3Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital; and
| | - Kang-Du Liu
- 2School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
- 3Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital; and
| | - Huai-che Yang
- 3Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital; and
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Examination of the predictive factors of the response to whole brain radiotherapy for brain metastases from lung cancer using MRI. Oncol Lett 2017; 14:1073-1079. [PMID: 28693276 DOI: 10.3892/ol.2017.6264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 03/09/2017] [Indexed: 11/05/2022] Open
Abstract
Previous studies have been conducted on the prognostic factors for overall survival in patients with brain metastases (BMs) following whole brain radiotherapy (WBRT). However, there have been a small number of studies regarding the prognostic factors for the response of tumor to WBRT. The aim of the present study was to identify the predictive factors for the response to WBRT from the point of view of reduction of tumor using magnetic resonance imaging. A retrospective analysis of 62 patients with BMs from primary lung cancer treated with WBRT was undertaken. The effects of the following factors on the response to WBRT were evaluated: Age; sex; performance status; lactate dehydrogenase; pathology; existence of extracranial metastases; activity of extracranial disease; chemo-history; chest radiotherapy history; treatment term; γ-knife radiotherapy; diffusion weighted image signal intensity; tumor diameter; extent of edema and the edema/tumor (E/T) ratio. The association between the reduction of tumors and clinical factors was evaluated using logistic regression analysis. P<0.05 was considered to indicate a statistically significant difference. The overall response ratio of this cohort was 54.8%. In the univariate analysis, the response of tumors was associated with the presence of small cell lung carcinoma (SCLC; P=0.0007), an E/T ratio of ≥1.5 (P=0.048), and a median tumor diameter of <20 mm (P=0.014). In the multivariate analysis, the presence of SCLC [P=0.001; odds ratio (OR), 17.152), an E/T ratio of ≥1.5 (P=0.019; OR, 9.526), and the presence of extracranial metastases (P=0.031; OR, 4.875) were revealed to be independent predictive factors for the reduction of tumor. The following 3 factors were significantly associated with the response of tumors to WBRT: The presence of SCLC; an E/T ratio of ≥1.5; and the presence of extracranial metastases. The E/T ratio is a novel index that provides a simple and easy predictive method for use in a clinical setting.
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32
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Zakaria R, Pomschar A, Jenkinson MD, Tonn JC, Belka C, Ertl-Wagner B, Niyazi M. Use of diffusion-weighted MRI to modify radiosurgery planning in brain metastases may reduce local recurrence. J Neurooncol 2017; 131:549-554. [PMID: 27844309 PMCID: PMC5350211 DOI: 10.1007/s11060-016-2320-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 11/08/2016] [Indexed: 01/09/2023]
Abstract
Stereotactic radiosurgery (SRS) is an effective and well tolerated treatment for selected brain metastases; however, local recurrence still occurs. We investigated the use of diffusion weighted MRI (DWI) as an adjunct for SRS treatment planning in brain metastases. Seventeen consecutive patients undergoing complete surgical resection of a solitary brain metastasis underwent image analysis retrospectively. SRS treatment plans were generated based on standard 3D post-contrast T1-weighted sequences at 1.5T and then separately using apparent diffusion coefficient (ADC) maps in a blinded fashion. Control scans immediately post operation confirmed complete tumour resection. Treatment plans were compared to one another and with volume of local recurrence at progression quantitatively and qualitatively by calculating the conformity index (CI), the overlapping volume as a proportion of the total combined volume, where 1 = identical plans and 0 = no conformation whatsoever. Gross tumour volumes (GTVs) using ADC and post-contrast T1-weighted sequences were quantitatively the same (related samples Wilcoxon signed rank test = -0.45, p = 0.653) but showed differing conformations (CI 0.53, p < 0.001). The diffusion treatment volume (DTV) obtained by combining the two target volumes was significantly greater than the treatment volume based on post contrast T1-weighted MRI alone, both quantitatively (median 13.65 vs. 9.52 cm3, related samples Wilcoxon signed rank test p < 0.001) and qualitatively (CI 0.74, p = 0.001). This DTV covered a greater volume of subsequent tumour recurrence than the standard plan (median 3.53 cm3 vs. 3.84 cm3, p = 0.002). ADC maps may be a useful tool in addition to the standard post-contrast T1-weighted sequence used for SRS planning.
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Affiliation(s)
- Rasheed Zakaria
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, Liverpool, L9 7LJ, UK.
- Institute of Integrative Biology, University of Liverpool, Liverpool, UK.
| | | | - Michael D Jenkinson
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, Liverpool, L9 7LJ, UK
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | | | - Claus Belka
- Department of Radiation Oncology, LMU Munich, Munich, Germany
- German Cancer Research Centre (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | | | - Maximilian Niyazi
- Department of Radiation Oncology, LMU Munich, Munich, Germany
- German Cancer Research Centre (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
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33
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Jakubovic R, Zhou S, Heyn C, Soliman H, Zhang L, Aviv R, Sahgal A. The predictive capacity of apparent diffusion coefficient (ADC) in response assessment of brain metastases following radiation. Clin Exp Metastasis 2016; 33:277-84. [PMID: 26786978 DOI: 10.1007/s10585-016-9778-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 01/16/2016] [Indexed: 01/17/2023]
Abstract
To investigate the predictive capacity of the apparent diffusion coefficient (ADC) as a biomarker of radiation response in brain metastases. Seventy brain metastases from 42 patients treated with either stereotactic radiosurgery or whole brain radiotherapy were imaged at baseline, 1 week, and 1 month post-treatment using diffusion-weighted MRI. Mean and median relative ADC for metastases was calculated by normalizing ADC measurements to baseline ADC. At 1 year post-treatment, or last available follow-up MRI, volume criteria determined final tumour response status. Uni- and multivariate analysis was used to account for factors associated with tumour response at 1 week and 1 month. A generalized estimating equations model took into consideration multiple tumours per subject. Optimal thresholds that distinguished responders from non-responders, as well as sensitivity and specificity were determined by receiver operator characteristic analysis and Youden's index. Lower relative ADC values distinguished responders from non-responders at 1 week and 1 month (P < 0.05). Optimal cut-off values for response were 1.060 at 1 week with a sensitivity and specificity of 75.0 and 56.3 %, respectively. At 1 month, the cut-off was 0.971 with a sensitivity and specificity of 70.0 and 68.8 %, respectively. A multivariate general estimating equations analysis identified no prior radiation [odds ratio (OR) 0.211 and 0.137, P = 0.033 and 0.0177], and a lower median relative ADC at 1 week and 1 month (OR 0.619 and 0.694, P = 0.0036 and 0.005), as predictors of tumour response. Lower relative ADC values at 1 week and 1 month following radiation distinguished responders from non-responders and may be a promising biomarker of early radiation response.
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Affiliation(s)
- Raphael Jakubovic
- Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada
| | - Stephanie Zhou
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Chris Heyn
- Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada
| | - Hany Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Liyang Zhang
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Richard Aviv
- Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
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34
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Ruiz-Espana S, Jimenez-Moya A, Arana E, Moratal D. Functional diffusion map: A biomarker of brain metastases response to treatment based on magnetic resonance image analysis. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2015:4282-4285. [PMID: 26737241 DOI: 10.1109/embc.2015.7319341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Validated biomarkers for treatment response in patients suffering from brain metastases are needed in daily clinical practice as they may improve survival by providing reliable prognostic information and allowing alternative therapies. This work presents a new analysis tool for an early and non-invasive evaluation of treatment response in patients with brain metastases. A set of twenty-five metastases from sixteen patients were examined by T1-weighted and diffusion magnetic resonance imaging before starting radiotherapy and at least once after treatment. Diffusion MRI can show a correlation between water diffusion variation within metastasis area and its clinical evolution. Images were co-registered to pretreatment scans. Diffusion changes, resulting in spatially varying changes in apparent diffusion coefficient values of metastatic lesions, were quantified and presented as a functional diffusion map (fDM). These functional maps were compared to two traditional criteria for assessing oncological response. Of the twenty-five metastases analyzed, seven were classified as partial response (PR), eight as stable disease (SD) and nine as progressive disease (PD). Normalized volume values of the metastases for each response group were obtained, disclosing that apparent diffusion coefficient increase was a good predictor of response. Sensitivity was 88%, specificity 100%, positive predictive value 100% and negative predictive value was 94%. Outcome reveals that the implemented tool, based on functional diffusion mapping as evolution biomarker, provides a reliable prediction of metastases response to treatment.
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