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Dagher R, Gad M, da Silva de Santana P, Sadeghi MA, Yewedalsew SF, Gujar SK, Yedavalli V, Köhler CA, Khan M, Tavora DGF, Kamson DO, Sair HI, Luna LP. Umbrella review and network meta-analysis of diagnostic imaging test accuracy studies in Differentiating between brain tumor progression versus pseudoprogression and radionecrosis. J Neurooncol 2024; 166:1-15. [PMID: 38212574 DOI: 10.1007/s11060-023-04528-8] [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: 11/05/2023] [Accepted: 12/01/2023] [Indexed: 01/13/2024]
Abstract
PURPOSE In this study we gathered and analyzed the available evidence regarding 17 different imaging modalities and performed network meta-analysis to find the most effective modality for the differentiation between brain tumor recurrence and post-treatment radiation effects. METHODS We conducted a comprehensive systematic search on PubMed and Embase. The quality of eligible studies was assessed using the Assessment of Multiple Systematic Reviews-2 (AMSTAR-2) instrument. For each meta-analysis, we recalculated the effect size, sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio from the individual study data provided in the original meta-analysis using a random-effects model. Imaging technique comparisons were then assessed using NMA. Ranking was assessed using the multidimensional scaling approach and by visually assessing surface under the cumulative ranking curves. RESULTS We identified 32 eligible studies. High confidence in the results was found in only one of them, with a substantial heterogeneity and small study effect in 21% and 9% of included meta-analysis respectively. Comparisons between MRS Cho/NAA, Cho/Cr, DWI, and DSC were most studied. Our analysis showed MRS (Cho/NAA) and 18F-DOPA PET displayed the highest sensitivity and negative likelihood ratios. 18-FET PET was ranked highest among the 17 studied techniques with statistical significance. APT MRI was the only non-nuclear imaging modality to rank higher than DSC, with statistical insignificance, however. CONCLUSION The evidence regarding which imaging modality is best for the differentiation between radiation necrosis and post-treatment radiation effects is still inconclusive. Using NMA, our analysis ranked FET PET to be the best for such a task based on the available evidence. APT MRI showed promising results as a non-nuclear alternative.
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Affiliation(s)
- Richard Dagher
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins Hospital, 600 N Wolfe Street Phipps B100F, Baltimore, MD, 21287, USA
| | - Mona Gad
- Diagnostic Radiology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Mohammad Amin Sadeghi
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins Hospital, 600 N Wolfe Street Phipps B100F, Baltimore, MD, 21287, USA
| | | | - Sachin K Gujar
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins Hospital, 600 N Wolfe Street Phipps B100F, Baltimore, MD, 21287, USA
| | - Vivek Yedavalli
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins Hospital, 600 N Wolfe Street Phipps B100F, Baltimore, MD, 21287, USA
| | - Cristiano André Köhler
- Medical Sciences Post-Graduation Program, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Majid Khan
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins Hospital, 600 N Wolfe Street Phipps B100F, Baltimore, MD, 21287, USA
| | | | - David Olayinka Kamson
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA
| | - Haris I Sair
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins Hospital, 600 N Wolfe Street Phipps B100F, Baltimore, MD, 21287, USA
| | - Licia P Luna
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins Hospital, 600 N Wolfe Street Phipps B100F, Baltimore, MD, 21287, USA.
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Alizadeh M, Broomand Lomer N, Azami M, Khalafi M, Shobeiri P, Arab Bafrani M, Sotoudeh H. Radiomics: The New Promise for Differentiating Progression, Recurrence, Pseudoprogression, and Radionecrosis in Glioma and Glioblastoma Multiforme. Cancers (Basel) 2023; 15:4429. [PMID: 37760399 PMCID: PMC10526457 DOI: 10.3390/cancers15184429] [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: 07/11/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
Glioma and glioblastoma multiform (GBM) remain among the most debilitating and life-threatening brain tumors. Despite advances in diagnosing approaches, patient follow-up after treatment (surgery and chemoradiation) is still challenging for differentiation between tumor progression/recurrence, pseudoprogression, and radionecrosis. Radiomics emerges as a promising tool in initial diagnosis, grading, and survival prediction in patients with glioma and can help differentiate these post-treatment scenarios. Preliminary published studies are promising about the role of radiomics in post-treatment glioma/GBM. However, this field faces significant challenges, including a lack of evidence-based solid data, scattering publication, heterogeneity of studies, and small sample sizes. The present review explores radiomics's capabilities in following patients with glioma/GBM status post-treatment and to differentiate tumor progression, recurrence, pseudoprogression, and radionecrosis.
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Affiliation(s)
- Mohammadreza Alizadeh
- Physiology Research Center, Iran University of Medical Sciences, Tehran 14496-14535, Iran;
| | - Nima Broomand Lomer
- Faculty of Medicine, Guilan University of Medical Sciences, Rasht 41937-13111, Iran;
| | - Mobin Azami
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj 66186-34683, Iran;
| | - Mohammad Khalafi
- Radiology Department, Tabriz University of Medical Sciences, Tabriz 51656-65931, Iran;
| | - Parnian Shobeiri
- School of Medicine, Tehran University of Medical Sciences, Tehran 14167-53955, Iran; (P.S.); (M.A.B.)
| | - Melika Arab Bafrani
- School of Medicine, Tehran University of Medical Sciences, Tehran 14167-53955, Iran; (P.S.); (M.A.B.)
| | - Houman Sotoudeh
- Department of Radiology and Neurology, Heersink School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA
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Shen F, Li J, Liu F, Sun N, Qiu X, Ding W, Sun X. The efficacy and adverse effects of anlotinib in the treatment of high-grade glioma: A retrospective analysis. Front Oncol 2023; 13:1095362. [PMID: 36874124 PMCID: PMC9982121 DOI: 10.3389/fonc.2023.1095362] [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] [Received: 11/11/2022] [Accepted: 01/19/2023] [Indexed: 02/19/2023] Open
Abstract
Introduction Anlotinib, a novel multi-kinase inhibitor, was found to improve progression-free survival (PFS) in brain metastases. Methods This paper retrospectively analyzed 26 newly diagnosed or recurrent high-grade gliomas from 2017 to 2022, and the patients received oral anlotinib during concurrent postoperative chemoradiotherapy or after recurrence. Efficacy was evaluated according to the Response Assessment in Neuro-Oncology (RANO) criteria, and the main study endpoints were PFS at 6 months and overall survival (OS) at 1 year. Results After the follow-up, until May 2022, 13 patients survived and 13 patients died, with a median follow-up time of 25.6 months. The disease control rate (DCR) was 96.2% (25/26), and the overall response rate (ORR) rate was 73.1% (19/26). The median PFS after oral anlotinib was 8.9 months (0.8-15.1), and the PFS at 6 months was 72.5%. The median OS after oral anlotinib was 12 months (1.6-24.4), and the OS at 12 months was 42.6%. Anlotinib-related toxicities were observed in 11 patients, mostly grades 1-2. In the multivariate analysis, patients with Karnofsky Performance Scale (KPS) above 80 had a highermedian PFS of 9.9months (p = 0.02), and their sex, age, IDH mutation, MGMTmethylation, and whether anlotinib was combined with chemoradiotherapy or maintenance treatment had no effect on PFS. Conclusion We found that anlotinib combined with chemoradiotherapy in treating high-grade central nervous system (CNS) tumors can prolong PFS and OS and that it was safe.
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Affiliation(s)
| | | | | | | | | | - Wei Ding
- *Correspondence: Wei Ding, ; XiangDong Sun,
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4
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Stadlbauer A, Heinz G, Oberndorfer S, Zimmermann M, Kinfe TM, Buchfelder M, Dörfler A, Kremenevski N, Marhold F. Physiological MRI of microvascular architecture, neovascularization activity, and oxygen metabolism facilitate early recurrence detection in patients with IDH-mutant WHO grade 3 glioma. Neuroradiology 2021; 64:265-277. [PMID: 34115146 PMCID: PMC8789727 DOI: 10.1007/s00234-021-02740-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/27/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE This study aimed to determine the diagnostic performance of physiological MRI biomarkers including microvascular perfusion and architecture, neovascularization activity, tissue oxygen metabolism, and tension for recurrence detection of IDH-mutant WHO grade 3 glioma. METHODS Sixty patients with IDH-mutant WHO grade 3 glioma who received overall 288 follow-up MRI examinations at 3 Tesla after standard treatment were retrospectively evaluated. A conventional MRI protocol was extended with a physiological MRI approach including vascular architecture mapping and quantitative blood-oxygen-level-dependent imaging which required 7 min extra data acquisition time. Custom-made MATLAB software was used for the calculation of MRI biomarker maps of microvascular perfusion and architecture, neovascularization activity, tissue oxygen metabolism, and tension. Statistical procedures included receiver operating characteristic analysis. RESULTS Overall, 34 patients showed recurrence of the WHO grade 3 glioma; of these, in 15 patients, recurrence was detected one follow-up examination (averaged 160 days) earlier by physiological MRI data than by conventional MRI. During this time period, the tumor volume increased significantly (P = 0.001) on average 7.4-fold from 1.5 to 11.1 cm3. Quantitative analysis of MRI biomarkers demonstrated microvascular but no macrovascular hyperperfusion in early recurrence. Neovascularization activity (AUC = 0.833), microvascular perfusion (0.682), and oxygen metabolism (0.661) showed higher diagnostic performance for early recurrence detection of WHO grade 3 glioma compared to conventional MRI including cerebral blood volume (0.649). CONCLUSION This study demonstrated that the targeted assessment of microvascular features and tissue oxygen tension as an early sign of neovascularization activity provided valuable information for recurrence diagnostic of WHO grade 3 glioma.
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Affiliation(s)
- Andreas Stadlbauer
- Institute of Medical Radiology, University Clinic St. Pölten, Karl Landsteiner University of Health Sciences, Dunant Platz 1, A-3100, St. Pölten, Austria.
- Department of Neurosurgery, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany.
| | - Gertraud Heinz
- Institute of Medical Radiology, University Clinic St. Pölten, Karl Landsteiner University of Health Sciences, Dunant Platz 1, A-3100, St. Pölten, Austria
| | - Stefan Oberndorfer
- Department of Neurology, University Clinic of St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten, Austria
| | - Max Zimmermann
- Department of Neurosurgery, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Department of Preclinical Imaging and Radiopharmacy, University of Tübingen, Tübingen, Germany
| | - Thomas M Kinfe
- Department of Neurosurgery, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Division of Functional Neurosurgery and Stereotaxy, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Arnd Dörfler
- Department of Neuroradiology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Natalia Kremenevski
- Department of Neurosurgery, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Franz Marhold
- Department of Neurosurgery, University Clinic of St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten, Austria
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5
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Gao F, Zhao W, Li M, Ren X, Jiang H, Cui Y, Lin S. Role of circulating tumor cell detection in differentiating tumor recurrence from treatment necrosis of brain gliomas. Biosci Trends 2021; 15:107-117. [PMID: 33952802 DOI: 10.5582/bst.2021.01017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Differentiating treatment necrosis from tumor recurrence poses a diagnostic conundrum for many clinicians in neuro-oncology. To investigate the potential role of circulating tumor cells (CTCs) detection in differentiating tumor recurrence and treatment necrosis in brain gliomas, we retrospectively analyzed the data of 22 consecutive patients with tumor totally removed and new enhancing mass lesion(s) showed on MRI after initial radiotherapy. The 22 patients were finally classified into tumor recurrence group (n = 10) and treatment necrosis group (n = 12), according to evidence from the clinical course (n = 11) and histological confirmation (n = 11). All 22 patients received CTCs detection, and DSC-MRP and 11C-MET-PET were performed on 20 patients (90.9%) and 17patients (77.3%) respectively. The data of the diagnosis efficacy to differentiate the two lesions by CTC detection, MPR and PET were analyzed by ROC analysis. The mean CTCs counts were significantly higher in the tumor recurrence group (6.10 ± 3.28) compared to the treatment necrosis group (1.08 ± 2.54, p < 0.001). The ROC curve showed that an optimized cell count threshold of 2 had 100% sensitivity and 91.2% specificity with AUC = 0.933 to declare tumor recurrence. The diagnostic efficacy of CTC detection was superior to rCBV of DSC-MRP and rSUVmax in MET-PET. Furthermore, we observed that CTCs detection could have a potential role in predicting tumor recurrence in one patient. Our research results preliminarily showed the potential value of CTC detection in differentiating treatment necrosis from tumor recurrence in brain gliomas, and is worthy of further confirmation with large samples involved.
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Affiliation(s)
- Faliang Gao
- Department of Neurosurgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China; Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Wenyan Zhao
- General Practice Department, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Mingxiao Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xiaohui Ren
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Haihui Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yong Cui
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Song Lin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
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6
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Winter SF, Loebel F, Loeffler J, Batchelor TT, Martinez-Lage M, Vajkoczy P, Dietrich J. Treatment-induced brain tissue necrosis: a clinical challenge in neuro-oncology. Neuro Oncol 2020; 21:1118-1130. [PMID: 30828724 DOI: 10.1093/neuonc/noz048] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/04/2018] [Accepted: 02/25/2019] [Indexed: 12/29/2022] Open
Abstract
Cancer therapy-induced adverse effects on the brain are a major challenge in neuro-oncology. Brain tissue necrosis (treatment necrosis [TN]) as a consequence of brain directed cancer therapy remains an insufficiently characterized condition with diagnostic and therapeutic difficulties and is frequently associated with significant patient morbidity. A better understanding of the underlying mechanisms, improvement of diagnostic tools, development of preventive strategies, and implementation of evidence-based therapeutic practices are pivotal to improve patient management. In this comprehensive review, we address existing challenges associated with current TN-related clinical and research practices and highlight unanswered questions and areas in need of further research with the ultimate goal to improve management of patients affected by this important neuro-oncological condition.
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Affiliation(s)
- Sebastian F Winter
- MGH Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurosurgery, Charité‒Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Franziska Loebel
- Department of Neurosurgery, Charité‒Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jay Loeffler
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tracy T Batchelor
- MGH Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Maria Martinez-Lage
- C S Kubik Laboratory for Neuropathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité‒Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jorg Dietrich
- MGH Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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7
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Bastos DCDA, Weinberg J, Kumar VA, Fuentes DT, Stafford J, Li J, Rao G, Prabhu SS. Laser Interstitial Thermal Therapy in the treatment of brain metastases and radiation necrosis. Cancer Lett 2020; 489:9-18. [PMID: 32504657 DOI: 10.1016/j.canlet.2020.05.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 05/04/2020] [Accepted: 05/13/2020] [Indexed: 01/16/2023]
Abstract
Stereotactic Radiosurgery has become the main treatment for patients with limited number of brain metastases (BM). Recently, with the increasing use of this modality, there is a growth in recurrence cases. Recurrence after radiation therapy can be divided in changes favoring either tumor recurrence or radiation necrosis (RN). Laser Interstitial Thermal Therapy (LITT) is minimally invasive treatment modality that has been used to treat primary and metastatic brain tumors. When associated with real-time thermometry using Magnetic Resonance Imaging, the extent of ablation can be controlled to provide maximum coverage and avoid eloquent areas. The objective of this study was to investigate the use of LITT in the treatment of BM. An extensive review of the relevant literature was conducted and the outcome results are discussed. There is an emphasis on safety and local control rate of patients treated with this modality. The findings of our study suggest that LITT is a viable safe technique to treat recurrent BM, especially in patients with deep-seated lesions where surgical resection is not an option.
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Affiliation(s)
- Dhiego Chaves de Almeida Bastos
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Blvd, FC7.2000, Unit Number: 442, Houston, TX, 77030, USA.
| | - Jeffrey Weinberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Blvd, FC7.2000, Unit Number: 442, Houston, TX, 77030, USA.
| | - Vinodh A Kumar
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1482, Houston, Texa, 77030-4008, USA.
| | - David T Fuentes
- Department of Imaging Physics - UNIT 1472, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, FCT14.5000, Houston, TX, 77030, USA.
| | - Jason Stafford
- Department of Imaging Physics - UNIT 1472, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, FCT14.5000, Houston, TX, 77030, USA.
| | - Jing Li
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Unit 1482, PO Box 301402, Houston, TX, 77030, USA.
| | - Ganesh Rao
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Blvd, FC7.2000, Unit Number: 442, Houston, TX, 77030, USA.
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Blvd, FC7.2000, Unit Number: 442, Houston, TX, 77030, USA.
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8
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Nosrati S, Molavipordanjani S, Emami S, Abedi SM, Talebpour Amiri F, Hosseinimehr SJ. 99mTc-radiolabeled imidazo[2,1-b]benzothiazole derivatives as potential radiotracers for glioblastoma. J Radioanal Nucl Chem 2019. [DOI: 10.1007/s10967-019-06945-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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9
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Hu YJ, Zhang LF, Ding C, Chen D, Chen J. Hypofractionated stereotactic radiotherapy combined with chemotherapy or not in the management of recurrent malignant gliomas: A systematic review and meta-analysis. Clin Neurol Neurosurg 2019; 183:105401. [PMID: 31260910 DOI: 10.1016/j.clineuro.2019.105401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/07/2019] [Accepted: 06/24/2019] [Indexed: 02/05/2023]
Abstract
Hypofractionated stereotactic radiotherapy (HFSRT) is a common salvage treatment for recurrent malignant glioma (MG). However, it remains controversial whether the combination of HFSRT and chemotherapy could improve survival for patients with recurrent MG compared to HFSRT alone. The present systematic review and meta-analysis aims to investigate this question, and tries to determine to what extent the addition of chemotherapy to HFSRT affects survival. A systematic review was performed to analyse the survival for patients treated with HFSRT combined with chemotherapy or not. Hazard ratios (HRs) with 95% confidence intervals (CIs) for overall survival (OS) were pooled with random effects; and standard mean difference (MD) with 95% CIs for OS were pooled using the same strategy. A total of 7 studies including 388 patients with recurrent MG were eligible for our study. The OS survival of patients receiving combination therapy ranged from 8.7 to 23 months, and the median OS of patients underwent HFSRT ranged from 3.9 to 12 months. The meta-analyses resulted in the pooled HR of 0.44 (95% CI 0.30-0.65, p < 0.0001) (Cochran Q statistic 4.70, P = 0.320, I2 = 14.8%) and pooled standard MD of 0.80 months (95% CI 0.41-1.18, p < 0.001) (Cochran Q statistic 10.16, p = 0.71, I2 = 50.8%). The present study suggests that HFSRT + chemotherapy confers a slight survival improvement for patients with recurrent MG as compared with sole HFSRT management. To draw a more solid conclusion, greater investigation is warranted.
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Affiliation(s)
- Y J Hu
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - L F Zhang
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - C Ding
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - D Chen
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - J Chen
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
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10
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Tamrazi B, Mankad K, Nelson M, D'Arco F. Current concepts and challenges in the radiologic assessment of brain tumors in children: part 2. Pediatr Radiol 2018; 48:1844-1860. [PMID: 30215111 DOI: 10.1007/s00247-018-4232-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 07/06/2018] [Accepted: 08/08/2018] [Indexed: 12/16/2022]
Abstract
Assessing tumor response is a large part of everyday clinical work in neuroradiology. However in the setting of tumor treatment, distinguishing tumor progression from treatment-related changes is difficult on conventional MRI sequences. This is made even more challenging in children where mainstay advanced imaging techniques that are often used to decipher progression versus treatment-related changes have technical limitations. In this review, we highlight the challenges in pediatric neuro-oncologic tumor assessment with discussion of pseudophenomenon including pseudoresponse and pseudoprogression. Additionally, we discuss the advanced imaging techniques often employed in neuroradiology to distinguish between pseudophenomenon and true progressive disease.
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Affiliation(s)
- Benita Tamrazi
- Department of Radiology, Children's Hospital Los Angeles, 4650 Sunset Blvd., MS #81, Los Angeles, CA, 90027, USA.
| | - Kshitij Mankad
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Marvin Nelson
- Department of Radiology, Children's Hospital Los Angeles, 4650 Sunset Blvd., MS #81, Los Angeles, CA, 90027, USA
| | - Felice D'Arco
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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11
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Marra JS, Mendes GP, Yoshinari GH, da Silva Guimarães F, Mazin SC, de Oliveira HF. Survival after radiation therapy for high-grade glioma. Rep Pract Oncol Radiother 2018; 24:35-40. [PMID: 30337846 DOI: 10.1016/j.rpor.2018.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 01/28/2018] [Accepted: 09/12/2018] [Indexed: 10/28/2022] Open
Abstract
Background High-grade gliomas (HGGs) are a heterogeneous disease group, with variable prognosis, inevitably causing deterioration of the quality of life. The estimated 2-year overall survival is 20%, despite the best trimodality treatment consisting of surgery, chemotherapy, and radiotherapy. Aim To evaluate long-term survival outcomes and factors influencing the survival of patients with high-grade gliomas treated with radiotherapy. Materials and methods Data from 47 patients diagnosed with high-grade gliomas between 2009 and 2014 and treated with three-dimensional radiotherapy (3DRT) or intensity-modulated radiotherapy (IMRT) were analyzed retrospectively. Results Median survival was 16.6 months; 29 patients (62%) died before the time of analysis. IMRT was employed in 68% of cases. The mean duration of radiotherapy was 56 days, and the mean delay to the start of radiotherapy was 61.7 days (range, 27-123 days). There were no statistically significant effects of duration of radiotherapy or delay to the start of radiotherapy on patient outcomes. Conclusions Age, total amount of gross resection, histological type, and use of adjuvant temozolomide influenced survival rate (p < 0.05). The estimated overall survival was 18 months (Kaplan-Meier estimator). Our results corroborated those reported in the literature.
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Affiliation(s)
- Joana Spaggiari Marra
- Department of Radiation Oncology, Hospital das Clínicas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.,Department of Radiation Oncology, Hospital Regional do Cancer de Passos, Passos, MG, Brazil
| | - Guilherme Paulão Mendes
- Department of Radiation Oncology, Centro de Radioterapia de São Carlos, São Carlos, SP, Brazil.,Department of Radiation Oncology, Serviço de Radioterapia da Santa Casa de Araraquara, Araraquara, SP, Brazil
| | - Gerson Hiroshi Yoshinari
- Department of Radiation Oncology, Hospital Márcio Cunha, Fundação São Francisco Xavier, Ipatinga, MG, Brazil
| | - Flávio da Silva Guimarães
- Department of Radiation Oncology, Centro de Radioterapia de São Carlos, São Carlos, SP, Brazil.,Department of Radiation Oncology, Hospital das Clínicas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Suleimy Cristina Mazin
- Department of Gynaecology and Obstetrics, Hospital das Clínicas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto - SP, Brazil
| | - Harley Francisco de Oliveira
- Department of Radiation Oncology, Hospital Márcio Cunha, Fundação São Francisco Xavier, Ipatinga, MG, Brazil.,Department of Gynaecology and Obstetrics, Hospital das Clínicas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto - SP, Brazil.,Department of Radiation Oncology, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.,Department of Radiation Oncology, Centro de Tratamento em Radio-oncologia, Ribeirão Preto, SP, Brazil
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12
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Villanueva-Meyer JE, Mabray MC, Cha S. Current Clinical Brain Tumor Imaging. Neurosurgery 2017; 81:397-415. [PMID: 28486641 PMCID: PMC5581219 DOI: 10.1093/neuros/nyx103] [Citation(s) in RCA: 194] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 02/23/2017] [Indexed: 01/12/2023] Open
Abstract
Neuroimaging plays an ever evolving role in the diagnosis, treatment planning, and post-therapy assessment of brain tumors. This review provides an overview of current magnetic resonance imaging (MRI) methods routinely employed in the care of the brain tumor patient. Specifically, we focus on advanced techniques including diffusion, perfusion, spectroscopy, tractography, and functional MRI as they pertain to noninvasive characterization of brain tumors and pretreatment evaluation. The utility of both structural and physiological MRI in the post-therapeutic brain evaluation is also reviewed with special attention to the challenges presented by pseudoprogression and pseudoresponse.
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Affiliation(s)
- Javier E. Villanueva-Meyer
- Department of Radiology and Biomedical Imaging, Neuroradiology Section, University of California San Francisco, San Francisco, California
| | - Marc C. Mabray
- Department of Radiology and Biomedical Imaging, Neuroradiology Section, University of California San Francisco, San Francisco, California
| | - Soonmee Cha
- Department of Radiology and Biomedical Imaging, Neuroradiology Section, University of California San Francisco, San Francisco, California
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13
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Galante JR, Rodriguez F, Grossman SA, Strowd RE. Late post-treatment radiographic changes 3 years following chemoradiation for glioma: the importance of histopathology. CNS Oncol 2017; 6:195-201. [PMID: 28718307 PMCID: PMC6009212 DOI: 10.2217/cns-2016-0040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 01/18/2017] [Indexed: 11/21/2022] Open
Abstract
Treatment-related changes can mimic brain tumor progression both clinically and radiographically. Distinguishing these two entities represents a major challenge in neuro-oncology. No single imaging modality is capable of reliably achieving such distinction. While histopathology remains the gold standard, definitive pathological criteria are also lacking which can further complicate such cases. We report a patient with high-grade glioma who, after initially presenting with histopathologically confirmed pseudoprogression 10 months following treatment, re-presented 3 years following concurrent chemoradiation with clinical and radiographic changes that were most consistent with progressive disease but for which histopathology revealed treatment effects without active glioma. This case highlights the potential late onset of treatment-related changes and underscores the importance of histopathologic assessment even years following initial therapy.
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Affiliation(s)
- Joao R Galante
- Poznan University of Medical Sciences, 41 Jackowskiego Street, 60-512 Poznan, Poland
- Department of Oncology, Johns Hopkins University School of Medicine, 733 North Broadway Street, Baltimore, MD 21205, USA
| | - Fausto Rodriguez
- Department of Pathology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, David H. Koch Cancer Research Bldg II, 1550 Orleans Street, Room 1M16, Baltimore, MD 21287, USA
| | - Stuart A Grossman
- Medical Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, David H. Koch Cancer Research Bldg II, 1550 Orleans Street, Room 1M16, Baltimore, MD 21287, USA
| | - Roy E Strowd
- Department of Neurology and Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston Salem, NC 27157, USA
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14
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Belliveau JG, Bauman G, Macdonald DR. Detecting tumor progression in glioma: current standards and new techniques. Expert Rev Anticancer Ther 2016; 16:1177-1188. [PMID: 27661768 DOI: 10.1080/14737140.2016.1240621] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The post-treatment monitoring of glioma patients remains an area of active research and development. Conventional imaging with MRI is a highly sensitive modality for detecting and monitoring primary and secondary brain tumors and includes multi-parametric sequences to better characterize the disease. Standardized schemes for measuring response to treatment are in wide clinical use; however, the introduction of new therapeutics have introduced new patterns of response that can confound interpretation of conventional MRI and can cause uncertainty in the proper management following therapy. Areas covered: A summary of current and evolving techniques for assessing glioma response in this era of new therapies that address these challenges are presented in this review. While this review focuses more on clinical and early clinical methodologies for MRI and nuclear medicine techniques some promising pre-clinical techniques are also presented. Expert commentary: While successful single institution results have been widely reported in the literature, any new methodologies must be undertaken in multi-center settings. Additionally, the need for standardization of protocols in quantitative measured are an important area that must be addressed for new and promising techniques to be implemented to a wide array of patients.
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Affiliation(s)
- Jean-Guy Belliveau
- a Department of Medical Biophysics , University of Western Ontario , London , ON , Canada
| | - Glenn Bauman
- b Department of Medical Biophysics and Oncology , University of Western Ontario , London , ON , Canada
| | - David R Macdonald
- c Department of Oncology , University of Western Ontario , London , ON , Canada
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15
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Abstract
A previous review published in 2012 demonstrated the role of clinical PET for diagnosis and management of brain tumors using mainly FDG, amino acid tracers, and 18F-fluorothymidine. This review provides an update on clinical PET studies, most of which are motivated by prediction of prognosis and planning and monitoring of therapy in gliomas. For FDG, there has been additional evidence supporting late scanning, and combination with 13N ammonia has yielded some promising results. Large neutral amino acid tracers have found widespread applications mostly based on 18F-labeled compounds fluoroethyltyrosine and fluorodopa for targeting biopsies, therapy planning and monitoring, and as outcome markers in clinical trials. 11C-alpha-methyltryptophan (AMT) has been proposed as an alternative to 11C-methionine, and there may also be a role for cyclic amino acid tracers. 18F-fluorothymidine has shown strengths for tumor grading and as an outcome marker. Studies using 18F-fluorocholine (FCH) and 68Ga-labeled compounds are promising but have not yet clearly defined their role. Studies on radiotherapy planning have explored the use of large neutral amino acid tracers to improve the delineation of tumor volume for irradiation and the use of hypoxia markers, in particular 18F-fluoromisonidazole. Many studies employed the combination of PET with advanced multimodal MR imaging methods, mostly demonstrating complementarity and some potential benefits of hybrid PET/MR.
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Affiliation(s)
- Karl Herholz
- The University of Manchester, Division of Neuroscience and Experimental Psychology Wolfson Molecular Imaging Centre, Manchester, England, United Kingdom.
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16
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Albert NL, Weller M, Suchorska B, Galldiks N, Soffietti R, Kim MM, la Fougère C, Pope W, Law I, Arbizu J, Chamberlain MC, Vogelbaum M, Ellingson BM, Tonn JC. Response Assessment in Neuro-Oncology working group and European Association for Neuro-Oncology recommendations for the clinical use of PET imaging in gliomas. Neuro Oncol 2016; 18:1199-208. [PMID: 27106405 DOI: 10.1093/neuonc/now058] [Citation(s) in RCA: 465] [Impact Index Per Article: 58.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 03/14/2016] [Indexed: 12/30/2022] Open
Abstract
This guideline provides recommendations for the use of PET imaging in gliomas. The review examines established clinical benefit in glioma patients of PET using glucose ((18)F-FDG) and amino acid tracers ((11)C-MET, (18)F-FET, and (18)F-FDOPA). An increasing number of studies have been published on PET imaging in the setting of diagnosis, biopsy, and resection as well radiotherapy planning, treatment monitoring, and response assessment. Recommendations are based on evidence generated from studies which validated PET findings by histology or clinical course. This guideline emphasizes the clinical value of PET imaging with superiority of amino acid PET over glucose PET and provides a framework for the use of PET to assist in the management of patients with gliomas.
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Affiliation(s)
- Nathalie L Albert
- Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.)
| | - Michael Weller
- Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.)
| | - Bogdana Suchorska
- Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.)
| | - Norbert Galldiks
- Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.)
| | - Riccardo Soffietti
- Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.)
| | - Michelle M Kim
- Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.)
| | - Christian la Fougère
- Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.)
| | - Whitney Pope
- Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.)
| | - Ian Law
- Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.)
| | - Javier Arbizu
- Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.)
| | - Marc C Chamberlain
- Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.)
| | - Michael Vogelbaum
- Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.)
| | - Ben M Ellingson
- Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.)
| | - Joerg C Tonn
- Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Munich, Germany (N.L.A.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany (B.S., J.C.T.); Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany (N.G.); Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Department of Neuro-Oncology, University of Turin, Turin, Italy (R.S.); Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (M.M.K.); Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University of Tübingen, Tübingen, Germany (C.l.F.); Radiological Sciences, University of California Los Angeles, Los Angeles, California (W.P.); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (I.L.); Department of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain (J.A.); Department of Neurology, University of Washington, Seattle, Washington (M.C.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.A.V.); Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (B.M.E.)
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17
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Wray R, Solnes L, Mena E, Meoded A, Subramaniam RM. (18)F-Flourodeoxy-Glucose PET/Computed Tomography in Brain Tumors: Value to Patient Management and Survival Outcomes. PET Clin 2016; 10:423-30. [PMID: 26099676 DOI: 10.1016/j.cpet.2015.03.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
(18)F-flourodeoxy-glucose (FDG) PET/computed tomography (CT) is most useful in the evaluation of primary central nervous system (CNS) lymphoma, important in diagnosis, pretherapy prognosis, and therapy response evaluation. Utility in working up gliomas is less effective, and FDG PET/CT is most helpful when MR imaging is unclear. FDG avidity correlates with the grade of gliomas. FDG PET/CT can be used to noninvasively identify malignant transformation. Establishing this change in the disease process has significant effects on patient management and survival outcome.
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Affiliation(s)
- Rick Wray
- Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, JHOC 3230, 601 North Caroline Street, Baltimore, MD 21287, USA
| | - Lilja Solnes
- Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, JHOC 3230, 601 North Caroline Street, Baltimore, MD 21287, USA
| | - Esther Mena
- Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, JHOC 3230, 601 North Caroline Street, Baltimore, MD 21287, USA
| | - Avner Meoded
- Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, JHOC 3230, 601 North Caroline Street, Baltimore, MD 21287, USA
| | - Rathan M Subramaniam
- Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, JHOC 3230, 601 North Caroline Street, Baltimore, MD 21287, USA; Department of Oncology, Johns Hopkins School of Medicine, 401 North Broadway, Baltimore, MD 21231, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA.
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18
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Gzell CE, Wheeler HR, McCloud P, Kastelan M, Back M. Small increases in enhancement on MRI may predict survival post radiotherapy in patients with glioblastoma. J Neurooncol 2016; 128:67-74. [PMID: 26879084 DOI: 10.1007/s11060-016-2074-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 02/10/2016] [Indexed: 11/30/2022]
Abstract
To assess impact of volumetric changes in tumour volume post chemoradiotherapy in glioblastoma. Patients managed with chemoradiotherapy between 2008 and 2011 were included. Patients with incomplete MRI sets were excluded. Analyses were performed on post-operative MRI, and MRIs at 1 month (M+1), 3 months (M+3), 5 months (M+5), 7 months (M+7), and 12 months (M+12) post completion of RT. RANO definitions of response were used for all techniques. Modified RANO criteria and two volumetric analysis techniques were used. The two volumetric analysis techniques involved utility of the Eclipse treatment planning software to calculate the volume of delineated tissue: surgical cavity plus all surrounding enhancement (Volumetric) versus surrounding enhancement only (Rim). Retrospective analysis of 49 patients with median survival of 18.4 months. Using Volumetric analysis the difference in MS for patients who had a <5 % increase versus ≥5 % at M+3 was 23.1 versus 15.1 months (p = 0.006), and M+5 was 26.3 versus 15.1 months (p = 0.006). For patients who were classified as progressive disease using modified RANO criteria at M+1 and M+3 there was a difference in MS compared with those who were not (M+1: 13.1 vs. 19.4 months, p = 0.017, M+3: 13.2 vs. 20.1 months, p = 0.096). An increase in the volume of cavity and enhancement of ≥5 % at M+3 and M+5 post RT was associated with reduced survival, suggesting that increases in radiological abnormality of <25 % may predict survival.
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Affiliation(s)
- Cecelia Elizabeth Gzell
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, 2065, Australia. .,Northern Sydney Clinical School, Sydney University Medical School, Sydney, NSW, 2065, Australia. .,Genesis Cancer Care, Level A, 438 Victoria Street, Darlinghurst, Sydney, NSW, 2010, Australia.
| | - Helen R Wheeler
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, 2065, Australia.,Northern Sydney Clinical School, Sydney University Medical School, Sydney, NSW, 2065, Australia
| | - Philip McCloud
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, 2065, Australia
| | - Marina Kastelan
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, 2065, Australia
| | - Michael Back
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, 2065, Australia.,Northern Sydney Clinical School, Sydney University Medical School, Sydney, NSW, 2065, Australia
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19
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Zhang H, Ma L, Wang Q, Zheng X, Wu C, Xu BN. Role of magnetic resonance spectroscopy for the differentiation of recurrent glioma from radiation necrosis: a systematic review and meta-analysis. Eur J Radiol 2015; 83:2181-2189. [PMID: 25452098 DOI: 10.1016/j.ejrad.2014.09.018] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 09/29/2014] [Indexed: 11/17/2022]
Abstract
PURPOSE Differentiating glioma recurrence from radiation necrosis remains a great challenge. We conducted a meta-analysis to evaluate the diagnostic quality of magnetic resonance spectroscopy (MRS) in differentiating glioma recurrence from radiation necrosis. METHODS Studies about evaluation of MRS for the differential diagnosis of glioma recurrence from radiation necrosis were systematically searched in PubMed, Embase and Chinese Biomedical databases up to May 4, 2014. The data were extracted to perform heterogeneity test, threshold effect test and to calculate sensitivity (SEN), specificity (SPE) and areas under summary receiver operating characteristic curve (SROC). RESULTS Eighteen articles comprising a total sample size of 455 patients (447 lesions) with suspected glioma recurrence after radiotherapy, met all inclusion and exclusion criteria, and were included in our meta-analysis. Quantitative synthesis of studies showed that the pooled SEN and SPE for Cho/Cr ratio were 0.83 (95% CI: 0.77, 0.89) and 0.83 (95% CI: 0.74, 0.90). The area under the curve (AUC) under the SROC was 0.9001. The pooled SEN and SPE for Cho/NAA ratio were 0.88 (95% CI: 0.81, 0.93) and 0.86 (95% CI: 0.76, 0.93). The AUC under the SROC was 0.9185. CONCLUSION This meta-analysis shows that MRS alone has moderate diagnostic performance in differentiating glioma recurrence from radiation necrosis using metabolite ratios like Cho/Cr and Cho/NAA ratio. It is strongly recommended that MRS should combine other advanced imaging technologies to improve diagnostic accuracy. This article underlines the importance of implementing multimodal imaging trials and multicentre trials in the future.
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Affiliation(s)
- Hui Zhang
- Department of Neurosurgery, Air Force General Hospital of the Chinese PLA, 30 Fucheng Road, Haidian District, Beijing 100142, China; Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road,Haidian District, Beijing 100853, China
| | - Li Ma
- Department of Anesthesiology, Beijing Military General Hospital, Beijing 100700, China
| | - Qun Wang
- Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road,Haidian District, Beijing 100853, China
| | - Xuan Zheng
- Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road,Haidian District, Beijing 100853, China
| | - Chen Wu
- Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road,Haidian District, Beijing 100853, China
| | - Bai-Nan Xu
- Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road,Haidian District, Beijing 100853, China.
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20
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Zhang H, Ma L, Shu C, Wang YB, Dong LQ. Diagnostic accuracy of diffusion MRI with quantitative ADC measurements in differentiating glioma recurrence from radiation necrosis. J Neurol Sci 2015; 351:65-71. [PMID: 25748965 DOI: 10.1016/j.jns.2015.02.038] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 02/03/2015] [Accepted: 02/21/2015] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Differentiating radiation necrosis from glioma recurrence remains a great challenge. Several advanced imaging modalities have been developed to differentiate between these two entities with disparate outcomes. We conducted a meta-analysis to evaluate the diagnostic quality of diffusion MRI in differentiating glioma recurrence from radiation necrosis. METHOD PubMed, Embase and Chinese Biomedical databases were systematically searched to identify published articles about evaluation of diffusion MRI for the differential diagnosis of glioma recurrence from radiation necrosis. Pooled sensitivity (SEN), specificity (SPE), negative likelihood ratio (NLR), positive likelihood ratio (PLR), and diagnostic odds ratio (DOR) were calculated. RESULTS Nine studies involving 284 patients (288 lesions) met all inclusion and exclusion criteria. Quantitative synthesis of studies showed that the pooled weighted values were determined to be SEN: 0.82 (95% CI: 0.75, 0.87); SPE: 0.84 (95% CI: 0.76, 0.91); PLR: 5.10 (95% CI: 3.27, 7.95); NLR: 0.21 (95% CI: 0.15, 0.29); and DOR: 23.90 (95% CI: 12.44, 45.89). CONCLUSIONS This meta-analysis shows that diffusion MRI has moderate diagnostic performance in differentiating glioma recurrence from radiation necrosis using quantitative ADC. It is recommended not to use diffusion MRI alone in differentiating between glioma recurrence and radiation necrosis. Multimodal imaging trials should be implemented in the future.
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Affiliation(s)
- Hui Zhang
- Department of Neurosurgery, Air Force General Hospital of the Chinese PLA, 30 Fucheng Road, Haidian District, Beijing 100142, China
| | - Li Ma
- Department of Anesthesiology, Beijing Military General Hospital, Beijing 100700, China.
| | - Cheng Shu
- Department of Neurosurgery, Air Force General Hospital of the Chinese PLA, 30 Fucheng Road, Haidian District, Beijing 100142, China
| | - Yu-Bo Wang
- Department of Neurosurgery, Air Force General Hospital of the Chinese PLA, 30 Fucheng Road, Haidian District, Beijing 100142, China
| | - Lian-Qiang Dong
- Department of Neurosurgery, Air Force General Hospital of the Chinese PLA, 30 Fucheng Road, Haidian District, Beijing 100142, China.
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21
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Performance of SPECT in the differential diagnosis of glioma recurrence from radiation necrosis. J Clin Neurosci 2015; 22:229-37. [DOI: 10.1016/j.jocn.2014.06.102] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 05/31/2014] [Accepted: 06/14/2014] [Indexed: 11/17/2022]
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22
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The Pathophysiology of Cerebral Radiation Necrosis and the Role of Laser Interstitial Thermal Therapy. World Neurosurg 2015; 83:23-6. [DOI: 10.1016/j.wneu.2014.03.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 03/07/2014] [Indexed: 11/20/2022]
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23
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Li W, Ma L, Wang X, Sun J, Wang S, Hu X. 11C-choline PET/CT tumor recurrence detection and survival prediction in post-treatment patients with high-grade gliomas. Tumour Biol 2014; 35:12353-60. [DOI: 10.1007/s13277-014-2549-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 08/25/2014] [Indexed: 11/30/2022] Open
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24
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Raimbault A, Cazals X, Lauvin MA, Destrieux C, Chapet S, Cottier JP. Radionecrosis of malignant glioma and cerebral metastasis: a diagnostic challenge in MRI. Diagn Interv Imaging 2014; 95:985-1000. [PMID: 25001364 DOI: 10.1016/j.diii.2014.06.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Detecting a new area of contrast-enhancement at MRI after irradiation of malignant brain tumor arises the problem of differential diagnosis between tumor recurrence and radiation necrosis induced by the treatment. The challenge for imaging is to distinguish the two diagnoses given: the prognostic and therapeutic issues. Various criteria have been proposed in the literature based on morphological, functional or metabolic MRI. The purpose of this study was to perform an analysis of these tools to identify MRI best criteria to differentiate radiation necrosis lesions from malignant gliomas and brain metastases recurrence. For gliomas, the morphology of the contrast-enhancement cannot guide the diagnosis and the use of perfusion techniques and spectroscopy (multivoxels if possible) are necessary. In the follow-up of metastasis, a transient increase and moderate lesion volume is possible with a good prognosis. Morphological characteristics (volume ratio T2/T1Gd) and perfusion analysis provide valuable tools for approaching the diagnosis of radionecrosis.
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Affiliation(s)
- A Raimbault
- General Radiology - Diagnostic and Therapeutic Neuroradiology, Bretonneau Hospital, 2, boulevard Tonnellé, 37044 Tours cedex, France
| | - X Cazals
- General Radiology - Diagnostic and Therapeutic Neuroradiology, Bretonneau Hospital, 2, boulevard Tonnellé, 37044 Tours cedex, France
| | - M-A Lauvin
- General Radiology - Diagnostic and Therapeutic Neuroradiology, Bretonneau Hospital, 2, boulevard Tonnellé, 37044 Tours cedex, France
| | - C Destrieux
- Department of Neurosurgery, Bretonneau Hospital, Tours University Hospitals, 2, boulevard Tonnellé, 37044 Tours cedex, France
| | - S Chapet
- Department of radiotherapy, Bretonneau Hospital, Tours University Hospitals, 2, boulevard Tonnellé, 37044 Tours cedex, France
| | - J-P Cottier
- General Radiology - Diagnostic and Therapeutic Neuroradiology, Bretonneau Hospital, 2, boulevard Tonnellé, 37044 Tours cedex, France.
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25
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Hilario A, Sepulveda JM, Perez-Nuñez A, Salvador E, Millan JM, Hernandez-Lain A, Rodriguez-Gonzalez V, Lagares A, Ramos A. A prognostic model based on preoperative MRI predicts overall survival in patients with diffuse gliomas. AJNR Am J Neuroradiol 2014; 35:1096-102. [PMID: 24457819 PMCID: PMC7965146 DOI: 10.3174/ajnr.a3837] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 11/10/2013] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Diffuse gliomas are classified as grades II-IV on the basis of histologic features, with prognosis determined mainly by clinical factors and histologic grade supported by molecular markers. Our aim was to evaluate, in patients with diffuse gliomas, the relationship of relative CBV and ADC values to overall survival. In addition, we also propose a prognostic model based on preoperative MR imaging findings that predicts survival independent of histopathology. MATERIALS AND METHODS We conducted a retrospective analysis of the preoperative diffusion and perfusion MR imaging in 126 histologically confirmed diffuse gliomas. Median relative CBV and ADC values were selected for quantitative analysis. Survival univariate analysis was made by constructing survival curves by using the Kaplan-Meier method and comparing subgroups by log-rank probability tests. A Cox regression model was made for multivariate analysis. RESULTS The study included 126 diffuse gliomas (median follow-up of 14.5 months). ADC and relative CBV values had a significant influence on overall survival. Median overall survival for patients with ADC < 0.799 × 10(-3) mm(2)/s was <1 year. Multivariate analysis revealed that patient age, relative CBV, and ADC values were associated with survival independent of pathology. The preoperative model provides greater ability to predict survival than that obtained by histologic grade alone. CONCLUSIONS ADC values had a better correlation with overall survival than relative CBV values. A preoperative prognostic model based on patient age, relative CBV, and ADC values predicted overall survival of patients with diffuse gliomas independent of pathology. This preoperative model provides a more accurate predictor of survival than histologic grade alone.
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Affiliation(s)
- A Hilario
- From the Departments of Radiology (A.H., A.R., E.S., J.M.M.)
| | | | - A Perez-Nuñez
- Neurosurgery (A.P.-N., A.L.), Hospital 12 de Octubre, Madrid, Spain
| | - E Salvador
- From the Departments of Radiology (A.H., A.R., E.S., J.M.M.)
| | - J M Millan
- From the Departments of Radiology (A.H., A.R., E.S., J.M.M.)
| | | | | | - A Lagares
- Neurosurgery (A.P.-N., A.L.), Hospital 12 de Octubre, Madrid, Spain
| | - A Ramos
- From the Departments of Radiology (A.H., A.R., E.S., J.M.M.)
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26
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Cha J, Kim ST, Kim HJ, Kim BJ, Kim YK, Lee JY, Jeon P, Kim KH, Kong DS, Nam DH. Differentiation of tumor progression from pseudoprogression in patients with posttreatment glioblastoma using multiparametric histogram analysis. AJNR Am J Neuroradiol 2014; 35:1309-17. [PMID: 24676005 DOI: 10.3174/ajnr.a3876] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The multiparametric imaging can show us different aspects of tumor behavior and may help differentiation of tumor recurrence from treatment related change. Our aim was to differentiate tumor progression from pseudoprogression in patients with glioblastoma by using multiparametric histogram analysis of 2 consecutive MR imaging studies with relative cerebral blood volume and ADC values. MATERIALS AND METHODS Thirty-five consecutive patients with glioblastoma with new or increased size of enhancing lesions after concomitant chemoradiation therapy following surgical resection were included. Combined histograms were made by using the relative cerebral blood volume and ADC values of enhancing areas for initial and follow-up MR imaging, and subtracted histograms were also prepared. The histogram parameters between groups were compared. The diagnostic accuracy of tumor progression based on the histogram parameters of initial and follow-up MR imaging and subtracted histograms was compared and correlated with overall survival. RESULTS Twenty-four pseudoprogressions and 11 tumor progressions were determined. Diagnosis based on the subtracted histogram mode with a multiparametric approach was more accurate than the diagnosis based on the uniparametric approach (area under the receiver operating characteristic curve of 0.877 versus 0.801), with 81.8% sensitivity and 100% specificity. A high mode of relative cerebral blood volume on the subtracted histogram by using a multiparametric approach (relative cerebral blood volume ×ADC) was the best predictor of true tumor progression (P < .001) and worse survival (P = .003). CONCLUSIONS Multiparametric histogram analysis of posttreatment glioblastoma was useful to predict true tumor progression and worse survival.
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Affiliation(s)
- J Cha
- From the Departments of Radiology and Center for Imaging Science (J.C., S.T.K., H.-J.K., B.-j.K., Y.K.K., J.Y.L., P.J., K.H.K.)
| | - S T Kim
- From the Departments of Radiology and Center for Imaging Science (J.C., S.T.K., H.-J.K., B.-j.K., Y.K.K., J.Y.L., P.J., K.H.K.)
| | - H-J Kim
- From the Departments of Radiology and Center for Imaging Science (J.C., S.T.K., H.-J.K., B.-j.K., Y.K.K., J.Y.L., P.J., K.H.K.)
| | - B-J Kim
- From the Departments of Radiology and Center for Imaging Science (J.C., S.T.K., H.-J.K., B.-j.K., Y.K.K., J.Y.L., P.J., K.H.K.)
| | - Y K Kim
- From the Departments of Radiology and Center for Imaging Science (J.C., S.T.K., H.-J.K., B.-j.K., Y.K.K., J.Y.L., P.J., K.H.K.)
| | - J Y Lee
- From the Departments of Radiology and Center for Imaging Science (J.C., S.T.K., H.-J.K., B.-j.K., Y.K.K., J.Y.L., P.J., K.H.K.)
| | - P Jeon
- From the Departments of Radiology and Center for Imaging Science (J.C., S.T.K., H.-J.K., B.-j.K., Y.K.K., J.Y.L., P.J., K.H.K.)
| | - K H Kim
- From the Departments of Radiology and Center for Imaging Science (J.C., S.T.K., H.-J.K., B.-j.K., Y.K.K., J.Y.L., P.J., K.H.K.)
| | - D-S Kong
- Neurosurgery (D.-s.K., D.-H.N.), Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - D-H Nam
- Neurosurgery (D.-s.K., D.-H.N.), Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
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Shin KE, Ahn KJ, Choi HS, Jung SL, Kim BS, Jeon SS, Hong YG. DCE and DSC MR perfusion imaging in the differentiation of recurrent tumour from treatment-related changes in patients with glioma. Clin Radiol 2014; 69:e264-72. [PMID: 24594379 DOI: 10.1016/j.crad.2014.01.016] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 01/09/2014] [Accepted: 01/16/2014] [Indexed: 01/04/2023]
Abstract
AIM To retrospectively compare the utility of perfusion magnetic resonance imaging (MRI) in distinguishing treatment-related changes from recurrent disease in glioma patients. MATERIALS AND METHODS Thirty-one patients with histologically diagnosed gliomas and increased enhancement after or during concurrent (chemo-) radiation therapy were enrolled. They underwent dynamic contrast-enhanced (DCE) permeability MRI followed by dynamic susceptibility contrast (DSC) perfusion MRI. The vascular transfer constant (rK(trans)) and initial areas under the concentration curve (riAUC) were obtained from DCE MRI, and cerebral blood volume (rCBV) was obtained from DSC MRI. Patients were classified as having treatment-related changes or recurrent tumours based on clinicoradiological results or pathological results from surgery. RESULTS Nineteen patients were diagnosed as having recurrences and 12 patients as having treatment-related changes. The rK(trans), riAUC, and rCBV values in the recurrent group were significantly higher than the values in the group with treatment-related changes (p < 0.05). For all 31 patients, there was no significant difference between DSC MRI and DCE MRI for the differentiating power between recurrence and treatment-related changes (p = 0.7227). However, when including only the 24 patients with concordant values of rK(trans) and riAUC, DCE MRI showed a significant AUC value of 0.786 in the receiver operating characteristic (ROC) curve analysis (p = 0.003), whereas DSC MRI did not (AUC = 0.643, p = 0.229). CONCLUSION MRI perfusion images appear to show promise in distinguishing treatment-related changes from recurrent tumours. When both rK(trans) and riAUC show concordant values, DCE MRI seems to be more powerful than DSC MRI in the differentiation of recurrence from treatment-related changes.
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Affiliation(s)
- K E Shin
- Diagnostic Radiology, Kyung-Hee University Medical Center, Hoegi-dong, Dongdaemun-gu, Republic of Korea
| | - K J Ahn
- Department of Radiology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - H S Choi
- Department of Radiology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - S L Jung
- Department of Radiology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - B S Kim
- Department of Radiology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - S S Jeon
- Department of Neurosurgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Y G Hong
- Department of Neurosurgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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28
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Chang JH, Kim CY, Choi BS, Kim YJ, Kim JS, Kim IA. Pseudoprogression and pseudoresponse in the management of high-grade glioma : optimal decision timing according to the response assessment of the neuro-oncology working group. J Korean Neurosurg Soc 2014; 55:5-11. [PMID: 24570811 PMCID: PMC3928350 DOI: 10.3340/jkns.2014.55.1.5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 05/24/2013] [Accepted: 12/16/2013] [Indexed: 11/27/2022] Open
Abstract
Objective We evaluated pseudoprogression (PsPD) following radiation therapy combined with concurrent temozolomide (TMZ), and we assessed pseudoresponse following anti-angiogenic therapy for patients with recurrent disease using the Response Assessment of the Neuro-Oncology Working Group. Methods Patients who were pathologically confirmed as having high-grade glioma received radiotherapy with concurrent TMZ followed by adjuvant TMZ. Bevacizumab (Avastin) with CPT-11 were used as a salvage option for cases of radiologic progression. Magnetic resonance imaging (MRI) was routinely performed 1 month after concurrent radiochemotherapy (CRT) and every 3 months thereafter. For cases treated with the bevacizumab-containing regimen for progressive disease, MRI was performed every 2 months. Results Of 55 patients, 21 (38%) showed radiologic progression within 4 weeks after CRT. Of these patients, 16 (29%) showed progression at second post-CRT MRI (etPD) and five (9%) showed improvement (PsPD). Seven of thirty-four initially non-progressed patients showed progression at the second post-CRT MRI (ltPD). No difference in survival was observed between the etPD and ltPD groups (p=0.595). Five (50%) of ten patients showed a radiological response after salvage bevacizumab therapy. Four of those patients exhibited rapid progression immediately after discontinuation of the drug (drug holiday). Conclusion Twelve weeks following treatment could be the optimal timing to determine PsPD or true progression. MRI with gadolinium enhancement alone is not sufficient to characterize tumor response or growth. Clinical correlation with adequate follow-up duration and histopathologic validation may be helpful in discriminating PsPD from true progression.
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Affiliation(s)
- Ji Hyun Chang
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chae-Yong Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Byung Se Choi
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yu Jung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Sung Kim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - In Ah Kim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea
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29
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Lin NU, Lee EQ, Aoyama H, Barani IJ, Baumert BG, Brown PD, Camidge DR, Chang SM, Dancey J, Gaspar LE, Harris GJ, Hodi FS, Kalkanis SN, Lamborn KR, Linskey ME, Macdonald DR, Margolin K, Mehta MP, Schiff D, Soffietti R, Suh JH, van den Bent MJ, Vogelbaum MA, Wefel JS, Wen PY. Challenges relating to solid tumour brain metastases in clinical trials, part 1: patient population, response, and progression. A report from the RANO group. Lancet Oncol 2013; 14:e396-406. [PMID: 23993384 DOI: 10.1016/s1470-2045(13)70311-5] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Therapeutic outcomes for patients with brain metastases need to improve. A critical review of trials specifically addressing brain metastases shows key issues that could prevent acceptance of results by regulatory agencies, including enrolment of heterogeneous groups of patients and varying definitions of clinical endpoints. Considerations specific to disease, modality, and treatment are not consistently addressed. Additionally, the schedule of CNS imaging and consequences of detection of new or progressive brain metastases in trials mainly exploring the extra-CNS activity of systemic drugs are highly variable. The Response Assessment in Neuro-Oncology (RANO) working group is an independent, international, collaborative effort to improve the design of trials in patients with brain tumours. In this two-part series, we review the state of clinical trials of brain metastases and suggest a consensus recommendation for the development of criteria for future clinical trials.
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Affiliation(s)
- Nancy U Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
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30
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Diagnostic Challenges of Radiation Necrosis. Can J Neurol Sci 2013; 40:763-4. [DOI: 10.1017/s0317167100015845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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31
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Na A, Haghigi N, Drummond KJ. Cerebral radiation necrosis. Asia Pac J Clin Oncol 2013; 10:11-21. [PMID: 24175987 DOI: 10.1111/ajco.12124] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2013] [Indexed: 11/26/2022]
Abstract
Cerebral radiation-induced injury ranges from acute reversible edema to late irreversible radiation necrosis (RN). Cerebral RN is poorly responsive to treatment, is associated with permanent neurological deficits and occasionally progresses to death. We review the literature regarding cerebral RN after radiotherapy for various brain and head and neck lesions and discuss its clinical features, imaging characteristics, pathophysiology and treatment. For new enhancing lesions on computed tomography or magnetic resonance imaging, apart from tumor progression or recurrence, RN needs to be considered in the differential diagnosis. Further studies are required to design chemoradiotherapy protocols that are effective in treating tumors while minimizing risk of RN. Current available treatments for RN, steroid and surgery, only relieve the mass effect. None of the experimental treatments to date have consistently been shown to reverse the pathologic process of RN.
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Affiliation(s)
- Angelika Na
- Department of Neurosurgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
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32
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Levitt MR, Levitt R, Silbergeld DL. Controversies in the management of brain metastases. Surg Neurol Int 2013; 4:S231-5. [PMID: 23717794 PMCID: PMC3656559 DOI: 10.4103/2152-7806.111300] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 03/11/2013] [Indexed: 01/20/2023] Open
Abstract
The multidisciplinary management of brain metastases has generated substantial controversy as treatment has diversified in recent years. Debate about the type, role, and timing of different diagnostic and therapeutic strategies has promoted rigorous scientific research into efficacy. However, much still remains unanswered in the treatment of this difficult disease process. This manuscript seeks to highlight some of the controversies identified in previous sections of this supplement, including prognosis, pathology, radiation and surgical treatment, neuroimaging, and the biochemical underpinnings of brain metastases. By recognizing what is yet unanswered, we hope to identify areas in which further research may yield promising results.
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Affiliation(s)
- Michael R Levitt
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle WA, USA
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Knudsen-Baas KM, Moen G, Fluge Ø, Storstein A. Pseudoprogression in high-grade glioma. Acta Neurol Scand 2012. [PMID: 23190289 DOI: 10.1111/ane.12047] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Pseudoprogression is a treatment-related effect seen on imaging in high-grade glioma. Enhancement of gadolinium contrast on control MRI can be misinterpreted as tumor recurrence and is also difficult to distinguish from radiation necrosis. Pseudoprogression is seen in up to 30% after standard treatment for glioblastoma multiforme (GBM), which is radiotherapy concurrent with chemotherapy with temozolomide (TMZ) and adjuvant cycles of TMZ. In this article, the current literature on pseudoprogression in high-grade glioma is reviewed by searches in PubMed. We also present two clinical cases, one of which had medullary pseudoprogression. No articles on this subentity of pseudoprogression were found in PubMed. Standard MRI with gadolinium contrast cannot differentiate between pseudoprogression, tumor recurrence and radiation necrosis. More advanced imaging techniques are often not available. Pseudoprogression seems to be related to methylated promoter of the O(6)--methyl-guanine methyl transferase (MGMT) gene, which is associated with improved treatment effect. Discontinuation or change of therapy on the basis of misinterpretation of MRI as disease progression is thus unfortunate. MRI should be interpreted with caution the first 6 months after standard treatment of high-grade glioma. In a GBM patient with contrast enhancement on MRI but few or no new symptoms and/or stable steroid doses, treatment should be continued and control imaging performed after 2-3 months.
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Affiliation(s)
| | - G. Moen
- Department of Radiology; Haukeland University Hospital; Bergen; Norway
| | - Ø. Fluge
- Department of Oncology; Haukeland University Hospital; Bergen; Norway
| | - A. Storstein
- Department of Neurology; Haukeland University Hospital; Bergen; Norway
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DeSalvo MN. Radiation necrosis of the pons after radiotherapy for nasopharyngeal carcinoma: diagnosis and treatment. J Radiol Case Rep 2012; 6:9-16. [PMID: 23365707 DOI: 10.3941/jrcr.v6i7.1108] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We report a case of radiation necrosis in an unusual location, the pons, in a patient who had received chemoradiation for nasopharyngeal carcinoma (NPC) over one year prior to presentation. This patient presented with subacute onset of ataxic hemiparesis and slurred speech. Initial magnetic resonance imaging (MRI) studies showed two 1-2 cm peripherally contrast-enhancing lesions in the pons with extensive surrounding edema. Proton magnetic resonance spectroscopy (MRS) played a key role in narrowing the differential diagnosis to radiation necrosis. The patient underwent biweekly bevacizumab therapy and has remained clinically stable with radiologic improvement of his lesion. In addition to this case, we present an overview of the use of advanced neuroimaging in distinguishing radiation necrosis of the central nervous system (CNS) from other entities as well as the role of bevacizumab in treatment.
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