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Fu P, Shen J, Song K, Xu M, Zhou Z, Xu H. Prognostic Factors for Recurrent Glioma: A Population-Based Analysis. Clin Med Insights Oncol 2024; 18:11795549241252652. [PMID: 38883848 PMCID: PMC11177728 DOI: 10.1177/11795549241252652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 03/03/2024] [Indexed: 06/18/2024] Open
Abstract
Background The overall survival (OS) for patients with recurrent glioma is meager. Also, the effect of radionecrosis and prognostic factors for recurrent glioma remains controversial. In this regard, developing effective predictive models and guiding clinical care is crucial for these patients. Methods We screened patients with recurrent glioma after radiotherapy and those who received surgery between August 1, 2013, and December 31, 2020. Univariate and multivariate Cox regression analyses determined the independent prognostic factors affecting the prognosis of recurrent glioma. Moreover, nomograms were constructed to predict recurrent glioma risk and prognosis. Statistical methods were used to determine the prediction accuracy and discriminability of the nomogram prediction model based on the area under the curve (AUC), the C-index, the decision curve analysis (DCA), and the calibration curve. In order to distinguish high-risk and low-risk groups for OS, the X-Tile and Kaplan-Meier (K-M) survival curves were employed, and the nomogram prediction model was further validated by the X-Tile and K-M survival curves. Results According to a Cox regression analysis, independent prognostic factors of recurrent glioma after radiotherapy with radionecrosis were World Health Organization (WHO) grade and gliosis percentage. We utilized a nomogram prediction model to analyze results visually. The C-index was 0.682 (95% CI: 0.616-0.748). According to receiver operating characteristic (ROC) analysis, calibration plots, and DCA, the nomogram prediction model was found to have a high-performance ability, and all patients were divided into low-risk and high-risk groups based on OS (P < .001). Conclusion WHO grade and gliosis percentage are prognostic factors for recurrent glioma with radionecrosis, and a nomogram prediction model was established based on these two variables. Patients could be divided into high- and low-risk groups with different OS by this model, and it will provide individualized clinical decisions for future treatment.
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Affiliation(s)
- Pengfei Fu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Neurosurgical Institute of Fudan University, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jingjing Shen
- Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Kun Song
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Neurosurgical Institute of Fudan University, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ming Xu
- Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhirui Zhou
- Radiation Oncology Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hongzhi Xu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Neurosurgical Institute of Fudan University, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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Kossmann MRP, Ehret F, Roohani S, Winter SF, Ghadjar P, Acker G, Senger C, Schmid S, Zips D, Kaul D. Histopathologically confirmed radiation-induced damage of the brain - an in-depth analysis of radiation parameters and spatio-temporal occurrence. Radiat Oncol 2023; 18:198. [PMID: 38087368 PMCID: PMC10717523 DOI: 10.1186/s13014-023-02385-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Radiation-induced damage (RID) after radiotherapy (RT) of primary brain tumors and metastases can be challenging to clinico-radiographically distinguish from tumor progression. RID includes pseudoprogression and radiation necrosis; the latter being irreversible and often associated with severe symptoms. While histopathology constitutes the diagnostic gold standard, biopsy-controlled clinical studies investigating RID remain limited. Whether certain brain areas are potentially more vulnerable to RID remains an area of active investigation. Here, we analyze histopathologically confirmed cases of RID in relation to the temporal and spatial dose distribution. METHODS Histopathologically confirmed cases of RID after photon-based RT for primary or secondary central nervous system malignancies were included. Demographic, clinical, and dosimetric data were collected from patient records and treatment planning systems. We calculated the equivalent dose in 2 Gy fractions (EQD22) and the biologically effective dose (BED2) for normal brain tissue (α/β ratio of 2 Gy) and analyzed the spatial and temporal distribution using frequency maps. RESULTS Thirty-three patients were identified. High-grade glioma patients (n = 18) mostly received one normofractionated RT series (median cumulative EQD22 60 Gy) to a large planning target volume (PTV) (median 203.9 ccm) before diagnosis of RID. Despite the low EQD22 and BED2, three patients with an accelerated hyperfractionated RT developed RID. In contrast, brain metastases patients (n = 15; 16 RID lesions) were often treated with two or more RT courses and with radiosurgery or fractionated stereotactic RT, resulting in a higher cumulative EQD22 (median 162.4 Gy), to a small PTV (median 6.7 ccm). All (n = 34) RID lesions occurred within the PTV of at least one of the preceding RT courses. RID in the high-grade glioma group showed a frontotemporal distribution pattern, whereas, in metastatic patients, RID was observed throughout the brain with highest density in the parietal lobe. The cumulative EQD22 was significantly lower in RID lesions that involved the subventricular zone (SVZ) than in lesions without SVZ involvement (median 60 Gy vs. 141 Gy, p = 0.01). CONCLUSIONS Accelerated hyperfractionated RT can lead to RID despite computationally low EQD22 and BED2 in high-grade glioma patients. The anatomical location of RID corresponded to the general tumor distribution of gliomas and metastases. The SVZ might be a particularly vulnerable area.
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Affiliation(s)
- Mario R P Kossmann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Augustenburger Platz 1, 13353, Berlin, Germany
- Department of Radiotherapy and Radiation Oncology, Pius-Hospital Oldenburg, Georgstr. 12, 26121, Oldenburg, Germany
| | - Felix Ehret
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Augustenburger Platz 1, 13353, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Berlin, Germany; German Cancer Consortium (DKTK), partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Siyer Roohani
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Augustenburger Platz 1, 13353, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Berlin, Germany; German Cancer Consortium (DKTK), partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Sebastian F Winter
- Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Pirus Ghadjar
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Güliz Acker
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Augustenburger Platz 1, 13353, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurosurgery, Charitéplatz 1, 10117, Berlin, Germany
| | - Carolin Senger
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Simone Schmid
- Charité - Universitätsmedizin Berlin, Berlin, Germany; German Cancer Consortium (DKTK), partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neuropathology, Charitéplatz 1, 10117, Berlin, Germany
| | - Daniel Zips
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Augustenburger Platz 1, 13353, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Berlin, Germany; German Cancer Consortium (DKTK), partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David Kaul
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Augustenburger Platz 1, 13353, Berlin, Germany.
- Charité - Universitätsmedizin Berlin, Berlin, Germany; German Cancer Consortium (DKTK), partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany.
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3
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Newman WC, Goldberg J, Guadix SW, Brown S, Reiner AS, Panageas K, Beal K, Brennan CW, Tabar V, Young RJ, Moss NS. The effect of surgery on radiation necrosis in irradiated brain metastases: extent of resection and long-term clinical and radiographic outcomes. J Neurooncol 2021; 153:507-518. [PMID: 34146223 DOI: 10.1007/s11060-021-03790-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 06/15/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Radiation therapy is a cornerstone of brain metastasis (BrM) management but carries the risk of radiation necrosis (RN), which can require resection for palliation or diagnosis. We sought to determine the relationship between extent of resection (EOR) of pathologically-confirmed RN and postoperative radiographic and symptomatic outcomes. METHODS A single-center retrospective review was performed at an NCI-designated Comprehensive Cancer Center to identify all surgically-resected, previously-irradiated necrotic BrM without admixed recurrent malignancy from 2003 to 2018. Clinical, pathologic and radiographic parameters were collected. Volumetric analysis determined EOR and longitudinally evaluated perilesional T2-FLAIR signal preoperatively, postoperatively, and at 3-, 6-, 12-, and 24-months postoperatively when available. Rates of time to 50% T2-FLAIR reduction was calculated using cumulative incidence in the competing risks setting with last follow-up and death as competing events. The Spearman method was used to calculate correlation coefficients, and continuous variables for T2-FLAIR signal change, including EOR, were compared across groups. RESULTS Forty-six patients were included. Most underwent prior stereotactic radiosurgery with or without whole-brain irradiation (N = 42, 91%). Twenty-seven operations resulted in gross-total resection (59%; GTR). For the full cohort, T2-FLAIR edema decreased by a mean of 78% by 6 months postoperatively that was durable to last follow-up (p < 0.05). EOR correlated with edema reduction at last follow-up, with significantly greater T2-FLAIR reduction with GTR versus subtotal resection (p < 0.05). Among surviving patients, a significant proportion were able to decrease their steroid use: steroid-dependency decreased from 54% preoperatively to 15% at 12 months postoperatively (p = 0.001). CONCLUSIONS RN resection conferred both durable T2-FLAIR reduction, which correlated with EOR; and reduced steroid dependency.
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Affiliation(s)
- William C Newman
- Department of Neurosurgery, Louisiana State University Health Sciences, Shreveport, LA, USA
| | - Jacob Goldberg
- Department of Neurological Surgery and Brain Metastasis Center, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.,Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | - Sergio W Guadix
- Department of Neurological Surgery and Brain Metastasis Center, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.,Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | - Samantha Brown
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anne S Reiner
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Katherine Panageas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kathryn Beal
- Department of Radiation Oncology and Brain Metastasis Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cameron W Brennan
- Department of Neurological Surgery and Brain Metastasis Center, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Viviane Tabar
- Department of Neurological Surgery and Brain Metastasis Center, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Robert J Young
- Department of Radiology and Brain Metastasis Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nelson S Moss
- Department of Neurological Surgery and Brain Metastasis Center, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
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Patrizz A, Dono A, Zhu P, Tandon N, Ballester LY, Esquenazi Y. Tumor recurrence or treatment-related changes following chemoradiation in patients with glioblastoma: does pathology predict outcomes? J Neurooncol 2021; 152:163-172. [PMID: 33481149 DOI: 10.1007/s11060-020-03690-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Despite surgical resection and chemoradiation, all patients with GBM invariably recur. Radiological imaging is limited in differentiating tumor recurrence (TR) from treatment-related changes (TRC); therefore, re-resection is often needed. Few studies have assessed the relationship between re-resection histopathology and overall survival (OS). We performed a large retrospective study to analyze the clinical significance of histopathology following re-resection and its influence on genomic sequencing results. METHODS Clinical, radiographic, and histological information was compiled from 675 patients with GBM (2005-2017). 137-patients met the inclusion criteria. IDH1 p.R132H immunohistochemistry was performed in all patients. Next-generation sequencing interrogating 205 tumor-related genes was performed in 68-patients. Molecular alterations from initial and subsequent resections were compared in a subset of cases. RESULTS There were no differences in OS (17.3-months TRC vs. 21-months TR, p = 0.881) and survival from progression (9.0 vs. 11.7-months, p = 0.778) between patients with TR and TRC on re-resection. TR patients were more likely to receive salvage radiotherapy (26% vs. 0%) and tumor-treating fields (25% vs. 5%,) after the 2nd surgery than the TRC group (p = < 0.045). There was no correlation between mutations and TRC. IDH status was not predictive of TRC. Fifteen-patients had sequencing results from multiple surgeries without evident differences in genomic alterations. CONCLUSIONS Histopathologic findings following chemoradiation do not correlate with clinical outcomes. Such findings should be considered during patient management and clinical trial enrollment. Standardization of tissue sampling and interpretation following reoperation is urgently needed. Future work is required to understand the relationship between the mutation profile following TRC and outcomes.
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Affiliation(s)
- Anthony Patrizz
- Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston, McGovern Medical School, 6400 Fannin Street, Suite # 2800, Houston, TX, 77030, USA
| | - Antonio Dono
- Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston, McGovern Medical School, 6400 Fannin Street, Suite # 2800, Houston, TX, 77030, USA.,Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Ping Zhu
- Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston, McGovern Medical School, 6400 Fannin Street, Suite # 2800, Houston, TX, 77030, USA.,Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Houston, TX, USA
| | - Nitin Tandon
- Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston, McGovern Medical School, 6400 Fannin Street, Suite # 2800, Houston, TX, 77030, USA
| | - Leomar Y Ballester
- Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston, McGovern Medical School, 6400 Fannin Street, Suite # 2800, Houston, TX, 77030, USA. .,Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA. .,Memorial Hermann Hospital-TMC, Houston, TX, USA. .,Department of Pathology & Laboratory Medicine and Department of Neurosurgery, The University of Texas Health Science Center at Houston - McGovern Medical School, 6431 Fannin Street, MSB 2.136, Houston, TX, 77030, USA.
| | - Yoshua Esquenazi
- Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston, McGovern Medical School, 6400 Fannin Street, Suite # 2800, Houston, TX, 77030, USA. .,Center for Precision Health, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA. .,Memorial Hermann Hospital-TMC, Houston, TX, USA.
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Wang L, Wei L, Wang J, Li N, Gao Y, Ma H, Qu X, Zhang M. Evaluation of perfusion MRI value for tumor progression assessment after glioma radiotherapy: A systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e23766. [PMID: 33350761 PMCID: PMC7769293 DOI: 10.1097/md.0000000000023766] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 10/22/2020] [Accepted: 11/15/2020] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES This study aimed to evaluate the diagnostic performance of magnetic resonance perfusion-weighted imaging (PWI) as a noninvasive method to assess post-treatment radiation effect and tumor progression in patients with glioma. METHODS A systematic literature search was performed in the PubMed, Cochrane Library, and Embase databases up to March 2020. The quality of the included studies was assessed by the quality assessment of diagnostic accuracy studies 2. Data were extracted to calculate sensitivity, specificity, and diagnostic odds ratio (DOR), 95% Confidence interval (CI) and analyze the heterogeneity of the studies (Spearman correlation coefficient, I2 test). We performed meta-regression and subgroup analyses to identify the impact of study heterogeneity. RESULTS Twenty studies were included, with available data for analysis on 939 patients and 968 lesions. All included studies used dynamic susceptibility contrast (DSC) PWI, four also used dynamic contrast-enhanced PWI, and three also used arterial spin marker imaging PWI. When DSC was considered, the pooled sensitivity and specificity were 0.83 (95% CI, 0.79 to 0.86) and 0.83 (95% CI, 0.78 to 0.87), respectively; pooled DOR, 21.31 (95% CI, 13.07 to 34.73); area under the curve (AUC), 0.887; Q∗, 0.8176. In studies using dynamic contrast-enhanced, the pooled sensitivity and specificity were 0.73 (95% CI, 0.66 to 0.80) and 0.80 (95% CI, 0.69 to 0.88), respectively; pooled DOR, 10.83 (95% CI, 2.01 to 58.43); AUC, 0.9416; Q∗, 0.8795. In studies using arterial spin labeling, the pooled sensitivity and specificity were 0.79 (95% CI, 0.69 to 0.87) and 0.78 (95% CI, 0.67 to 0.87), respectively; pooled DOR, 15.63 (95% CI, 4.61 to 53.02); AUC, 0.8786; Q∗, 0.809. CONCLUSIONS Perfusion magnetic resonance imaging displays moderate overall accuracy in identifying post-treatment radiation effect and tumor progression in patients with glioma. Based on the current evidence, DSC-PWI is a relatively reliable option for assessing tumor progression after glioma radiotherapy.
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Affiliation(s)
| | - Lizhou Wei
- Department of neurosurgery, Xijing hospital, Fourth military medical university
| | | | - Na Li
- Department of radiology, Ninth Hospital of Xi’an
| | - Yanzhong Gao
- Department of radiology, Ninth Hospital of Xi’an
| | - Hongge Ma
- Department of radiology, Ninth Hospital of Xi’an
| | - Xinran Qu
- Department of radiology, Ninth Hospital of Xi’an
| | - Ming Zhang
- Department of Radiology, the First Affiliated Hospital of Xi ’an Jiao tong University, Shaanxi Province, China
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Radiolabeled 6-(2, 3-Dichlorophenyl)-N4-methylpyrimidine-2, 4-diamine (TH287): A Potential Radiotracer for Measuring and Imaging MTH1. Int J Mol Sci 2020; 21:ijms21228860. [PMID: 33238630 PMCID: PMC7700685 DOI: 10.3390/ijms21228860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/03/2020] [Accepted: 11/20/2020] [Indexed: 12/18/2022] Open
Abstract
MTH1 (MutT homolog 1) or NUDT1 (Nudix Hydrolase 1), also known as oxidized purine nucleoside triphosphatase, has potential as a biomarker for monitoring cancer progression and quantifying target engagement for relevant therapies. In this study, we validate one MTH1 inhibitor TH287 as a PET MTH1 radiotracer. TH287 was radiolabeled with tritium and the binding of [3H]TH287 to MTH1 was evaluated in live glioblastoma cells (U251MG) through saturation and competitive binding assays, together with in vitro enzymatic assays. Furthermore, TH287 was radiolabeled with carbon-11 for in vivo microPET studies. Saturation binding assays show that [3H]TH287 has a dissociation constant (Kd) of 1.97 ± 0.18 nM, Bmax of 2676 ± 122 fmol/mg protein for U251MG cells, and nH of 0.98 ± 0.02. Competitive binding assays show that TH287 (Ki: 3.04 ± 0.14 nM) has a higher affinity for MTH1 in U251MG cells compared to another well studied MTH1 inhibitor: (S)-crizotinib (Ki: 153.90 ± 20.48 nM). In vitro enzymatic assays show that TH287 has an IC50 of 2.2 nM in inhibiting MTH1 hydrolase activity and a Ki of 1.3 nM from kinetics assays, these results are consistent with our radioligand binding assays. Furthermore, MicroPET imaging shows that [11C]TH287 gets into the brain with rapid clearance from the brain, kidney, and heart. The results presented here indicate that radiolabeled TH287 has favorable properties to be a useful tool for measuring MTH1 in vitro and for further evaluation for in vivo PET imaging MTH1 of brain tumors and other central nervous system disorders.
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Abstract
Reoperation for glioma is increasingly common but there is neither firm agreement on the indications nor unequivocally proven benefit from clinical trials. Patient and tumor factors should be considered when offering reoperation and a clear surgical goal set. Reoperation is challenging because of placement of previous incisions, wound devascularization by preceding radiotherapy and/or chemotherapy, chronic steroid use, the need for further adjuvant therapy, and adherent and defective dura. This article reviews indications, challenges, and recommendations for repeat surgery in the patient with glioma.
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Affiliation(s)
- Rasheed Zakaria
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 442, Houston, TX 77030, USA
| | - Jeffrey S Weinberg
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 442, Houston, TX 77030, USA.
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Tejada Solís S, Plans Ahicart G, Iglesias Lozano I, de Quintana Schmidt C, Fernández Coello A, Hostalot Panisello C, Ley Urzaiz L, García Romero JC, Díez Valle R, González Sánchez J, Duque S. Glioblastoma treatment guidelines: Consensus by the Spanish Society of Neurosurgery Tumor Section. Neurocirugia (Astur) 2020; 31:289-298. [PMID: 32690400 DOI: 10.1016/j.neucir.2020.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/20/2020] [Accepted: 06/03/2020] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Glioblastoma (GBM) treatment starts in most patients with surgery, either resection surgery or biopsy, to reach a histology diagnose. Multidisciplinar team, including specialists in brain tumors diagnose and treatment, must make an individualize assessment to get the maximum benefit of the available treatments. MATERIAL AND METHODS Experts in each GBM treatment field have briefly described it based in their experience and the reviewed of the literature. RESULTS Each area has been summarized and the consensus of the brain tumor group has been included at the end. CONCLUSIONS GBM are aggressive tumors with a dismal prognosis, however accurate treatments can improve overall survival and quality of life. Neurosurgeons must know treatment options, indications and risks to participate actively in the decision making and to offer the best surgical treatment in every case.
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Affiliation(s)
- Sonia Tejada Solís
- Departamento de Neurocirugía, Hospital Universitario Fundación Jiménez Díaz, Madrid, España.
| | - Gerard Plans Ahicart
- Departamento de Neurocirugía, Hospital Universitari Bellvitge, L'Hospitalet de Llobregat (Barcelona), España
| | - Irene Iglesias Lozano
- Departamento de Neurocirugía, Hospital Universitario Puerta del Mar, Barcelona, España
| | | | - Alejandro Fernández Coello
- Departamento de Neurocirugía, Hospital Universitari Bellvitge, L'Hospitalet de Llobregat (Barcelona), España
| | | | - Luis Ley Urzaiz
- Departamento de Neurocirugía, Hospital Universitario Ramón y Cajal, Madrid, España
| | | | - Ricardo Díez Valle
- Departamento de Neurocirugía, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
| | - Josep González Sánchez
- Departamento de Neurocirugía, Hospital Clínic y Provincial de Barcelona, Barcelona, España
| | - Sara Duque
- Departamento de Neurocirugía, Hospital Universitario HM Montepríncipe, Majadahonda (Madrid), España
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9
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Barajas RF, Schwartz D, McConnell HL, Kersch CN, Li X, Hamilton BE, Starkey J, Pettersson DR, Nickerson JP, Pollock JM, Fu RF, Horvath A, Szidonya L, Varallyay CG, Jaboin JJ, Raslan AM, Dogan A, Cetas JS, Ciporen J, Han SJ, Ambady P, Muldoon LL, Woltjer R, Rooney WD, Neuwelt EA. Distinguishing Extravascular from Intravascular Ferumoxytol Pools within the Brain: Proof of Concept in Patients with Treated Glioblastoma. AJNR Am J Neuroradiol 2020; 41:1193-1200. [PMID: 32527840 DOI: 10.3174/ajnr.a6600] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 04/02/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Glioblastoma-associated macrophages are a major constituent of the immune response to therapy and are known to engulf the iron-based MR imaging contrast agent, ferumoxytol. Current ferumoxytol MR imaging techniques for localizing macrophages are confounded by contaminating intravascular signal. The aim of this study was to assess the utility of a newly developed MR imaging technique, segregation and extravascular localization of ferumoxytol imaging, for differentiating extravascular-from-intravascular ferumoxytol contrast signal at a delayed 24-hour imaging time point. MATERIALS AND METHODS Twenty-three patients with suspected post-chemoradiotherapy glioblastoma progression underwent ferumoxytol-enhanced SWI. Segregation and extravascular localization of ferumoxytol imaging maps were generated as the voxelwise difference of the delayed (24 hours) from the early (immediately after administration) time point SWI maps. Continuous segregation and extravascular localization of ferumoxytol imaging map values were separated into positive and negative components. Image-guided biologic correlation was performed. RESULTS Negative segregation and extravascular localization of ferumoxytol imaging values correlated with early and delayed time point SWI values, demonstrating that intravascular signal detected in the early time point persists into the delayed time point. Positive segregation and extravascular localization of ferumoxytol imaging values correlated only with delayed time point SWI values, suggesting successful detection of the newly developed extravascular signal. CONCLUSIONS Segregation and extravascular localization of ferumoxytol MR imaging improves on current techniques by eliminating intrinsic tissue and intravascular ferumoxytol signal and may inform glioblastoma outcomes by serving as a more specific metric of macrophage content compared with uncorrected T1 and SWI techniques.
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Affiliation(s)
- R F Barajas
- From the Departments of Radiology (R.F.B. Jr, D.S., B.E.H., J.S., D.R.P., J.P.N., J.M.P., L.S., C.G.V.)
- Advanced Imaging Research Center (R.F.B. Jr, D.S., X.L., A.H., W.D.R.)
- Knight Cancer Institute Translational Oncology Research Program (R.F.B. Jr)
| | - D Schwartz
- From the Departments of Radiology (R.F.B. Jr, D.S., B.E.H., J.S., D.R.P., J.P.N., J.M.P., L.S., C.G.V.)
- Advanced Imaging Research Center (R.F.B. Jr, D.S., X.L., A.H., W.D.R.)
| | - H L McConnell
- Departments of Neurology (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.)
- Blood-Brain Barrier Program (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.), Oregon Health & Science University, Portland, Oregon
| | - C N Kersch
- Departments of Neurology (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.)
- Blood-Brain Barrier Program (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.), Oregon Health & Science University, Portland, Oregon
| | - X Li
- Advanced Imaging Research Center (R.F.B. Jr, D.S., X.L., A.H., W.D.R.)
| | - B E Hamilton
- From the Departments of Radiology (R.F.B. Jr, D.S., B.E.H., J.S., D.R.P., J.P.N., J.M.P., L.S., C.G.V.)
| | - J Starkey
- From the Departments of Radiology (R.F.B. Jr, D.S., B.E.H., J.S., D.R.P., J.P.N., J.M.P., L.S., C.G.V.)
| | - D R Pettersson
- From the Departments of Radiology (R.F.B. Jr, D.S., B.E.H., J.S., D.R.P., J.P.N., J.M.P., L.S., C.G.V.)
| | - J P Nickerson
- From the Departments of Radiology (R.F.B. Jr, D.S., B.E.H., J.S., D.R.P., J.P.N., J.M.P., L.S., C.G.V.)
| | - J M Pollock
- From the Departments of Radiology (R.F.B. Jr, D.S., B.E.H., J.S., D.R.P., J.P.N., J.M.P., L.S., C.G.V.)
| | - R F Fu
- Medical Informatics and Clinical Epidemiology (R.F.F.)
| | - A Horvath
- Advanced Imaging Research Center (R.F.B. Jr, D.S., X.L., A.H., W.D.R.)
| | - L Szidonya
- From the Departments of Radiology (R.F.B. Jr, D.S., B.E.H., J.S., D.R.P., J.P.N., J.M.P., L.S., C.G.V.)
- Departments of Neurology (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.)
- Blood-Brain Barrier Program (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.), Oregon Health & Science University, Portland, Oregon
- Department of Diagnostic Radiology (L.S.), Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - C G Varallyay
- From the Departments of Radiology (R.F.B. Jr, D.S., B.E.H., J.S., D.R.P., J.P.N., J.M.P., L.S., C.G.V.)
- Departments of Neurology (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.)
- Blood-Brain Barrier Program (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.), Oregon Health & Science University, Portland, Oregon
| | | | - A M Raslan
- Neurological Surgery (A.M.R., A.D., J.S.C., J.C., S.J.H., E.A.N.)
| | - A Dogan
- Neurological Surgery (A.M.R., A.D., J.S.C., J.C., S.J.H., E.A.N.)
| | - J S Cetas
- Neurological Surgery (A.M.R., A.D., J.S.C., J.C., S.J.H., E.A.N.)
| | - J Ciporen
- Neurological Surgery (A.M.R., A.D., J.S.C., J.C., S.J.H., E.A.N.)
| | - S J Han
- Neurological Surgery (A.M.R., A.D., J.S.C., J.C., S.J.H., E.A.N.)
| | - P Ambady
- Departments of Neurology (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.)
- Blood-Brain Barrier Program (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.), Oregon Health & Science University, Portland, Oregon
| | - L L Muldoon
- Departments of Neurology (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.)
- Blood-Brain Barrier Program (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.), Oregon Health & Science University, Portland, Oregon
| | | | - W D Rooney
- Advanced Imaging Research Center (R.F.B. Jr, D.S., X.L., A.H., W.D.R.)
| | - E A Neuwelt
- Departments of Neurology (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.)
- Neurological Surgery (A.M.R., A.D., J.S.C., J.C., S.J.H., E.A.N.)
- Blood-Brain Barrier Program (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.), Oregon Health & Science University, Portland, Oregon
- Portland Veterans Affairs Medical Center (E.A.N.), Portland, Oregon
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Dalle Ore CL, Chandra A, Rick J, Lau D, Shahin M, Nguyen AT, McDermott M, Berger MS, Aghi MK. Presence of Histopathological Treatment Effects at Resection of Recurrent Glioblastoma: Incidence and Effect on Outcome. Neurosurgery 2020; 85:793-800. [PMID: 30445646 DOI: 10.1093/neuros/nyy501] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 09/24/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Resection may be appropriate for select patients with recurrent glioblastoma. The incidence of histopathological findings related to prior treatment and their prognostic implications are incompletely characterized. OBJECTIVE To quantify the incidence and survival outcomes associated with treatment effect at resection of recurrent glioblastoma (GBM). METHODS Patients who underwent resection for recurrent GBM were retrospectively reviewed, and pathology, treatment history, and survival data were collected. Treatment effect was defined as any component of treatment-related changes on pathology. RESULTS In total, 110 patients underwent 146 reoperations. Median age at first reoperation was 57.2 yr and overall survival from reoperation was 10.8 mo. Treatment effect of any kind was noted in 81 of 146 reoperations (55%). Increased treatment effect was observed closer to radiotherapy; by quartile of time from radiotherapy, the rates of treatment effect were 77.8%, 55.6%, 40.7%, and 44.4% (P = .028). Treatment effect was associated with earlier reoperation (8.9 vs 13.8 mo after radiotherapy, P = .003), and the presence of treatment effect did not impact survival from primary surgery (25.4 vs 24.3 mo, P = .084). Patients treated with bevacizumab prior to reoperation were less likely to have treatment effect (20% vs 65%, P < .001). CONCLUSION Histopathological treatment-related changes are evident in a majority of patients undergoing resection for recurrent glioblastoma. There was no association of treatment effect with overall survival from primary surgery.
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Affiliation(s)
- Cecilia L Dalle Ore
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Ankush Chandra
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Jonathan Rick
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Darryl Lau
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Maryam Shahin
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Alan T Nguyen
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Michael McDermott
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Mitchel S Berger
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Manish K Aghi
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
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11
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Lowe S, Bhat KP, Olar A. Current clinical management of patients with glioblastoma. Cancer Rep (Hoboken) 2019; 2:e1216. [PMID: 32721125 DOI: 10.1002/cnr2.1216] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 04/11/2019] [Accepted: 04/29/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Glioblastoma (GB) is the most aggressive primary brain tumor, historically resistant to treatment, and with overall fatal outcome. RECENT FINDINGS Recently, several molecular subgroups and rare genetic alterations have been described in GB. In this review article, we will describe the current clinical management of patients with GB in the United States, discuss selected next-generation molecular-targeted therapies in GB, and present ongoing clinical trials for patients with GB. This review is intended for clinical and preclinical researchers who conduct work on GB and would like to understand more about the current standard of treatment of GB patients, historical perspectives, current challenges, and ongoing and upcoming clinical trials. CONCLUSIONS GB is an extremely complex disease, and despite recent progress and advanced therapeutic strategies, the overall patient's prognosis remains dismal. Innovative strategies and integrative ways of approach to disease are urgently needed.
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Affiliation(s)
- Stephen Lowe
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
| | - Krishna P Bhat
- Deparment of Translational Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Adriana Olar
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina.,Departments of Pathology and Laboratory Medicine, Medical University of South Carolina & Hollings Cancer Center, Charleston, South Carolina
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12
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Shah A, Downey B, Menacho ST. Viable treatment options for patients with symptomatic radiation necrosis treated with stereotactic radiosurgery and immunotherapy. Clin Neurol Neurosurg 2019; 184:105444. [DOI: 10.1016/j.clineuro.2019.105444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/13/2019] [Indexed: 10/26/2022]
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13
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Shah AH, Mahavadi AK, Morell A, Eichberg DG, Luther E, Sarkiss CA, Semonche A, Ivan ME, Komotar RJ. Salvage craniotomy for treatment-refractory symptomatic cerebral radiation necrosis. Neurooncol Pract 2019; 7:94-102. [PMID: 32257288 DOI: 10.1093/nop/npz028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The incidence of symptomatic radiation necrosis (RN) has risen as radiotherapy is increasingly used to control brain tumor progression. Traditionally managed with steroids, symptomatic RN can remain refractory to medical treatment, requiring surgical intervention for control. The purpose of our study was to assess a single institution's experience with craniotomy for steroid-refractory pure RN. Methods The medical records of all tumor patients who underwent craniotomies at our institution from 2011 to 2016 were retrospectively reviewed for a history of preoperative radiotherapy or radiosurgery. RN was confirmed histopathologically and patients with active tumor were excluded. Preoperative, intraoperative, and outcome information was collected. Primary outcomes measured were postoperative KPS and time to steroid freedom. Results Twenty-four patients with symptomatic RN were identified. Gross total resection was achieved for all patients. Patients with metastases experienced an increase in KPS (80 vs 100, P < .001) and required a shortened course of dexamethasone vs patients with high-grade gliomas (3.4 vs 22.2 weeks, P = .003). RN control and neurological improvement at 13.3 months' follow-up were 100% and 66.7%, respectively. Adrenal insufficiency after rapidly tapering dexamethasone was the only morbidity (n = 1). Overall survival was 93.3% (14/15) at 1 year. Conclusion In cases of treatment-refractory symptomatic RN, resection can lead to an overall improvement in postoperative health status and neurological outcomes with minimal RN recurrence. Craniotomy for surgically accessible RN can safely manage symptomatic patients, and future studies assessing the efficacy of resection vs bevacizumab may be warranted.
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Affiliation(s)
- Ashish H Shah
- Department of Neurosurgery, University of Miami, FL, USA
| | | | - Alexis Morell
- Department of Neurosurgery, University of Miami, FL, USA
| | | | - Evan Luther
- Department of Neurosurgery, University of Miami, FL, USA
| | | | - Alexa Semonche
- Department of Neurosurgery, University of Miami, FL, USA
| | - Michael E Ivan
- Department of Neurosurgery, University of Miami, FL, USA
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14
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Thust SC, van den Bent MJ, Smits M. Pseudoprogression of brain tumors. J Magn Reson Imaging 2018; 48:571-589. [PMID: 29734497 PMCID: PMC6175399 DOI: 10.1002/jmri.26171] [Citation(s) in RCA: 178] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 04/07/2018] [Indexed: 12/11/2022] Open
Abstract
This review describes the definition, incidence, clinical implications, and magnetic resonance imaging (MRI) findings of pseudoprogression of brain tumors, in particular, but not limited to, high-grade glioma. Pseudoprogression is an important clinical problem after brain tumor treatment, interfering not only with day-to-day patient care but also the execution and interpretation of clinical trials. Radiologically, pseudoprogression is defined as a new or enlarging area(s) of contrast agent enhancement, in the absence of true tumor growth, which subsides or stabilizes without a change in therapy. The clinical definitions of pseudoprogression have been quite variable, which may explain some of the differences in reported incidences, which range from 9-30%. Conventional structural MRI is insufficient for distinguishing pseudoprogression from true progressive disease, and advanced imaging is needed to obtain higher levels of diagnostic certainty. Perfusion MRI is the most widely used imaging technique to diagnose pseudoprogression and has high reported diagnostic accuracy. Diagnostic performance of MR spectroscopy (MRS) appears to be somewhat higher, but MRS is less suitable for the routine and universal application in brain tumor follow-up. The combination of MRS and diffusion-weighted imaging and/or perfusion MRI seems to be particularly powerful, with diagnostic accuracy reaching up to or even greater than 90%. While diagnostic performance can be high with appropriate implementation and interpretation, even a combination of techniques, however, does not provide 100% accuracy. It should also be noted that most studies to date are small, heterogeneous, and retrospective in nature. Future improvements in diagnostic accuracy can be expected with harmonization of acquisition and postprocessing, quantitative MRI and computer-aided diagnostic technology, and meticulous evaluation with clinical and pathological data. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018.
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Affiliation(s)
- Stefanie C. Thust
- Lysholm Neuroradiology DepartmentNational Hospital for Neurology and NeurosurgeryLondonUK
- Department of Brain Rehabilitation and RepairUCL Institute of NeurologyLondonUK
- Imaging DepartmentUniversity College London HospitalLondonUK
| | - Martin J. van den Bent
- Department of NeurologyThe Brain Tumor Centre at Erasmus MC Cancer InstituteRotterdamThe Netherlands
| | - Marion Smits
- Department of Radiology and Nuclear Medicine, Erasmus MCUniversity Medical Centre RotterdamRotterdamThe Netherlands
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15
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Mehta S, Shah A, Jung H. Diagnosis and treatment options for sequelae following radiation treatment of brain tumors. Clin Neurol Neurosurg 2017; 163:1-8. [DOI: 10.1016/j.clineuro.2017.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 10/18/2022]
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16
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Leiva-Salinas C, Schiff D, Flors L, Patrie JT, Rehm PK. FDG PET/MR Imaging Coregistration Helps Predict Survival in Patients with Glioblastoma and Radiologic Progression after Standard of Care Treatment. Radiology 2016; 283:508-514. [PMID: 28234553 DOI: 10.1148/radiol.2016161172] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Purpose To determine the correlation between metabolic activity at fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) and survival in patients with glioblastoma and suspected progression at posttherapy magnetic resonance (MR) imaging. Materials and Methods The authors retrospectively examined the relationship between metabolic activity at FDG PET in the residual lesion identified at brain MR imaging and survival time in 56 patients with glioblastoma who were treated with postoperative concurrent radiation and temozolomide therapy and who underwent FDG PET/computed tomography because of radiologic deterioration at follow-up MR imaging between 2006 and 2015. A normalized metric of metabolic activity in the residual lesion (standardized uptake value ratio [SUVr]) was calculated as the maximum standardized uptake value (SUVmax) in the tumor relative to that in healthy white matter. The primary end point of the study was survival time from PET. Patients were stratified according to SUVr. Comparisons of risk for death between subgroups were made with the log-hazard ratio of the Cox proportional hazard model. Results There was a significant association between overall survival and SUVr in the residual lesion (P = .006), and a survival benefit was observed in patients with SUVr of less than 1.7, who had a median survival time of 23.1 months (95% confidence interval [CI]: 12.7, 38.9), which was significantly longer than that in patients with an SUVr of 2.0 to less than 2.5 and those with an SUVr of at least 2.5, who had a median survival time of 10.1 (95% CI: 2.4, 15.9; P = .008) and 7.5 (95% CI: 3.9, 9.7; P < .001) months, respectively. Conclusion Patients with glioblastoma whose posttherapy MR images showed a residual lesion with high relative metabolic activity at FDG PET had a shorter survival time than did those with low activity at FDG PET. © RSNA, 2016.
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Affiliation(s)
- Carlos Leiva-Salinas
- From the Department of Radiology (C.L.S., L.F., P.K.R.), Department of Neurology, Neuro-Oncology Center (D.S.), and Department of Public Health Sciences (J.T.P.), University of Virginia, 1215 Lee St, Charlottesville, VA 22908
| | - David Schiff
- From the Department of Radiology (C.L.S., L.F., P.K.R.), Department of Neurology, Neuro-Oncology Center (D.S.), and Department of Public Health Sciences (J.T.P.), University of Virginia, 1215 Lee St, Charlottesville, VA 22908
| | - Lucia Flors
- From the Department of Radiology (C.L.S., L.F., P.K.R.), Department of Neurology, Neuro-Oncology Center (D.S.), and Department of Public Health Sciences (J.T.P.), University of Virginia, 1215 Lee St, Charlottesville, VA 22908
| | - James T Patrie
- From the Department of Radiology (C.L.S., L.F., P.K.R.), Department of Neurology, Neuro-Oncology Center (D.S.), and Department of Public Health Sciences (J.T.P.), University of Virginia, 1215 Lee St, Charlottesville, VA 22908
| | - Patrice K Rehm
- From the Department of Radiology (C.L.S., L.F., P.K.R.), Department of Neurology, Neuro-Oncology Center (D.S.), and Department of Public Health Sciences (J.T.P.), University of Virginia, 1215 Lee St, Charlottesville, VA 22908
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