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van Dorth D, Jiang FY, Schmitz-Abecassis B, Croese RJI, Taphoorn MJB, Smits M, Koekkoek JAF, Dirven L, de Bresser J, van Osch MJP. Influence of arterial transit time delays on the differentiation between tumor progression and pseudoprogression in glioblastoma by arterial spin labeling magnetic resonance imaging. NMR IN BIOMEDICINE 2024:e5166. [PMID: 38654579 DOI: 10.1002/nbm.5166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/26/2024]
Abstract
Arterial spin labeling (ASL) and dynamic susceptibility contrast (DSC) magnetic resonance imaging (MRI) have shown potential for differentiating tumor progression from pseudoprogression. For pseudocontinuous ASL with a single postlabeling delay, the presence of delayed arterial transit times (ATTs) could affect the evaluation of ASL-MRI perfusion data. In this study, the influence of ATT artifacts on the perfusion assessment and differentiation between tumor progression and pseudoprogression were studied. This study comprised 66 adult patients (mean age 60 ± 13 years; 40 males) with a histologically confirmed glioblastoma who received postoperative radio (chemo)therapy. ASL-MRI and DSC-MRI scans were acquired at 3 months postradiotherapy as part of the standard clinical routine. These scans were visually scored regarding (i) the severity of ATT artifacts (%) on the ASL-MRI scans only, scored by two neuroradiologists; (ii) perfusion of the enhancing tumor lesion; and (iii) radiological evaluation of tumor progression versus pseudoprogression by one neuroradiologist. The final outcome was based on combined clinical and radiological follow-up until 9 months postradiotherapy. ATT artifacts were identified in all patients based on the mean scores of two raters. A significant difference between the radiological evaluation of ASL-MRI and DSC-MRI was observed only for ASL images with moderate ATT severity (30%-65%). The perfusion assessment showed ASL-MRI tending more towards hyperperfusion than DSC-MRI in the case of moderate ATT artifacts. In addition, there was a significant difference between the prediction of tumor progression with ASL-MRI and the final outcome in the case of severe ATT artifacts (McNemar test, p = 0.041). Despite using ASL imaging parameters close to the recommended settings, ATT artifacts frequently occur in patients with treated brain tumors. Those artifacts could hinder the radiological evaluation of ASL-MRI data and the detection of true disease progression, potentially affecting treatment decisions for patients with glioblastoma.
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Affiliation(s)
- Daniëlle van Dorth
- C. J. Gorter MRI Center, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Feng Yan Jiang
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Radiology, HagaZiekenhuis, Den Haag, The Netherlands
| | - Bárbara Schmitz-Abecassis
- C. J. Gorter MRI Center, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Medical Delta, Delft, The Netherlands
| | - Robert J I Croese
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, Den Haag, The Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, Den Haag, The Netherlands
| | - Marion Smits
- Medical Delta, Delft, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Johan A F Koekkoek
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, Den Haag, The Netherlands
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, Den Haag, The Netherlands
| | - Jeroen de Bresser
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Matthias J P van Osch
- C. J. Gorter MRI Center, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Medical Delta, Delft, The Netherlands
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2
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Martucci M, Russo R, Giordano C, Schiarelli C, D’Apolito G, Tuzza L, Lisi F, Ferrara G, Schimperna F, Vassalli S, Calandrelli R, Gaudino S. Advanced Magnetic Resonance Imaging in the Evaluation of Treated Glioblastoma: A Pictorial Essay. Cancers (Basel) 2023; 15:3790. [PMID: 37568606 PMCID: PMC10417432 DOI: 10.3390/cancers15153790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/14/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
MRI plays a key role in the evaluation of post-treatment changes, both in the immediate post-operative period and during follow-up. There are many different treatment's lines and many different neuroradiological findings according to the treatment chosen and the clinical timepoint at which MRI is performed. Structural MRI is often insufficient to correctly interpret and define treatment-related changes. For that, advanced MRI modalities, including perfusion and permeability imaging, diffusion tensor imaging, and magnetic resonance spectroscopy, are increasingly utilized in clinical practice to characterize treatment effects more comprehensively. This article aims to provide an overview of the role of advanced MRI modalities in the evaluation of treated glioblastomas. For a didactic purpose, we choose to divide the treatment history in three main timepoints: post-surgery, during Stupp (first-line treatment) and at recurrence (second-line treatment). For each, a brief introduction, a temporal subdivision (when useful) or a specific drug-related paragraph were provided. Finally, the current trends and application of radiomics and artificial intelligence (AI) in the evaluation of treated GB have been outlined.
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Affiliation(s)
- Matia Martucci
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico “A. Gemelli” IRCCS, 00168 Rome, Italy; (R.R.); (C.G.); (C.S.); (G.D.); (R.C.); (S.G.)
| | - Rosellina Russo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico “A. Gemelli” IRCCS, 00168 Rome, Italy; (R.R.); (C.G.); (C.S.); (G.D.); (R.C.); (S.G.)
| | - Carolina Giordano
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico “A. Gemelli” IRCCS, 00168 Rome, Italy; (R.R.); (C.G.); (C.S.); (G.D.); (R.C.); (S.G.)
| | - Chiara Schiarelli
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico “A. Gemelli” IRCCS, 00168 Rome, Italy; (R.R.); (C.G.); (C.S.); (G.D.); (R.C.); (S.G.)
| | - Gabriella D’Apolito
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico “A. Gemelli” IRCCS, 00168 Rome, Italy; (R.R.); (C.G.); (C.S.); (G.D.); (R.C.); (S.G.)
| | - Laura Tuzza
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.T.); (F.L.); (G.F.); (F.S.); (S.V.)
| | - Francesca Lisi
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.T.); (F.L.); (G.F.); (F.S.); (S.V.)
| | - Giuseppe Ferrara
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.T.); (F.L.); (G.F.); (F.S.); (S.V.)
| | - Francesco Schimperna
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.T.); (F.L.); (G.F.); (F.S.); (S.V.)
| | - Stefania Vassalli
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.T.); (F.L.); (G.F.); (F.S.); (S.V.)
| | - Rosalinda Calandrelli
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico “A. Gemelli” IRCCS, 00168 Rome, Italy; (R.R.); (C.G.); (C.S.); (G.D.); (R.C.); (S.G.)
| | - Simona Gaudino
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico “A. Gemelli” IRCCS, 00168 Rome, Italy; (R.R.); (C.G.); (C.S.); (G.D.); (R.C.); (S.G.)
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.T.); (F.L.); (G.F.); (F.S.); (S.V.)
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Mei N, Lu Y, Yang S, Jiang S, Ruan Z, Wang D, Liu X, Ying Y, Li X, Yin B. Oligodendrocyte Transcription Factor 2 as a Potential Prognostic Biomarker of Glioblastoma: Kaplan-Meier Analysis and the Development of a Binary Predictive Model Based on Visually Accessible Rembrandt Image and Magnetic Resonance Imaging Radiomic Features. J Comput Assist Tomogr 2023; Publish Ahead of Print:00004728-990000000-00157. [PMID: 37380154 DOI: 10.1097/rct.0000000000001454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
OBJECTIVE Oligodendrocyte transcription factor 2 (OLIG2) is universally expressed in human glioblastoma (GB). Our study explores whether OLIG2 expression impacts GB patients' overall survival and establishes a machine learning model for OLIG2 level prediction in patients with GB based on clinical, semantic, and magnetic resonance imaging radiomic features. METHODS Kaplan-Meier analysis was used to determine the optimal cutoff value of the OLIG2 in 168 GB patients. Three hundred thirteen patients enrolled in the OLIG2 prediction model were randomly divided into training and testing sets in a ratio of 7:3. The radiomic, semantic, and clinical features were collected for each patient. Recursive feature elimination (RFE) was used for feature selection. The random forest (RF) model was built and fine-tuned, and the area under the curve was calculated to evaluate the performance. Finally, a new testing set excluding IDH-mutant patients was built and tested in a predictive model using the fifth edition of the central nervous system tumor classification criteria. RESULTS One hundred nineteen patients were included in the survival analysis. Oligodendrocyte transcription factor 2 was positively associated with GB survival, with an optimal cutoff of 10% (P = 0.00093). One hundred thirty-four patients were eligible for the OLIG2 prediction model. An RFE-RF model based on 2 semantic and 21 radiomic signatures achieved areas under the curve of 0.854 in the training set, 0.819 in the testing set, and 0.825 in the new testing set. CONCLUSIONS Glioblastoma patients with ≤10% OLIG2 expression tended to have worse overall survival. An RFE-RF model integrating 23 features can predict the OLIG2 level of GB patients preoperatively, irrespective of the central nervous system classification criteria, further guiding individualized treatment.
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Affiliation(s)
- Nan Mei
- From the Departments of Radiology
| | | | | | | | | | | | - Xiujuan Liu
- Pathology, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | | | | | - Bo Yin
- From the Departments of Radiology
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Martucci M, Russo R, Schimperna F, D’Apolito G, Panfili M, Grimaldi A, Perna A, Ferranti AM, Varcasia G, Giordano C, Gaudino S. Magnetic Resonance Imaging of Primary Adult Brain Tumors: State of the Art and Future Perspectives. Biomedicines 2023; 11:biomedicines11020364. [PMID: 36830900 PMCID: PMC9953338 DOI: 10.3390/biomedicines11020364] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/20/2023] [Accepted: 01/22/2023] [Indexed: 01/28/2023] Open
Abstract
MRI is undoubtedly the cornerstone of brain tumor imaging, playing a key role in all phases of patient management, starting from diagnosis, through therapy planning, to treatment response and/or recurrence assessment. Currently, neuroimaging can describe morphologic and non-morphologic (functional, hemodynamic, metabolic, cellular, microstructural, and sometimes even genetic) characteristics of brain tumors, greatly contributing to diagnosis and follow-up. Knowing the technical aspects, strength and limits of each MR technique is crucial to correctly interpret MR brain studies and to address clinicians to the best treatment strategy. This article aimed to provide an overview of neuroimaging in the assessment of adult primary brain tumors. We started from the basilar role of conventional/morphological MR sequences, then analyzed, one by one, the non-morphological techniques, and finally highlighted future perspectives, such as radiomics and artificial intelligence.
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Affiliation(s)
- Matia Martucci
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico “A. Gemelli” IRCCS, 00168 Rome, Italy
- Correspondence:
| | - Rosellina Russo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico “A. Gemelli” IRCCS, 00168 Rome, Italy
| | | | - Gabriella D’Apolito
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Marco Panfili
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Alessandro Grimaldi
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Alessandro Perna
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | | | - Giuseppe Varcasia
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Carolina Giordano
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Simona Gaudino
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico “A. Gemelli” IRCCS, 00168 Rome, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Alom Z, Tran QT, Bag AK, Lucas JT, Orr BA. Predicting methylation class from diffusely infiltrating adult gliomas using multimodality MRI data. Neurooncol Adv 2023; 5:vdad045. [PMID: 37215955 PMCID: PMC10195196 DOI: 10.1093/noajnl/vdad045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
Background Radiogenomic studies of adult-type diffuse gliomas have used magnetic resonance imaging (MRI) data to infer tumor attributes, including abnormalities such as IDH-mutation status and 1p19q deletion. This approach is effective but does not generalize to tumor types that lack highly recurrent alterations. Tumors have intrinsic DNA methylation patterns and can be grouped into stable methylation classes even when lacking recurrent mutations or copy number changes. The purpose of this study was to prove the principle that a tumor's DNA-methylation class could be used as a predictive feature for radiogenomic modeling. Methods Using a custom DNA methylation-based classification model, molecular classes were assigned to diffuse gliomas in The Cancer Genome Atlas (TCGA) dataset. We then constructed and validated machine learning models to predict a tumor's methylation family or subclass from matched multisequence MRI data using either extracted radiomic features or directly from MRI images. Results For models using extracted radiomic features, we demonstrated top accuracies above 90% for predicting IDH-glioma and GBM-IDHwt methylation families, IDH-mutant tumor methylation subclasses, or GBM-IDHwt molecular subclasses. Classification models utilizing MRI images directly demonstrated average accuracies of 80.6% for predicting methylation families, compared to 87.2% and 89.0% for differentiating IDH-mutated astrocytomas from oligodendrogliomas and glioblastoma molecular subclasses, respectively. Conclusions These findings demonstrate that MRI-based machine learning models can effectively predict the methylation class of brain tumors. Given appropriate datasets, this approach could generalize to most brain tumor types, expanding the number and types of tumors that could be used to develop radiomic or radiogenomic models.
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Affiliation(s)
- Zahangir Alom
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Quynh T Tran
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Asim K Bag
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - John T Lucas
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Brent A Orr
- Corresponding Author: Brent A. Orr MD, PhD, Department of Pathology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, MS 250, Memphis, TN 38-105-3678, USA ()
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Gahrmann R, Smits M, Vernhout RM, Taal W, Kapsas G, de Groot JC, Hanse M, Vos M, Beerepoot LV, Buter J, Flach ZH, van der Holt B, van den Bent M. The impact of different volumetric thresholds to determine progressive disease in patients with recurrent glioblastoma treated with bevacizumab. Neurooncol Adv 2022; 4:vdac032. [PMID: 35419519 PMCID: PMC9000300 DOI: 10.1093/noajnl/vdac032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The optimal volumetric threshold for determining progressive disease (PD) in recurrent glioblastoma is yet to be determined. We investigated a range of thresholds in association with overall survival (OS). Methods First recurrent glioblastoma patients treated with bevacizumab and/or lomustine were included from the phase II BELOB and phase III EORTC26101 trials. Enhancing and nonenhancing tumor volumes were measured at baseline, first (6 weeks), and second (12 weeks) follow-up. Hazard ratios (HRs) for the appearance of new lesions and several thresholds for tumor volume increase were calculated using cox regression analysis. Results were corrected in a multivariate analysis for well-established prognostic factors. Results At first and second follow-up, 138 and 94 patients respectively, were deemed eligible for analysis of enhancing volumes, while 89 patients were included in the analysis of nonenhancing volumes at first follow-up. New lesions were associated with a significantly worse OS (3.2 versus 11.2 months, HR = 7.03, P < .001). At first follow-up a threshold of enhancing volume increase of ≥20% provided the highest HR (5.55, p = .001. At second follow-up, any increase in enhancing volume (≥0%) provided the highest HR (9.00, p < .001). When measuring nonenhancing volume at first follow-up, only 6 additional patients were scored as PD with the highest HR of ≥25% increase in volume (HR=3.25, p = .008). Conclusion Early appearing new lesions were associated with poor OS. Lowering the volumetric threshold for PD at both first and second follow-up improved survival prediction. However, the additional number of patients categorized as PD by lowering the threshold was very low. The per-RANO added change in nonenhancing volumes to the analyses was of limited value.
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Affiliation(s)
- Renske Gahrmann
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Marion Smits
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - René Michel Vernhout
- Clinical Trial Center, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Walter Taal
- The Brain Tumor Center at Erasmus MC Cancer Institute Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Giorgios Kapsas
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Jan Cees de Groot
- Department of Radiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Monique Hanse
- Department of Neurology, Catharina Hospital Eindhoven, The Netherlands
| | - Maaike Vos
- Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands
| | | | - Jan Buter
- Department of Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Bronno van der Holt
- Clinical Trial Center, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Martin van den Bent
- The Brain Tumor Center at Erasmus MC Cancer Institute Erasmus University Medical Center, Rotterdam, The Netherlands
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Wu C, Zheng H, Li J, Zhang Y, Duan S, Li Y, Wang D. MRI-based radiomics signature and clinical factor for predicting H3K27M mutation in pediatric high-grade gliomas located in the midline of the brain. Eur Radiol 2022; 32:1813-1822. [PMID: 34655310 DOI: 10.1007/s00330-021-08234-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/11/2021] [Accepted: 07/26/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To develop a nomogram based on MRI radiomics and clinical features for preoperatively predicting H3K27M mutation in pediatric high-grade gliomas (pHGGs) with a midline location of the brain. METHODS The institutional database was reviewed to identify patients with pHGGs with a midline location of the brain who underwent tumor biopsy with preoperative MRI scans between June 2016 and June 2021. A total of 107 patients with pHGGs, including 79 patients with H3K27M mutation, were consecutively included and randomly divided into training and test sets. Radiomics features were extracted from fluid-attenuated inversion recovery (FLAIR), diffusion-weighted (DW) and post-contrast T1-weighted images, and apparent diffusion coefficient (ADC) maps. The minimum redundancy maximum relevance (MRMR) and least absolute shrinkage and selection operator (LASSO) logistic regression were performed for radiomics signature construction. Clinical and radiological features were analyzed to select clinical predictors. A nomogram was then developed by incorporating the radiomics signature and selected clinical predictors. RESULTS Nine radiomics features were selected to construct the radiomics signature, which showed a favorable discriminatory ability in training and test sets with an area under the curve (AUC) of 0.95 and 0.92, respectively. Ring enhancement was identified as an independent clinical predictor (p < 0.01). The nomogram, constructed with radiomics signature and ring enhancement, showed good calibration and discrimination in training and testing sets (AUC: 0.95 and 0.90 respectively). CONCLUSIONS The nomogram which combined radiomics signature and ring enhancement had a satisfactory ability to predict H3K27M mutation in pHGGs with a midline of the brain. KEY POINTS • Conventional MRI features were not powerful enough to predict H3K27M mutation status in pediatric high-grade gliomas (pHGGs) with a midline location of the brain. • An MRI-based radiomics signature showed satisfactory ability to predict H3K27M mutation status of pHGGs located in the midline of the brain. • Associating the radiomics signature with clinical factors improved predictive performance.
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Affiliation(s)
- Chenqing Wu
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Hui Zheng
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Jinning Li
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Yuzhen Zhang
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Shaofeng Duan
- GE Healthcare, Pudong New Town, No.1 Huatuo Road, Shanghai, 210000, China
| | - Yuhua Li
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Dengbin Wang
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China.
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8
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Werner JM, Weller J, Ceccon G, Schaub C, Tscherpel C, Lohmann P, Bauer EK, Schäfer N, Stoffels G, Baues C, Celik E, Marnitz S, Kabbasch C, Gielen GH, Fink GR, Langen KJ, Herrlinger U, Galldiks N. Diagnosis of Pseudoprogression Following Lomustine-Temozolomide Chemoradiation in Newly Diagnosed Glioblastoma Patients Using FET-PET. Clin Cancer Res 2021; 27:3704-3713. [PMID: 33947699 DOI: 10.1158/1078-0432.ccr-21-0471] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/15/2021] [Accepted: 04/28/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE The CeTeG/NOA-09 phase III trial demonstrated a significant survival benefit of lomustine-temozolomide chemoradiation in patients with newly diagnosed glioblastoma with methylated O6-methylguanine-DNA methyltransferase (MGMT) promoter. Following lomustine-temozolomide chemoradiation, late and prolonged pseudoprogression may occur. We here evaluated the value of amino acid PET using O-(2-[18F]fluoroethyl)-l-tyrosine (FET) for differentiating pseudoprogression from tumor progression. EXPERIMENTAL DESIGN We retrospectively identified patients (i) who were treated off-study according to the CeTeG/NOA-09 protocol, (ii) had equivocal MRI findings after radiotherapy, and (iii) underwent additional FET-PET imaging for diagnostic evaluation (number of scans, 1-3). Maximum and mean tumor-to-brain ratios (TBRmax, TBRmean) and dynamic FET uptake parameters (e.g., time-to-peak) were calculated. In patients with more than one FET-PET scan, relative changes of TBR values were evaluated, that is, an increase or decrease of >10% compared with the reference scan was considered as tumor progression or pseudoprogression. Diagnostic performances were evaluated using ROC curve analyses and Fisher exact test. Diagnoses were confirmed histologically or clinicoradiologically. RESULTS We identified 23 patients with 32 FET-PET scans. Within 5-25 weeks after radiotherapy (median time, 9 weeks), pseudoprogression occurred in 11 patients (48%). The parameter TBRmean calculated from the FET-PET performed 10 ± 7 days after the equivocal MRI showed the highest accuracy (87%) to identify pseudoprogression (threshold, <1.95; P = 0.029). The integration of relative changes of TBRmean further improved the accuracy (91%; P < 0.001). Moreover, the combination of static and dynamic parameters increased the specificity to 100% (P = 0.005). CONCLUSIONS The data suggest that FET-PET parameters are of significant clinical value to diagnose pseudoprogression related to lomustine-temozolomide chemoradiation.
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Affiliation(s)
- Jan-Michael Werner
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Johannes Weller
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Garry Ceccon
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christina Schaub
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Caroline Tscherpel
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Philipp Lohmann
- Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany.,Department of Stereotaxy and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Elena K Bauer
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Niklas Schäfer
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Gabriele Stoffels
- Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany
| | - Christian Baues
- Department of Radiation Oncology and Cyberknife Center, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Eren Celik
- Department of Radiation Oncology and Cyberknife Center, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Simone Marnitz
- Department of Radiation Oncology and Cyberknife Center, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.,Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
| | - Christoph Kabbasch
- Department of Neuroradiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gerrit H Gielen
- Institute of Neuropathology, University Hospital Bonn, Bonn, Germany
| | - Gereon R Fink
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany.,Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany.,Department of Nuclear Medicine, University Hospital Aachen, Aachen, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
| | - Norbert Galldiks
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany.,Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
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9
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Schidlowski M, Stirnberg R, Stöcker T, Rüber T. Reliability of quantitative transverse relaxation time mapping with [Formula: see text]-prepared whole brain pCASL. Sci Rep 2020; 10:18299. [PMID: 33110203 PMCID: PMC7592060 DOI: 10.1038/s41598-020-74680-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/29/2020] [Indexed: 01/21/2023] Open
Abstract
Arterial spin labeling (ASL) is increasingly applied for cerebral blood flow mapping, but [Formula: see text] relaxation of the ASL signal magnetization is often ignored, although it may be clinically relevant. To investigate the extent, to which quantitative [Formula: see text] values in gray matter (GM) obtained by pseudocontinuous ASL (pCASL) perfusion MRI can be reproduced, are reliable and a potential neuroscientific biomarker, a prospective study was performed with ten healthy volunteers (5F,28 ± 3y) at a 3 T scanner. A [Formula: see text]-prepared pCASL sequence enabled the measurement of quantitative [Formula: see text] and perfusion maps. [Formula: see text] times were modeled per voxel and analyzed within four GM-regions-of-interest (ROI). The intraclass correlation coefficients (ICCs) of the quantified ASL-[Formula: see text] varied across brain regions. When averaged across subjects and postlabeling delays (PLDs), the ICCs ranged from reasonable values in parietal regions (ICC = 0.56) to smaller values in frontal regions (ICC = 0.36). Corresponding subject-averaged within-subject coefficients of variation (WSCVs) showed good test-retest measurement precision ([Formula: see text] for all PLDs), but more pronounced inter-subject variance. Reliability and precision of quantified ASL-[Formula: see text] were region-, PLD- and subject-specific, showing fair to robust results in occipital, parietal and temporal ROIs. The results give rise to consider the method for future cerebral studies, where variable perfusion or altered [Formula: see text] times are suspected.
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Affiliation(s)
- Martin Schidlowski
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | | | - Tony Stöcker
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department for Physics and Astronomy, University of Bonn, Bonn, Germany
| | - Theodor Rüber
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt/Main, Germany
- Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt/Main, Germany
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10
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Erker C, Tamrazi B, Poussaint TY, Mueller S, Mata-Mbemba D, Franceschi E, Brandes AA, Rao A, Haworth KB, Wen PY, Goldman S, Vezina G, MacDonald TJ, Dunkel IJ, Morgan PS, Jaspan T, Prados MD, Warren KE. Response assessment in paediatric high-grade glioma: recommendations from the Response Assessment in Pediatric Neuro-Oncology (RAPNO) working group. Lancet Oncol 2020; 21:e317-e329. [PMID: 32502458 DOI: 10.1016/s1470-2045(20)30173-x] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/05/2020] [Accepted: 03/12/2020] [Indexed: 12/27/2022]
Abstract
Response criteria for paediatric high-grade glioma vary historically and across different cooperative groups. The Response Assessment in Neuro-Oncology working group developed response criteria for adult high-grade glioma, but these were not created to meet the unique challenges in children with the disease. The Response Assessment in Pediatric Neuro-Oncology (RAPNO) working group, consisting of an international panel of paediatric and adult neuro-oncologists, clinicians, radiologists, radiation oncologists, and neurosurgeons, was established to address issues and unique challenges in assessing response in children with CNS tumours. We established a subcommittee to develop response assessment criteria for paediatric high-grade glioma. Current practice and literature were reviewed to identify major challenges in assessing the response of paediatric high-grade gliomas to various treatments. For areas in which scientific investigation was scarce, consensus was reached through an iterative process. RAPNO response assessment recommendations include the use of MRI of the brain and the spine, assessment of clinical status, and the use of corticosteroids or antiangiogenics. Imaging standards for brain and spine are defined. Compared with the recommendations for the management of adult high-grade glioma, for paediatrics there is inclusion of diffusion-weighted imaging and a higher reliance on T2-weighted fluid-attenuated inversion recovery. Consensus recommendations and response definitions have been established and, similar to other RAPNO recommendations, prospective validation in clinical trials is warranted.
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Affiliation(s)
- Craig Erker
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Dalhousie University and IWK Health Centre, Halifax, NS, Canada.
| | - Benita Tamrazi
- Department of Radiology, Keck School of Medicine, University of Southern California and Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Tina Y Poussaint
- Department of Radiology, Boston Children's Hospital, Boston, MA, USA
| | - Sabine Mueller
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA; Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA; Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA
| | - Daddy Mata-Mbemba
- Department of Diagnostic Imaging, Dalhousie University and IWK Health Centre, Halifax, NS, Canada
| | - Enrico Franceschi
- Department of Medical Oncology, Azienda USL, Bologna, Italy; IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Alba A Brandes
- Department of Medical Oncology, Azienda USL, Bologna, Italy; IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Arvind Rao
- Departments of Computational Medicine and Bioinformatics and Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Kellie B Haworth
- Division of Neuro-Oncology, Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Patrick Y Wen
- Center For Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Stewart Goldman
- Department of Haematology, Oncology, Neuro-Oncology, and Stem Cell Transplantation, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Gilbert Vezina
- Department of Radiology, Children's National Medical Center, Washington, DC, USA
| | - Tobey J MacDonald
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Ira J Dunkel
- Department of Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paul S Morgan
- Department of Medical Physics and Clinical Engineering, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK
| | - Tim Jaspan
- Department of Radiology, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK
| | - Michael D Prados
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA
| | - Katherine E Warren
- Department of Pediatric Oncology, Dana- Farber/Boston Children's Cancer and Blood Disorders Center, Dana-Farber Cancer Institute, Boston, MA, USA
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11
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Woodroffe RW, Zanaty M, Soni N, Mott SL, Helland LC, Pasha A, Maley J, Dhungana N, Jones KA, Monga V, Greenlee JDW. Survival after reoperation for recurrent glioblastoma. J Clin Neurosci 2020; 73:118-124. [PMID: 31987636 DOI: 10.1016/j.jocn.2020.01.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 11/30/2019] [Accepted: 01/04/2020] [Indexed: 10/25/2022]
Abstract
Determining which patients will benefit from reoperation for recurrent glioblastoma remains difficult and the impact of the volume of FLAIR signal hyperintensity is not well known. The primary purpose of this study is to analyze the impact of preoperative volume of FLAIR hyperintensity on prognosis. 37 patients who underwent a reoperation for recurrent glioblastoma after initial gross total resection followed by standard chemoradiation were retrospectively reviewed. Volumetric analysis of preoperative MR images from the initial and second surgery was performed and correlated with clinical data. Survival probabilities were estimated using the Kaplan-Meier method and Cox regression to assess the effect of risk factors on time to reoperation (TTR), progression-free survival (PFS) after reoperation, and overall survival (OS). The volumes of FLAIR signal hyperintensity prior to the initial surgery and reoperation were not associated with prognosis. TTR and OS were significantly affected by the preoperative enhancement volume at the initial surgery, with increasing volumes yielding poorer prognosis. Patients with tumor in critical/eloquent areas were found to have a worse prognosis. Median TTR was 11 months, median PFS after reoperation was 3 months, and OS in patients undergoing a reoperation was 21 months. The results suggest FLAIR signal change seen in patients with glioblastoma does not influence time to reoperation, progression-free survival, or overall survival. These findings suggest the amount of FLAIR signal change should not greatly influence a surgeon's decision to perform a second surgical resection compare to other factors, and when appropriate, aggressive surgical intervention should be considered.
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Affiliation(s)
- Royce W Woodroffe
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
| | - Mario Zanaty
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Neetu Soni
- Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Sarah L Mott
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | - Logan C Helland
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Arham Pasha
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Joan Maley
- Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Neha Dhungana
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Karra A Jones
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Varun Monga
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Jeremy D W Greenlee
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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12
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Kern M, Auer TA, Picht T, Misch M, Wiener E. T2 mapping of molecular subtypes of WHO grade II/III gliomas. BMC Neurol 2020; 20:8. [PMID: 31914945 PMCID: PMC6947951 DOI: 10.1186/s12883-019-1590-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 12/27/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND According to the new WHO classification from 2016, molecular profiles have shown to provide reliable information about prognosis and treatment response. The purpose of our study is to evaluate the diagnostic potential of non-invasive quantitative T2 mapping in the detection of IDH1/2 mutation status in grade II-III gliomas. METHODS Retrospective evaluation of MR examinations in 30 patients with histopathological proven WHO-grade II (n = 9) and III (n = 21) astrocytomas (18 IDH-mutated, 12 IDH-wildtype). Consensus annotation by two observers by use of ROI's in quantitative T2-mapping sequences were performed in all patients. T2 relaxation times were measured pixelwise. RESULTS A significant difference (p = 0,0037) between the central region of IDH-mutated tumors (356,83 ± 114,97 ms) and the IDH-wildtype (199,92 ± 53,13 ms) was found. Furthermore, relaxation times between the central region (322,62 ± 127,41 ms) and the peripheral region (211,1 ± 74,16 ms) of WHO grade II and III astrocytomas differed significantly (p = 0,0021). The central regions relaxation time of WHO-grade II (227,44 ± 80,09 ms) and III gliomas (322,62 ± 127,41 ms) did not differ significantly (p = 0,2276). The difference between the smallest and the largest T2 value (so called "range") is significantly larger (p = 0,0017) in IDH-mutated tumors (230,89 ± 121,11 ms) than in the IDH-wildtype (96,33 ± 101,46 ms). Interobserver variability showed no significant differences. CONCLUSIONS Quantitative evaluation of T2-mapping relaxation times shows significant differences regarding the IDH-status in WHO grade II and III gliomas adding important information regarding the new 2016 World Health Organization (WHO) Classification of tumors of the central nervous system. This to our knowledge is the first study regarding T2 mapping and the IDH1/2 status shows that the mutational status seems to be more important for the appearance on T2 images than the WHO grade.
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Affiliation(s)
- Maike Kern
- Department of Neuroradiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Timo Alexander Auer
- Department of Radiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Thomas Picht
- Department of Neurosurgery, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Martin Misch
- Department of Neurosurgery, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Edzard Wiener
- Department of Neuroradiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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13
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Zeiner PS, Kinzig M, Divé I, Maurer GD, Filipski K, Harter PN, Senft C, Bähr O, Hattingen E, Steinbach JP, Sörgel F, Voss M, Steidl E, Ronellenfitsch MW. Regorafenib CSF Penetration, Efficacy, and MRI Patterns in Recurrent Malignant Glioma Patients. J Clin Med 2019; 8:jcm8122031. [PMID: 31766326 PMCID: PMC6947028 DOI: 10.3390/jcm8122031] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 10/28/2019] [Accepted: 11/18/2019] [Indexed: 12/13/2022] Open
Abstract
(1) Background: The phase 2 Regorafenib in Relapsed Glioblastoma (REGOMA) trial indicated a survival benefit for patients with first recurrence of a glioblastoma when treated with the multikinase inhibitor regorafenib (REG) instead of lomustine. The aim of this retrospective study was to investigate REG penetration to cerebrospinal fluid (CSF), treatment efficacy, and effects on magnetic resonance imaging (MRI) in patients with recurrent high-grade gliomas. (2) Methods: Patients were characterized by histology, adverse events, steroid treatment, overall survival (OS), and MRI growth pattern. REG and its two active metabolites were quantified by liquid chromatography/tandem mass spectrometry in patients’ serum and CSF. (3) Results: 21 patients mainly with IDH-wildtype glioblastomas who had been treated with REG were retrospectively identified. Thirteen CFS samples collected from 3 patients of the cohort were available for pharmacokinetic testing. CSF levels of REG and its metabolites were significantly lower than in serum. Follow-up MRI was available in 19 patients and showed progressive disease (PD) in all but 2 patients. Two distinct MRI patterns were identified: 7 patients showed classic PD with progression of contrast enhancing lesions, whereas 11 patients showed a T2-dominant MRI pattern characterized by a marked reduction of contrast enhancement. Median OS was significantly better in patients with a T2-dominant growth pattern (10 vs. 27 weeks respectively, p = 0.003). Diffusion restrictions were observed in 13 patients. (4) Conclusion: REG and its metabolites were detectable in CSF. A distinct MRI pattern that might be associated with an improved OS was observed in half of the patient cohort. Treatment response in the total cohort was poor.
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Affiliation(s)
- Pia S. Zeiner
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany; (P.S.Z.); (I.D.); (G.D.M.); (O.B.); (J.P.S.); (M.V.)
- University Cancer Center (UCT) Frankfurt, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany; (K.F.); (P.N.H.); (E.H.); (E.S.)
- German Cancer Consortium (DKTK), 60590 Frankfurt am Main, Germany
- Frankfurt Cancer Institute (FCI), University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany
| | - Martina Kinzig
- IBMP—Institute for Biomedical and Pharmaceutical Research, 90562 Nürnberg-Heroldsberg, Germany; (M.K.); (F.S.)
| | - Iris Divé
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany; (P.S.Z.); (I.D.); (G.D.M.); (O.B.); (J.P.S.); (M.V.)
- University Cancer Center (UCT) Frankfurt, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany; (K.F.); (P.N.H.); (E.H.); (E.S.)
- German Cancer Consortium (DKTK), 60590 Frankfurt am Main, Germany
- Frankfurt Cancer Institute (FCI), University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany
| | - Gabriele D. Maurer
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany; (P.S.Z.); (I.D.); (G.D.M.); (O.B.); (J.P.S.); (M.V.)
- University Cancer Center (UCT) Frankfurt, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany; (K.F.); (P.N.H.); (E.H.); (E.S.)
| | - Katharina Filipski
- University Cancer Center (UCT) Frankfurt, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany; (K.F.); (P.N.H.); (E.H.); (E.S.)
- German Cancer Consortium (DKTK), 60590 Frankfurt am Main, Germany
- Institute of Neurology (Edinger-Institute), University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany
| | - Patrick N. Harter
- University Cancer Center (UCT) Frankfurt, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany; (K.F.); (P.N.H.); (E.H.); (E.S.)
- German Cancer Consortium (DKTK), 60590 Frankfurt am Main, Germany
- Frankfurt Cancer Institute (FCI), University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany
- Institute of Neurology (Edinger-Institute), University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany
| | - Christian Senft
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany;
| | - Oliver Bähr
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany; (P.S.Z.); (I.D.); (G.D.M.); (O.B.); (J.P.S.); (M.V.)
- Department of Neurology, Klinikum Aschaffenburg-Alzenau, 63739 Aschaffenburg, Germany
| | - Elke Hattingen
- University Cancer Center (UCT) Frankfurt, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany; (K.F.); (P.N.H.); (E.H.); (E.S.)
- German Cancer Consortium (DKTK), 60590 Frankfurt am Main, Germany
- Department of Neuroradiology, University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany
| | - Joachim P. Steinbach
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany; (P.S.Z.); (I.D.); (G.D.M.); (O.B.); (J.P.S.); (M.V.)
- University Cancer Center (UCT) Frankfurt, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany; (K.F.); (P.N.H.); (E.H.); (E.S.)
- German Cancer Consortium (DKTK), 60590 Frankfurt am Main, Germany
- Frankfurt Cancer Institute (FCI), University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany
| | - Fritz Sörgel
- IBMP—Institute for Biomedical and Pharmaceutical Research, 90562 Nürnberg-Heroldsberg, Germany; (M.K.); (F.S.)
- Institute of Pharmacology, University Duisburg-Essen, 45141 Essen, Germany
| | - Martin Voss
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany; (P.S.Z.); (I.D.); (G.D.M.); (O.B.); (J.P.S.); (M.V.)
- University Cancer Center (UCT) Frankfurt, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany; (K.F.); (P.N.H.); (E.H.); (E.S.)
- German Cancer Consortium (DKTK), 60590 Frankfurt am Main, Germany
- Frankfurt Cancer Institute (FCI), University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany
| | - Eike Steidl
- University Cancer Center (UCT) Frankfurt, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany; (K.F.); (P.N.H.); (E.H.); (E.S.)
- German Cancer Consortium (DKTK), 60590 Frankfurt am Main, Germany
- Department of Neuroradiology, University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany
| | - Michael W. Ronellenfitsch
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany; (P.S.Z.); (I.D.); (G.D.M.); (O.B.); (J.P.S.); (M.V.)
- University Cancer Center (UCT) Frankfurt, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany; (K.F.); (P.N.H.); (E.H.); (E.S.)
- German Cancer Consortium (DKTK), 60590 Frankfurt am Main, Germany
- Frankfurt Cancer Institute (FCI), University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany
- Correspondence: ; Tel.: +49-69-6301-87711; Fax: +49-69-6301-87713
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14
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Boxerman JL, Zhang Z, Safriel Y, Rogg JM, Wolf RL, Mohan S, Marques H, Sorensen AG, Gilbert MR, Barboriak DP. Prognostic value of contrast enhancement and FLAIR for survival in newly diagnosed glioblastoma treated with and without bevacizumab: results from ACRIN 6686. Neuro Oncol 2019; 20:1400-1410. [PMID: 29590461 DOI: 10.1093/neuonc/noy049] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background ACRIN 6686/RTOG 0825 was a phase III trial of conventional chemoradiation plus adjuvant temozolomide with bevacizumab or without (placebo) in newly diagnosed glioblastoma. This study investigated whether changes in contrast-enhancing and fluid attenuated inversion recovery (FLAIR)-hyperintense tumor assessed by central reading prognosticate overall survival (OS). Methods Two hundred eighty-four patients (171 men; median age 57 y, range 19-79; 159 on bevacizumab) had MRI at post-op (baseline) and pre-cycle 4 of adjuvant temozolomide (22 wk post chemoradiation initiation). Four central readers measured bidimensional lesion enhancement (2D-T1) and FLAIR hyperintensity at both time points. Changes from baseline to pre-cycle 4 for both markers were dichotomized (increasing vs non-increasing). Cox proportional hazards model and Kaplan-Meier survival estimates were used for inference. Results Adjusting for treatment, increasing 2D-T1 (n = 262, hazard ratio [HR] = 2.07, 95% CI: 1.48-2.91, P < 0.0001) and FLAIR (n = 273, HR = 1.75, 95% CI: 1.26-2.41, P = 0.0008) significantly predicted worse OS. Median OS (days) was significantly shorter for patients with increasing versus non-increasing 2D-T1 for both bevacizumab (443 vs 535, P = 0.004) and placebo (526 vs 887, P = 0.001). Median OS was significantly shorter for patients with increasing versus non-increasing FLAIR for placebo (595 vs 872, P = 0.001), and trended similarly for bevacizumab (499 vs 535, P = 0.0935). Adjusting for 2D-T1 and treatment, increasing FLAIR represented significantly higher risk for death (HR = 1.59 [1.11-2.26], P = 0.01). Conclusion Increased 2D-T1 significantly predicts worse OS in both treatment groups, implying absence of a substantial proportion of pseudoprogression 22 weeks after initiation of standard therapy. FLAIR adds value beyond 2D-T1 in predicting OS, potentially addressing the pseudoresponse effect by substratifying bevacizumab-treated patients with non-increasing 2D-T1.
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Affiliation(s)
- Jerrold L Boxerman
- Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island
| | - Zheng Zhang
- Center for Statistical Sciences, Brown University, Providence, Rhode Island
| | - Yair Safriel
- Pharmascan Clinical Trials and Radiology Associates of Clearwater-University of South Florida, Clearwater, Florida
| | - Jeffrey M Rogg
- Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island
| | - Ronald L Wolf
- Department of Radiology, Neuroradiology Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Suyash Mohan
- Department of Radiology, Neuroradiology Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Helga Marques
- Center for Statistical Sciences, Brown University, Providence, Rhode Island
| | - A Gregory Sorensen
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts.,IMRIS, Deerfield Imaging, Inc, Minnetonka, Minnesota
| | - Mark R Gilbert
- Department of Neuro-oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Neuro-Oncology Branch of the National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Daniel P Barboriak
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
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15
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Reulen HJ, Suero Molina E, Zeidler R, Gildehaus FJ, Böning G, Gosewisch A, Stummer W. Intracavitary radioimmunotherapy of high-grade gliomas: present status and future developments. Acta Neurochir (Wien) 2019; 161:1109-1124. [PMID: 30980242 DOI: 10.1007/s00701-019-03882-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 03/20/2019] [Indexed: 02/07/2023]
Abstract
There is a distinct need for new and second-line therapies to delay or prevent local tumor regrowth after current standard of care therapy. Intracavitary radioimmunotherapy, in combination with radiotherapy, is discussed in the present review as a therapeutic strategy of high potential. We performed a systematic literature search following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). The available body of literature on intracavitary radioimmunotherapy (iRIT) in glioblastoma and anaplastic astrocytomas is presented. Several past and current phase I and II clinical trials, using mostly an anti-tenascin monoclonal antibody labeled with I-131, have shown median overall survival of 19-25 months in glioblastoma, while adverse events remain low. Tenascin, followed by EGFR and variants, or smaller peptides have been used as targets, and most clinical studies were performed with I-131 or Y-90 as radionuclides while only recently Re-188, I-125, and Bi-213 were applied. The pharmacokinetics of iRIT, as well as the challenges encountered with this therapy, is comprehensively discussed. This promising approach deserves further exploration in future studies by incorporating several innovative modifications.
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Affiliation(s)
| | - Eric Suero Molina
- Department of Neurosurgery, University Hospital of Münster, Münster, Germany.
| | - Reinhard Zeidler
- Helmholtz-Zentrum Munich, German Research Center for Environmental Health, Research Group Gene Vectors, Munich, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, LMU Munich, Munich, Germany
| | | | - Guido Böning
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Astrid Gosewisch
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Walter Stummer
- Department of Neurosurgery, University Hospital of Münster, Münster, Germany
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Brognaro E. Glioblastoma Unique Features Drive the Ways for Innovative Therapies in the Trunk-branch Era. Folia Med (Plovdiv) 2019. [DOI: 10.3897/folmed.61.e34900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Glioblastoma multiforme is a solid tumor with particular aspects due to its organ of origin and its development modalities. The brain is very sensitive to oxygen and glucose deprivation and it is the only organ that cannot be either transplanted or entirely removed. Furthermore, many clues and recent indirect experimental evidence indicate that the micro-infiltration of the whole brain parenchyma occurs in very early stages of tumor bulk growth or likely even before. As a consequence, the primary glioblastoma (IDH-wildtype, WHO 2016) is the only tumor where the malignant (i.e. distantly infiltrating the organ of origin) and deadly (i.e. leading cause to patient’s death) phases coincide and overlap in one single phase of its natural history. To date, the prognosis of optimally treated glioblastoma patients remains dismal despite recent fundamental progress in neurosurgical techniques which are enabling better maximal safe resection and survival outcome. Intratumor variegated heterogeneity of glioblastoma bulk due to trunk-branch evolution and very early micro-infiltration and settlement of neoplastic cells in the entire brain parenchyma are the reasons for resistance to current therapeutic treatments. With the aim of future innovative and effective therapies, this paper deals with the unique glioblastoma features, the appropriate research methods as well as the strategies to follow to overcome current causes of resistance.
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Prasanna P, Mitra J, Beig N, Nayate A, Patel J, Ghose S, Thawani R, Partovi S, Madabhushi A, Tiwari P. Mass Effect Deformation Heterogeneity (MEDH) on Gadolinium-contrast T1-weighted MRI is associated with decreased survival in patients with right cerebral hemisphere Glioblastoma: A feasibility study. Sci Rep 2019; 9:1145. [PMID: 30718547 PMCID: PMC6362117 DOI: 10.1038/s41598-018-37615-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 12/04/2018] [Indexed: 12/04/2022] Open
Abstract
Subtle tissue deformations caused by mass-effect in Glioblastoma (GBM) are often not visually evident, and may cause neurological deficits, impacting survival. Radiomic features provide sub-visual quantitative measures to uncover disease characteristics. We present a new radiomic feature to capture mass effect-induced deformations in the brain on Gadolinium-contrast (Gd-C) T1w-MRI, and their impact on survival. Our rationale is that larger variations in deformation within functionally eloquent areas of the contralateral hemisphere are likely related to decreased survival. Displacements in the cortical and subcortical structures were measured by aligning the Gd-C T1w-MRI to a healthy atlas. The variance of deformation magnitudes was measured and defined as Mass Effect Deformation Heterogeneity (MEDH) within the brain structures. MEDH values were then correlated with overall-survival of 89 subjects on the discovery cohort, with tumors on the right (n = 41) and left (n = 48) cerebral hemispheres, and evaluated on a hold-out cohort (n = 49 subjects). On both cohorts, decreased survival time was found to be associated with increased MEDH in areas of language comprehension, social cognition, visual perception, emotion, somato-sensory, cognitive and motor-control functions, particularly in the memory areas in the left-hemisphere. Our results suggest that higher MEDH in functionally eloquent areas of the left-hemisphere due to GBM in the right-hemisphere may be associated with poor-survival.
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Affiliation(s)
- Prateek Prasanna
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, USA
| | - Jhimli Mitra
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, USA
- General Electric Global Research, New York, USA
| | - Niha Beig
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, USA
| | - Ameya Nayate
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Jay Patel
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, USA
| | - Soumya Ghose
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, USA
| | - Rajat Thawani
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, USA
| | - Sasan Partovi
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Anant Madabhushi
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, USA
| | - Pallavi Tiwari
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, USA.
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19
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Sarkaria JN, Hu LS, Parney IF, Pafundi DH, Brinkmann DH, Laack NN, Giannini C, Burns TC, Kizilbash SH, Laramy JK, Swanson KR, Kaufmann TJ, Brown PD, Agar NYR, Galanis E, Buckner JC, Elmquist WF. Is the blood-brain barrier really disrupted in all glioblastomas? A critical assessment of existing clinical data. Neuro Oncol 2019; 20:184-191. [PMID: 29016900 DOI: 10.1093/neuonc/nox175] [Citation(s) in RCA: 400] [Impact Index Per Article: 80.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The blood-brain barrier (BBB) excludes the vast majority of cancer therapeutics from normal brain. However, the importance of the BBB in limiting drug delivery and efficacy is controversial in high-grade brain tumors, such as glioblastoma (GBM). The accumulation of normally brain impenetrant radiographic contrast material in essentially all GBM has popularized a belief that the BBB is uniformly disrupted in all GBM patients so that consideration of drug distribution across the BBB is not relevant in designing therapies for GBM. However, contrary to this view, overwhelming clinical evidence demonstrates that there is also a clinically significant tumor burden with an intact BBB in all GBM, and there is little doubt that drugs with poor BBB permeability do not provide therapeutically effective drug exposures to this fraction of tumor cells. This review provides an overview of the clinical literature to support a central hypothesis: that all GBM patients have tumor regions with an intact BBB, and cure for GBM will only be possible if these regions of tumor are adequately treated.
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Affiliation(s)
- Jann N Sarkaria
- Mayo Clinic, Rochester, Minnesota (J.N.S., I.F.P., D.H.P., D.H.B., N.N.L., C.G., T.C.B., S.H.K., T.J.K., P.D.B., E.G., J.C.B.)
| | - Leland S Hu
- Mayo Clinic, Scottsdale, Arizona (L.S.H., K.R.S.)
| | - Ian F Parney
- Mayo Clinic, Rochester, Minnesota (J.N.S., I.F.P., D.H.P., D.H.B., N.N.L., C.G., T.C.B., S.H.K., T.J.K., P.D.B., E.G., J.C.B.)
| | - Deanna H Pafundi
- Mayo Clinic, Rochester, Minnesota (J.N.S., I.F.P., D.H.P., D.H.B., N.N.L., C.G., T.C.B., S.H.K., T.J.K., P.D.B., E.G., J.C.B.)
| | - Debra H Brinkmann
- Mayo Clinic, Rochester, Minnesota (J.N.S., I.F.P., D.H.P., D.H.B., N.N.L., C.G., T.C.B., S.H.K., T.J.K., P.D.B., E.G., J.C.B.)
| | - Nadia N Laack
- Mayo Clinic, Rochester, Minnesota (J.N.S., I.F.P., D.H.P., D.H.B., N.N.L., C.G., T.C.B., S.H.K., T.J.K., P.D.B., E.G., J.C.B.)
| | - Caterina Giannini
- Mayo Clinic, Rochester, Minnesota (J.N.S., I.F.P., D.H.P., D.H.B., N.N.L., C.G., T.C.B., S.H.K., T.J.K., P.D.B., E.G., J.C.B.)
| | - Terence C Burns
- Mayo Clinic, Rochester, Minnesota (J.N.S., I.F.P., D.H.P., D.H.B., N.N.L., C.G., T.C.B., S.H.K., T.J.K., P.D.B., E.G., J.C.B.)
| | - Sani H Kizilbash
- Mayo Clinic, Rochester, Minnesota (J.N.S., I.F.P., D.H.P., D.H.B., N.N.L., C.G., T.C.B., S.H.K., T.J.K., P.D.B., E.G., J.C.B.)
| | - Janice K Laramy
- University of Minnesota, Minneapolis, Minnesota (J.K.L., W.F.E.)
| | | | - Timothy J Kaufmann
- Mayo Clinic, Rochester, Minnesota (J.N.S., I.F.P., D.H.P., D.H.B., N.N.L., C.G., T.C.B., S.H.K., T.J.K., P.D.B., E.G., J.C.B.)
| | - Paul D Brown
- Mayo Clinic, Rochester, Minnesota (J.N.S., I.F.P., D.H.P., D.H.B., N.N.L., C.G., T.C.B., S.H.K., T.J.K., P.D.B., E.G., J.C.B.)
| | | | - Evanthia Galanis
- Mayo Clinic, Rochester, Minnesota (J.N.S., I.F.P., D.H.P., D.H.B., N.N.L., C.G., T.C.B., S.H.K., T.J.K., P.D.B., E.G., J.C.B.)
| | - Jan C Buckner
- Mayo Clinic, Rochester, Minnesota (J.N.S., I.F.P., D.H.P., D.H.B., N.N.L., C.G., T.C.B., S.H.K., T.J.K., P.D.B., E.G., J.C.B.)
| | - William F Elmquist
- Mayo Clinic, Rochester, Minnesota (J.N.S., I.F.P., D.H.P., D.H.B., N.N.L., C.G., T.C.B., S.H.K., T.J.K., P.D.B., E.G., J.C.B.)
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Förster A, Böhme J, Maros ME, Brehmer S, Seiz-Rosenhagen M, Hänggi D, Wenz F, Groden C, Pope WB, Giordano FA. Longitudinal MRI findings in patients with newly diagnosed glioblastoma after intraoperative radiotherapy. J Neuroradiol 2019; 47:166-173. [PMID: 30659892 DOI: 10.1016/j.neurad.2019.01.090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 12/31/2018] [Accepted: 01/14/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Post-radiation treatment effects (pseudoprogression/radionecrosis) may bias MRI-based tumor response evaluation. To understand these changes specifically after high doses of radiotherapy, we analyzed MRIs of patients enrolled in the INTRAGO study (NCT02104882), a phase I/II dose-escalation trial of intraoperative radiotherapy (20-40 Gy) in glioblastoma. METHODS INTRAGO patients were evaluated and compared to control patients who received standard therapy with focus on contrast enhancement patterns/volume, T2 lesion volume, and mean rCBV. RESULTS Overall, 11/15 (73.3%) INTRAGO patients (median age 60 years) were included. Distant failure was observed in 7/11 (63.6%) patients, local tumor recurrence in one patient (9.1%). On the first follow-up MRI all but one patient demonstrated enhancement of varying patterns around the resection cavity which were: in 2/11 (18.2%) patients thin and linear, in 7/11 (63.6%) combined linear and nodular, and in 1/11 (9.1%) voluminous, indistinct, and mesh-like. In the course of treatment, most patients developed the latter two patterns (8/11 [72.7%]). INTRAGO patients demonstrated more often combined linear and nodular and/or voluminous, indistinct, mesh-like components (8/11 [72.7%]) in comparison to control patients (3/12 [25%], P = 0.02). INTRAGO patients demonstrated significantly increasing enhancing lesion (P = 0.001) and T2 lesion volumes (P < 0.001) in the longitudinal non-parametric analysis in comparison to the control group. rCBV showed no significant differences between both groups. CONCLUSIONS High doses of radiotherapy to the tumor cavity result in more pronounced enhancement patterns/volumes and T2 lesion volumes. These results will be useful for the response evaluation of patients exposed to high doses of radiotherapy in future studies.
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Affiliation(s)
- Alex Förster
- Department of Neuroradiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany.
| | - Johannes Böhme
- Department of Neuroradiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Máté E Maros
- Department of Neuroradiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Stefanie Brehmer
- Department of Neurosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Marcel Seiz-Rosenhagen
- Department of Neurosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Frederik Wenz
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Christoph Groden
- Department of Neuroradiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Whitney B Pope
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Frank A Giordano
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany
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Vallatos A, Al-Mubarak HFI, Birch JL, Galllagher L, Mullin JM, Gilmour L, Holmes WM, Chalmers AJ. Quantitative histopathologic assessment of perfusion MRI as a marker of glioblastoma cell infiltration in and beyond the peritumoral edema region. J Magn Reson Imaging 2018; 50:529-540. [PMID: 30569620 DOI: 10.1002/jmri.26580] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/26/2018] [Accepted: 10/26/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Conventional MRI fails to detect regions of glioblastoma cell infiltration beyond the contrast-enhanced T1 solid tumor region, with infiltrating tumor cells often migrating along host blood vessels. PURPOSE To quantitatively and qualitatively analyze the correlation between perfusion MRI signal and tumor cell density in order to assess whether local perfusion perturbation could provide a useful biomarker of glioblastoma cell infiltration. STUDY TYPE Animal model. SUBJECTS Mice bearing orthotopic glioblastoma xenografts generated from a patient-derived glioblastoma cell line. FIELD STRENGTH/SEQUENCES 7T perfusion images acquired using a high signal-to-noise ratio (SNR) multiple boli arterial spin labeling sequence were compared with conventional MRI (T1 /T2 weighted, contrast-enhanced T1 , diffusion-weighted, and apparent diffusion coefficient). ASSESSMENT Immunohistochemistry sections were stained for human leukocyte antigen (probing human-derived tumor cells). To achieve quantitative MRI-tissue comparison, multiple histological slices cut in the MRI plane were stacked to produce tumor cell density maps acting as a "ground truth." STATISTICAL TESTS Sensitivity, specificity, accuracy, and Dice similarity indices were calculated and a two-tailed, paired t-test used for statistical analysis. RESULTS High comparison test results (Dice 0.62-0.72, Accuracy 0.86-0.88, Sensitivity 0.51-0.7, and Specificity 0.92-0.97) indicate a good segmentation for all imaging modalities and highlight the quality of the MRI tissue assessment protocol. Perfusion imaging exhibits higher sensitivity (0.7) than conventional MRI (0.51-0.61). MRI/histology voxel-to-voxel comparison revealed a negative correlation between tumor cell infiltration and perfusion at the tumor margins (P = 0.0004). DATA CONCLUSION These results demonstrate the ability of perfusion imaging to probe regions of low tumor cell infiltration while confirming the sensitivity limitations of conventional imaging modalities. The quantitative relationship between tumor cell density and perfusion identified in and beyond the edematous T2 hyperintensity region surrounding macroscopic tumor could be used to detect marginal tumor cell infiltration with greater accuracy. LEVEL OF EVIDENCE 1 Technical stage: 2 J. Magn. Reson. Imaging 2019;50:529-540.
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Affiliation(s)
- A Vallatos
- Glasgow Experimental MRI Centre, Institute of Neuroscience and Psychology, University of Glasgow, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, UK
| | - H F I Al-Mubarak
- Glasgow Experimental MRI Centre, Institute of Neuroscience and Psychology, University of Glasgow, UK.,University of Misan, Iraq
| | - J L Birch
- Wolfson Wohl Translational Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, UK
| | - L Galllagher
- Glasgow Experimental MRI Centre, Institute of Neuroscience and Psychology, University of Glasgow, UK
| | - J M Mullin
- Glasgow Experimental MRI Centre, Institute of Neuroscience and Psychology, University of Glasgow, UK
| | - L Gilmour
- Wolfson Wohl Translational Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, UK
| | - W M Holmes
- Glasgow Experimental MRI Centre, Institute of Neuroscience and Psychology, University of Glasgow, UK
| | - A J Chalmers
- Wolfson Wohl Translational Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, UK
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22
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Ameratunga M, Pavlakis N, Wheeler H, Grant R, Simes J, Khasraw M. Anti-angiogenic therapy for high-grade glioma. Cochrane Database Syst Rev 2018; 11:CD008218. [PMID: 30480778 PMCID: PMC6516839 DOI: 10.1002/14651858.cd008218.pub4] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND This is an updated version of the original Cochrane Review published in September 2014. The most common primary brain tumours in adults are gliomas. Gliomas span a spectrum from low to high grade and are graded pathologically on a scale of one to four according to the World Health Organization (WHO) classification. High-grade glioma (HGG) carries a poor prognosis. Grade IV glioma is known as glioblastoma and carries a median survival in treated patients of about 15 months. Glioblastomas are rich in blood vessels (i.e. highly vascular) and also rich in a protein known as vascular endothelial growth factor (VEGF) that promotes new blood vessel formation (the process of angiogenesis). Anti-angiogenic agents inhibit the process of new blood vessel formation and promote regression of existing vessels. Several anti-angiogenic agents have been investigated in clinical trials, both in newly diagnosed and recurrent HGG, showing preliminary promising results. This review was undertaken to report on the benefits and harms associated with the use of anti-angiogenic agents in the treatment of HGGs. OBJECTIVES To evaluate the efficacy and toxicity of anti-angiogenic therapy in people with high-grade glioma (HGG). The intervention can be used in two broad groups: at first diagnosis as part of 'adjuvant' therapy, or in the setting of recurrent disease. SEARCH METHODS We conducted updated searches to identify published and unpublished randomised controlled trials (RCTs), including the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 9), MEDLINE and Embase to October 2018. We handsearched proceedings of relevant oncology conferences up to 2018. We also searched trial registries for ongoing studies. SELECTION CRITERIA RCTs evaluating the use of anti-angiogenic therapy to treat HGG versus the same therapy without anti-angiogenic therapy. DATA COLLECTION AND ANALYSIS Review authors screened the search results and reviewed the abstracts of potentially relevant articles before retrieving the full text of eligible articles. MAIN RESULTS After a comprehensive literature search, we identified 11 eligible RCTs (3743 participants), of which 7 were included in the original review (2987 participants). There was significant design heterogeneity in the included studies, especially in the response assessment criteria used. All eligible studies were restricted to glioblastomas and there were no eligible studies evaluating other HGGs. Ten studies were available as fully published peer-reviewed manuscripts, and one study was available in abstract form. The overall risk of bias in included studies was low. This risk was based upon low rates of selection bias, detection bias, attrition bias and reporting bias. The 11 studies included in this review did not show an improvement in overall survival with the addition of anti-angiogenic therapy (pooled hazard ratio (HR) of 0.95, 95% confidence interval (CI) 0.88 to 1.02; P = 0.16; 11 studies, 3743 participants; high-certainty evidence). However, pooled analysis from 10 studies (3595 participants) showed improvement in progression-free survival with the addition of anti-angiogenic therapy (HR 0.73, 95% CI 0.68 to 0.79; P < 0.00001; high-certainty evidence).We carried out additional analyses of overall survival and progression-free survival according to treatment setting and for anti-angiogenic therapy combined with chemotherapy compared to chemotherapy alone. Pooled analysis of overall survival in either the adjuvant or recurrent setting did not show an improvement (HR 0.93, 95% CI 0.86 to 1.02; P = 0.12; 8 studies, 2833 participants; high-certainty evidence and HR 0.99, 95% CI 0.85 to 1.16; P = 0.90; 3 studies, 910 participants; moderate-certainty evidence, respectively). Pooled analysis of overall survival for anti-angiogenic therapy combined with chemotherapy compared to chemotherapy also did not clearly show an improvement (HR 0.92, 95% CI 0.85 to 1.00; P = 0.05; 11 studies, 3506 participants; low-certainty evidence). The progression-free survival in the subgroups all showed findings that demonstrated improvements in progression-free survival with the addition of anti-angiogenic therapy. Pooled analysis of progression-free survival in both the adjuvant and recurrent setting showed an improvement (HR 0.75, 95% CI 0.69 to 0.82; P < 0.00001; 8 studies, 2833 participants; high-certainty evidence and HR 0.64, 95% CI 0.54 to 0.76; P < 0.00001; 2 studies, 762 participants; moderate-certainty evidence, respectively). Pooled analysis of progression-free survival for anti-angiogenic therapy combined with chemotherapy compared to chemotherapy alone showed an improvement (HR 0.72, 95% CI 0.66 to 0.77; P < 0.00001; 10 studies, 3464 participants). Similar to trials of anti-angiogenic therapies in other solid tumours, adverse events related to this class of therapy included hypertension and proteinuria, poor wound healing, and the potential for thromboembolic events, although generally, the rate of grade 3 and 4 adverse events was low (< 14.1%) and in keeping with the literature. The impact of anti-angiogenic therapy on quality of life varied between studies. AUTHORS' CONCLUSIONS The use of anti-angiogenic therapy does not significantly improve overall survival in newly diagnosed people with glioblastoma. Thus, there is insufficient evidence to support the use of anti-angiogenic therapy for people with newly diagnosed glioblastoma at this time. Overall there is a lack of evidence of a survival advantage for anti-angiogenic therapy over chemotherapy in recurrent glioblastoma. When considering the combination anti-angiogenic therapy with chemotherapy compared with the same chemotherapy alone, there may possibly be a small improvement in overall survival. While there is strong evidence that bevacizumab (an anti-angiogenic drug) prolongs progression-free survival in newly diagnosed and recurrent glioblastoma, the impact of this on quality of life and net clinical benefit for patients remains unclear. Not addressed here is whether subsets of people with glioblastoma may benefit from anti-angiogenic therapies, nor their utility in other HGG histologies.
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Affiliation(s)
- Malaka Ameratunga
- Alfred HospitalMedical OncologyCommercial RoadMelbourneVictoriaAustralia3004
| | - Nick Pavlakis
- Royal North Shore HospitalDepartment of Medical OncologyPacific HighwaySt LeonardsNew South WalesAustralia2065
| | - Helen Wheeler
- Royal North Shore HospitalDepartment of Medical OncologyPacific HighwaySt LeonardsNew South WalesAustralia2065
| | - Robin Grant
- Western General HospitalEdinburgh Centre for Neuro‐Oncology (ECNO)Crewe RoadEdinburghScotlandUKEH4 2XU
| | - John Simes
- The University of SydneyNHMRC Clinical Trials CentreLocked Bag 77CamperdownNSWAustralia1450
| | - Mustafa Khasraw
- NHMRC Clinical Trials Centre, The University of SydneyCamperdownAustralia
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Deike-Hofmann K, Thünemann D, Breckwoldt MO, Schwarz D, Radbruch A, Enk A, Bendszus M, Hassel J, Schlemmer HP, Bäumer P. Sensitivity of different MRI sequences in the early detection of melanoma brain metastases. PLoS One 2018; 13:e0193946. [PMID: 29596475 PMCID: PMC5875773 DOI: 10.1371/journal.pone.0193946] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 02/21/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND After the emergence of new MRI techniques such as susceptibility- and diffusion-weighted imaging (SWI and DWI) and because of specific imaging characteristics of melanoma brain metastases (MBM), it is unclear which MRI sequences are most beneficial for detection of MBM. This study was performed to investigate the sensitivity of six clinical MRI sequences in the early detection of MBM. METHODS Medical records of all melanoma patients referred to our center between November 2005 and December 2016 were reviewed for presence of MBM. Analysis encompassed six MRI sequences at the time of initial diagnosis of first or new MBM, including non-enhanced T1-weighted (T1w), contrast-enhanced T1w (ceT1w), T2-weighted (T2w), T2w-FLAIR, susceptibility-weighted (SWI) and diffusion-weighted (DWI) MRI. Each lesion was rated with respect to its conspicuity (score from 0-not detectable to 3-clearly visible). RESULTS Of 1210 patients, 217 with MBM were included in the analysis and up to 5 lesions per patient were evaluated. A total of 720 metastases were assessed and all six sequences were available for 425 MBM. Sensitivity (conspicuity ≥2) was 99.7% for ceT1w, 77.0% for FLAIR, 64.7% for SWI, 61.0% for T2w, 56.7% for T1w, and 48.4% for DWI. Thirty-one (7.3%) of 425 lesions were only detectable by ceT1w but no other sequence. CONCLUSIONS Contrast-enhanced T1-weighting is more sensitive than all other sequences for detection of MBM. Disruption of the blood-brain-barrier is consistently an earlier sign in MBM than perifocal edema, signal loss on SWI or diffusion restriction.
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Affiliation(s)
| | - Daniel Thünemann
- Department of Radiology, German Cancer Research Center, DKFZ, Heidelberg, Germany
| | - Michael O. Breckwoldt
- Department of Radiology, German Cancer Research Center, DKFZ, Heidelberg, Germany
- Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Daniel Schwarz
- Department of Radiology, German Cancer Research Center, DKFZ, Heidelberg, Germany
- Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Alexander Radbruch
- Department of Radiology, German Cancer Research Center, DKFZ, Heidelberg, Germany
| | - Alexander Enk
- Department of Dermatology, National Center for Tumor Diseases, NCT, University of Heidelberg Medical Center Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Jessica Hassel
- Department of Dermatology, National Center for Tumor Diseases, NCT, University of Heidelberg Medical Center Heidelberg, Germany
| | | | - Philipp Bäumer
- Department of Radiology, German Cancer Research Center, DKFZ, Heidelberg, Germany
- * E-mail:
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Nandu H, Wen PY, Huang RY. Imaging in neuro-oncology. Ther Adv Neurol Disord 2018; 11:1756286418759865. [PMID: 29511385 PMCID: PMC5833173 DOI: 10.1177/1756286418759865] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 01/18/2018] [Indexed: 12/11/2022] Open
Abstract
Imaging plays several key roles in managing brain tumors, including diagnosis, prognosis, and treatment response assessment. Ongoing challenges remain as new therapies emerge and there are urgent needs to find accurate and clinically feasible methods to noninvasively evaluate brain tumors before and after treatment. This review aims to provide an overview of several advanced imaging modalities including magnetic resonance imaging and positron emission tomography (PET), including advances in new PET agents, and summarize several key areas of their applications, including improving the accuracy of diagnosis and addressing the challenging clinical problems such as evaluation of pseudoprogression and anti-angiogenic therapy, and rising challenges of imaging with immunotherapy.
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Affiliation(s)
- Hari Nandu
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02445, USA
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Deuschl C, Kirchner J, Poeppel TD, Schaarschmidt B, Kebir S, El Hindy N, Hense J, Quick HH, Glas M, Herrmann K, Umutlu L, Moenninghoff C, Radbruch A, Forsting M, Schlamann M. 11C-MET PET/MRI for detection of recurrent glioma. Eur J Nucl Med Mol Imaging 2017; 45:593-601. [PMID: 29282517 DOI: 10.1007/s00259-017-3916-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 12/11/2017] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Radiological assessment of brain tumors is widely based on the Radiology Assessment of Neuro-Oncology (RANO) criteria that consider non-specific T1 and T2 weighted images. Limitation of the RANO criteria is that they do not include metabolic imaging techniques that have been reported to be helpful to differentiate treatment related changes from true tumor progression. In the current study, we assessed if the combined use of MRI and PET with hybrid 11C-MET PET/MRI can improve diagnostic accuracy and diagnostic confidence of the readers to differentiate treatment related changes from true progression in recurrent glioma. METHODS Fifty consecutive patients with histopathologically proven glioma were prospectively enrolled for a hybrid 11C-MET PET/MRI to differentiate recurrent glioma from treatment induced changes. Sole MRI data were analyzed based on RANO. Sole PET data and in a third evaluation hybrid 11C-MET-PET/MRI data were assessed for metabolic respectively metabolic and morphologic glioma recurrence. Diagnostic performance and diagnostic confidence of the reader were calculated for the different modalities, and the McNemar test and Mann-Whitney U Test were applied for statistical analysis. RESULTS Hybrid 11C-MET PET/MRI was successfully performed in all 50 patients. Glioma recurrence was diagnosed in 35 of the 50 patients (70%). Sensitivity and specificity were calculated for MRI (86.11% and 71.43%), for 11C-MET PET (96.77% and 73.68%), and for hybrid 11C-MET-PET/MRI (97.14% and 93.33%). For diagnostic accuracy hybrid 11C-MET-PET/MRI (96%) showed significantly higher values than MRI alone (82%), whereas no significant difference was found for 11C-MET PET (88%). Furthermore, by rating on a five-point Likert scale significantly higher scores were found for diagnostic confidence when comparing 11C-MET PET/MRI (4.26 ± 0,777) to either PET alone (3.44 ± 0.705) or MRI alone (3.56 ± 0.733). CONCLUSION This feasibility study showed that hybrid PET/MRI might strengthen RANO classification by adding metabolic information to conventional MRI information. Future studies should evaluate the clinical utility of the combined use of 11C-MET PET/MRI in larger patient cohorts.
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Affiliation(s)
- C Deuschl
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Essen, Germany.
| | - J Kirchner
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Duesseldorf, Duesseldorf, Germany
| | - T D Poeppel
- Clinic for Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - B Schaarschmidt
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Duesseldorf, Duesseldorf, Germany
| | - S Kebir
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Essen, Essen, Germany
| | - N El Hindy
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - J Hense
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - H H Quick
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Essen, Germany
- High Field and Hybrid MR Imaging, University Hospital Essen, Essen, Germany
| | - M Glas
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Essen, Essen, Germany
| | - K Herrmann
- Clinic for Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - L Umutlu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - C Moenninghoff
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - A Radbruch
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - M Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - M Schlamann
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
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Mullen KM, Huang RY. An Update on the Approach to the Imaging of Brain Tumors. Curr Neurol Neurosci Rep 2017; 17:53. [PMID: 28516376 DOI: 10.1007/s11910-017-0760-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Neuroimaging plays a critical role in diagnosis of brain tumors and in assessment of response to therapy. However, challenges remain, including accurately and reproducibly assessing response to therapy, defining endpoints for neuro-oncology trials, providing prognostic information, and differentiating progressive disease from post-therapeutic changes particularly in the setting of antiangiogenic and other novel therapies. RECENT FINDINGS Recent advances in the imaging of brain tumors include application of advanced MRI imaging techniques to assess tumor response to therapy and analysis of imaging features correlating to molecular markers, grade, and prognosis. This review aims to summarize recent advances in imaging as applied to current diagnostic and therapeutic neuro-oncologic challenges.
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Affiliation(s)
- Katherine M Mullen
- Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.
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Wick W, Gorlia T, Bendszus M, Taphoorn M, Sahm F, Harting I, Brandes AA, Taal W, Domont J, Idbaih A, Campone M, Clement PM, Stupp R, Fabbro M, Le Rhun E, Dubois F, Weller M, von Deimling A, Golfinopoulos V, Bromberg JC, Platten M, Klein M, van den Bent MJ. Lomustine and Bevacizumab in Progressive Glioblastoma. N Engl J Med 2017; 377:1954-1963. [PMID: 29141164 DOI: 10.1056/nejmoa1707358] [Citation(s) in RCA: 579] [Impact Index Per Article: 82.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Bevacizumab is approved for the treatment of patients with progressive glioblastoma on the basis of uncontrolled data. Data from a phase 2 trial suggested that the addition of bevacizumab to lomustine might improve overall survival as compared with monotherapies. We sought to determine whether the combination would result in longer overall survival than lomustine alone among patients at first progression of glioblastoma. METHODS We randomly assigned patients with progression after chemoradiation in a 2:1 ratio to receive lomustine plus bevacizumab (combination group, 288 patients) or lomustine alone (monotherapy group, 149 patients). The methylation status of the promoter of O6-methylguanine-DNA methyltransferase (MGMT) was assessed. Health-related quality of life and neurocognitive function were evaluated at baseline and every 12 weeks. The primary end point of the trial was overall survival. RESULTS A total of 437 patients underwent randomization. The median number of 6-week treatment cycles was three in the combination group and one in the monotherapy group. With 329 overall survival events (75.3%), the combination therapy did not provide a survival advantage; the median overall survival was 9.1 months (95% confidence interval [CI], 8.1 to 10.1) in the combination group and 8.6 months (95% CI, 7.6 to 10.4) in the monotherapy group (hazard ratio for death, 0.95; 95% CI, 0.74 to 1.21; P=0.65). Locally assessed progression-free survival was 2.7 months longer in the combination group than in the monotherapy group: 4.2 months versus 1.5 months (hazard ratio for disease progression or death, 0.49; 95% CI, 0.39 to 0.61; P<0.001). Grade 3 to 5 adverse events occurred in 63.6% of the patients in the combination group and 38.1% of the patients in the monotherapy group. The addition of bevacizumab to lomustine affected neither health-related quality of life nor neurocognitive function. The MGMT status was prognostic. CONCLUSIONS Despite somewhat prolonged progression-free survival, treatment with lomustine plus bevacizumab did not confer a survival advantage over treatment with lomustine alone in patients with progressive glioblastoma. (Funded by an unrestricted educational grant from F. Hoffmann-La Roche and by the EORTC Cancer Research Fund; EORTC 26101 ClinicalTrials.gov number, NCT01290939 ; Eudra-CT number, 2010-023218-30 .).
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Affiliation(s)
- Wolfgang Wick
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Thierry Gorlia
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Martin Bendszus
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Martin Taphoorn
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Felix Sahm
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Inga Harting
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Alba A Brandes
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Walter Taal
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Julien Domont
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Ahmed Idbaih
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Mario Campone
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Paul M Clement
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Roger Stupp
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Michel Fabbro
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Emilie Le Rhun
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Francois Dubois
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Michael Weller
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Andreas von Deimling
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Vassilis Golfinopoulos
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Jacoline C Bromberg
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Michael Platten
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Martin Klein
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
| | - Martin J van den Bent
- From the University Medical Center and German Cancer Research Center, Heidelberg, Germany (W.W., M.B., F.S., I.H., A.D., M.P.); the European Organization for Research and Treatment of Cancer, Brussels (T.G., V.G.), and Leuven Cancer Institute-KU Leuven, Leuven (P.M.C.) - both in Belgium; Haaglanden Medical Center, The Hague (M.T.), Erasmus MC Cancer Institute, Rotterdam (W.T., J.C.B., M.J.B.), and VU University Medical Center, Amsterdam (M.K.) - all in the Netherlands; the Medical Oncology Department, Azienda Unità Sanitaria Locale di Bologna-IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (A.A.B.); Institut Gustave Roussy, Villejuif (J.D.), Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie 2-Mazarin, INSERM Unité 1127, Centre National de la Recherche Scientifique Unité Mixte de Recherche (UMR) 7225, Sorbonne Universités, University Pierre and Marie Curie 06 UMR S1127, and Institut du Cerveau et de la Moelle Épinière, Paris (A.I.), Institut de Cancerologie de l'Ouest-Centre Rene Gauducheau, Saint-Herblain (M.C.), Institut Régional du Cancer Montpellier, Montpellier (M.F.), and Centre Hospitalier Régional Universitaire de Lille, Lille (E.L.R., F.D.) - all in France; and the Departments of Oncology and Neurology, University Hospital and University of Zurich, Zurich, Switzerland (R.S., M.W.)
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Sinnaeve J, Mobley BC, Ihrie RA. Space Invaders: Brain Tumor Exploitation of the Stem Cell Niche. THE AMERICAN JOURNAL OF PATHOLOGY 2017; 188:29-38. [PMID: 29024634 DOI: 10.1016/j.ajpath.2017.08.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 07/22/2017] [Accepted: 08/17/2017] [Indexed: 12/20/2022]
Abstract
Increasing evidence indicates that the adult neurogenic niche of the ventricular-subventricular zone (V-SVZ), beyond serving as a potential site of origin, affects the outcome of malignant brain cancers. Glioma contact with this niche predicts worse prognosis, suggesting a supportive role for the V-SVZ environment in tumor initiation or progression. In this review, we describe unique components of the V-SVZ that may permit or promote tumor growth within the region. Cell-cell interactions, soluble factors, and extracellular matrix composition are discussed, and the role of the niche in future therapies is explored. The purpose of this review is to highlight niche intrinsic factors that may promote or support malignant cell growth and maintenance, and point out how we might leverage these features to improve patient outcome.
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Affiliation(s)
- Justine Sinnaeve
- Departments of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Bret C Mobley
- Departments of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rebecca A Ihrie
- Departments of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, Tennessee; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
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29
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Garrett MD, Yanagihara TK, Yeh R, McKhann GM, Sisti MB, Bruce JN, Sheth SA, Sonabend AM, Wang TJC. Monitoring Radiation Treatment Effects in Glioblastoma: FLAIR Volume as Significant Predictor of Survival. Tomography 2017; 3:131-137. [PMID: 30042977 PMCID: PMC6024439 DOI: 10.18383/j.tom.2017.00009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Glioblastoma is the most common adult central nervous system malignancy and carries a poor prognosis. Disease progression and recurrence after chemoradiotherapy are assessed via serial magnetic resonance imaging sequences. T2-weighted fluid-attenuated inversion recovery (FLAIR) signal is presumed to represent edema containing microscopic cancer infiltration. Here we assessed the prognostic impact of computerized volumetry of FLAIR signal in the peri-treatment setting for glioblastoma. We analyzed pre- and posttreatment FLAIR sequences of 40 patients treated at the Columbia University Medical Center between 2011 and 2014, excluding those without high-quality FLAIR imaging within 2 weeks before treatment and 60 to 180 days afterward. We manually contoured regions of FLAIR hyperintensity as per Radiation Therapy Oncology Group guidelines and calculated the volumes of nonenhancing tumor burden. At the time of this study, all but 1 patient had died. Pre- and posttreatment FLAIR volumes were assessed for correlation to overall and progression-free survival. Larger post-treatment FLAIR volumes from sequences taken between 60 and 180 days after conclusion of chemoradiotherapy were negatively correlated with overall survival (P = .048 on Pearson's correlation and P = .017 and P = .043 on univariable and multivariable Cox regression analyses, respectively) and progression-free survival (P = .002 on Pearson's correlation and P = < .001 and P = < .001 on univariable and multivariable Cox regression analyses). This study suggests that higher FLAIR volumes in the 2- to 6-month posttreatment window are associated with worsened survival.
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Affiliation(s)
| | | | | | - Guy M. McKhann
- Neurological Surgery, Columbia University Medical Center, New York, NY; and,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
| | - Michael B. Sisti
- Neurological Surgery, Columbia University Medical Center, New York, NY; and,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
| | - Jeffrey N. Bruce
- Neurological Surgery, Columbia University Medical Center, New York, NY; and,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
| | - Sameer A. Sheth
- Neurological Surgery, Columbia University Medical Center, New York, NY; and,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
| | - Adam M. Sonabend
- Neurological Surgery, Columbia University Medical Center, New York, NY; and,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
| | - Tony J. C. Wang
- Radiation Oncology;,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
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30
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Field KM, Phal PM, Fitt G, Goh C, Nowak AK, Rosenthal MA, Simes J, Barnes EH, Sawkins K, Cher LM, Hovey EJ, Wheeler H. The role of early magnetic resonance imaging in predicting survival on bevacizumab for recurrent glioblastoma: Results from a prospective clinical trial (CABARET). Cancer 2017; 123:3576-3582. [DOI: 10.1002/cncr.30838] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 04/19/2017] [Accepted: 05/11/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Kathryn M. Field
- Royal Melbourne Hospital; Melbourne Victoria Australia
- University of Melbourne; Parkville Victoria Australia
| | | | - Greg Fitt
- Austin Hospital; Melbourne Victoria Australia
| | - Christine Goh
- Royal Melbourne Hospital; Melbourne Victoria Australia
| | - Anna K. Nowak
- School of Medicine and Pharmacology; University of Western Australia; Crawley Western Australia Australia
- Department of Medical Oncology; Sir Charles Gairdner Hospital, Nedlands; Perth Western Australia
| | - Mark A. Rosenthal
- Royal Melbourne Hospital; Melbourne Victoria Australia
- University of Melbourne; Parkville Victoria Australia
| | - John Simes
- National Health and Medical Research Council Clinical Trials Centre; University of Sydney; Sydney New South Wales Australia
| | - Elizabeth H. Barnes
- National Health and Medical Research Council Clinical Trials Centre; University of Sydney; Sydney New South Wales Australia
| | - Kate Sawkins
- National Health and Medical Research Council Clinical Trials Centre; University of Sydney; Sydney New South Wales Australia
| | | | | | - Helen Wheeler
- Royal North Shore Hospital, St Leonards; Sydney New South Wales Australia
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Low-Grade Glioma Segmentation Based on CNN with Fully Connected CRF. JOURNAL OF HEALTHCARE ENGINEERING 2017; 2017:9283480. [PMID: 29065666 PMCID: PMC5485483 DOI: 10.1155/2017/9283480] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 02/21/2017] [Accepted: 03/20/2017] [Indexed: 11/17/2022]
Abstract
This work proposed a novel automatic three-dimensional (3D) magnetic resonance imaging (MRI) segmentation method which would be widely used in the clinical diagnosis of the most common and aggressive brain tumor, namely, glioma. The method combined a multipathway convolutional neural network (CNN) and fully connected conditional random field (CRF). Firstly, 3D information was introduced into the CNN which makes more accurate recognition of glioma with low contrast. Then, fully connected CRF was added as a postprocessing step which purposed more delicate delineation of glioma boundary. The method was applied to T2flair MRI images of 160 low-grade glioma patients. With 59 cases of data training and manual segmentation as the ground truth, the Dice similarity coefficient (DSC) of our method was 0.85 for the test set of 101 MRI images. The results of our method were better than those of another state-of-the-art CNN method, which gained the DSC of 0.76 for the same dataset. It proved that our method could produce better results for the segmentation of low-grade gliomas.
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Response assessment of bevacizumab therapy in GBM with integrated 11C-MET-PET/MRI: a feasibility study. Eur J Nucl Med Mol Imaging 2017; 44:1285-1295. [DOI: 10.1007/s00259-017-3661-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 02/21/2017] [Indexed: 10/20/2022]
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Huber T, Alber G, Bette S, Kaesmacher J, Boeckh-Behrens T, Gempt J, Ringel F, Specht HM, Meyer B, Zimmer C, Wiestler B, Kirschke JS. Progressive disease in glioblastoma: Benefits and limitations of semi-automated volumetry. PLoS One 2017; 12:e0173112. [PMID: 28245291 PMCID: PMC5330491 DOI: 10.1371/journal.pone.0173112] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 02/15/2017] [Indexed: 11/18/2022] Open
Abstract
Purpose Unambiguous evaluation of glioblastoma (GB) progression is crucial, both for clinical trials as well as day by day routine management of GB patients. 3D-volumetry in the follow-up of GB provides quantitative data on tumor extent and growth, and therefore has the potential to facilitate objective disease assessment. The present study investigated the utility of absolute changes in volume (delta) or regional, segmentation-based subtractions for detecting disease progression in longitudinal MRI follow-ups. Methods 165 high resolution 3-Tesla MRIs of 30 GB patients (23m, mean age 60.2y) were retrospectively included in this single center study. Contrast enhancement (CV) and tumor-related signal alterations in FLAIR images (FV) were semi-automatically segmented. Delta volume (dCV, dFV) and regional subtractions (sCV, sFV) were calculated. Disease progression was classified for every follow-up according to histopathologic results, decisions of the local multidisciplinary CNS tumor board and a consensus rating of the neuro-radiologic report. Results A generalized logistic mixed model for disease progression (yes / no) with dCV, dFV, sCV and sFV as input variables revealed that only dCV was significantly associated with prediction of disease progression (P = .005). Delta volume had a better accuracy than regional, segmentation-based subtractions (79% versus 72%) and a higher area under the curve by trend in ROC curves (.83 versus .75). Conclusion Absolute volume changes of the contrast enhancing tumor part were the most accurate volumetric determinant to detect progressive disease in assessment of GB and outweighed FLAIR changes as well as regional, segmentation-based image subtractions. This parameter might be useful in upcoming objective response criteria for glioblastoma.
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Affiliation(s)
- Thomas Huber
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Germany
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Georgina Alber
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Stefanie Bette
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Johannes Kaesmacher
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Tobias Boeckh-Behrens
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Jens Gempt
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Florian Ringel
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Hanno M. Specht
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Claus Zimmer
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Benedikt Wiestler
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Jan S. Kirschke
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Germany
- * E-mail:
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Eidel O, Burth S, Neumann JO, Kieslich PJ, Sahm F, Jungk C, Kickingereder P, Bickelhaupt S, Mundiyanapurath S, Bäumer P, Wick W, Schlemmer HP, Kiening K, Unterberg A, Bendszus M, Radbruch A. Tumor Infiltration in Enhancing and Non-Enhancing Parts of Glioblastoma: A Correlation with Histopathology. PLoS One 2017; 12:e0169292. [PMID: 28103256 PMCID: PMC5245878 DOI: 10.1371/journal.pone.0169292] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 12/14/2016] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To correlate histopathologic findings from biopsy specimens with their corresponding location within enhancing areas, non-enhancing areas and necrotic areas on contrast enhanced T1-weighted MRI scans (cT1). MATERIALS AND METHODS In 37 patients with newly diagnosed glioblastoma who underwent stereotactic biopsy, we obtained a correlation of 561 1mm3 biopsy specimens with their corresponding position on the intraoperative cT1 image at 1.5 Tesla. Biopsy points were categorized as enhancing (CE), non-enhancing (NE) or necrotic (NEC) on cT1 and tissue samples were categorized as "viable tumor cells", "blood" or "necrotic tissue (with or without cellular component)". Cell counting was done semi-automatically. RESULTS NE had the highest content of tissue categorized as viable tumor cells (89% vs. 60% in CE and 30% NEC, respectively). Besides, the average cell density for NE (3764 ± 2893 cells/mm2) was comparable to CE (3506 ± 3116 cells/mm2), while NEC had a lower cell density with 2713 ± 3239 cells/mm2. If necrotic parts and bleeds were excluded, cell density in biopsies categorized as "viable tumor tissue" decreased from the center of the tumor (NEC, 5804 ± 3480 cells/mm2) to CE (4495 ± 3209 cells/mm2) and NE (4130 ± 2817 cells/mm2). DISCUSSION The appearance of a glioblastoma on a cT1 image (circular enhancement, central necrosis, peritumoral edema) does not correspond to its diffuse histopathological composition. Cell density is elevated in both CE and NE parts. Hence, our study suggests that NE contains considerable amounts of infiltrative tumor with a high cellularity which might be considered in resection planning.
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Affiliation(s)
- Oliver Eidel
- Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Radiology, Heidelberg, Germany
| | - Sina Burth
- Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Radiology, Heidelberg, Germany
| | - Jan-Oliver Neumann
- Department of Neurosurgery, Division Stereotactic Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Pascal J. Kieslich
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Felix Sahm
- Department of Neuropathology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Christine Jungk
- Department of Neurosurgery, Division Stereotactic Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Philipp Kickingereder
- Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany
| | | | - Sibu Mundiyanapurath
- Department of Neurology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Philipp Bäumer
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Wolfgang Wick
- Department of Neurology, University of Heidelberg Medical Center, Heidelberg, Germany
| | | | - Karl Kiening
- Department of Neurosurgery, Division Stereotactic Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Andreas Unterberg
- Department of Neurosurgery, Division Stereotactic Neurosurgery, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Alexander Radbruch
- Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Radiology, Heidelberg, Germany
- * E-mail:
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Piazza M, Munasinghe J, Murayi R, Edwards N, Montgomery B, Walbridge S, Merrill M, Chittiboina P. Simulating vasogenic brain edema using chronic VEGF infusion. J Neurosurg 2017; 127:905-916. [PMID: 28059647 DOI: 10.3171/2016.9.jns1627] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To study peritumoral brain edema (PTBE), it is necessary to create a model that accurately simulates vasogenic brain edema (VBE) without introducing a complicated tumor environment. PTBE associated with brain tumors is predominantly a result of vascular endothelial growth factor (VEGF) secreted by brain tumors, and VEGF infusion alone can lead to histological blood-brain barrier (BBB) breakdown in the absence of tumor. VBE is intimately linked to BBB breakdown. The authors sought to establish a model for VBE with chronic infusion of VEGF that can be validated by serial in-vivo MRI and histological findings. METHODS Male Fischer rats (n = 182) underwent stereotactic striatal implantation of MRI-safe brain cannulas for chronic infusion of VEGF (2-20 µg/ml). Following a preinfusion phase (4-6 days), the rats were exposed to VEGF or control rat serum albumin (1.5 µl/hr) for as long as 144 hours. Serial MRI was performed during infusion on a high-field (9.4-T) machine at 12-24, 24-36, 48-72, and 120-144 hours. Rat brains were then collected and histological analysis was performed. RESULTS Control animals and animals infused with 2 µg/ml of VEGF experienced no neurological deficits, seizure activity, or abnormal behavior. Animals treated with VEGF demonstrated a significantly larger volume (42.90 ± 3.842 mm3) of T2 hyper-attenuation at 144 hours when compared with the volume (8.585 ± 1.664 mm3) in control animals (mean difference 34.31 ± 4.187 mm3, p < 0.0001, 95% CI 25.74-42.89 mm3). Postcontrast T1 enhancement in the juxtacanalicular region indicating BBB breakdown was observed in rats undergoing infusion with VEGF. At the later time periods (120-144 hrs) the volume of T1 enhancement (34.97 ± 8.99 mm3) was significantly less compared with the region of edema (p < 0.0001). Histologically, no evidence of necrosis or inflammation was observed with VEGF or control infusion. Immunohistochemical analysis demonstrated astrocyte activation, vascular remodeling, and increased claudin-5 expression in juxtacanalicular regions. Aquaporin-4 expression was increased in both control and VEGF animals in the juxtacanalicular regions. CONCLUSIONS The results of this study show that chronic brain infusion of VEGF creates a reliable model of VBE. This model lacks necrosis and inflammation that are characteristic of previous models of VBE. The model allows for a precise investigation into the mechanism of VBE formation. The authors also anticipate that this model will allow for investigation into the mechanism of glucocorticoid action in abrogating VBE, and to test novel therapeutic strategies targeting PTBE.
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Affiliation(s)
- Martin Piazza
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, and
| | | | - Roger Murayi
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, and
| | - Nancy Edwards
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, and
| | - Blake Montgomery
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, and
| | - Stuart Walbridge
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, and
| | - Marsha Merrill
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, and
| | - Prashant Chittiboina
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, and
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Zhou M, Chaudhury B, Hall LO, Goldgof DB, Gillies RJ, Gatenby RA. Identifying spatial imaging biomarkers of glioblastoma multiforme for survival group prediction. J Magn Reson Imaging 2016; 46:115-123. [PMID: 27678245 DOI: 10.1002/jmri.25497] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 09/14/2016] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Glioblastoma multiforme (GBM) is the most common malignant brain tumor in adults. Most GBMs exhibit extensive regional heterogeneity at tissue, cellular, and molecular scales, but the clinical relevance of the observed spatial imaging characteristics remains unknown. We investigated pretreatment magnetic resonance imaging (MRI) scans of GBMs to identify tumor subregions and quantify their image-based spatial characteristics that are associated with survival time. MATERIALS AND METHODS We quantified tumor subregions (termed habitats) in GBMs, which are hypothesized to capture intratumoral characteristics using multiple MRI sequences. For proof-of-concept, we developed a computational framework that used intratumoral grouping and spatial mapping to identify GBM tumor subregions and yield habitat-based features. Using a feature selector and three classifiers, experimental results from two datasets are reported, including Dataset1 with 32 GBM patients (594 tumor slices) and Dataset2 with 22 GBM patients, who did not undergo resection (261 tumor slices) for survival group prediction. RESULTS In both datasets, we show that habitat-based features achieved 87.50% and 86.36% accuracies for survival group prediction, respectively, using leave-one-out cross-validation. Experimental results revealed that spatially correlated features between signal-enhanced subregions were effective for predicting survival groups (P < 0.05 for all three machine-learning classifiers). CONCLUSION The quantitative spatial-correlated features derived from MRI-defined tumor subregions in GBM could be effectively used to predict the survival time of patients. LEVEL OF EVIDENCE 2 J. MAGN. RESON. IMAGING 2017;46:115-123.
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Affiliation(s)
- Mu Zhou
- Stanford Center for Biomedical Informatics, Stanford University, Stanford, California, USA
| | - Baishali Chaudhury
- Department of Radiology, H. Lee Moffitt Cancer and Research Institute, Tampa, Florida, USA
| | - Lawrence O Hall
- Department of Computer Science and Engineering, University of South Florida, Tampa, Florida, USA
| | - Dmitry B Goldgof
- Department of Computer Science and Engineering, University of South Florida, Tampa, Florida, USA
| | - Robert J Gillies
- Department of Radiology, H. Lee Moffitt Cancer and Research Institute, Tampa, Florida, USA
| | - Robert A Gatenby
- Department of Radiology, H. Lee Moffitt Cancer and Research Institute, Tampa, Florida, USA
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Huang RY, Wen PY. Response Assessment in Neuro-Oncology Criteria and Clinical Endpoints. Magn Reson Imaging Clin N Am 2016; 24:705-718. [PMID: 27742111 DOI: 10.1016/j.mric.2016.06.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The Response Assessment in Neuro-Oncology (RANO) Working Group is an international multidisciplinary group whose goal is to improve response criteria and define endpoints for neuro-oncology trials. The RANO criteria for high-grade gliomas attempt to address the issues of pseudoprogression, pseudoresponse, and nonenhancing tumor progression. Incorporation of advanced MR imaging may eventually help improve the ability of these criteria to define enhancing and nonenhancing disease better. The RANO group has also developed criteria for neurologic response and evaluation of patients receiving immunologic therapies. RANO criteria have been developed for brain metastases and are in progress for meningiomas, leptomeningeal disease, spinal tumors, and pediatric tumors.
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Affiliation(s)
- Raymond Y Huang
- Division of Neuroradiology, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
| | - Patrick Y Wen
- Division of Neuro-Oncology, Department of Neurology, Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA
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Prognostic value of the extent of resection in supratentorial WHO grade II astrocytomas stratified for IDH1 mutation status: a single-center volumetric analysis. J Neurooncol 2016; 129:319-28. [PMID: 27344556 PMCID: PMC4992014 DOI: 10.1007/s11060-016-2177-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 06/04/2016] [Indexed: 01/16/2023]
Abstract
Current evidence supports a maximized extent of resection (EOR) in low-grade gliomas (LGG), regardless of different histological subtypes and molecular markers. We therefore evaluated the prognostic impact of extensive, mainly intraoperative (i)MRI-guided surgery in low-grade astrocytomas stratified for IDH1 mutation status. Retrospective assessment of 46 consecutive cases of newly diagnosed supratentorial WHO grade II astrocytomas treated during the last decade was performed. IDH1 mutation status was obtained for all patients. Volumetric analysis of tumor volumes was performed pre-, intra-, early postoperatively and at first follow-up. Survival analysis was conducted with uni-and multivariate regression models implementing clinical parameters and continuous volumetric variables. Median EOR was 90.4 % (range 17.5–100 %) and was increased to 94.9 % (range 34.8–100 %) in iMRI-guided resections (n = 33). A greater EOR was prognostic for increased progression-free survival (HR 0.23, p = 0.031) and time to re-intervention (TTR) (HR 0.23, p = 0.03). In IDH1 mutant patients, smaller residual tumor volumes were associated with increased TTR (HR 1.01, p = 0.03). IDH1 mutation (38/46 cases) was an independent positive prognosticator for overall survival (OS) in multivariate analysis (HR 0.09, p = 0.002), while extensive surgery had limited impact upon OS. In a subgroup of patients with ≥40 % EOR (n = 39), however, initial and residual tumor volumes were prognostic for OS (HR 1.03, p = 0.005 and HR 1.08, p = 0.007, respectively), persistent to adjustment for IDH1. No association between EOR and neurologic morbidity was found. In this analysis of low-grade astrocytomas stratified for IDH1, extensive tumor resections were prognostic for progression and TTR and, in patients with ≥40 % EOR, for OS.
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Abstract
This review covers important topics relating to the imaging evaluation of glioblastoma multiforme after therapy. An overview of the Macdonald and Response Assessment in Neuro-Oncology criteria as well as important questions and limitations regarding their use are provided. Pseudoprogression and pseudoresponse as well as the use of advanced magnetic resonance imaging techniques such as perfusion, diffusion, and spectroscopy in the evaluation of the posttherapeutic brain are also reviewed.
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Response Assessment and Magnetic Resonance Imaging Issues for Clinical Trials Involving High-Grade Gliomas. Top Magn Reson Imaging 2016; 24:127-36. [PMID: 26049816 DOI: 10.1097/rmr.0000000000000054] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
There exist multiple challenges associated with the current response assessment criteria for high-grade gliomas, including the uncertain role of changes in nonenhancing T2 hyperintensity, and the phenomena of pseudoresponse and pseudoprogression in the setting of antiangiogenic and chemoradiation therapies, respectively. Advanced physiological magnetic resonance imaging (MRI), including diffusion and perfusion (dynamic susceptibility contrast MRI and dynamic contrast-enhanced MRI) sensitive techniques for overcoming response assessment challenges, has been proposed, with their own potential advantages and inherent shortcomings. Measurement variability exists for conventional and advanced MRI techniques, necessitating the standardization of image acquisition parameters in order to establish the utility of these imaging methods in multicenter trials for high-grade gliomas. This review chapter highlights the important features of MRI in clinical brain tumor trials, focusing on the current state of response assessment in brain tumors, advanced imaging techniques that may provide additional value for determining response, and imaging issues to be considered for multicenter trials.
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Zaiss M, Windschuh J, Goerke S, Paech D, Meissner J, Burth S, Kickingereder P, Wick W, Bendszus M, Schlemmer H, Ladd ME, Bachert P, Radbruch A. Downfield‐NOE‐suppressed amide‐CEST‐MRI at 7 Tesla provides a unique contrast in human glioblastoma. Magn Reson Med 2016; 77:196-208. [DOI: 10.1002/mrm.26100] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 12/04/2015] [Accepted: 12/06/2015] [Indexed: 01/12/2023]
Affiliation(s)
- Moritz Zaiss
- Division of Medical Physics in RadiologyDeutsches Krebsforschungszentrum (DKFZ)Heidelberg Germany
| | - Johannes Windschuh
- Division of Medical Physics in RadiologyDeutsches Krebsforschungszentrum (DKFZ)Heidelberg Germany
| | - Steffen Goerke
- Division of Medical Physics in RadiologyDeutsches Krebsforschungszentrum (DKFZ)Heidelberg Germany
| | - Daniel Paech
- Department of NeuroradiologyUniversity of Heidelberg Medical CenterHeidelberg Germany
- Department of RadiologyDeutsches Krebsforschungszentrum (DKFZ)Heidelberg Germany
| | - Jan‐Eric Meissner
- Division of Medical Physics in RadiologyDeutsches Krebsforschungszentrum (DKFZ)Heidelberg Germany
- Department of RadiologyDeutsches Krebsforschungszentrum (DKFZ)Heidelberg Germany
| | - Sina Burth
- Department of NeuroradiologyUniversity of Heidelberg Medical CenterHeidelberg Germany
- Department of RadiologyDeutsches Krebsforschungszentrum (DKFZ)Heidelberg Germany
| | - Philipp Kickingereder
- Department of NeuroradiologyUniversity of Heidelberg Medical CenterHeidelberg Germany
| | - Wolfgang Wick
- University of Heidelberg Neurology ClinicHeidelberg Germany
- Clinical Cooperation Unit Neuro‐oncologyDeutsches Krebsforschungszentrum (DKFZ)Heidelberg
| | - Martin Bendszus
- Department of NeuroradiologyUniversity of Heidelberg Medical CenterHeidelberg Germany
| | | | - Mark E. Ladd
- Division of Medical Physics in RadiologyDeutsches Krebsforschungszentrum (DKFZ)Heidelberg Germany
| | - Peter Bachert
- Division of Medical Physics in RadiologyDeutsches Krebsforschungszentrum (DKFZ)Heidelberg Germany
| | - Alexander Radbruch
- Department of NeuroradiologyUniversity of Heidelberg Medical CenterHeidelberg Germany
- Department of RadiologyDeutsches Krebsforschungszentrum (DKFZ)Heidelberg Germany
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Chang SM, Wen PY, Vogelbaum MA, Macdonald DR, van den Bent MJ. Response Assessment in Neuro-Oncology (RANO): more than imaging criteria for malignant glioma. Neurooncol Pract 2015; 2:205-209. [PMID: 31386074 PMCID: PMC6664617 DOI: 10.1093/nop/npv037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Indexed: 12/12/2022] Open
Abstract
The introduction of antiangiogenic therapies for the treatment of malignant glioma and the effect of these agents on standard imaging studies were the stimuli for forming a small group of investigators to critically evaluate the limitations of the Macdonald criteria in assessing response to treatment. The initial goal of this group was to highlight the challenges in accurately determining the efficacy of therapeutic interventions for malignant glioma and to develop new criteria that could be implemented in clinical care as well as in the design and conduct of clinical trials. This initial Response Assessment in Neuro-Oncology (RANO) effort started in 2008 and over the last 7 years, it has expanded to include a critical review of response assessment across several tumor types as well as endpoint selection and trial design to improve outcome criteria for neuro-oncological trials. In this paper, we review the overarching principles of the RANO initiative and the efforts to date. We also highlight the diverse and expanding efforts of the multidisciplinary groups of investigators who have volunteered their time as part of this endeavor.
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Affiliation(s)
- Susan M. Chang
- Department of Neurological Surgery, University of California at San Francisco, San Francisco, California (S.M.C.); Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (P.Y.W.); Rose Ella Burkhardt Brain Tumor and NeuroOncology Center, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio (M.A.V.); Medical Oncology, London Regional Cancer Program, Western University, London, ON, Canada (D.R.M.); Dept Neuro-oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands (M.J.v.d.B.)
| | - Patrick Y. Wen
- Department of Neurological Surgery, University of California at San Francisco, San Francisco, California (S.M.C.); Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (P.Y.W.); Rose Ella Burkhardt Brain Tumor and NeuroOncology Center, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio (M.A.V.); Medical Oncology, London Regional Cancer Program, Western University, London, ON, Canada (D.R.M.); Dept Neuro-oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands (M.J.v.d.B.)
| | - Michael A. Vogelbaum
- Department of Neurological Surgery, University of California at San Francisco, San Francisco, California (S.M.C.); Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (P.Y.W.); Rose Ella Burkhardt Brain Tumor and NeuroOncology Center, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio (M.A.V.); Medical Oncology, London Regional Cancer Program, Western University, London, ON, Canada (D.R.M.); Dept Neuro-oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands (M.J.v.d.B.)
| | - David R. Macdonald
- Department of Neurological Surgery, University of California at San Francisco, San Francisco, California (S.M.C.); Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (P.Y.W.); Rose Ella Burkhardt Brain Tumor and NeuroOncology Center, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio (M.A.V.); Medical Oncology, London Regional Cancer Program, Western University, London, ON, Canada (D.R.M.); Dept Neuro-oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands (M.J.v.d.B.)
| | - Martin J. van den Bent
- Department of Neurological Surgery, University of California at San Francisco, San Francisco, California (S.M.C.); Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (P.Y.W.); Rose Ella Burkhardt Brain Tumor and NeuroOncology Center, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio (M.A.V.); Medical Oncology, London Regional Cancer Program, Western University, London, ON, Canada (D.R.M.); Dept Neuro-oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands (M.J.v.d.B.)
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Reliability of Semi-Automated Segmentations in Glioblastoma. Clin Neuroradiol 2015; 27:153-161. [PMID: 26490369 DOI: 10.1007/s00062-015-0471-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/29/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE In glioblastoma, quantitative volumetric measurements of contrast-enhancing or fluid-attenuated inversion recovery (FLAIR) hyperintense tumor compartments are needed for an objective assessment of therapy response. The aim of this study was to evaluate the reliability of a semi-automated, region-growing segmentation tool for determining tumor volume in patients with glioblastoma among different users of the software. METHODS A total of 320 segmentations of tumor-associated FLAIR changes and contrast-enhancing tumor tissue were performed by different raters (neuroradiologists, medical students, and volunteers). All patients underwent high-resolution magnetic resonance imaging including a 3D-FLAIR and a 3D-MPRage sequence. Segmentations were done using a semi-automated, region-growing segmentation tool. Intra- and inter-rater-reliability were addressed by intra-class-correlation (ICC). Root-mean-square error (RMSE) was used to determine the precision error. Dice score was calculated to measure the overlap between segmentations. RESULTS Semi-automated segmentation showed a high ICC (> 0.985) for all groups indicating an excellent intra- and inter-rater-reliability. Significant smaller precision errors and higher Dice scores were observed for FLAIR segmentations compared with segmentations of contrast-enhancement. Single rater segmentations showed the lowest RMSE for FLAIR of 3.3 % (MPRage: 8.2 %). Both, single raters and neuroradiologists had the lowest precision error for longitudinal evaluation of FLAIR changes. CONCLUSIONS Semi-automated volumetry of glioblastoma was reliably performed by all groups of raters, even without neuroradiologic expertise. Interestingly, segmentations of tumor-associated FLAIR changes were more reliable than segmentations of contrast enhancement. In longitudinal evaluations, an experienced rater can detect progressive FLAIR changes of less than 15 % reliably in a quantitative way which could help to detect progressive disease earlier.
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Wick W, Platten M, Wick A, Hertenstein A, Radbruch A, Bendszus M, Winkler F. Current status and future directions of anti-angiogenic therapy for gliomas. Neuro Oncol 2015; 18:315-28. [PMID: 26459812 DOI: 10.1093/neuonc/nov180] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 08/03/2015] [Indexed: 12/24/2022] Open
Abstract
Molecular targets for the pathological vasculature are the vascular endothelial growth factor (VEGF)/VEGF receptor axis, integrins, angiopoietins, and platelet-derived growth factor receptor (PDGFR), as well as several intracellular or downstream effectors like protein kinase C beta and mammalian target of rapamycin (mTOR). Besides hypoxic damage or tumor cell starvation, preclinical models imply vessel independent tumor regression and suggest differential effects of anti-angiogenic treatments on tumorous and nontumorous precursor cells or the immune system. Despite compelling preclinical data and positive data in other cancers, the outcomes of clinical trials with anti-angiogenic agents in gliomas by and large have been disappointing and include VEGF blockage with bevacizumab, integrin inhibition with cilengitide, VEGF receptor inhibition with sunitinib or cediranib, PDGFR inhibition with imatinib or dasatinib, protein kinase C inhibition with enzastaurin, and mTOR inhibition with sirolimus, everolimus, or temsirolimus. Importantly, there is a lack of real understanding for this negative data. Anti-angiogenic therapies have stimulated the development of standardized imaging assessment and the integration of functional MRI sequences into daily practice. Here, we delineate directions in the identification of molecularly or image-based defined subgroups, anti-angiogenic cotreatment for immunotherapy, and the potential of ongoing trials or modified targets to change the game.
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Affiliation(s)
- Wolfgang Wick
- Neurology Clinic and National Center for Tumor Diseases, University of Heidelberg and German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany (W.W., M.P., A.W., A.H., F.W.); Department of Neuroradiology, University of Heidelberg and German Cancer Research Center, Heidelberg, Germany (A.R., M.B.)
| | - Michael Platten
- Neurology Clinic and National Center for Tumor Diseases, University of Heidelberg and German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany (W.W., M.P., A.W., A.H., F.W.); Department of Neuroradiology, University of Heidelberg and German Cancer Research Center, Heidelberg, Germany (A.R., M.B.)
| | - Antje Wick
- Neurology Clinic and National Center for Tumor Diseases, University of Heidelberg and German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany (W.W., M.P., A.W., A.H., F.W.); Department of Neuroradiology, University of Heidelberg and German Cancer Research Center, Heidelberg, Germany (A.R., M.B.)
| | - Anne Hertenstein
- Neurology Clinic and National Center for Tumor Diseases, University of Heidelberg and German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany (W.W., M.P., A.W., A.H., F.W.); Department of Neuroradiology, University of Heidelberg and German Cancer Research Center, Heidelberg, Germany (A.R., M.B.)
| | - Alexander Radbruch
- Neurology Clinic and National Center for Tumor Diseases, University of Heidelberg and German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany (W.W., M.P., A.W., A.H., F.W.); Department of Neuroradiology, University of Heidelberg and German Cancer Research Center, Heidelberg, Germany (A.R., M.B.)
| | - Martin Bendszus
- Neurology Clinic and National Center for Tumor Diseases, University of Heidelberg and German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany (W.W., M.P., A.W., A.H., F.W.); Department of Neuroradiology, University of Heidelberg and German Cancer Research Center, Heidelberg, Germany (A.R., M.B.)
| | - Frank Winkler
- Neurology Clinic and National Center for Tumor Diseases, University of Heidelberg and German Consortium for Translational Cancer Research, German Cancer Research Center, Heidelberg, Germany (W.W., M.P., A.W., A.H., F.W.); Department of Neuroradiology, University of Heidelberg and German Cancer Research Center, Heidelberg, Germany (A.R., M.B.)
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Meissner JE, Goerke S, Rerich E, Klika KD, Radbruch A, Ladd ME, Bachert P, Zaiss M. Quantitative pulsed CEST-MRI using Ω-plots. NMR IN BIOMEDICINE 2015; 28:1196-208. [PMID: 26278686 DOI: 10.1002/nbm.3362] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 06/18/2015] [Accepted: 06/19/2015] [Indexed: 05/24/2023]
Abstract
Chemical exchange saturation transfer (CEST) allows the indirect detection of dilute metabolites in living tissue via MRI of the tissue water signal. Selective radio frequency (RF) with amplitude B1 is used to saturate the magnetization of protons of exchanging groups, which transfer the saturation to the abundant water pool. In a clinical setup, the saturation scheme is limited to a series of short pulses to follow regulation of the specific absorption rate (SAR). Pulsed saturation is difficult to describe theoretically, thus rendering quantitative CEST a challenging task. In this study, we propose a new analytical treatment of pulsed CEST by extending a former interleaved saturation-relaxation approach. Analytical integration of the continuous wave (cw) eigenvalue as a function of the RF pulse shape leads to a formula for pulsed CEST that has the same structure as that for cw CEST, but incorporates two form factors that are determined by the pulse shape. This enables analytical Z-spectrum calculations and permits deeper insight into pulsed CEST. Furthermore, it extends Dixon's Ω-plot method to the case of pulsed saturation, yielding separately, and independently, the exchange rate and the relative proton concentration. Consequently, knowledge of the form factors allows a direct comparison of the effect of the strength and B1 dispersion of pulsed CEST experiments with the ideal case of cw saturation. The extended pulsed CEST quantification approach was verified using creatine phantoms measured on a 7 T whole-body MR tomograph, and its range of validity was assessed by simulations.
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Affiliation(s)
- Jan-Eric Meissner
- Division of Medical Physics in Radiology, Deutsches Krebsforschungszentrum (DKFZ) [German Cancer Research Center], Heidelberg, Germany
- Division of Radiology, Deutsches Krebsforschungszentrum (DKFZ) [German Cancer Research Center], Heidelberg, Germany
| | - Steffen Goerke
- Division of Medical Physics in Radiology, Deutsches Krebsforschungszentrum (DKFZ) [German Cancer Research Center], Heidelberg, Germany
| | - Eugenia Rerich
- Division of Medical Physics in Radiology, Deutsches Krebsforschungszentrum (DKFZ) [German Cancer Research Center], Heidelberg, Germany
| | - Karel D Klika
- Molecular Structure Analysis, Deutsches Krebsforschungszentrum (DKFZ) [German Cancer Research Center], Heidelberg, Germany
| | - Alexander Radbruch
- Division of Radiology, Deutsches Krebsforschungszentrum (DKFZ) [German Cancer Research Center], Heidelberg, Germany
- Department of Neuroradiology, Medical Faculty, University of Heidelberg, Heidelberg, Germany
| | - Mark E Ladd
- Division of Medical Physics in Radiology, Deutsches Krebsforschungszentrum (DKFZ) [German Cancer Research Center], Heidelberg, Germany
| | - Peter Bachert
- Division of Medical Physics in Radiology, Deutsches Krebsforschungszentrum (DKFZ) [German Cancer Research Center], Heidelberg, Germany
| | - Moritz Zaiss
- Division of Medical Physics in Radiology, Deutsches Krebsforschungszentrum (DKFZ) [German Cancer Research Center], Heidelberg, Germany
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Ellingson BM, Wen PY, van den Bent MJ, Cloughesy TF. Pros and cons of current brain tumor imaging. Neuro Oncol 2015; 16 Suppl 7:vii2-11. [PMID: 25313235 DOI: 10.1093/neuonc/nou224] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Over the past 20 years, very few agents have been approved for the treatment of brain tumors. Recent studies have highlighted some of the challenges in assessing activity in novel agents for the treatment of brain tumors. This paper reviews some of the key challenges related to assessment of tumor response to therapy in adult high-grade gliomas and discusses the strengths and limitations of imaging-based endpoints. Although overall survival is considered the "gold standard" endpoint in the field of oncology, progression-free survival and response rate are endpoints that hold great value in neuro-oncology. Particular focus is given to advancements made since the January 2006 Brain Tumor Endpoints Workshop, including the development of Response Assessment in Neuro-Oncology criteria, the value of T2/fluid-attenuated inversion recovery, use of objective response rates and progression-free survival in clinical trials, and the evaluation of pseudoprogression, pseudoresponse, and inflammatory response in radiographic images.
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Affiliation(s)
- Benjamin M Ellingson
- Department of Radiological Sciences (B.M.E.), Department of Biomedical Physics, David Geffen School of Medicine at UCLA (B.M.E.); Department of Bioengineering, Henry Samueli School of Engineering and Applied Science at UCLA (B.M.E.); Brain Research Institute, David Geffen School of Medicine at UCLA (B.M.E., T.F.C.); UCLA Neuro-Oncology Program, David Geffen School of Medicine at UCLA, Los Angeles, California (B.M.E., T.F.C.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts (P.Y.W.); Department of Neuro-Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands (M.J.v.d.B.); Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California (T.F.C.)
| | - Patrick Y Wen
- Department of Radiological Sciences (B.M.E.), Department of Biomedical Physics, David Geffen School of Medicine at UCLA (B.M.E.); Department of Bioengineering, Henry Samueli School of Engineering and Applied Science at UCLA (B.M.E.); Brain Research Institute, David Geffen School of Medicine at UCLA (B.M.E., T.F.C.); UCLA Neuro-Oncology Program, David Geffen School of Medicine at UCLA, Los Angeles, California (B.M.E., T.F.C.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts (P.Y.W.); Department of Neuro-Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands (M.J.v.d.B.); Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California (T.F.C.)
| | - Martin J van den Bent
- Department of Radiological Sciences (B.M.E.), Department of Biomedical Physics, David Geffen School of Medicine at UCLA (B.M.E.); Department of Bioengineering, Henry Samueli School of Engineering and Applied Science at UCLA (B.M.E.); Brain Research Institute, David Geffen School of Medicine at UCLA (B.M.E., T.F.C.); UCLA Neuro-Oncology Program, David Geffen School of Medicine at UCLA, Los Angeles, California (B.M.E., T.F.C.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts (P.Y.W.); Department of Neuro-Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands (M.J.v.d.B.); Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California (T.F.C.)
| | - Timothy F Cloughesy
- Department of Radiological Sciences (B.M.E.), Department of Biomedical Physics, David Geffen School of Medicine at UCLA (B.M.E.); Department of Bioengineering, Henry Samueli School of Engineering and Applied Science at UCLA (B.M.E.); Brain Research Institute, David Geffen School of Medicine at UCLA (B.M.E., T.F.C.); UCLA Neuro-Oncology Program, David Geffen School of Medicine at UCLA, Los Angeles, California (B.M.E., T.F.C.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts (P.Y.W.); Department of Neuro-Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands (M.J.v.d.B.); Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California (T.F.C.)
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Wen PY, Cloughesy TF, Ellingson BM, Reardon DA, Fine HA, Abrey L, Ballman K, Bendszuz M, Buckner J, Chang SM, Prados MD, Pope WB, Gregory Sorensen A, van den Bent M, Yung WKA. Report of the Jumpstarting Brain Tumor Drug Development Coalition and FDA clinical trials neuroimaging endpoint workshop (January 30, 2014, Bethesda MD). Neuro Oncol 2015; 16 Suppl 7:vii36-47. [PMID: 25313237 DOI: 10.1093/neuonc/nou226] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
On January 30, 2014, a workshop was held on neuroimaging endpoints in high-grade glioma. This workshop was sponsored by the Jumpstarting Brain Tumor Drug Development Coalition, consisting of the National Brain Tumor Society, the Society for Neuro-Oncology, Accelerate Brain Cancer Cure, and the Musella Foundation for Research and Information, and conducted in collaboration with the Food and Drug Administration. The workshop included neuro-oncologists, neuroradiologists, radiation oncologists, neurosurgeons, biostatisticians, patient advocates, and representatives from industry, clinical research organizations, and the National Cancer Institute. This report summarizes the presentations and discussions of that workshop and the proposals that emerged to improve the Response Assessment in Neuro-Oncology (RANO) criteria and standardize neuroimaging parameters.
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Affiliation(s)
- Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - Timothy F Cloughesy
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - Benjamin M Ellingson
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - David A Reardon
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - Howard A Fine
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - Lauren Abrey
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - Karla Ballman
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - Martin Bendszuz
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - Jan Buckner
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - Susan M Chang
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - Michael D Prados
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - Whitney B Pope
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - Alma Gregory Sorensen
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - Martin van den Bent
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - Wai-Kwan Alfred Yung
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
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[Towards more precision in the therapy of brain tumors. Possibilities and limits of MRI]. DER NERVENARZT 2015; 86:701-2, 704-9. [PMID: 26017379 DOI: 10.1007/s00115-015-4313-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Due to the introduction of advanced functional and spectroscopic magnetic resonance (MR) sequences, MR imaging has gained significant importance in neuro-oncology. In contrast to recent years when neuro-oncological imaging was mostly limited to contrast-enhanced T1-weighted images, advanced MR methods provide direct visualization and assessment of tumor pathophysiology. This article summarizes the most relevant MR methods for neuro-oncological imaging and highlights the pathophysiological background as well as potential clinical applications. Ultimately, this article gives a glimpse into the future and introduces potential applications of ultra-high field MRI.
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Gerstner ER, Ye X, Duda DG, Levine MA, Mikkelsen T, Kaley TJ, Olson JJ, Nabors BL, Ahluwalia MS, Wen PY, Jain RK, Batchelor TT, Grossman S. A phase I study of cediranib in combination with cilengitide in patients with recurrent glioblastoma. Neuro Oncol 2015; 17:1386-92. [PMID: 26008604 DOI: 10.1093/neuonc/nov085] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 04/10/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite being a highly vascularized tumor, glioblastoma response to anti-vascular endothelial growth factor (VEGF) therapy is transient, possibly because of tumor co-option of preexisting blood vessels and infiltration into surrounding brain. Integrins, which are upregulated after VEGF inhibition, may play a critical role in this resistance mechanism. We designed a study of cediranib, a vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitor, combined with cilengitide, an integrin inhibitor. METHODS This phase I study was conducted through the Adult Brain Tumor Consortium in patients with recurrent glioblastoma. Once the maximum tolerated dose was determined, 40 patients enrolled in a dose expansion cohort with 20 being exposed to anti-VEGF therapy and 20 being naive. The primary endpoint was safety. Secondary endpoints included overall survival, proportion of participants alive and progression free at 6 months, radiographic response, and exploratory analyses of physiological imaging and blood biomarkers. RESULTS Forty-five patients enrolled, and no dose toxicities were observed at a dose of cediranib 30 mg daily and cilengitide 2000 mg twice weekly. Complete response was seen in 2 participants, partial response in 2, stable disease in 13, and progression in 21; 7 participants were not evaluable. Median overall survival was 6.5 months, median progression-free survival was 1.9 months, and progression-free survival at 6 months was 4.4%. Plasma-soluble VEGFR2 decreased with treatment and placental growth factor, carbonic anhydrase IX, and SDF1α, and cerebral blood flow increased. CONCLUSIONS The combination of cediranib with cilengitide was well tolerated and associated with changes in pharmacodynamic blood and imaging biomarkers. However, the survival and response rates do not warrant further development of this combination.
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Affiliation(s)
- Elizabeth R Gerstner
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts (E.R.G., D.G.D., R.K.J., T.T.B.); Johns Hopkins Medical Center, Baltimore, Maryland (X.Y., S.G.); Martinos Center for Biomedical Imaging, Charlestown, Massachusetts (E.R.G., M.A.L.); Henry Ford Hospital, Detroit, Michigan (T.M.); Memorial Sloan Kettering Cancer Center, New York, New York (T.J.K.); Emory University, Atlanta, Georgia (J.J.O.); University of Alabama, Birmingham, Alabama (B.L.N.); Case Comprehensive Cancer Center, Cleveland, Ohio (M.S.A.); Dana-Farber Cancer Institute, Boston, Massachusetts (P.Y.W.)
| | - Xiaobu Ye
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts (E.R.G., D.G.D., R.K.J., T.T.B.); Johns Hopkins Medical Center, Baltimore, Maryland (X.Y., S.G.); Martinos Center for Biomedical Imaging, Charlestown, Massachusetts (E.R.G., M.A.L.); Henry Ford Hospital, Detroit, Michigan (T.M.); Memorial Sloan Kettering Cancer Center, New York, New York (T.J.K.); Emory University, Atlanta, Georgia (J.J.O.); University of Alabama, Birmingham, Alabama (B.L.N.); Case Comprehensive Cancer Center, Cleveland, Ohio (M.S.A.); Dana-Farber Cancer Institute, Boston, Massachusetts (P.Y.W.)
| | - Dan G Duda
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts (E.R.G., D.G.D., R.K.J., T.T.B.); Johns Hopkins Medical Center, Baltimore, Maryland (X.Y., S.G.); Martinos Center for Biomedical Imaging, Charlestown, Massachusetts (E.R.G., M.A.L.); Henry Ford Hospital, Detroit, Michigan (T.M.); Memorial Sloan Kettering Cancer Center, New York, New York (T.J.K.); Emory University, Atlanta, Georgia (J.J.O.); University of Alabama, Birmingham, Alabama (B.L.N.); Case Comprehensive Cancer Center, Cleveland, Ohio (M.S.A.); Dana-Farber Cancer Institute, Boston, Massachusetts (P.Y.W.)
| | - Michael A Levine
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts (E.R.G., D.G.D., R.K.J., T.T.B.); Johns Hopkins Medical Center, Baltimore, Maryland (X.Y., S.G.); Martinos Center for Biomedical Imaging, Charlestown, Massachusetts (E.R.G., M.A.L.); Henry Ford Hospital, Detroit, Michigan (T.M.); Memorial Sloan Kettering Cancer Center, New York, New York (T.J.K.); Emory University, Atlanta, Georgia (J.J.O.); University of Alabama, Birmingham, Alabama (B.L.N.); Case Comprehensive Cancer Center, Cleveland, Ohio (M.S.A.); Dana-Farber Cancer Institute, Boston, Massachusetts (P.Y.W.)
| | - Tom Mikkelsen
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts (E.R.G., D.G.D., R.K.J., T.T.B.); Johns Hopkins Medical Center, Baltimore, Maryland (X.Y., S.G.); Martinos Center for Biomedical Imaging, Charlestown, Massachusetts (E.R.G., M.A.L.); Henry Ford Hospital, Detroit, Michigan (T.M.); Memorial Sloan Kettering Cancer Center, New York, New York (T.J.K.); Emory University, Atlanta, Georgia (J.J.O.); University of Alabama, Birmingham, Alabama (B.L.N.); Case Comprehensive Cancer Center, Cleveland, Ohio (M.S.A.); Dana-Farber Cancer Institute, Boston, Massachusetts (P.Y.W.)
| | - Thomas J Kaley
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts (E.R.G., D.G.D., R.K.J., T.T.B.); Johns Hopkins Medical Center, Baltimore, Maryland (X.Y., S.G.); Martinos Center for Biomedical Imaging, Charlestown, Massachusetts (E.R.G., M.A.L.); Henry Ford Hospital, Detroit, Michigan (T.M.); Memorial Sloan Kettering Cancer Center, New York, New York (T.J.K.); Emory University, Atlanta, Georgia (J.J.O.); University of Alabama, Birmingham, Alabama (B.L.N.); Case Comprehensive Cancer Center, Cleveland, Ohio (M.S.A.); Dana-Farber Cancer Institute, Boston, Massachusetts (P.Y.W.)
| | - Jeffrey J Olson
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts (E.R.G., D.G.D., R.K.J., T.T.B.); Johns Hopkins Medical Center, Baltimore, Maryland (X.Y., S.G.); Martinos Center for Biomedical Imaging, Charlestown, Massachusetts (E.R.G., M.A.L.); Henry Ford Hospital, Detroit, Michigan (T.M.); Memorial Sloan Kettering Cancer Center, New York, New York (T.J.K.); Emory University, Atlanta, Georgia (J.J.O.); University of Alabama, Birmingham, Alabama (B.L.N.); Case Comprehensive Cancer Center, Cleveland, Ohio (M.S.A.); Dana-Farber Cancer Institute, Boston, Massachusetts (P.Y.W.)
| | - Burt L Nabors
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts (E.R.G., D.G.D., R.K.J., T.T.B.); Johns Hopkins Medical Center, Baltimore, Maryland (X.Y., S.G.); Martinos Center for Biomedical Imaging, Charlestown, Massachusetts (E.R.G., M.A.L.); Henry Ford Hospital, Detroit, Michigan (T.M.); Memorial Sloan Kettering Cancer Center, New York, New York (T.J.K.); Emory University, Atlanta, Georgia (J.J.O.); University of Alabama, Birmingham, Alabama (B.L.N.); Case Comprehensive Cancer Center, Cleveland, Ohio (M.S.A.); Dana-Farber Cancer Institute, Boston, Massachusetts (P.Y.W.)
| | - Manmeet S Ahluwalia
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts (E.R.G., D.G.D., R.K.J., T.T.B.); Johns Hopkins Medical Center, Baltimore, Maryland (X.Y., S.G.); Martinos Center for Biomedical Imaging, Charlestown, Massachusetts (E.R.G., M.A.L.); Henry Ford Hospital, Detroit, Michigan (T.M.); Memorial Sloan Kettering Cancer Center, New York, New York (T.J.K.); Emory University, Atlanta, Georgia (J.J.O.); University of Alabama, Birmingham, Alabama (B.L.N.); Case Comprehensive Cancer Center, Cleveland, Ohio (M.S.A.); Dana-Farber Cancer Institute, Boston, Massachusetts (P.Y.W.)
| | - Patrick Y Wen
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts (E.R.G., D.G.D., R.K.J., T.T.B.); Johns Hopkins Medical Center, Baltimore, Maryland (X.Y., S.G.); Martinos Center for Biomedical Imaging, Charlestown, Massachusetts (E.R.G., M.A.L.); Henry Ford Hospital, Detroit, Michigan (T.M.); Memorial Sloan Kettering Cancer Center, New York, New York (T.J.K.); Emory University, Atlanta, Georgia (J.J.O.); University of Alabama, Birmingham, Alabama (B.L.N.); Case Comprehensive Cancer Center, Cleveland, Ohio (M.S.A.); Dana-Farber Cancer Institute, Boston, Massachusetts (P.Y.W.)
| | - Rakesh K Jain
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts (E.R.G., D.G.D., R.K.J., T.T.B.); Johns Hopkins Medical Center, Baltimore, Maryland (X.Y., S.G.); Martinos Center for Biomedical Imaging, Charlestown, Massachusetts (E.R.G., M.A.L.); Henry Ford Hospital, Detroit, Michigan (T.M.); Memorial Sloan Kettering Cancer Center, New York, New York (T.J.K.); Emory University, Atlanta, Georgia (J.J.O.); University of Alabama, Birmingham, Alabama (B.L.N.); Case Comprehensive Cancer Center, Cleveland, Ohio (M.S.A.); Dana-Farber Cancer Institute, Boston, Massachusetts (P.Y.W.)
| | - Tracy T Batchelor
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts (E.R.G., D.G.D., R.K.J., T.T.B.); Johns Hopkins Medical Center, Baltimore, Maryland (X.Y., S.G.); Martinos Center for Biomedical Imaging, Charlestown, Massachusetts (E.R.G., M.A.L.); Henry Ford Hospital, Detroit, Michigan (T.M.); Memorial Sloan Kettering Cancer Center, New York, New York (T.J.K.); Emory University, Atlanta, Georgia (J.J.O.); University of Alabama, Birmingham, Alabama (B.L.N.); Case Comprehensive Cancer Center, Cleveland, Ohio (M.S.A.); Dana-Farber Cancer Institute, Boston, Massachusetts (P.Y.W.)
| | - Stuart Grossman
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts (E.R.G., D.G.D., R.K.J., T.T.B.); Johns Hopkins Medical Center, Baltimore, Maryland (X.Y., S.G.); Martinos Center for Biomedical Imaging, Charlestown, Massachusetts (E.R.G., M.A.L.); Henry Ford Hospital, Detroit, Michigan (T.M.); Memorial Sloan Kettering Cancer Center, New York, New York (T.J.K.); Emory University, Atlanta, Georgia (J.J.O.); University of Alabama, Birmingham, Alabama (B.L.N.); Case Comprehensive Cancer Center, Cleveland, Ohio (M.S.A.); Dana-Farber Cancer Institute, Boston, Massachusetts (P.Y.W.)
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