1
|
Yuen CA, Pekmezci M, Bao S, Kong XT. Metastatic glioblastoma to the lungs: a case report and literature review. CNS Oncol 2024; 13:2351789. [PMID: 38864820 PMCID: PMC11172249 DOI: 10.1080/20450907.2024.2351789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 05/02/2024] [Indexed: 06/13/2024] Open
Abstract
Glioblastoma is the most common malignant primary brain tumor. Despite its infiltrative nature, extra-cranial glioblastoma metastases are rare. We present a case of a 63-year-old woman with metastatic glioblastoma in the lungs. Sarcomatous histology, a reported risk factor for disseminated disease, was found. Genomic alterations of TP53 mutation, TERT mutation, PTEN mutation, and +7/-10 were also uncovered. Early evidence suggests these molecular aberrations are common in metastatic glioblastoma. Treatment with third-line lenvatinib resulted in a mixed response. This case contributes to the growing body of evidence for the role of genomic alterations in predictive risk in metastatic glioblastoma. There remains an unmet need for treatment of metastatic glioblastoma.
Collapse
Affiliation(s)
- Carlen A Yuen
- Department of Neurology, Division of Neuro-Oncology, University of California, Irvine, CA92868, USA
| | - Melike Pekmezci
- Department of Pathology, University of California, San Francisco, CA94143, USA
| | - Silin Bao
- Department of Internal Medicine, Division of Neurosciences, Community Regional Medical Center, Fresno, CA93721, USA
| | - Xiao-Tang Kong
- Department of Neurology, Division of Neuro-Oncology, University of California, Irvine, CA92868, USA
| |
Collapse
|
2
|
Yuen CA, Bao S, Kong XT. A non-enhancing, T2 fluid-attenuated inversion recovery hyperintense, diffusion-restricting brainstem lesion in an EGFR tyrosine kinase inhibitor-treated non-small-cell lung cancer patient. Biomark Med 2024; 18:431-439. [PMID: 39007837 DOI: 10.1080/17520363.2024.2342231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/19/2024] [Indexed: 07/16/2024] Open
Abstract
Leptomeningeal metastasis (LM) is a devastating complication of malignancy. Diagnosis relies on both contrast enhancement on imaging and malignant cells in cerebral spinal fluid cytology. Though early detection and prompt intervention improves survival, the detection of LM is limited by false negatives. A rare brainstem imaging finding uncovered specifically in EGFR mutation-positive lung cancer patients may represent an early sign of LM. This sign demonstrates high signal on T2 fluid-attenuated inversion recovery and diffusion-weighted imaging sequences, but paradoxically lacks correlative contrast enhancement. Here we report a case of a 72-year-old female EGFR-positive lung cancer patient who developed this lesion following treatment with two first-generation EGFR tyrosine kinase inhibitors then showed subsequent response to osimertinib, an irreversible third-generation EGFR tyrosine kinase inhibitor.
Collapse
Affiliation(s)
- Carlen A Yuen
- Department of Neurology, Neuro-Oncology Division, University of California, Irvine, CA, 92780,USA
| | - Silin Bao
- Department of Internal Medicine, Neurosciences Division, Community Regional Medical Center, Fresno, CA 93721, USA
| | - Xiao-Tang Kong
- Department of Neurology, Neuro-Oncology Division, University of California, Irvine, CA, 92780,USA
| |
Collapse
|
3
|
Lombardi G, Spimpolo A, Berti S, Campi C, Anglani MG, Simeone R, Evangelista L, Causin F, Zorzi G, Gorgoni G, Caccese M, Padovan M, Zagonel V, Cecchin D. PET/MR in recurrent glioblastoma patients treated with regorafenib: [ 18F]FET and DWI-ADC for response assessment and survival prediction. Br J Radiol 2022; 95:20211018. [PMID: 34762492 PMCID: PMC8722234 DOI: 10.1259/bjr.20211018] [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: 11/10/2022] Open
Abstract
Objective: The use of regorafenib in recurrent glioblastoma patients has been recently approved by the Italian Medicines Agency (AIFA) and added to the National Comprehensive Cancer Network (NCCN) 2020 guidelines as a preferred regimen. Given its complex effects at the molecular level, the most appropriate imaging tools to assess early response to treatment is still a matter of debate. Diffusion-weighted imaging and O-(2-18F-fluoroethyl)-L-tyrosine positron emission tomography ([18F]FET PET) are promising methodologies providing additional information to the currently used RANO criteria. The aim of this study was to evaluate the variations in diffusion-weighted imaging/apparent diffusion coefficient (ADC) and [18F]FET PET-derived parameters in patients who underwent PET/MR at both baseline and after starting regorafenib. Methods: We retrospectively reviewed 16 consecutive GBM patients who underwent [18F]FET PET/MR before and after two cycles of regorafenib. Patients were sorted into stable (SD) or progressive disease (PD) categories in accordance with RANO criteria. We were also able to analyze four SD patients who underwent a third PET/MR after another four cycles of regorafenib. [18F]FET uptake greater than 1.6 times the mean background activity was used to define an area to be superimposed on an ADC map at baseline and after treatment. Several metrics were then derived and compared. Log-rank test was applied for overall survival analysis. Results: Percentage difference in FET volumes correlates with the corresponding percentage difference in ADC (R = 0.54). Patients with a twofold increase in FET after regorafenib showed a significantly higher increase in ADC pathological volume than the remaining subjects (p = 0.0023). Kaplan–Meier analysis, performed to compare the performance in overall survival prediction, revealed that the percentage variations of FET- and ADC-derived metrics performed at least as well as RANO criteria (p = 0.02, p = 0.024 and p = 0.04 respectively) and in some cases even better. TBR Max and TBR mean are not able to accurately predict overall survival. Conclusion In recurrent glioblastoma patients treated with regorafenib, [18F]FET and ADC metrics, are able to predict overall survival and being obtained from completely different measures as compared to RANO, could serve as semi-quantitative independent biomarkers of response to treatment. Advances in knowledge Simultaneous evaluation of [18F]FET and ADC metrics using PET/MR allows an early and reliable identification of response to treatment and predict overall survival.
Collapse
Affiliation(s)
- Giuseppe Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology - IRCCS, Padua, Italy
| | - Alessandro Spimpolo
- Nuclear Medicine Unit, Department of Medicine - DIMED, Padua University Hospital, Padua, Italy
| | - Sara Berti
- Nuclear Medicine Unit, Department of Medicine - DIMED, Padua University Hospital, Padua, Italy
| | - Cristina Campi
- Department of Mathematics, University of Genoa, Genoa, Italy
| | | | - Rossella Simeone
- Nuclear Medicine Unit, Department of Medicine - DIMED, Padua University Hospital, Padua, Italy
| | - Laura Evangelista
- Nuclear Medicine Unit, Department of Medicine - DIMED, Padua University Hospital, Padua, Italy
| | - Francesco Causin
- Neuroradiology Unit, Azienda Ospedaliera di Padova, Padua, Italy
| | - Giovanni Zorzi
- Department of Neurosciences (DNS), University of Padua, Padua, Italy
| | - Giancarlo Gorgoni
- Radiopharmacy, Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Mario Caccese
- Department of Oncology, Oncology 1, Veneto Institute of Oncology - IRCCS, Padua, Italy
| | - Marta Padovan
- Department of Oncology, Oncology 1, Veneto Institute of Oncology - IRCCS, Padua, Italy
| | - Vittorina Zagonel
- Department of Oncology, Oncology 1, Veneto Institute of Oncology - IRCCS, Padua, Italy
| | - Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine - DIMED, Padua University Hospital, Padua, Italy
| |
Collapse
|
4
|
Mirian C, Duun-Henriksen AK, Maier A, Pedersen MM, Jensen LR, Bashir A, Graillon T, Hrachova M, Bota D, van Essen M, Spanjol P, Kreis C, Law I, Broholm H, Poulsgaard L, Fugleholm K, Ziebell M, Munch T, Walter MA, Mathiesen T. Somatostatin Receptor-Targeted Radiopeptide Therapy in Treatment-Refractory Meningioma: Individual Patient Data Meta-analysis. J Nucl Med 2021; 62:507-513. [PMID: 32859705 DOI: 10.2967/jnumed.120.249607] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/29/2020] [Indexed: 11/16/2022] Open
Abstract
Somatostatin receptor (SSTR)-targeted peptide receptor radionuclide therapy (PRRT) represents a promising approach for treatment-refractory meningiomas. Methods: We performed an individual patient data meta-analysis, including all published data on meningioma patients treated with SSTR-targeted PRRT. The main outcomes were toxicity, response to treatment, progression-free survival (PFS), and overall survival (OS). We applied the Kaplan-Meier method to estimate survival probabilities and report incidence rates per 100 person-years. We applied Cox proportional hazards models to determine the effect of covariates. Results: We screened 537 papers and identified 6 eligible cohort studies. We included a total of 111 patients who had treatment-refractory meningioma and received SSTR-targeted PRRT. Disease control was achieved in 63% of patients. The 6-mo PFS rates were 94%, 48%, and 0% for World Health Organization grades I, II, and III, respectively. The risk of disease progression decreased by 13% per 1,000-MBq increase in the total applied activity. The 1-y OS rates were 88%, 71%, and 52% for World Health Organization grades I, II, and III, respectively. The risk of death decreased by 17% per 1,000-MBq increase in the total applied activity. The main side effects comprised transient hematotoxicity, such as anemia in 22% of patients, leukopenia in 13%, lymphocytopenia in 24%, and thrombocytopenia in 17%. Conclusion: To our knowledge, this individual patient data meta-analysis represents the most comprehensive analysis of the benefits of and adverse events associated with SSTR-targeted PRRT for treatment-refractory meningioma. The treatment was well tolerated, achieved disease control in most cases, and showed promising results regarding PFS and OS.
Collapse
Affiliation(s)
- Christian Mirian
- Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Nuclear Medicine, University Hospital of Geneva, Geneva, Switzerland
| | | | - Andrea Maier
- Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maria Møller Pedersen
- Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lasse Rehné Jensen
- Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Asma Bashir
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Copenhagen, Denmark
| | - Thomas Graillon
- APHM, Department of Neurosurgery, La Timone Hospital, Marseille, France
| | - Maya Hrachova
- Department of Neurology, UC Irvine Medical Center, Irvine, California
| | - Daniela Bota
- Department of Neurology, UC Irvine Medical Center, Irvine, California
- Department of Neurosurgery, UC Irvine Medical Center, Irvine, California
| | - Martjin van Essen
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Petar Spanjol
- Department of Nuclear Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Christian Kreis
- Department of Nuclear Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Copenhagen, Denmark
| | - Helle Broholm
- Department of Neuropathology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Poulsgaard
- Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kåre Fugleholm
- Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Morten Ziebell
- Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tina Munch
- Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark; and
| | - Martin A Walter
- Department of Nuclear Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Tiit Mathiesen
- Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
5
|
Distinct imaging patterns of pseudoprogression in glioma patients following proton versus photon radiation therapy. J Neurooncol 2021; 152:583-590. [PMID: 33751335 DOI: 10.1007/s11060-021-03734-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/05/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE Criteria by the Radiologic Assessment in Neuro-Oncology (RANO) group outline the diagnosis of pseudoprogression (Ps) after photon therapy for gliomas based on timing and location. We noted that patients receiving proton therapy manifested radiographic changes that appear different than Ps after photon therapy, which could be interpreted as tumor progression. In this study, we retrospectively reviewed MR imaging after proton or photon radiation for gliomas. We propose criteria to characterize proton pseudoprogression (ProPs) as distinct from Ps seen after photons. METHODS Post-treatment MR imaging, clinical and pathological data of low grade glioma patients were reviewed. Overall, 57 patients receiving protons were reviewed for the presence of ProPs, and 43 patients receiving photons were reviewed for any equivalent imaging changes. Data collected included the location and timing of the new enhancement, tumor grade, molecular subtype, chemotherapy received, and clinical symptoms. RESULTS Fourteen patients (24.6%) had new enhancement following radiation therapy that was unique to treatment with protons. The mean time to development of the ProPs was 15.4 months (7-27 months). We established the following criteria to characterize ProPs: located at the distal end of the proton beam; resolves without tumor-directed therapy; and subjectively multifocal, patchy, and small (< 1 cm). In the group receiving photons, none had changes that met our criteria for ProPs. CONCLUSION Patients who receive protons have unique imaging changes after radiation therapy. ProPs could be mistaken for tumor progression, but typically resolves on follow up. Further studies are needed to understand the radiobiology and pathophysiology underlying these imaging changes.
Collapse
|
6
|
Booth TC, Thompson G, Bulbeck H, Boele F, Buckley C, Cardoso J, Dos Santos Canas L, Jenkinson D, Ashkan K, Kreindler J, Huskens N, Luis A, McBain C, Mills SJ, Modat M, Morley N, Murphy C, Ourselin S, Pennington M, Powell J, Summers D, Waldman AD, Watts C, Williams M, Grant R, Jenkinson MD. A Position Statement on the Utility of Interval Imaging in Standard of Care Brain Tumour Management: Defining the Evidence Gap and Opportunities for Future Research. Front Oncol 2021; 11:620070. [PMID: 33634034 PMCID: PMC7900557 DOI: 10.3389/fonc.2021.620070] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/06/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIV E To summarise current evidence for the utility of interval imaging in monitoring disease in adult brain tumours, and to develop a position for future evidence gathering while incorporating the application of data science and health economics. METHODS Experts in 'interval imaging' (imaging at pre-planned time-points to assess tumour status); data science; health economics, trial management of adult brain tumours, and patient representatives convened in London, UK. The current evidence on the use of interval imaging for monitoring brain tumours was reviewed. To improve the evidence that interval imaging has a role in disease management, we discussed specific themes of data science, health economics, statistical considerations, patient and carer perspectives, and multi-centre study design. Suggestions for future studies aimed at filling knowledge gaps were discussed. RESULTS Meningioma and glioma were identified as priorities for interval imaging utility analysis. The "monitoring biomarkers" most commonly used in adult brain tumour patients were standard structural MRI features. Interval imaging was commonly scheduled to provide reported imaging prior to planned, regular clinic visits. There is limited evidence relating interval imaging in the absence of clinical deterioration to management change that alters morbidity, mortality, quality of life, or resource use. Progression-free survival is confounded as an outcome measure when using structural MRI in glioma. Uncertainty from imaging causes distress for some patients and their caregivers, while for others it provides an important indicator of disease activity. Any study design that changes imaging regimens should consider the potential for influencing current or planned therapeutic trials, ensure that opportunity costs are measured, and capture indirect benefits and added value. CONCLUSION Evidence for the value, and therefore utility, of regular interval imaging is currently lacking. Ongoing collaborative efforts will improve trial design and generate the evidence to optimise monitoring imaging biomarkers in standard of care brain tumour management.
Collapse
Affiliation(s)
- Thomas C. Booth
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
- Department of Neuroradiology, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Gerard Thompson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Florien Boele
- Leeds Institute of Medical Research at St James’s, St James’s University Hospital, Leeds, United Kingdom
- Faculty of Medicine and Health, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | | | - Jorge Cardoso
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
| | - Liane Dos Santos Canas
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
| | | | - Keyoumars Ashkan
- Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Nicky Huskens
- The Tessa Jowell Brain Cancer Mission, London, United Kingdom
| | - Aysha Luis
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Catherine McBain
- Department of Oncology, Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Samantha J. Mills
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
| | - Nick Morley
- Department of Radiology, Wales Research and Diagnostic PET Imaging Centre, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Caroline Murphy
- King’s College Trials Unit, King’s College London, London, United Kingdom
| | - Sebastian Ourselin
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
| | - Mark Pennington
- King’s Health Economics, King’s College London, London, United Kingdom
| | - James Powell
- Department of Oncology, Velindre Cancer Centre, Cardiff, United Kingdom
| | - David Summers
- Department of Neuroradiology, Western General Hospital, Edinburgh, United Kingdom
| | - Adam D. Waldman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Colin Watts
- Birmingham Brain Cancer Program, University of Birmingham, Birmingham, United Kingdom
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Matthew Williams
- Department of Neuro-oncology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Robin Grant
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Michael D. Jenkinson
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| |
Collapse
|
7
|
Evaluation of Glycolytic Response to Multiple Classes of Anti-glioblastoma Drugs by Noninvasive Measurement of Pyruvate Kinase M2 Using [ 18F]DASA-23. Mol Imaging Biol 2021; 22:124-133. [PMID: 30989436 DOI: 10.1007/s11307-019-01353-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE Pyruvate kinase M2 (PKM2) catalyzes the final step in glycolysis, the key process of tumor metabolism. PKM2 is found in high levels in glioblastoma (GBM) cells with marginal expression within healthy brain tissue, rendering it a key biomarker of GBM metabolic re-programming. Our group has reported the development of a novel radiotracer, 1-((2-fluoro- 6-[18F]fluorophenyl)sulfonyl)-4-((4-methoxyphenyl)sulfonyl)piperazine ([18F]DASA- 23), to non-invasively detect PKM2 levels with positron emission tomography (PET). PROCEDURE U87 human GBM cells were treated with the IC50 concentration of various agents used in the treatment of GBM, including alkylating agents (temozolomide, carmustine, lomustine, procarbazine), inhibitor of topoisomerase I (irinotecan), vascular endothelial and epidermal growth factor receptor inhibitors (cediranib and erlotinib, respectively) anti-metabolite (5-fluorouracil), microtubule inhibitor (vincristine), and metabolic agents (dichloroacetate and IDH1 inhibitor ivosidenib). Following drug exposure for three or 6 days (n = 6 replicates per condition), the radiotracer uptake of [18F]DASA-23 and 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) was assessed. Changes in PKM2 protein levels were determined via Western blot and correlated to radiotracer uptake. RESULTS Significant interactions were found between the treatment agent (n = 12 conditions total comprised 11 drugs and vehicle) and the duration of treatment (3- or 6-day exposure to each drug) on the cellular uptake of [18F]DASA-23 (p = 0.0001). The greatest change in the cellular uptake of [18F]DASA-23 was found after exposure to alkylating agents (p < 0. 0001) followed by irinotecan (p = 0. 0012), erlotinib (p = 0. 02), and 5-fluorouracil (p = 0. 005). Correlation of PKM2 protein levels and [18F]DASA-23 cellular uptake revealed a moderate correlation (r = 0.44, p = 0.15). CONCLUSIONS These proof of principle studies emphasize the superiority of [18F]DASA-23 to [18F]FDG in detecting the glycolytic response of GBM to multiple classes of anti-neoplastic drugs in cell culture. A clinical trial evaluating the diagnostic utility of [18F]DASA-23 PET in GBM patients (NCT03539731) is ongoing.
Collapse
|
8
|
Wykes V, Zisakis A, Irimia M, Ughratdar I, Sawlani V, Watts C. Importance and Evidence of Extent of Resection in Glioblastoma. J Neurol Surg A Cent Eur Neurosurg 2020; 82:75-86. [PMID: 33049795 DOI: 10.1055/s-0040-1701635] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Maximal safe resection is an essential part of the multidisciplinary care of patients with glioblastoma. A growing body of data shows that gross total resection is an independent prognostic factor associated with improved clinical outcome. The relationship between extent of glioblastoma (GB) resection and clinical benefit depends critically on the balance between cytoreduction and avoiding neurologic morbidity. The definition of the extent of tumor resection, how this is best measured pre- and postoperatively, and its relation to volume of residual tumor is still discussed. We review the literature supporting extent of resection in GB, highlighting the importance of a standardized definition and measurement of extent of resection to allow greater collaboration in research projects and trials. Recent developments in neurosurgical techniques and technologies focused on maximizing extent of resection and safety are discussed.
Collapse
Affiliation(s)
- Victoria Wykes
- Institute of Cancer and Genomic Sciences, University of Birmingham College of Medical and Dental Sciences, Birmingham, United Kingdom of Great Britain and Northern Ireland.,Department of Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Athanasios Zisakis
- Department of Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Mihaela Irimia
- Department of Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Ismail Ughratdar
- Department of Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Vijay Sawlani
- Department of Radiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Colin Watts
- Institute of Cancer and Genomic Sciences, University of Birmingham College of Medical and Dental Sciences, Birmingham, United Kingdom of Great Britain and Northern Ireland.,Department of Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom of Great Britain and Northern Ireland
| |
Collapse
|
9
|
Benzakoun J, Robert C, Legrand L, Pallud J, Meder JF, Oppenheim C, Dhermain F, Edjlali M. Anatomical and functional MR imaging to define tumoral boundaries and characterize lesions in neuro-oncology. Cancer Radiother 2020; 24:453-462. [PMID: 32278653 DOI: 10.1016/j.canrad.2020.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/04/2020] [Indexed: 12/19/2022]
Abstract
Neuroimaging and especially MRI has emerged as a necessary imaging modality to detect, measure, characterize and monitor brain tumours. Advanced MRI sequences such as perfusion MRI, diffusion MRI and spectroscopy as well as new post-processing techniques such as automatic segmentation of tumours and radiomics play a crucial role in characterization and follow up of brain tumours. The purpose of this review is to provide an overview on anatomical and functional MRI use for brain tumours boundaries determination and tumour characterization in the specific context of radiotherapy. The usefulness of anatomical and functional MRI on particular challenges posed by radiotherapy such as pseudo progression and pseudo esponse and new treatment strategies such as dose painting is also described.
Collapse
Affiliation(s)
- J Benzakoun
- Radiology Department, GHU de Paris, centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France; Université de Paris, 85, boulevard Saint-Germain, 75006 Paris, France; Imabrain, Institut de psychiatrie et neurosciences de Paris (IPNP), 102-108, rue de la Santé, 75014 Paris, France; Inserm, U1266, 102, rue de la Santé, 75013 Paris, France.
| | - C Robert
- Medical Physics Department, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France; Molecular Radiotherapy, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France; Inserm, 114, rue Édouard-Vaillant, 94805 Villejuif, France; Paris-Sud University, Paris-Saclay University, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - L Legrand
- Radiology Department, GHU de Paris, centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France; Université de Paris, 85, boulevard Saint-Germain, 75006 Paris, France; Imabrain, Institut de psychiatrie et neurosciences de Paris (IPNP), 102-108, rue de la Santé, 75014 Paris, France; Inserm, U1266, 102, rue de la Santé, 75013 Paris, France
| | - J Pallud
- Université de Paris, 85, boulevard Saint-Germain, 75006 Paris, France; Imabrain, Institut de psychiatrie et neurosciences de Paris (IPNP), 102-108, rue de la Santé, 75014 Paris, France; Inserm, U1266, 102, rue de la Santé, 75013 Paris, France; Neurosurgery Department, GHU de Paris, centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France
| | - J-F Meder
- Radiology Department, GHU de Paris, centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France; Université de Paris, 85, boulevard Saint-Germain, 75006 Paris, France; Imabrain, Institut de psychiatrie et neurosciences de Paris (IPNP), 102-108, rue de la Santé, 75014 Paris, France; Inserm, U1266, 102, rue de la Santé, 75013 Paris, France
| | - C Oppenheim
- Radiology Department, GHU de Paris, centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France; Université de Paris, 85, boulevard Saint-Germain, 75006 Paris, France; Imabrain, Institut de psychiatrie et neurosciences de Paris (IPNP), 102-108, rue de la Santé, 75014 Paris, France; Inserm, U1266, 102, rue de la Santé, 75013 Paris, France
| | - F Dhermain
- Radiotherapy Department, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - M Edjlali
- Radiology Department, GHU de Paris, centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France; Université de Paris, 85, boulevard Saint-Germain, 75006 Paris, France; Imabrain, Institut de psychiatrie et neurosciences de Paris (IPNP), 102-108, rue de la Santé, 75014 Paris, France; Inserm, U1266, 102, rue de la Santé, 75013 Paris, France
| |
Collapse
|
10
|
Lennartz S, Zopfs D, Nobis A, Paquet S, Hoyer UCI, Zäske C, Goertz L, Kabbasch C, Laukamp KR, Große Hokamp N, Galldiks N, Borggrefe J. MRI Follow-up of Astrocytoma: Automated Coregistration and Color-Coding of FLAIR Sequences Improves Diagnostic Accuracy With Comparable Reading Time. J Magn Reson Imaging 2020; 52:1197-1206. [PMID: 32246803 DOI: 10.1002/jmri.27136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND MRI follow-up is widely used for longitudinal assessment of astrocytoma, yet reading can be tedious and error-prone, in particular when changes are subtle. PURPOSE/HYPOTHESIS To determine the effect of automated, color-coded coregistration (AC) of fluid attenuated inversion recovery (FLAIR) sequences on diagnostic accuracy, certainty, and reading time compared to conventional follow-up MRI assessment of astrocytoma patients. STUDY TYPE Retrospective. POPULATION In all, 41 patients with neuropathologically confirmed astrocytoma. FIELD STRENGTH/SEQUENCE 1.0-3.0T/FLAIR ASSESSMENT: The presence or absence of tumor progression was determined based on FLAIR sequences, contrast-enhanced T1 sequences, and clinical data. Three radiologists assessed 47 MRI study pairs in a conventional reading (CR) and in a second reading supported by AC after 6 weeks. Readers determined the presence/absence of tumor progression and indicated diagnostic certainty on a 5-point Likert scale. Reading time was recorded by an independent assessor. STATISTICAL TESTS The Wilcoxon test was used to assess reading time and diagnostic certainty. Differences in diagnostic accuracy, sensitivity, and specificity were analyzed with the McNemar mid-p test. RESULTS Readers attained significantly higher overall sensitivity (0.86 vs. 0.75; P < 0.05) and diagnostic accuracy (0.84 vs. 0.73; P < 0.05) for detection of progressive nonenhancing tumor burden when using AC compared to CR. There was a strong trend towards higher specificity within the AC-augmented reading, yet without statistical significance (0.83 vs. 0.71; P = 0.08). Sensitivity for unequivocal disease progression was similarly high in both approaches (AC: 0.94, CR: 0.92), while for marginal disease progressions, it was significantly higher in AC (AC: 0.78, CR: 0.58; P < 0.05). Reading time including application loading time was comparable (AC: 38.1 ± 16.8 sec, CR: 36.0 ± 18.9 s; P = 0.25). DATA CONCLUSION Compared to CR, AC improves comparison of FLAIR signal hyperintensity at MRI follow-up of astrocytoma patients, allowing for a significantly higher diagnostic accuracy, particularly for subtle disease progression at a comparable reading time. EVIDENCE LEVEL 3 TECHNICAL EFFICACY STAGE: 6 J. Magn. Reson. Imaging 2020;52:1197-1206.
Collapse
Affiliation(s)
- Simon Lennartz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Else Kröner Forschungskolleg Clonal Evolution in Cancer, University Hospital Cologne, Cologne, Germany.,Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David Zopfs
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anne Nobis
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stefanie Paquet
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ulrike Cornelia Isabel Hoyer
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Charlotte Zäske
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lukas Goertz
- Center for Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Christoph Kabbasch
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Kai Roman Laukamp
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nils Große Hokamp
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Norbert Galldiks
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Köln, Germany.,Institute of Neuroscience and Medicine (INM-3), Research Center Juelich, Juelich, Germany.,Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and Duesseldorf, Germany
| | - Jan Borggrefe
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| |
Collapse
|
11
|
Chukwueke UN, Wen PY. Use of the Response Assessment in Neuro-Oncology (RANO) criteria in clinical trials and clinical practice. CNS Oncol 2019; 8:CNS28. [PMID: 30806082 PMCID: PMC6499019 DOI: 10.2217/cns-2018-0007] [Citation(s) in RCA: 144] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/15/2018] [Indexed: 11/21/2022] Open
Affiliation(s)
- Ugonma N Chukwueke
- Department of Medical Oncology, Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Department of Neurology, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Patrick Y Wen
- Department of Medical Oncology, Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA
- Department of Neurology, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
| |
Collapse
|
12
|
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.
Collapse
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.)
| |
Collapse
|
13
|
Brown D, Chen ZP, Guo C, Yang Q, Li J, Wu S, Deng M, Du X, Sai K, Jiang X, Chen Z, Zhang J, Lin F, Wang J, Chen Y, Ke C, Zhang X, Ju X, Mou Y, Bacha J, Steino A, Kanekal S, Kwan C, Johnson G, Schwartz R, Langlands J. Phase 2 clinical trial of VAL-083 as first-line treatment in newly-diagnosed MGMT-unmethylated glioblastoma multiforme (GBM): Halfway report. GLIOMA 2019. [DOI: 10.4103/glioma.glioma_25_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
14
|
Andronesi OC, Arrillaga-Romany IC, Ly KI, Bogner W, Ratai EM, Reitz K, Iafrate AJ, Dietrich J, Gerstner ER, Chi AS, Rosen BR, Wen PY, Cahill DP, Batchelor TT. Pharmacodynamics of mutant-IDH1 inhibitors in glioma patients probed by in vivo 3D MRS imaging of 2-hydroxyglutarate. Nat Commun 2018; 9:1474. [PMID: 29662077 PMCID: PMC5902553 DOI: 10.1038/s41467-018-03905-6] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 03/21/2018] [Indexed: 12/27/2022] Open
Abstract
Inhibitors of the mutant isocitrate dehydrogenase 1 (IDH1) entered recently in clinical trials for glioma treatment. Mutant IDH1 produces high levels of 2-hydroxyglurate (2HG), thought to initiate oncogenesis through epigenetic modifications of gene expression. In this study, we show the initial evidence of the pharmacodynamics of a new mutant IDH1 inhibitor in glioma patients, using non-invasive 3D MR spectroscopic imaging of 2HG. Our results from a Phase 1 clinical trial indicate a rapid decrease of 2HG levels by 70% (CI 13%, P = 0.019) after 1 week of treatment. Importantly, inhibition of mutant IDH1 may lead to the reprogramming of tumor metabolism, suggested by simultaneous changes in glutathione, glutamine, glutamate, and lactate. An inverse correlation between metabolic changes and diffusion MRI indicates an effect on the tumor-cell density. We demonstrate a feasible radiopharmacodynamics approach to support the rapid clinical translation of rationally designed drugs targeting IDH1/2 mutations for personalized and precision medicine of glioma patients.
Collapse
Affiliation(s)
- Ovidiu C Andronesi
- Department of Radiology, Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, MA, 02129, USA.
| | - Isabel C Arrillaga-Romany
- Department of Neurology, Massachusetts General Hospital, Stephen E. and Catherine Pappas Center for Neuro-Oncology, Division of Hematology/Oncology, Harvard Medical School, Boston, MA, 02114, USA
| | - K Ina Ly
- Department of Neurology, Massachusetts General Hospital, Stephen E. and Catherine Pappas Center for Neuro-Oncology, Division of Hematology/Oncology, Harvard Medical School, Boston, MA, 02114, USA
| | - Wolfgang Bogner
- Department of Biomedical Imaging and Image-guided Therapy, High Field MR Centre, Medical University of Vienna, Vienna, 1090, Austria
| | - Eva M Ratai
- Department of Radiology, Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, MA, 02129, USA
| | - Kara Reitz
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - A John Iafrate
- Department of Pathology, Massachusetts General Hospital, Center for Integrated Diagnostics, Harvard Medical School, Boston, MA, 02114, USA
| | - Jorg Dietrich
- Department of Neurology, Massachusetts General Hospital, Stephen E. and Catherine Pappas Center for Neuro-Oncology, Division of Hematology/Oncology, Harvard Medical School, Boston, MA, 02114, USA
| | - Elizabeth R Gerstner
- Department of Neurology, Massachusetts General Hospital, Stephen E. and Catherine Pappas Center for Neuro-Oncology, Division of Hematology/Oncology, Harvard Medical School, Boston, MA, 02114, USA
| | - Andrew S Chi
- Brain Tumor Center, Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center and School of Medicine, New York, NY, 10016, USA
| | - Bruce R Rosen
- Department of Radiology, Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, MA, 02129, USA
| | - Patrick Y Wen
- Dana-Farber Cancer Institute, Boston, MA, 02284, USA
| | - Daniel P Cahill
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Tracy T Batchelor
- Department of Neurology, Massachusetts General Hospital, Stephen E. and Catherine Pappas Center for Neuro-Oncology, Division of Hematology/Oncology, Harvard Medical School, Boston, MA, 02114, USA
| |
Collapse
|
15
|
Thust SC, Heiland S, Falini A, Jäger HR, Waldman AD, Sundgren PC, Godi C, Katsaros VK, Ramos A, Bargallo N, Vernooij MW, Yousry T, Bendszus M, Smits M. Glioma imaging in Europe: A survey of 220 centres and recommendations for best clinical practice. Eur Radiol 2018. [PMID: 29536240 PMCID: PMC6028837 DOI: 10.1007/s00330-018-5314-5] [Citation(s) in RCA: 131] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objectives At a European Society of Neuroradiology (ESNR) Annual Meeting 2015 workshop, commonalities in practice, current controversies and technical hurdles in glioma MRI were discussed. We aimed to formulate guidance on MRI of glioma and determine its feasibility, by seeking information on glioma imaging practices from the European Neuroradiology community. Methods Invitations to a structured survey were emailed to ESNR members (n=1,662) and associates (n=6,400), European national radiologists’ societies and distributed via social media. Results Responses were received from 220 institutions (59% academic). Conventional imaging protocols generally include T2w, T2-FLAIR, DWI, and pre- and post-contrast T1w. Perfusion MRI is used widely (85.5%), while spectroscopy seems reserved for specific indications. Reasons for omitting advanced imaging modalities include lack of facility/software, time constraints and no requests. Early postoperative MRI is routinely carried out by 74% within 24–72 h, but only 17% report a percent measure of resection. For follow-up, most sites (60%) issue qualitative reports, while 27% report an assessment according to the RANO criteria. A minority of sites use a reporting template (23%). Conclusion Clinical best practice recommendations for glioma imaging assessment are proposed and the current role of advanced MRI modalities in routine use is addressed. Key Points • We recommend the EORTC-NBTS protocol as the clinical standard glioma protocol. • Perfusion MRI is recommended for diagnosis and follow-up of glioma. • Use of advanced imaging could be promoted with increased education activities. • Most response assessment is currently performed qualitatively. • Reporting templates are not widely used, and could facilitate standardisation. Electronic supplementary material The online version of this article (10.1007/s00330-018-5314-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- S C Thust
- Lysholm Neuroradiology Department, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Brain Rehabilitation and Repair, UCL Institute of Neurology, London, UK
- Imaging Department, University College London Hospital, London, UK
| | - S Heiland
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - A Falini
- Department of Neuroradiology, San Raffaele Scientific Institute, Milan, Italy
| | - H R Jäger
- Lysholm Neuroradiology Department, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Brain Rehabilitation and Repair, UCL Institute of Neurology, London, UK
- Imaging Department, University College London Hospital, London, UK
| | - A D Waldman
- Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK
| | - P C Sundgren
- Institution for Clinical Sciences/Radiology, Lund University, Lund, Sweden
- Centre for Imaging and Physiology, Skåne University hospital, Lund, Sweden
| | - C Godi
- Department of Neuroradiology, San Raffaele Scientific Institute, Milan, Italy
| | - V K Katsaros
- General Anti-Cancer and Oncological Hospital "Agios Savvas", Athens, Greece
- Central Clinic of Athens, Athens, Greece
- University of Athens, Athens, Greece
| | - A Ramos
- Hospital 12 de Octubre, Madrid, Spain
| | - N Bargallo
- Image Diagnostic Centre, Hospital Clinic de Barcelona, Barcelona, Spain
- Magnetic Resonance Core Facility, Institut per la Recerca Biomedica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - M W Vernooij
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - T Yousry
- Lysholm Neuroradiology Department, National Hospital for Neurology and Neurosurgery, London, UK
| | - M Bendszus
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - M Smits
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.
| |
Collapse
|
16
|
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.
Collapse
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.
| |
Collapse
|
17
|
McCullough BJ, Ader V, Aguedan B, Feng X, Susanto D, Benkers TL, Henson JW, Mayberg M, Cobbs CS, Gwinn RP, Monteith SJ, Newell DW, Delashaw J, Fouke SJ, Rostad S, Keogh BP. Preoperative relative cerebral blood volume analysis in gliomas predicts survival and mitigates risk of biopsy sampling error. J Neurooncol 2017; 136:181-188. [PMID: 29098571 DOI: 10.1007/s11060-017-2642-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 10/21/2017] [Indexed: 10/18/2022]
Abstract
Appropriate management of adult gliomas requires an accurate histopathological diagnosis. However, the heterogeneity of gliomas can lead to misdiagnosis and undergrading, especially with biopsy. We evaluated the role of preoperative relative cerebral blood volume (rCBV) analysis in conjunction with histopathological analysis as a predictor of overall survival and risk of undergrading. We retrospectively identified 146 patients with newly diagnosed gliomas (WHO grade II-IV) that had undergone preoperative MRI with rCBV analysis. We compared overall survival by histopathologically determined WHO tumor grade and by rCBV using Kaplan-Meier survival curves and the Cox proportional hazards model. We also compared preoperative imaging findings and initial histopathological diagnosis in 13 patients who underwent biopsy followed by subsequent resection. Survival curves by WHO grade and rCBV tier similarly separated patients into low, intermediate, and high-risk groups with shorter survival corresponding to higher grade or rCBV tier. The hazard ratio for WHO grade III versus II was 3.91 (p = 0.018) and for grade IV versus II was 11.26 (p < 0.0001) and the hazard ratio for each increase in 1.0 rCBV units was 1.12 (p < 0.002). Additionally, 3 of 13 (23%) patients initially diagnosed by biopsy were upgraded on subsequent resection. Preoperative rCBV was elevated at least one standard deviation above the mean in the 3 upgraded patients, suggestive of undergrading, but not in the ten concordant diagnoses. In conclusion, rCBV can predict overall survival similarly to pathologically determined WHO grade in patients with gliomas. Discordant rCBV analysis and histopathology may help identify patients at higher risk for undergrading.
Collapse
Affiliation(s)
- Brendan J McCullough
- Swedish Neuroscience Institute, 550 17th Avenue, Seattle, WA, 98122, USA.
- Ben and Catherine Ivy Center for Advanced Brain Tumor Treatment, 550 17th Avenue, Seattle, WA, 98122, USA.
- Radia, Inc., 19020 33rd Avenue West, Suite 210, Lynwood, WA, 98036, USA.
- Department of Health Services, University of Washington, 4333 Brooklyn Avenue NE, Box 359455, Seattle, WA, 98195, USA.
| | - Valerie Ader
- Radia, Inc., 19020 33rd Avenue West, Suite 210, Lynwood, WA, 98036, USA
| | - Brian Aguedan
- Radia, Inc., 19020 33rd Avenue West, Suite 210, Lynwood, WA, 98036, USA
| | - Xu Feng
- Radia, Inc., 19020 33rd Avenue West, Suite 210, Lynwood, WA, 98036, USA
| | - Daniel Susanto
- Swedish Neuroscience Institute, 550 17th Avenue, Seattle, WA, 98122, USA
- Radia, Inc., 19020 33rd Avenue West, Suite 210, Lynwood, WA, 98036, USA
| | - Tara L Benkers
- Swedish Neuroscience Institute, 550 17th Avenue, Seattle, WA, 98122, USA
| | - John W Henson
- Piedmont Brain Tumor Center, 2001 Peachtree Road, Suite 645, Atlanta, GA, 30309, USA
| | - Marc Mayberg
- Swedish Neuroscience Institute, 550 17th Avenue, Seattle, WA, 98122, USA
| | - Charles S Cobbs
- Swedish Neuroscience Institute, 550 17th Avenue, Seattle, WA, 98122, USA
| | - Ryder P Gwinn
- Swedish Neuroscience Institute, 550 17th Avenue, Seattle, WA, 98122, USA
| | - Stephen J Monteith
- Swedish Neuroscience Institute, 550 17th Avenue, Seattle, WA, 98122, USA
| | - David W Newell
- Swedish Neuroscience Institute, 550 17th Avenue, Seattle, WA, 98122, USA
| | - Johnny Delashaw
- Swedish Neuroscience Institute, 550 17th Avenue, Seattle, WA, 98122, USA
| | - Sarah J Fouke
- Brain and Spine Center, St. Luke's Hospital, 232 South Woods Mill Road, St. Louis, MO, 63117, USA
| | - Steven Rostad
- Swedish Neuroscience Institute, 550 17th Avenue, Seattle, WA, 98122, USA
- Cellnetix Pathology, 1124 Columbia Street, Suite 200, Seattle, WA, 98104, USA
| | - Bart P Keogh
- Swedish Neuroscience Institute, 550 17th Avenue, Seattle, WA, 98122, USA
- Radia, Inc., 19020 33rd Avenue West, Suite 210, Lynwood, WA, 98036, USA
| |
Collapse
|
18
|
Ellingson BM, Gerstner ER, Smits M, Huang RY, Colen R, Abrey LE, Aftab DT, Schwab GM, Hessel C, Harris RJ, Chakhoyan A, Gahrmann R, Pope WB, Leu K, Raymond C, Woodworth DC, de Groot J, Wen PY, Batchelor TT, van den Bent MJ, Cloughesy TF. Diffusion MRI Phenotypes Predict Overall Survival Benefit from Anti-VEGF Monotherapy in Recurrent Glioblastoma: Converging Evidence from Phase II Trials. Clin Cancer Res 2017; 23:5745-5756. [PMID: 28655794 PMCID: PMC5626594 DOI: 10.1158/1078-0432.ccr-16-2844] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 05/16/2017] [Accepted: 06/21/2017] [Indexed: 01/25/2023]
Abstract
Purpose: Anti-VEGF therapies remain controversial in the treatment of recurrent glioblastoma (GBM). In the current study, we demonstrate that recurrent GBM patients with a specific diffusion MR imaging signature have an overall survival (OS) advantage when treated with cediranib, bevacizumab, cabozantinib, or aflibercept monotherapy at first or second recurrence. These findings were validated using a separate trial comparing bevacizumab with lomustine.Experimental Design: Patients with recurrent GBM and diffusion MRI from the monotherapy arms of 5 separate phase II clinical trials were included: (i) cediranib (NCT00035656); (ii) bevacizumab (BRAIN Trial, AVF3708g; NCT00345163); (iii) cabozantinib (XL184-201; NCT00704288); (iv) aflibercept (VEGF Trap; NCT00369590); and (v) bevacizumab or lomustine (BELOB; NTR1929). Apparent diffusion coefficient (ADC) histogram analysis was performed prior to therapy to estimate "ADCL," the mean of the lower ADC distribution. Pretreatment ADCL, enhancing volume, and clinical variables were tested as independent prognostic factors for OS.Results: The coefficient of variance (COV) in double baseline ADCL measurements was 2.5% and did not significantly differ (P = 0.4537). An ADCL threshold of 1.24 μm2/ms produced the largest OS differences between patients (HR ∼ 0.5), and patients with an ADCL > 1.24 μm2/ms had close to double the OS in all anti-VEGF therapeutic scenarios tested. Training and validation data confirmed that baseline ADCL was an independent predictive biomarker for OS in anti-VEGF therapies, but not in lomustine, after accounting for age and baseline enhancing tumor volume.Conclusions: Pretreatment diffusion MRI is a predictive imaging biomarker for OS in patients with recurrent GBM treated with anti-VEGF monotherapy at first or second relapse. Clin Cancer Res; 23(19); 5745-56. ©2017 AACR.
Collapse
Affiliation(s)
- Benjamin M Ellingson
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
- UCLA Neuro Oncology Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | | | - Marion Smits
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Centre Rotterdam, The Netherlands
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Rivka Colen
- Department of Neuroradiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | | | | | - Robert J Harris
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Ararat Chakhoyan
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Renske Gahrmann
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Centre Rotterdam, The Netherlands
| | - Whitney B Pope
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Kevin Leu
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Catalina Raymond
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Davis C Woodworth
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - John de Groot
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | | | - Martin J van den Bent
- Department of Neuro-Oncology, Erasmus MC, University Medical Centre Rotterdam, The Netherlands
| | - Timothy F Cloughesy
- UCLA Neuro Oncology Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| |
Collapse
|
19
|
Wen PY, Chang SM, Van den Bent MJ, Vogelbaum MA, Macdonald DR, Lee EQ. Response Assessment in Neuro-Oncology Clinical Trials. J Clin Oncol 2017; 35:2439-2449. [PMID: 28640707 PMCID: PMC5516482 DOI: 10.1200/jco.2017.72.7511] [Citation(s) in RCA: 276] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Development of novel therapies for CNS tumors requires reliable assessment of response and progression. This requirement has been particularly challenging in neuro-oncology for which contrast enhancement serves as an imperfect surrogate for tumor volume and is influenced by agents that affect vascular permeability, such as antiangiogenic therapies. In addition, most tumors have a nonenhancing component that can be difficult to accurately quantify. To improve the response assessment in neuro-oncology and to standardize the criteria that are used for different CNS tumors, the Response Assessment in Neuro-Oncology (RANO) working group was established. This multidisciplinary international working group consists of neuro-oncologists, medical oncologists, neuroradiologists, neurosurgeons, radiation oncologists, neuropsychologists, and experts in clinical outcomes assessments, working in collaboration with government and industry to enhance the interpretation of clinical trials. The RANO working group was originally created to update response criteria for high- and low-grade gliomas and to address such issues as pseudoresponse and nonenhancing tumor progression from antiangiogenic therapies, and pseudoprogression from radiochemotherapy. RANO has expanded to include working groups that are focused on other tumors, including brain metastases, leptomeningeal metastases, spine tumors, pediatric brain tumors, and meningiomas, as well as other clinical trial end points, such as clinical outcomes assessments, seizures, corticosteroid use, and positron emission tomography imaging. In an effort to standardize the measurement of neurologic function for clinical assessment, the Neurologic Assessment in Neuro-Oncology scale was drafted. Born out of a workshop conducted by the Jumpstarting Brain Tumor Drug Development Coalition and the US Food and Drug Administration, a standardized brain tumor imaging protocol now exists to reduce variability and improve reliability. Efforts by RANO have been widely accepted and are increasingly being used in neuro-oncology trials, although additional refinements will be needed.
Collapse
Affiliation(s)
- Patrick Y. Wen
- Patrick Y. Wen and Eudocia Q. Lee, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; Susan M. Chang, University of California, San Francisco, San Francisco, CA; Michael A. Vogelbaum, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH; Martin J. Van den Bent, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands; and David R. Macdonald, London Regional Cancer Program, Western University, London, Ontario, Canada
| | - Susan M. Chang
- Patrick Y. Wen and Eudocia Q. Lee, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; Susan M. Chang, University of California, San Francisco, San Francisco, CA; Michael A. Vogelbaum, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH; Martin J. Van den Bent, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands; and David R. Macdonald, London Regional Cancer Program, Western University, London, Ontario, Canada
| | - Martin J. Van den Bent
- Patrick Y. Wen and Eudocia Q. Lee, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; Susan M. Chang, University of California, San Francisco, San Francisco, CA; Michael A. Vogelbaum, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH; Martin J. Van den Bent, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands; and David R. Macdonald, London Regional Cancer Program, Western University, London, Ontario, Canada
| | - Michael A. Vogelbaum
- Patrick Y. Wen and Eudocia Q. Lee, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; Susan M. Chang, University of California, San Francisco, San Francisco, CA; Michael A. Vogelbaum, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH; Martin J. Van den Bent, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands; and David R. Macdonald, London Regional Cancer Program, Western University, London, Ontario, Canada
| | - David R. Macdonald
- Patrick Y. Wen and Eudocia Q. Lee, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; Susan M. Chang, University of California, San Francisco, San Francisco, CA; Michael A. Vogelbaum, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH; Martin J. Van den Bent, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands; and David R. Macdonald, London Regional Cancer Program, Western University, London, Ontario, Canada
| | - Eudocia Q. Lee
- Patrick Y. Wen and Eudocia Q. Lee, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA; Susan M. Chang, University of California, San Francisco, San Francisco, CA; Michael A. Vogelbaum, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH; Martin J. Van den Bent, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands; and David R. Macdonald, London Regional Cancer Program, Western University, London, Ontario, Canada
| |
Collapse
|
20
|
The ratio of HLA-DR and VNN2 + expression on CD14 + myeloid derived suppressor cells can distinguish glioblastoma from radiation necrosis patients. J Neurooncol 2017; 134:189-196. [PMID: 28551851 DOI: 10.1007/s11060-017-2508-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 05/15/2017] [Indexed: 12/22/2022]
Abstract
Glioblastoma (GBM) is the most aggressive and lethal type of brain cancer with a median survival of less than two years even following aggressive treatment (Stupp et al., N Engl J Med 352:987-996, 2005). Among the many challenges in treating patients with this devastating disease is the ability to differentiate Magnetic Resonance Imaging (MRI) images that appear following radiation therapy, often termed "radiation necrosis" from true GBM recurrence. Radiation necrosis (RN) and GBM are very difficult to distinguish and currently only a brain biopsy can conclusively differentiate these pathologies. In the present study, we introduce a differential diagnostic approach using a newly identified Myeloid-Derived Suppressor Cell (MDSC) biomarker, vascular non-inflammatory molecule 2 (VNN2+), in combination with expression of traditional HLA-DR on peripheral blood CD14+ monocytes isolated from GBM and/or RN patients. We performed proof-of-principle experiments confirming the sensitivity and specificity of this approach based upon the combined expression levels of HLA-DR and VNN2 among CD14+ Mo-MDSC, which we called the DR-Vanin Index or DVI. The DVI was able to distinguish GBM from RN patients with a high degree of certainty (n = 18 and n = 6 respectively; p = 0.0004). This novel, quick and inexpensive blood-based liquid biopsy could potentially replace invasive brain biopsies in differentiating GBM from RN patients using a minimally-invasive technique.
Collapse
|
21
|
Pseudoprogression, radionecrosis, inflammation or true tumor progression? challenges associated with glioblastoma response assessment in an evolving therapeutic landscape. J Neurooncol 2017; 134:495-504. [PMID: 28382534 DOI: 10.1007/s11060-017-2375-2] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 01/13/2017] [Indexed: 01/24/2023]
Abstract
The wide variety of treatment options that exist for glioblastoma, including surgery, ionizing radiation, anti-neoplastic chemotherapies, anti-angiogenic therapies, and active or passive immunotherapies, all may alter aspects of vascular permeability within the tumor and/or normal parenchyma. These alterations manifest as changes in the degree of contrast enhancement or T2-weighted signal hyperintensity on standard anatomic MRI scans, posing a potential challenge for accurate radiographic response assessment for identifying anti-tumor effects. The current review highlights the challenges that remain in differentiating true disease progression from changes due to radiation therapy, including pseudoprogression and radionecrosis, as well as immune or inflammatory changes that may occur as either an undesired result of cytotoxic therapy or as a desired consequence of immunotherapies.
Collapse
|
22
|
Ellingson BM, Wen PY, Cloughesy TF. Modified Criteria for Radiographic Response Assessment in Glioblastoma Clinical Trials. Neurotherapeutics 2017; 14:307-320. [PMID: 28108885 PMCID: PMC5398984 DOI: 10.1007/s13311-016-0507-6] [Citation(s) in RCA: 266] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Radiographic endpoints including response and progression are important for the evaluation of new glioblastoma therapies. The current RANO criteria was developed to overcome many of the challenges identified with previous guidelines for response assessment, however, significant challenges and limitations remain. The current recommendations build on the strengths of the current RANO criteria, while addressing many of these limitations. Modifications to the current RANO criteria include suggestions for volumetric response evaluation, use contrast enhanced T1 subtraction maps to increase lesion conspicuity, removal of qualitative non-enhancing tumor assessment requirements, use of the post-radiation time point as the baseline for newly diagnosed glioblastoma response assessment, and "treatment-agnostic" response assessment rubrics for identifying pseudoprogression, pseudoresponse, and a confirmed durable response in newly diagnosed and recurrent glioblastoma trials.
Collapse
Affiliation(s)
- Benjamin M Ellingson
- UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers, University of California Los Angeles, 924 Westwood Blvd., Suite 615, Los Angeles, CA, 90024, USA.
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA.
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
- UCLA Neuro-Oncology Program, University of California Los Angeles, Los Angeles, CA, USA.
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Timothy F Cloughesy
- UCLA Neuro-Oncology Program, University of California Los Angeles, Los Angeles, CA, USA
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
23
|
Belliveau JG, Bauman G, Macdonald DR. Detecting tumor progression in glioma: current standards and new techniques. Expert Rev Anticancer Ther 2016; 16:1177-1188. [PMID: 27661768 DOI: 10.1080/14737140.2016.1240621] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The post-treatment monitoring of glioma patients remains an area of active research and development. Conventional imaging with MRI is a highly sensitive modality for detecting and monitoring primary and secondary brain tumors and includes multi-parametric sequences to better characterize the disease. Standardized schemes for measuring response to treatment are in wide clinical use; however, the introduction of new therapeutics have introduced new patterns of response that can confound interpretation of conventional MRI and can cause uncertainty in the proper management following therapy. Areas covered: A summary of current and evolving techniques for assessing glioma response in this era of new therapies that address these challenges are presented in this review. While this review focuses more on clinical and early clinical methodologies for MRI and nuclear medicine techniques some promising pre-clinical techniques are also presented. Expert commentary: While successful single institution results have been widely reported in the literature, any new methodologies must be undertaken in multi-center settings. Additionally, the need for standardization of protocols in quantitative measured are an important area that must be addressed for new and promising techniques to be implemented to a wide array of patients.
Collapse
Affiliation(s)
- Jean-Guy Belliveau
- a Department of Medical Biophysics , University of Western Ontario , London , ON , Canada
| | - Glenn Bauman
- b Department of Medical Biophysics and Oncology , University of Western Ontario , London , ON , Canada
| | - David R Macdonald
- c Department of Oncology , University of Western Ontario , London , ON , Canada
| |
Collapse
|
24
|
Dynamic Susceptibility Contrast MR Imaging in Glioma: Review of Current Clinical Practice. Magn Reson Imaging Clin N Am 2016; 24:649-670. [PMID: 27742108 DOI: 10.1016/j.mric.2016.06.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Dynamic susceptibility contrast (DSC) MR imaging, a perfusion-weighted MR imaging technique typically used in neuro-oncologic applications for estimating the relative cerebral blood volume within brain tumors, has demonstrated much potential for determining prognosis, predicting therapeutic response, and assessing early treatment response of gliomas. This review highlights recent developments using DSC-MR imaging and emphasizes the need for technical standardization and validation in prospective studies in order for this technique to become incorporated into standard-of-care imaging for patients with brain tumors.
Collapse
|
25
|
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.
Collapse
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
| |
Collapse
|
26
|
|
27
|
Sul J, Krainak DM. Brain tumor clinical trials imaging: a (well-standardized) picture is worth a thousand words. Neuro Oncol 2016; 17:1179-80. [PMID: 26293326 DOI: 10.1093/neuonc/nov158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Joohee Sul
- Office of Hematology and Oncology Products, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland (J.S.); Division of Radiological Health, Office of In vitro Diagnostics and Radiological Health, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland (D.M.K.)
| | - Daniel M Krainak
- Office of Hematology and Oncology Products, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland (J.S.); Division of Radiological Health, Office of In vitro Diagnostics and Radiological Health, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland (D.M.K.)
| |
Collapse
|
28
|
Gilbert MR, Rubinstein L, Lesser G. Creating clinical trial designs that incorporate clinical outcome assessments. Neuro Oncol 2016; 18 Suppl 2:ii21-ii25. [PMID: 26989129 DOI: 10.1093/neuonc/nov254] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Clinical outcome assessments (COAs) are increasingly being used in determining the efficacy of new treatment regimens. This was typified in the recent use of a symptom-based instrument combined with an organ-based measure of response for the approval of ruxolitinib in myelofibrosis. There are challenges in incorporating these COAs into clinical trials, including designating the level of priority, incorporating these measures into a combined or composite endpoint, and dealing with issues related to compliance and interpretation of results accounting for missing data. This article describes the results of a recent panel discussion that attempted to address these issues and provide guidance to the incorporation of COAs into clinical trials, including novel statistical designs, so that the testing of new treatments in patients with cancers of the central nervous system can incorporate these important clinical endpoints.
Collapse
Affiliation(s)
- Mark R Gilbert
- Neuro-Oncology Branch, National Institutes of Health (NIH), Bethesda, Maryland (M.R.G.); NIH, Rockville, Maryland (L.R.); Comprehensive Cancer Center of Wake Forest University, Winston-Salem, North Carolina (G.L.)
| | - Lawrence Rubinstein
- Neuro-Oncology Branch, National Institutes of Health (NIH), Bethesda, Maryland (M.R.G.); NIH, Rockville, Maryland (L.R.); Comprehensive Cancer Center of Wake Forest University, Winston-Salem, North Carolina (G.L.)
| | - Glenn Lesser
- Neuro-Oncology Branch, National Institutes of Health (NIH), Bethesda, Maryland (M.R.G.); NIH, Rockville, Maryland (L.R.); Comprehensive Cancer Center of Wake Forest University, Winston-Salem, North Carolina (G.L.)
| |
Collapse
|
29
|
Helfer JL, Wen PY, Blakeley J, Gilbert MR, Armstrong TS. Report of the Jumpstarting Brain Tumor Drug Development Coalition and FDA clinical trials clinical outcome assessment endpoints workshop (October 15, 2014, Bethesda MD). Neuro Oncol 2016; 18 Suppl 2:ii26-ii36. [PMID: 26989130 PMCID: PMC4795997 DOI: 10.1093/neuonc/nov270] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 09/22/2015] [Indexed: 11/13/2022] Open
Abstract
On October 15, 2014, a workshop was held on the use of clinical outcome assessments in clinical trials for high-grade glioma of the brain. This workshop was sponsored by the Jumpstarting Brain Tumor Drug Development Coalition, consisting of the National Brain Tumor Society, the Society for Neuro-Oncology, the Musella Foundation for Brain Tumor Research and Information, and Accelerate Brain Cancer Cure. It was planned and carried out with participation from the US Food and Drug Administration. The workshop also included stakeholders from all aspects of the brain tumor community, including clinicians, researchers, industry, clinical research organizations, patients and patient advocates, and the National Cancer Institute. This report summarizes the presentations and discussions of that workshop and the proposals that emerged to move the field forward and toward greater inclusion of these endpoints in future clinical trials for high-grade gliomas.
Collapse
Affiliation(s)
- Jennifer L Helfer
- National Brain Tumor Society, Newton, Massachusetts (J.L.H.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W.); Department of Neuro-Oncology, Johns Hopkins University, Brain Cancer Program, Baltimore, Maryland (J.B.); Center for Cancer Research, Neuro-Oncology Branch, National Cancer Institute, Bethesda, Maryland (M.R.G.); The University of Texas Health Science Center at Houston, School of Nursing, Department of Family Health, Houston, Texas (T.S.A.)
| | - Patrick Y Wen
- National Brain Tumor Society, Newton, Massachusetts (J.L.H.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W.); Department of Neuro-Oncology, Johns Hopkins University, Brain Cancer Program, Baltimore, Maryland (J.B.); Center for Cancer Research, Neuro-Oncology Branch, National Cancer Institute, Bethesda, Maryland (M.R.G.); The University of Texas Health Science Center at Houston, School of Nursing, Department of Family Health, Houston, Texas (T.S.A.)
| | - Jaishri Blakeley
- National Brain Tumor Society, Newton, Massachusetts (J.L.H.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W.); Department of Neuro-Oncology, Johns Hopkins University, Brain Cancer Program, Baltimore, Maryland (J.B.); Center for Cancer Research, Neuro-Oncology Branch, National Cancer Institute, Bethesda, Maryland (M.R.G.); The University of Texas Health Science Center at Houston, School of Nursing, Department of Family Health, Houston, Texas (T.S.A.)
| | - Mark R Gilbert
- National Brain Tumor Society, Newton, Massachusetts (J.L.H.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W.); Department of Neuro-Oncology, Johns Hopkins University, Brain Cancer Program, Baltimore, Maryland (J.B.); Center for Cancer Research, Neuro-Oncology Branch, National Cancer Institute, Bethesda, Maryland (M.R.G.); The University of Texas Health Science Center at Houston, School of Nursing, Department of Family Health, Houston, Texas (T.S.A.)
| | - Terri S Armstrong
- National Brain Tumor Society, Newton, Massachusetts (J.L.H.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W.); Department of Neuro-Oncology, Johns Hopkins University, Brain Cancer Program, Baltimore, Maryland (J.B.); Center for Cancer Research, Neuro-Oncology Branch, National Cancer Institute, Bethesda, Maryland (M.R.G.); The University of Texas Health Science Center at Houston, School of Nursing, Department of Family Health, Houston, Texas (T.S.A.)
| |
Collapse
|
30
|
Wu A, Lim M. Issues to Consider in Designing Immunotherapy Clinical Trials for Glioblastoma Management. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/jct.2016.78060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
31
|
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.
Collapse
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.)
| |
Collapse
|
32
|
Shiroishi MS, Boxerman JL, Pope WB. Physiologic MRI for assessment of response to therapy and prognosis in glioblastoma. Neuro Oncol 2015; 18:467-78. [PMID: 26364321 DOI: 10.1093/neuonc/nov179] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 08/01/2015] [Indexed: 02/06/2023] Open
Abstract
Aside from bidimensional measurements from conventional contrast-enhanced MRI, there are no validated or FDA-qualified imaging biomarkers for high-grade gliomas. However, advanced functional MRI techniques, including perfusion- and diffusion-weighted MRI, have demonstrated much potential for determining prognosis, predicting therapeutic response, and assessing early treatment response. They may also prove useful for differentiating pseudoprogression from true progression after temozolomide chemoradiation and pseudoresponse from true response after anti-angiogenic therapy. This review will highlight recent developments using these techniques and emphasize the need for technical standardization and validation in prospective studies in order for these methods to become incorporated into standard-of-care imaging for brain tumor patients.
Collapse
Affiliation(s)
- Mark S Shiroishi
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California (M.S.S.); Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island (J.L.B.); Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California (W.B.P.)
| | - Jerrold L Boxerman
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California (M.S.S.); Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island (J.L.B.); Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California (W.B.P.)
| | - Whitney B Pope
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California (M.S.S.); Department of Diagnostic Imaging, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island (J.L.B.); Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California (W.B.P.)
| |
Collapse
|
33
|
Kang JH, Adamson C. Novel chemotherapeutics and other therapies for treating high-grade glioma. Expert Opin Investig Drugs 2015; 24:1361-79. [PMID: 26289791 DOI: 10.1517/13543784.2015.1048332] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Despite extensive research, high-grade glioma (HGG) remains a dire diagnosis with no change in the standard of care in almost a decade. However, recent advancements uncovering molecular biomarkers of brain tumors and tumor-specific antigens targeted by immunotherapies provide opportunities for novel personalized treatment regimens to improve survival. AREAS COVERED In this review, the authors provide a comprehensive overview of recent therapeutic advancements in HGG. Furthermore, they describe new molecular biomarkers and molecular classifications, in addition to updated research on bevacizumab, targeted molecular therapies, immunotherapy and alternative delivery methods that overcome the blood-brain barrier to reach the target tumor tissue. Challenges regarding each therapy are also outlined. The authors also provide some insight into a novel non-chemotherapeutic treatment for malignant glioma, NovoTTFA, as well as a summary of current treatment options for recurrence. EXPERT OPINION Current research for treating malignant gliomas are paving the path to personalized therapy, including immunotherapy, that involve integrated genomic and histolopathologic data, as well as a multi-modal treatment regimen. Immunotherapy will potentially be the next addition to the current standard of care, specialized to the antigens presented on the tumors. The results of the current trials of multi-antigen vaccines are eagerly anticipated.
Collapse
Affiliation(s)
- Jennifer H Kang
- a 1 Duke University School of Medicine , Box 3807, Durham, NC, USA
| | - Cory Adamson
- b 2 Director, Molecular Neuro-oncology Lab, Duke Medical Center , DUMC Box 3807, Durham, NC, USA.,c 3 Chief of Neurosurgery, Durham VA Medical Center , 508 Fulton Street, Durham, NC, USA +1 919 698 3152 ; .,d 4 Duke Medical Center , DUMC Box 3807, Durham, NC, USA
| |
Collapse
|
34
|
Ellingson BM, Bendszus M, Boxerman J, Barboriak D, Erickson BJ, Smits M, Nelson SJ, Gerstner E, Alexander B, Goldmacher G, Wick W, Vogelbaum M, Weller M, Galanis E, Kalpathy-Cramer J, Shankar L, Jacobs P, Pope WB, Yang D, Chung C, Knopp MV, Cha S, van den Bent MJ, Chang S, Yung WKA, Cloughesy TF, Wen PY, Gilbert MR. Consensus recommendations for a standardized Brain Tumor Imaging Protocol in clinical trials. Neuro Oncol 2015; 17:1188-98. [PMID: 26250565 DOI: 10.1093/neuonc/nov095] [Citation(s) in RCA: 261] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 05/01/2015] [Indexed: 12/22/2022] Open
Abstract
A recent joint meeting was held on January 30, 2014, with the US Food and Drug Administration (FDA), National Cancer Institute (NCI), clinical scientists, imaging experts, pharmaceutical and biotech companies, clinical trials cooperative groups, and patient advocate groups to discuss imaging endpoints for clinical trials in glioblastoma. This workshop developed a set of priorities and action items including the creation of a standardized MRI protocol for multicenter studies. The current document outlines consensus recommendations for a standardized Brain Tumor Imaging Protocol (BTIP), along with the scientific and practical justifications for these recommendations, resulting from a series of discussions between various experts involved in aspects of neuro-oncology neuroimaging for clinical trials. The minimum recommended sequences include: (i) parameter-matched precontrast and postcontrast inversion recovery-prepared, isotropic 3D T1-weighted gradient-recalled echo; (ii) axial 2D T2-weighted turbo spin-echo acquired after contrast injection and before postcontrast 3D T1-weighted images to control timing of images after contrast administration; (iii) precontrast, axial 2D T2-weighted fluid-attenuated inversion recovery; and (iv) precontrast, axial 2D, 3-directional diffusion-weighted images. Recommended ranges of sequence parameters are provided for both 1.5 T and 3 T MR systems.
Collapse
Affiliation(s)
- Benjamin M Ellingson
- UCLA Neuro-Oncology Program and UCLA Brain Tumor Imaging Laboratory (BTIL), David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., T.F.C.); Department of Radiological Sciences, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M.B.); Department of Diagnostic Imaging, Warrne Alpert Medical School, Brown University, Providence, Rhode Island (J.B.); Department of Neuroradiology, Duke University School of Medicine, Durham, North Carolina (D.B.); Department of Radiology, Mayo Clinic, Rochester, Minnesota (B.J.E.); Department of Radiology, Erasmus MC University, Rotterdam, Netherlands (M.S.); Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California (S.J.N., S.C.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (E.G.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts (B.A., P.Y.W.); Medical and Scientific Affairs, ICON Medical Imaging, Warrington, Pennsylvania (G.G., D.Y.); Department of Neurooncology, National Center of Tumor Disease, University Clinic Heidelberg, Heidelberg, Germany (W.W.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.V.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota (E.G.); Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (J.K.-C.); Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), Bethesda, Maryland (L.S., P.J.); Department of Radiation Oncology, University of Toronto and Princess Margaret
| | - Martin Bendszus
- UCLA Neuro-Oncology Program and UCLA Brain Tumor Imaging Laboratory (BTIL), David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., T.F.C.); Department of Radiological Sciences, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M.B.); Department of Diagnostic Imaging, Warrne Alpert Medical School, Brown University, Providence, Rhode Island (J.B.); Department of Neuroradiology, Duke University School of Medicine, Durham, North Carolina (D.B.); Department of Radiology, Mayo Clinic, Rochester, Minnesota (B.J.E.); Department of Radiology, Erasmus MC University, Rotterdam, Netherlands (M.S.); Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California (S.J.N., S.C.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (E.G.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts (B.A., P.Y.W.); Medical and Scientific Affairs, ICON Medical Imaging, Warrington, Pennsylvania (G.G., D.Y.); Department of Neurooncology, National Center of Tumor Disease, University Clinic Heidelberg, Heidelberg, Germany (W.W.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.V.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota (E.G.); Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (J.K.-C.); Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), Bethesda, Maryland (L.S., P.J.); Department of Radiation Oncology, University of Toronto and Princess Margaret
| | - Jerrold Boxerman
- UCLA Neuro-Oncology Program and UCLA Brain Tumor Imaging Laboratory (BTIL), David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., T.F.C.); Department of Radiological Sciences, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M.B.); Department of Diagnostic Imaging, Warrne Alpert Medical School, Brown University, Providence, Rhode Island (J.B.); Department of Neuroradiology, Duke University School of Medicine, Durham, North Carolina (D.B.); Department of Radiology, Mayo Clinic, Rochester, Minnesota (B.J.E.); Department of Radiology, Erasmus MC University, Rotterdam, Netherlands (M.S.); Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California (S.J.N., S.C.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (E.G.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts (B.A., P.Y.W.); Medical and Scientific Affairs, ICON Medical Imaging, Warrington, Pennsylvania (G.G., D.Y.); Department of Neurooncology, National Center of Tumor Disease, University Clinic Heidelberg, Heidelberg, Germany (W.W.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.V.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota (E.G.); Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (J.K.-C.); Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), Bethesda, Maryland (L.S., P.J.); Department of Radiation Oncology, University of Toronto and Princess Margaret
| | - Daniel Barboriak
- UCLA Neuro-Oncology Program and UCLA Brain Tumor Imaging Laboratory (BTIL), David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., T.F.C.); Department of Radiological Sciences, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M.B.); Department of Diagnostic Imaging, Warrne Alpert Medical School, Brown University, Providence, Rhode Island (J.B.); Department of Neuroradiology, Duke University School of Medicine, Durham, North Carolina (D.B.); Department of Radiology, Mayo Clinic, Rochester, Minnesota (B.J.E.); Department of Radiology, Erasmus MC University, Rotterdam, Netherlands (M.S.); Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California (S.J.N., S.C.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (E.G.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts (B.A., P.Y.W.); Medical and Scientific Affairs, ICON Medical Imaging, Warrington, Pennsylvania (G.G., D.Y.); Department of Neurooncology, National Center of Tumor Disease, University Clinic Heidelberg, Heidelberg, Germany (W.W.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.V.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota (E.G.); Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (J.K.-C.); Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), Bethesda, Maryland (L.S., P.J.); Department of Radiation Oncology, University of Toronto and Princess Margaret
| | - Bradley J Erickson
- UCLA Neuro-Oncology Program and UCLA Brain Tumor Imaging Laboratory (BTIL), David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., T.F.C.); Department of Radiological Sciences, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M.B.); Department of Diagnostic Imaging, Warrne Alpert Medical School, Brown University, Providence, Rhode Island (J.B.); Department of Neuroradiology, Duke University School of Medicine, Durham, North Carolina (D.B.); Department of Radiology, Mayo Clinic, Rochester, Minnesota (B.J.E.); Department of Radiology, Erasmus MC University, Rotterdam, Netherlands (M.S.); Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California (S.J.N., S.C.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (E.G.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts (B.A., P.Y.W.); Medical and Scientific Affairs, ICON Medical Imaging, Warrington, Pennsylvania (G.G., D.Y.); Department of Neurooncology, National Center of Tumor Disease, University Clinic Heidelberg, Heidelberg, Germany (W.W.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.V.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota (E.G.); Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (J.K.-C.); Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), Bethesda, Maryland (L.S., P.J.); Department of Radiation Oncology, University of Toronto and Princess Margaret
| | - Marion Smits
- UCLA Neuro-Oncology Program and UCLA Brain Tumor Imaging Laboratory (BTIL), David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., T.F.C.); Department of Radiological Sciences, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M.B.); Department of Diagnostic Imaging, Warrne Alpert Medical School, Brown University, Providence, Rhode Island (J.B.); Department of Neuroradiology, Duke University School of Medicine, Durham, North Carolina (D.B.); Department of Radiology, Mayo Clinic, Rochester, Minnesota (B.J.E.); Department of Radiology, Erasmus MC University, Rotterdam, Netherlands (M.S.); Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California (S.J.N., S.C.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (E.G.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts (B.A., P.Y.W.); Medical and Scientific Affairs, ICON Medical Imaging, Warrington, Pennsylvania (G.G., D.Y.); Department of Neurooncology, National Center of Tumor Disease, University Clinic Heidelberg, Heidelberg, Germany (W.W.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.V.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota (E.G.); Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (J.K.-C.); Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), Bethesda, Maryland (L.S., P.J.); Department of Radiation Oncology, University of Toronto and Princess Margaret
| | - Sarah J Nelson
- UCLA Neuro-Oncology Program and UCLA Brain Tumor Imaging Laboratory (BTIL), David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., T.F.C.); Department of Radiological Sciences, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M.B.); Department of Diagnostic Imaging, Warrne Alpert Medical School, Brown University, Providence, Rhode Island (J.B.); Department of Neuroradiology, Duke University School of Medicine, Durham, North Carolina (D.B.); Department of Radiology, Mayo Clinic, Rochester, Minnesota (B.J.E.); Department of Radiology, Erasmus MC University, Rotterdam, Netherlands (M.S.); Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California (S.J.N., S.C.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (E.G.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts (B.A., P.Y.W.); Medical and Scientific Affairs, ICON Medical Imaging, Warrington, Pennsylvania (G.G., D.Y.); Department of Neurooncology, National Center of Tumor Disease, University Clinic Heidelberg, Heidelberg, Germany (W.W.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.V.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota (E.G.); Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (J.K.-C.); Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), Bethesda, Maryland (L.S., P.J.); Department of Radiation Oncology, University of Toronto and Princess Margaret
| | - Elizabeth Gerstner
- UCLA Neuro-Oncology Program and UCLA Brain Tumor Imaging Laboratory (BTIL), David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., T.F.C.); Department of Radiological Sciences, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M.B.); Department of Diagnostic Imaging, Warrne Alpert Medical School, Brown University, Providence, Rhode Island (J.B.); Department of Neuroradiology, Duke University School of Medicine, Durham, North Carolina (D.B.); Department of Radiology, Mayo Clinic, Rochester, Minnesota (B.J.E.); Department of Radiology, Erasmus MC University, Rotterdam, Netherlands (M.S.); Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California (S.J.N., S.C.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (E.G.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts (B.A., P.Y.W.); Medical and Scientific Affairs, ICON Medical Imaging, Warrington, Pennsylvania (G.G., D.Y.); Department of Neurooncology, National Center of Tumor Disease, University Clinic Heidelberg, Heidelberg, Germany (W.W.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.V.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota (E.G.); Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (J.K.-C.); Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), Bethesda, Maryland (L.S., P.J.); Department of Radiation Oncology, University of Toronto and Princess Margaret
| | - Brian Alexander
- UCLA Neuro-Oncology Program and UCLA Brain Tumor Imaging Laboratory (BTIL), David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., T.F.C.); Department of Radiological Sciences, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M.B.); Department of Diagnostic Imaging, Warrne Alpert Medical School, Brown University, Providence, Rhode Island (J.B.); Department of Neuroradiology, Duke University School of Medicine, Durham, North Carolina (D.B.); Department of Radiology, Mayo Clinic, Rochester, Minnesota (B.J.E.); Department of Radiology, Erasmus MC University, Rotterdam, Netherlands (M.S.); Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California (S.J.N., S.C.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (E.G.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts (B.A., P.Y.W.); Medical and Scientific Affairs, ICON Medical Imaging, Warrington, Pennsylvania (G.G., D.Y.); Department of Neurooncology, National Center of Tumor Disease, University Clinic Heidelberg, Heidelberg, Germany (W.W.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.V.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota (E.G.); Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (J.K.-C.); Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), Bethesda, Maryland (L.S., P.J.); Department of Radiation Oncology, University of Toronto and Princess Margaret
| | - Gregory Goldmacher
- UCLA Neuro-Oncology Program and UCLA Brain Tumor Imaging Laboratory (BTIL), David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., T.F.C.); Department of Radiological Sciences, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M.B.); Department of Diagnostic Imaging, Warrne Alpert Medical School, Brown University, Providence, Rhode Island (J.B.); Department of Neuroradiology, Duke University School of Medicine, Durham, North Carolina (D.B.); Department of Radiology, Mayo Clinic, Rochester, Minnesota (B.J.E.); Department of Radiology, Erasmus MC University, Rotterdam, Netherlands (M.S.); Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California (S.J.N., S.C.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (E.G.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts (B.A., P.Y.W.); Medical and Scientific Affairs, ICON Medical Imaging, Warrington, Pennsylvania (G.G., D.Y.); Department of Neurooncology, National Center of Tumor Disease, University Clinic Heidelberg, Heidelberg, Germany (W.W.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.V.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota (E.G.); Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (J.K.-C.); Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), Bethesda, Maryland (L.S., P.J.); Department of Radiation Oncology, University of Toronto and Princess Margaret
| | - Wolfgang Wick
- UCLA Neuro-Oncology Program and UCLA Brain Tumor Imaging Laboratory (BTIL), David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., T.F.C.); Department of Radiological Sciences, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M.B.); Department of Diagnostic Imaging, Warrne Alpert Medical School, Brown University, Providence, Rhode Island (J.B.); Department of Neuroradiology, Duke University School of Medicine, Durham, North Carolina (D.B.); Department of Radiology, Mayo Clinic, Rochester, Minnesota (B.J.E.); Department of Radiology, Erasmus MC University, Rotterdam, Netherlands (M.S.); Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California (S.J.N., S.C.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (E.G.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts (B.A., P.Y.W.); Medical and Scientific Affairs, ICON Medical Imaging, Warrington, Pennsylvania (G.G., D.Y.); Department of Neurooncology, National Center of Tumor Disease, University Clinic Heidelberg, Heidelberg, Germany (W.W.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.V.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota (E.G.); Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (J.K.-C.); Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), Bethesda, Maryland (L.S., P.J.); Department of Radiation Oncology, University of Toronto and Princess Margaret
| | - Michael Vogelbaum
- UCLA Neuro-Oncology Program and UCLA Brain Tumor Imaging Laboratory (BTIL), David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., T.F.C.); Department of Radiological Sciences, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M.B.); Department of Diagnostic Imaging, Warrne Alpert Medical School, Brown University, Providence, Rhode Island (J.B.); Department of Neuroradiology, Duke University School of Medicine, Durham, North Carolina (D.B.); Department of Radiology, Mayo Clinic, Rochester, Minnesota (B.J.E.); Department of Radiology, Erasmus MC University, Rotterdam, Netherlands (M.S.); Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California (S.J.N., S.C.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (E.G.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts (B.A., P.Y.W.); Medical and Scientific Affairs, ICON Medical Imaging, Warrington, Pennsylvania (G.G., D.Y.); Department of Neurooncology, National Center of Tumor Disease, University Clinic Heidelberg, Heidelberg, Germany (W.W.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.V.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota (E.G.); Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (J.K.-C.); Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), Bethesda, Maryland (L.S., P.J.); Department of Radiation Oncology, University of Toronto and Princess Margaret
| | - Michael Weller
- UCLA Neuro-Oncology Program and UCLA Brain Tumor Imaging Laboratory (BTIL), David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., T.F.C.); Department of Radiological Sciences, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M.B.); Department of Diagnostic Imaging, Warrne Alpert Medical School, Brown University, Providence, Rhode Island (J.B.); Department of Neuroradiology, Duke University School of Medicine, Durham, North Carolina (D.B.); Department of Radiology, Mayo Clinic, Rochester, Minnesota (B.J.E.); Department of Radiology, Erasmus MC University, Rotterdam, Netherlands (M.S.); Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California (S.J.N., S.C.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (E.G.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts (B.A., P.Y.W.); Medical and Scientific Affairs, ICON Medical Imaging, Warrington, Pennsylvania (G.G., D.Y.); Department of Neurooncology, National Center of Tumor Disease, University Clinic Heidelberg, Heidelberg, Germany (W.W.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.V.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota (E.G.); Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (J.K.-C.); Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), Bethesda, Maryland (L.S., P.J.); Department of Radiation Oncology, University of Toronto and Princess Margaret
| | - Evanthia Galanis
- UCLA Neuro-Oncology Program and UCLA Brain Tumor Imaging Laboratory (BTIL), David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., T.F.C.); Department of Radiological Sciences, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M.B.); Department of Diagnostic Imaging, Warrne Alpert Medical School, Brown University, Providence, Rhode Island (J.B.); Department of Neuroradiology, Duke University School of Medicine, Durham, North Carolina (D.B.); Department of Radiology, Mayo Clinic, Rochester, Minnesota (B.J.E.); Department of Radiology, Erasmus MC University, Rotterdam, Netherlands (M.S.); Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California (S.J.N., S.C.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (E.G.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts (B.A., P.Y.W.); Medical and Scientific Affairs, ICON Medical Imaging, Warrington, Pennsylvania (G.G., D.Y.); Department of Neurooncology, National Center of Tumor Disease, University Clinic Heidelberg, Heidelberg, Germany (W.W.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.V.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota (E.G.); Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (J.K.-C.); Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), Bethesda, Maryland (L.S., P.J.); Department of Radiation Oncology, University of Toronto and Princess Margaret
| | - Jayashree Kalpathy-Cramer
- UCLA Neuro-Oncology Program and UCLA Brain Tumor Imaging Laboratory (BTIL), David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., T.F.C.); Department of Radiological Sciences, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M.B.); Department of Diagnostic Imaging, Warrne Alpert Medical School, Brown University, Providence, Rhode Island (J.B.); Department of Neuroradiology, Duke University School of Medicine, Durham, North Carolina (D.B.); Department of Radiology, Mayo Clinic, Rochester, Minnesota (B.J.E.); Department of Radiology, Erasmus MC University, Rotterdam, Netherlands (M.S.); Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California (S.J.N., S.C.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (E.G.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts (B.A., P.Y.W.); Medical and Scientific Affairs, ICON Medical Imaging, Warrington, Pennsylvania (G.G., D.Y.); Department of Neurooncology, National Center of Tumor Disease, University Clinic Heidelberg, Heidelberg, Germany (W.W.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.V.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota (E.G.); Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (J.K.-C.); Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), Bethesda, Maryland (L.S., P.J.); Department of Radiation Oncology, University of Toronto and Princess Margaret
| | - Lalitha Shankar
- UCLA Neuro-Oncology Program and UCLA Brain Tumor Imaging Laboratory (BTIL), David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., T.F.C.); Department of Radiological Sciences, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M.B.); Department of Diagnostic Imaging, Warrne Alpert Medical School, Brown University, Providence, Rhode Island (J.B.); Department of Neuroradiology, Duke University School of Medicine, Durham, North Carolina (D.B.); Department of Radiology, Mayo Clinic, Rochester, Minnesota (B.J.E.); Department of Radiology, Erasmus MC University, Rotterdam, Netherlands (M.S.); Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California (S.J.N., S.C.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (E.G.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts (B.A., P.Y.W.); Medical and Scientific Affairs, ICON Medical Imaging, Warrington, Pennsylvania (G.G., D.Y.); Department of Neurooncology, National Center of Tumor Disease, University Clinic Heidelberg, Heidelberg, Germany (W.W.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.V.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota (E.G.); Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (J.K.-C.); Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), Bethesda, Maryland (L.S., P.J.); Department of Radiation Oncology, University of Toronto and Princess Margaret
| | - Paula Jacobs
- UCLA Neuro-Oncology Program and UCLA Brain Tumor Imaging Laboratory (BTIL), David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., T.F.C.); Department of Radiological Sciences, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M.B.); Department of Diagnostic Imaging, Warrne Alpert Medical School, Brown University, Providence, Rhode Island (J.B.); Department of Neuroradiology, Duke University School of Medicine, Durham, North Carolina (D.B.); Department of Radiology, Mayo Clinic, Rochester, Minnesota (B.J.E.); Department of Radiology, Erasmus MC University, Rotterdam, Netherlands (M.S.); Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California (S.J.N., S.C.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (E.G.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts (B.A., P.Y.W.); Medical and Scientific Affairs, ICON Medical Imaging, Warrington, Pennsylvania (G.G., D.Y.); Department of Neurooncology, National Center of Tumor Disease, University Clinic Heidelberg, Heidelberg, Germany (W.W.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.V.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota (E.G.); Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (J.K.-C.); Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), Bethesda, Maryland (L.S., P.J.); Department of Radiation Oncology, University of Toronto and Princess Margaret
| | - Whitney B Pope
- UCLA Neuro-Oncology Program and UCLA Brain Tumor Imaging Laboratory (BTIL), David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., T.F.C.); Department of Radiological Sciences, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M.B.); Department of Diagnostic Imaging, Warrne Alpert Medical School, Brown University, Providence, Rhode Island (J.B.); Department of Neuroradiology, Duke University School of Medicine, Durham, North Carolina (D.B.); Department of Radiology, Mayo Clinic, Rochester, Minnesota (B.J.E.); Department of Radiology, Erasmus MC University, Rotterdam, Netherlands (M.S.); Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California (S.J.N., S.C.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (E.G.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts (B.A., P.Y.W.); Medical and Scientific Affairs, ICON Medical Imaging, Warrington, Pennsylvania (G.G., D.Y.); Department of Neurooncology, National Center of Tumor Disease, University Clinic Heidelberg, Heidelberg, Germany (W.W.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.V.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota (E.G.); Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (J.K.-C.); Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), Bethesda, Maryland (L.S., P.J.); Department of Radiation Oncology, University of Toronto and Princess Margaret
| | - Dewen Yang
- UCLA Neuro-Oncology Program and UCLA Brain Tumor Imaging Laboratory (BTIL), David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., T.F.C.); Department of Radiological Sciences, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M.B.); Department of Diagnostic Imaging, Warrne Alpert Medical School, Brown University, Providence, Rhode Island (J.B.); Department of Neuroradiology, Duke University School of Medicine, Durham, North Carolina (D.B.); Department of Radiology, Mayo Clinic, Rochester, Minnesota (B.J.E.); Department of Radiology, Erasmus MC University, Rotterdam, Netherlands (M.S.); Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California (S.J.N., S.C.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (E.G.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts (B.A., P.Y.W.); Medical and Scientific Affairs, ICON Medical Imaging, Warrington, Pennsylvania (G.G., D.Y.); Department of Neurooncology, National Center of Tumor Disease, University Clinic Heidelberg, Heidelberg, Germany (W.W.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.V.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota (E.G.); Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (J.K.-C.); Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), Bethesda, Maryland (L.S., P.J.); Department of Radiation Oncology, University of Toronto and Princess Margaret
| | - Caroline Chung
- UCLA Neuro-Oncology Program and UCLA Brain Tumor Imaging Laboratory (BTIL), David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., T.F.C.); Department of Radiological Sciences, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M.B.); Department of Diagnostic Imaging, Warrne Alpert Medical School, Brown University, Providence, Rhode Island (J.B.); Department of Neuroradiology, Duke University School of Medicine, Durham, North Carolina (D.B.); Department of Radiology, Mayo Clinic, Rochester, Minnesota (B.J.E.); Department of Radiology, Erasmus MC University, Rotterdam, Netherlands (M.S.); Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California (S.J.N., S.C.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (E.G.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts (B.A., P.Y.W.); Medical and Scientific Affairs, ICON Medical Imaging, Warrington, Pennsylvania (G.G., D.Y.); Department of Neurooncology, National Center of Tumor Disease, University Clinic Heidelberg, Heidelberg, Germany (W.W.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.V.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota (E.G.); Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (J.K.-C.); Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), Bethesda, Maryland (L.S., P.J.); Department of Radiation Oncology, University of Toronto and Princess Margaret
| | - Michael V Knopp
- UCLA Neuro-Oncology Program and UCLA Brain Tumor Imaging Laboratory (BTIL), David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., T.F.C.); Department of Radiological Sciences, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M.B.); Department of Diagnostic Imaging, Warrne Alpert Medical School, Brown University, Providence, Rhode Island (J.B.); Department of Neuroradiology, Duke University School of Medicine, Durham, North Carolina (D.B.); Department of Radiology, Mayo Clinic, Rochester, Minnesota (B.J.E.); Department of Radiology, Erasmus MC University, Rotterdam, Netherlands (M.S.); Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California (S.J.N., S.C.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (E.G.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts (B.A., P.Y.W.); Medical and Scientific Affairs, ICON Medical Imaging, Warrington, Pennsylvania (G.G., D.Y.); Department of Neurooncology, National Center of Tumor Disease, University Clinic Heidelberg, Heidelberg, Germany (W.W.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.V.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota (E.G.); Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (J.K.-C.); Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), Bethesda, Maryland (L.S., P.J.); Department of Radiation Oncology, University of Toronto and Princess Margaret
| | - Soonme Cha
- UCLA Neuro-Oncology Program and UCLA Brain Tumor Imaging Laboratory (BTIL), David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., T.F.C.); Department of Radiological Sciences, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M.B.); Department of Diagnostic Imaging, Warrne Alpert Medical School, Brown University, Providence, Rhode Island (J.B.); Department of Neuroradiology, Duke University School of Medicine, Durham, North Carolina (D.B.); Department of Radiology, Mayo Clinic, Rochester, Minnesota (B.J.E.); Department of Radiology, Erasmus MC University, Rotterdam, Netherlands (M.S.); Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California (S.J.N., S.C.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (E.G.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts (B.A., P.Y.W.); Medical and Scientific Affairs, ICON Medical Imaging, Warrington, Pennsylvania (G.G., D.Y.); Department of Neurooncology, National Center of Tumor Disease, University Clinic Heidelberg, Heidelberg, Germany (W.W.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.V.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota (E.G.); Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (J.K.-C.); Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), Bethesda, Maryland (L.S., P.J.); Department of Radiation Oncology, University of Toronto and Princess Margaret
| | - Martin J van den Bent
- UCLA Neuro-Oncology Program and UCLA Brain Tumor Imaging Laboratory (BTIL), David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., T.F.C.); Department of Radiological Sciences, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M.B.); Department of Diagnostic Imaging, Warrne Alpert Medical School, Brown University, Providence, Rhode Island (J.B.); Department of Neuroradiology, Duke University School of Medicine, Durham, North Carolina (D.B.); Department of Radiology, Mayo Clinic, Rochester, Minnesota (B.J.E.); Department of Radiology, Erasmus MC University, Rotterdam, Netherlands (M.S.); Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California (S.J.N., S.C.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (E.G.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts (B.A., P.Y.W.); Medical and Scientific Affairs, ICON Medical Imaging, Warrington, Pennsylvania (G.G., D.Y.); Department of Neurooncology, National Center of Tumor Disease, University Clinic Heidelberg, Heidelberg, Germany (W.W.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.V.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota (E.G.); Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (J.K.-C.); Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), Bethesda, Maryland (L.S., P.J.); Department of Radiation Oncology, University of Toronto and Princess Margaret
| | - Susan Chang
- UCLA Neuro-Oncology Program and UCLA Brain Tumor Imaging Laboratory (BTIL), David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., T.F.C.); Department of Radiological Sciences, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M.B.); Department of Diagnostic Imaging, Warrne Alpert Medical School, Brown University, Providence, Rhode Island (J.B.); Department of Neuroradiology, Duke University School of Medicine, Durham, North Carolina (D.B.); Department of Radiology, Mayo Clinic, Rochester, Minnesota (B.J.E.); Department of Radiology, Erasmus MC University, Rotterdam, Netherlands (M.S.); Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California (S.J.N., S.C.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (E.G.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts (B.A., P.Y.W.); Medical and Scientific Affairs, ICON Medical Imaging, Warrington, Pennsylvania (G.G., D.Y.); Department of Neurooncology, National Center of Tumor Disease, University Clinic Heidelberg, Heidelberg, Germany (W.W.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.V.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota (E.G.); Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (J.K.-C.); Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), Bethesda, Maryland (L.S., P.J.); Department of Radiation Oncology, University of Toronto and Princess Margaret
| | - W K Al Yung
- UCLA Neuro-Oncology Program and UCLA Brain Tumor Imaging Laboratory (BTIL), David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., T.F.C.); Department of Radiological Sciences, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M.B.); Department of Diagnostic Imaging, Warrne Alpert Medical School, Brown University, Providence, Rhode Island (J.B.); Department of Neuroradiology, Duke University School of Medicine, Durham, North Carolina (D.B.); Department of Radiology, Mayo Clinic, Rochester, Minnesota (B.J.E.); Department of Radiology, Erasmus MC University, Rotterdam, Netherlands (M.S.); Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California (S.J.N., S.C.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (E.G.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts (B.A., P.Y.W.); Medical and Scientific Affairs, ICON Medical Imaging, Warrington, Pennsylvania (G.G., D.Y.); Department of Neurooncology, National Center of Tumor Disease, University Clinic Heidelberg, Heidelberg, Germany (W.W.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.V.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota (E.G.); Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (J.K.-C.); Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), Bethesda, Maryland (L.S., P.J.); Department of Radiation Oncology, University of Toronto and Princess Margaret
| | - Timothy F Cloughesy
- UCLA Neuro-Oncology Program and UCLA Brain Tumor Imaging Laboratory (BTIL), David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., T.F.C.); Department of Radiological Sciences, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M.B.); Department of Diagnostic Imaging, Warrne Alpert Medical School, Brown University, Providence, Rhode Island (J.B.); Department of Neuroradiology, Duke University School of Medicine, Durham, North Carolina (D.B.); Department of Radiology, Mayo Clinic, Rochester, Minnesota (B.J.E.); Department of Radiology, Erasmus MC University, Rotterdam, Netherlands (M.S.); Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California (S.J.N., S.C.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (E.G.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts (B.A., P.Y.W.); Medical and Scientific Affairs, ICON Medical Imaging, Warrington, Pennsylvania (G.G., D.Y.); Department of Neurooncology, National Center of Tumor Disease, University Clinic Heidelberg, Heidelberg, Germany (W.W.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.V.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota (E.G.); Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (J.K.-C.); Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), Bethesda, Maryland (L.S., P.J.); Department of Radiation Oncology, University of Toronto and Princess Margaret
| | - Patrick Y Wen
- UCLA Neuro-Oncology Program and UCLA Brain Tumor Imaging Laboratory (BTIL), David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., T.F.C.); Department of Radiological Sciences, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M.B.); Department of Diagnostic Imaging, Warrne Alpert Medical School, Brown University, Providence, Rhode Island (J.B.); Department of Neuroradiology, Duke University School of Medicine, Durham, North Carolina (D.B.); Department of Radiology, Mayo Clinic, Rochester, Minnesota (B.J.E.); Department of Radiology, Erasmus MC University, Rotterdam, Netherlands (M.S.); Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California (S.J.N., S.C.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (E.G.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts (B.A., P.Y.W.); Medical and Scientific Affairs, ICON Medical Imaging, Warrington, Pennsylvania (G.G., D.Y.); Department of Neurooncology, National Center of Tumor Disease, University Clinic Heidelberg, Heidelberg, Germany (W.W.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.V.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota (E.G.); Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (J.K.-C.); Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), Bethesda, Maryland (L.S., P.J.); Department of Radiation Oncology, University of Toronto and Princess Margaret
| | - Mark R Gilbert
- UCLA Neuro-Oncology Program and UCLA Brain Tumor Imaging Laboratory (BTIL), David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., T.F.C.); Department of Radiological Sciences, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, California (B.M.E., W.B.P.); Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany (M.B.); Department of Diagnostic Imaging, Warrne Alpert Medical School, Brown University, Providence, Rhode Island (J.B.); Department of Neuroradiology, Duke University School of Medicine, Durham, North Carolina (D.B.); Department of Radiology, Mayo Clinic, Rochester, Minnesota (B.J.E.); Department of Radiology, Erasmus MC University, Rotterdam, Netherlands (M.S.); Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California (S.J.N., S.C.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (E.G.); Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts (B.A., P.Y.W.); Medical and Scientific Affairs, ICON Medical Imaging, Warrington, Pennsylvania (G.G., D.Y.); Department of Neurooncology, National Center of Tumor Disease, University Clinic Heidelberg, Heidelberg, Germany (W.W.); Department of Neurological Surgery, Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio (M.V.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W.); Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota (E.G.); Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (J.K.-C.); Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), Bethesda, Maryland (L.S., P.J.); Department of Radiation Oncology, University of Toronto and Princess Margaret
| | | |
Collapse
|
35
|
Yang D. Standardized MRI assessment of high-grade glioma response: a review of the essential elements and pitfalls of the RANO criteria. Neurooncol Pract 2015; 3:59-67. [PMID: 31579522 DOI: 10.1093/nop/npv023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Indexed: 01/01/2023] Open
Abstract
Accurately evaluating response in the treatment of high-grade gliomas presents considerable challenges. This review looks at the advancements made in response criteria while critically outlining remaining weaknesses, and directs our vision toward promising endpoints to come. The 2010 guidelines from the Response Assessment in Neuro-Oncology (RANO) working group have enhanced interpretation of clinical trials involving novel treatments for high-grade glioma. Yet, while the criteria are considered clinically applicable to high-grade glioma trials, as well as reasonably accurate and reproducible, RANO lacks sufficient detail for consistent implementation in certain aspects and leaves some issues from the original Macdonald guidelines unresolved. To provide the most accurate assessment of response to therapeutic intervention currently possible, it is essential that trial oncologists and radiologists not only have a solid understanding of RANO guidelines, but also proper insight into the inherent limitations of the criteria. With the expectation of improved data collection as a standard, the author anticipates that the next high-grade glioma response criteria updates will incorporate advanced MRI methods and quantitative tumor volume measurements, availing a more accurate interpretation of response in the future.
Collapse
Affiliation(s)
- Dewen Yang
- ICON Medical Imaging, 2800 Kelly Road, Warrington, PA 18976
| |
Collapse
|
36
|
Ellingson BM, Lai A, Nguyen HN, Nghiemphu PL, Pope WB, Cloughesy TF. Quantification of Nonenhancing Tumor Burden in Gliomas Using Effective T2 Maps Derived from Dual-Echo Turbo Spin-Echo MRI. Clin Cancer Res 2015; 21:4373-83. [PMID: 25901082 DOI: 10.1158/1078-0432.ccr-14-2862] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 04/08/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE Evaluation of nonenhancing tumor (NET) burden is an important yet challenging part of brain tumor response assessment. This study focuses on using dual-echo turbo spin-echo MRI as a means of quickly estimating tissue T2, which can be used to objectively define NET burden. EXPERIMENTAL DESIGN A series of experiments were performed to establish the use of T2 maps for defining NET burden. First, variation in T2 was determined using the American College of Radiology (ACR) water phantoms in 16 scanners evaluated over 3 years. Next, the sensitivity and specificity of T2 maps for delineating NET from other tissues were examined. Then, T2-defined NET was used to predict survival in separate subsets of patients with glioblastoma treated with radiotherapy, concurrent radiation, and chemotherapy, or bevacizumab at recurrence. RESULTS Variability in T2 in the ACR phantom was 3% to 5%. In training data, ROC analysis suggested that 125 ms < T2 < 250 ms could delineate NET with a sensitivity of >90% and specificity of >65%. Using this criterion, NET burden after completion of radiotherapy alone, or concurrent radiotherapy, and chemotherapy was shown to be predictive of survival (Cox, P < 0.05), and the change in NET volume before and after bevacizumab therapy in recurrent glioblastoma was also a predictive of survival (P < 0.05). CONCLUSIONS T2 maps using dual-echo data are feasible, stable, and can be used to objectively define NET burden for use in brain tumor characterization, prognosis, and response assessment. The use of effective T2 maps for defining NET burden should be validated in a randomized, clinical trial.
Collapse
Affiliation(s)
- Benjamin M Ellingson
- UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California, Los Angeles, California. Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California. Biomedical Physics Program, David Geffen School of Medicine, University of California, Los Angeles, California. Department of Bioengineering, Henry Samueli School of Engineering and Applied Science, University of California, Los Angeles, California. UCLA Brain Research Institute, David Geffen School of Medicine, University of California, Los Angeles, California. Jonsson Comprehensive Cancer Center, University of California, Los Angeles, California.
| | - Albert Lai
- UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California, Los Angeles, California. Jonsson Comprehensive Cancer Center, University of California, Los Angeles, California. Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Huytram N Nguyen
- UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California, Los Angeles, California. Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Phioanh L Nghiemphu
- UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California, Los Angeles, California. Jonsson Comprehensive Cancer Center, University of California, Los Angeles, California. Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Whitney B Pope
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Timothy F Cloughesy
- UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California, Los Angeles, California. Jonsson Comprehensive Cancer Center, University of California, Los Angeles, California. Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, California
| |
Collapse
|
37
|
Neagu MR, Huang RY, Reardon DA, Wen PY. How treatment monitoring is influencing treatment decisions in glioblastomas. Curr Treat Options Neurol 2015; 17:343. [PMID: 25749847 DOI: 10.1007/s11940-015-0343-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OPINION STATEMENT Glioblastoma (GBM), the most common malignant primary tumor in adults, carries a dismal prognosis with an average median survival of 14-16 months. The current standard of care for newly diagnosed GBM consists of maximal safe resection followed by fractionated radiotherapy combined with concurrent temozolomide and 6 to 12 cycles of adjuvant temozolomide. The determination of treatment response and clinical decision-making in the treatment of GBM depends on accurate radiographic assessment. Differentiating treatment response from tumor progression is challenging and combines long-term follow-up using standard MRI, with assessing clinical status and corticosteroid dependency. At progression, bevacizumab is the mainstay of treatment. Incorporation of antiangiogenic therapies leads to rapid blood-brain barrier normalization with remarkable radiographic response often not accompanied by the expected survival benefit, further complicating imaging assessment. Improved radiographic interpretation criteria, such as the Response Assessment in Neuro-Oncology (RANO) criteria, incorporate non-enhancing disease but still fall short of definitely distinguishing tumor progression, pseudoresponse, and pseudoprogression. With new evolving treatment modalities for this devastating disease, advanced imaging modalities are increasingly becoming part of routine clinical care in a field where neuroimaging has such essential role in guiding treatment decisions and defining clinical trial eligibility and efficacy.
Collapse
Affiliation(s)
- Martha R Neagu
- Dana Farber Cancer Institute, G4200, 44 Binney St, Boston, MA, 02115, USA
| | | | | | | |
Collapse
|
38
|
Huang RY, Neagu MR, Reardon DA, Wen PY. Pitfalls in the neuroimaging of glioblastoma in the era of antiangiogenic and immuno/targeted therapy - detecting illusive disease, defining response. Front Neurol 2015; 6:33. [PMID: 25755649 PMCID: PMC4337341 DOI: 10.3389/fneur.2015.00033] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 02/09/2015] [Indexed: 02/04/2023] Open
Abstract
Glioblastoma, the most common malignant primary brain tumor in adults is a devastating diagnosis with an average survival of 14–16 months using the current standard of care treatment. The determination of treatment response and clinical decision making is based on the accuracy of radiographic assessment. Notwithstanding, challenges exist in the neuroimaging evaluation of patients undergoing treatment for malignant glioma. Differentiating treatment response from tumor progression is problematic and currently combines long-term follow-up using standard magnetic resonance imaging (MRI), with clinical status and corticosteroid-dependency assessments. In the clinical trial setting, treatment with gene therapy, vaccines, immunotherapy, and targeted biologicals similarly produces MRI changes mimicking disease progression. A neuroimaging method to clearly distinguish between pseudoprogression and tumor progression has unfortunately not been found to date. With the incorporation of antiangiogenic therapies, a further pitfall in imaging interpretation is pseudoresponse. The Macdonald criteria that correlate tumor burden with contrast-enhanced imaging proved insufficient and misleading in the context of rapid blood–brain barrier normalization following antiangiogenic treatment that is not accompanied by expected survival benefit. Even improved criteria, such as the RANO criteria, which incorporate non-enhancing disease, clinical status, and need for corticosteroid use, fall short of definitively distinguishing tumor progression, pseudoresponse, and pseudoprogression. This review focuses on advanced imaging techniques including perfusion MRI, diffusion MRI, MR spectroscopy, and new positron emission tomography imaging tracers. The relevant image analysis algorithms and interpretation methods of these promising techniques are discussed in the context of determining response and progression during treatment of glioblastoma both in the standard of care and in clinical trial context.
Collapse
Affiliation(s)
- Raymond Y Huang
- Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center , Boston, MA , USA
| | - Martha R Neagu
- Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center , Boston, MA , USA
| | - David A Reardon
- Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center , Boston, MA , USA
| | - Patrick Y Wen
- Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center , Boston, MA , USA
| |
Collapse
|