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Truong NCD, Bangalore Yogananda CG, Wagner BC, Holcomb JM, Reddy D, Saadat N, Hatanpaa KJ, Patel TR, Fei B, Lee MD, Jain R, Bruce RJ, Pinho MC, Madhuranthakam AJ, Maldjian JA. Two-Stage Training Framework Using Multicontrast MRI Radiomics for IDH Mutation Status Prediction in Glioma. Radiol Artif Intell 2024; 6:e230218. [PMID: 38775670 PMCID: PMC11294953 DOI: 10.1148/ryai.230218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 03/18/2024] [Accepted: 04/25/2024] [Indexed: 06/21/2024]
Abstract
Purpose To develop a radiomics framework for preoperative MRI-based prediction of isocitrate dehydrogenase (IDH) mutation status, a crucial glioma prognostic indicator. Materials and Methods Radiomics features (shape, first-order statistics, and texture) were extracted from the whole tumor or the combination of nonenhancing, necrosis, and edema regions. Segmentation masks were obtained via the federated tumor segmentation tool or the original data source. Boruta, a wrapper-based feature selection algorithm, identified relevant features. Addressing the imbalance between mutated and wild-type cases, multiple prediction models were trained on balanced data subsets using random forest or XGBoost and assembled to build the final classifier. The framework was evaluated using retrospective MRI scans from three public datasets (The Cancer Imaging Archive [TCIA, 227 patients], the University of California San Francisco Preoperative Diffuse Glioma MRI dataset [UCSF, 495 patients], and the Erasmus Glioma Database [EGD, 456 patients]) and internal datasets collected from the University of Texas Southwestern Medical Center (UTSW, 356 patients), New York University (NYU, 136 patients), and University of Wisconsin-Madison (UWM, 174 patients). TCIA and UTSW served as separate training sets, while the remaining data constituted the test set (1617 or 1488 testing cases, respectively). Results The best performing models trained on the TCIA dataset achieved area under the receiver operating characteristic curve (AUC) values of 0.89 for UTSW, 0.86 for NYU, 0.93 for UWM, 0.94 for UCSF, and 0.88 for EGD test sets. The best performing models trained on the UTSW dataset achieved slightly higher AUCs: 0.92 for TCIA, 0.88 for NYU, 0.96 for UWM, 0.93 for UCSF, and 0.90 for EGD. Conclusion This MRI radiomics-based framework shows promise for accurate preoperative prediction of IDH mutation status in patients with glioma. Keywords: Glioma, Isocitrate Dehydrogenase Mutation, IDH Mutation, Radiomics, MRI Supplemental material is available for this article. Published under a CC BY 4.0 license. See also commentary by Moassefi and Erickson in this issue.
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Affiliation(s)
- Nghi C. D. Truong
- From the Departments of Radiology (N.C.D.T., C.G.B.Y., B.C.W.,
J.M.H., D.R., N.S., B.F., M.C.P., A.J.M., J.A.M.), Pathology (K.J.H.), and
Neurologic Surgery (T.R.P.), The University of Texas Southwestern Medical
Center, 5323 Harry Hines Blvd, Dallas, TX 75390; Department of Bioengineering,
The University of Texas at Dallas, Richardson, Tex (B.F.); Departments of
Radiology (M.D.L., R.J.) and Neurosurgery (R.J.), New York University Grossman
School of Medicine, New York, NY; and Department of Radiology, University of
Wisconsin–Madison, Madison, Wis (R.J.B.)
| | - Chandan Ganesh Bangalore Yogananda
- From the Departments of Radiology (N.C.D.T., C.G.B.Y., B.C.W.,
J.M.H., D.R., N.S., B.F., M.C.P., A.J.M., J.A.M.), Pathology (K.J.H.), and
Neurologic Surgery (T.R.P.), The University of Texas Southwestern Medical
Center, 5323 Harry Hines Blvd, Dallas, TX 75390; Department of Bioengineering,
The University of Texas at Dallas, Richardson, Tex (B.F.); Departments of
Radiology (M.D.L., R.J.) and Neurosurgery (R.J.), New York University Grossman
School of Medicine, New York, NY; and Department of Radiology, University of
Wisconsin–Madison, Madison, Wis (R.J.B.)
| | - Benjamin C. Wagner
- From the Departments of Radiology (N.C.D.T., C.G.B.Y., B.C.W.,
J.M.H., D.R., N.S., B.F., M.C.P., A.J.M., J.A.M.), Pathology (K.J.H.), and
Neurologic Surgery (T.R.P.), The University of Texas Southwestern Medical
Center, 5323 Harry Hines Blvd, Dallas, TX 75390; Department of Bioengineering,
The University of Texas at Dallas, Richardson, Tex (B.F.); Departments of
Radiology (M.D.L., R.J.) and Neurosurgery (R.J.), New York University Grossman
School of Medicine, New York, NY; and Department of Radiology, University of
Wisconsin–Madison, Madison, Wis (R.J.B.)
| | - James M. Holcomb
- From the Departments of Radiology (N.C.D.T., C.G.B.Y., B.C.W.,
J.M.H., D.R., N.S., B.F., M.C.P., A.J.M., J.A.M.), Pathology (K.J.H.), and
Neurologic Surgery (T.R.P.), The University of Texas Southwestern Medical
Center, 5323 Harry Hines Blvd, Dallas, TX 75390; Department of Bioengineering,
The University of Texas at Dallas, Richardson, Tex (B.F.); Departments of
Radiology (M.D.L., R.J.) and Neurosurgery (R.J.), New York University Grossman
School of Medicine, New York, NY; and Department of Radiology, University of
Wisconsin–Madison, Madison, Wis (R.J.B.)
| | - Divya Reddy
- From the Departments of Radiology (N.C.D.T., C.G.B.Y., B.C.W.,
J.M.H., D.R., N.S., B.F., M.C.P., A.J.M., J.A.M.), Pathology (K.J.H.), and
Neurologic Surgery (T.R.P.), The University of Texas Southwestern Medical
Center, 5323 Harry Hines Blvd, Dallas, TX 75390; Department of Bioengineering,
The University of Texas at Dallas, Richardson, Tex (B.F.); Departments of
Radiology (M.D.L., R.J.) and Neurosurgery (R.J.), New York University Grossman
School of Medicine, New York, NY; and Department of Radiology, University of
Wisconsin–Madison, Madison, Wis (R.J.B.)
| | - Niloufar Saadat
- From the Departments of Radiology (N.C.D.T., C.G.B.Y., B.C.W.,
J.M.H., D.R., N.S., B.F., M.C.P., A.J.M., J.A.M.), Pathology (K.J.H.), and
Neurologic Surgery (T.R.P.), The University of Texas Southwestern Medical
Center, 5323 Harry Hines Blvd, Dallas, TX 75390; Department of Bioengineering,
The University of Texas at Dallas, Richardson, Tex (B.F.); Departments of
Radiology (M.D.L., R.J.) and Neurosurgery (R.J.), New York University Grossman
School of Medicine, New York, NY; and Department of Radiology, University of
Wisconsin–Madison, Madison, Wis (R.J.B.)
| | - Kimmo J. Hatanpaa
- From the Departments of Radiology (N.C.D.T., C.G.B.Y., B.C.W.,
J.M.H., D.R., N.S., B.F., M.C.P., A.J.M., J.A.M.), Pathology (K.J.H.), and
Neurologic Surgery (T.R.P.), The University of Texas Southwestern Medical
Center, 5323 Harry Hines Blvd, Dallas, TX 75390; Department of Bioengineering,
The University of Texas at Dallas, Richardson, Tex (B.F.); Departments of
Radiology (M.D.L., R.J.) and Neurosurgery (R.J.), New York University Grossman
School of Medicine, New York, NY; and Department of Radiology, University of
Wisconsin–Madison, Madison, Wis (R.J.B.)
| | - Toral R. Patel
- From the Departments of Radiology (N.C.D.T., C.G.B.Y., B.C.W.,
J.M.H., D.R., N.S., B.F., M.C.P., A.J.M., J.A.M.), Pathology (K.J.H.), and
Neurologic Surgery (T.R.P.), The University of Texas Southwestern Medical
Center, 5323 Harry Hines Blvd, Dallas, TX 75390; Department of Bioengineering,
The University of Texas at Dallas, Richardson, Tex (B.F.); Departments of
Radiology (M.D.L., R.J.) and Neurosurgery (R.J.), New York University Grossman
School of Medicine, New York, NY; and Department of Radiology, University of
Wisconsin–Madison, Madison, Wis (R.J.B.)
| | - Baowei Fei
- From the Departments of Radiology (N.C.D.T., C.G.B.Y., B.C.W.,
J.M.H., D.R., N.S., B.F., M.C.P., A.J.M., J.A.M.), Pathology (K.J.H.), and
Neurologic Surgery (T.R.P.), The University of Texas Southwestern Medical
Center, 5323 Harry Hines Blvd, Dallas, TX 75390; Department of Bioengineering,
The University of Texas at Dallas, Richardson, Tex (B.F.); Departments of
Radiology (M.D.L., R.J.) and Neurosurgery (R.J.), New York University Grossman
School of Medicine, New York, NY; and Department of Radiology, University of
Wisconsin–Madison, Madison, Wis (R.J.B.)
| | - Matthew D. Lee
- From the Departments of Radiology (N.C.D.T., C.G.B.Y., B.C.W.,
J.M.H., D.R., N.S., B.F., M.C.P., A.J.M., J.A.M.), Pathology (K.J.H.), and
Neurologic Surgery (T.R.P.), The University of Texas Southwestern Medical
Center, 5323 Harry Hines Blvd, Dallas, TX 75390; Department of Bioengineering,
The University of Texas at Dallas, Richardson, Tex (B.F.); Departments of
Radiology (M.D.L., R.J.) and Neurosurgery (R.J.), New York University Grossman
School of Medicine, New York, NY; and Department of Radiology, University of
Wisconsin–Madison, Madison, Wis (R.J.B.)
| | - Rajan Jain
- From the Departments of Radiology (N.C.D.T., C.G.B.Y., B.C.W.,
J.M.H., D.R., N.S., B.F., M.C.P., A.J.M., J.A.M.), Pathology (K.J.H.), and
Neurologic Surgery (T.R.P.), The University of Texas Southwestern Medical
Center, 5323 Harry Hines Blvd, Dallas, TX 75390; Department of Bioengineering,
The University of Texas at Dallas, Richardson, Tex (B.F.); Departments of
Radiology (M.D.L., R.J.) and Neurosurgery (R.J.), New York University Grossman
School of Medicine, New York, NY; and Department of Radiology, University of
Wisconsin–Madison, Madison, Wis (R.J.B.)
| | - Richard J. Bruce
- From the Departments of Radiology (N.C.D.T., C.G.B.Y., B.C.W.,
J.M.H., D.R., N.S., B.F., M.C.P., A.J.M., J.A.M.), Pathology (K.J.H.), and
Neurologic Surgery (T.R.P.), The University of Texas Southwestern Medical
Center, 5323 Harry Hines Blvd, Dallas, TX 75390; Department of Bioengineering,
The University of Texas at Dallas, Richardson, Tex (B.F.); Departments of
Radiology (M.D.L., R.J.) and Neurosurgery (R.J.), New York University Grossman
School of Medicine, New York, NY; and Department of Radiology, University of
Wisconsin–Madison, Madison, Wis (R.J.B.)
| | - Marco C. Pinho
- From the Departments of Radiology (N.C.D.T., C.G.B.Y., B.C.W.,
J.M.H., D.R., N.S., B.F., M.C.P., A.J.M., J.A.M.), Pathology (K.J.H.), and
Neurologic Surgery (T.R.P.), The University of Texas Southwestern Medical
Center, 5323 Harry Hines Blvd, Dallas, TX 75390; Department of Bioengineering,
The University of Texas at Dallas, Richardson, Tex (B.F.); Departments of
Radiology (M.D.L., R.J.) and Neurosurgery (R.J.), New York University Grossman
School of Medicine, New York, NY; and Department of Radiology, University of
Wisconsin–Madison, Madison, Wis (R.J.B.)
| | - Ananth J. Madhuranthakam
- From the Departments of Radiology (N.C.D.T., C.G.B.Y., B.C.W.,
J.M.H., D.R., N.S., B.F., M.C.P., A.J.M., J.A.M.), Pathology (K.J.H.), and
Neurologic Surgery (T.R.P.), The University of Texas Southwestern Medical
Center, 5323 Harry Hines Blvd, Dallas, TX 75390; Department of Bioengineering,
The University of Texas at Dallas, Richardson, Tex (B.F.); Departments of
Radiology (M.D.L., R.J.) and Neurosurgery (R.J.), New York University Grossman
School of Medicine, New York, NY; and Department of Radiology, University of
Wisconsin–Madison, Madison, Wis (R.J.B.)
| | - Joseph A. Maldjian
- From the Departments of Radiology (N.C.D.T., C.G.B.Y., B.C.W.,
J.M.H., D.R., N.S., B.F., M.C.P., A.J.M., J.A.M.), Pathology (K.J.H.), and
Neurologic Surgery (T.R.P.), The University of Texas Southwestern Medical
Center, 5323 Harry Hines Blvd, Dallas, TX 75390; Department of Bioengineering,
The University of Texas at Dallas, Richardson, Tex (B.F.); Departments of
Radiology (M.D.L., R.J.) and Neurosurgery (R.J.), New York University Grossman
School of Medicine, New York, NY; and Department of Radiology, University of
Wisconsin–Madison, Madison, Wis (R.J.B.)
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4
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Li S, Zheng Y, Sun W, Lasič S, Szczepankiewicz F, Wei Q, Han S, Zhang S, Zhong X, Wang L, Li H, Cai Y, Xu D, Li Z, He Q, van Westen D, Bryskhe K, Topgaard D, Xu H. Glioma grading, molecular feature classification, and microstructural characterization using MR diffusional variance decomposition (DIVIDE) imaging. Eur Radiol 2021; 31:8197-8207. [PMID: 33914116 DOI: 10.1007/s00330-021-07959-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/10/2021] [Accepted: 03/29/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the potential of diffusional variance decomposition (DIVIDE) for grading, molecular feature classification, and microstructural characterization of gliomas. MATERIALS AND METHODS Participants with suspected gliomas underwent DIVIDE imaging, yielding parameter maps of fractional anisotropy (FA), mean diffusivity (MD), anisotropic mean kurtosis (MKA), isotropic mean kurtosis (MKI), total mean kurtosis (MKT), MKA/MKT, and microscopic fractional anisotropy (μFA). Tumor type and grade, isocitrate dehydrogenase (IDH) 1/2 mutant status, and the Ki-67 labeling index (Ki-67 LI) were determined after surgery. Statistical analysis included 33 high-grade gliomas (HGG) and 17 low-grade gliomas (LGG). Tumor diffusion metrics were compared between HGG and LGG, among grades, and between wild and mutated IDH types using appropriate tests according to normality assessment results. Receiver operating characteristic and Spearman correlation analysis were also used for statistical evaluations. RESULTS FA, MD, MKA, MKI, MKT, μFA, and MKA/MKT differed between HGG and LGG (FA: p = 0.047; MD: p = 0.037, others p < 0.001), and among glioma grade II, III, and IV (FA: p = 0.048; MD: p = 0.038, others p < 0.001). All diffusion metrics differed between wild-type and mutated IDH tumors (MKI: p = 0.003; others: p < 0.001). The metrics that best discriminated between HGG and LGGs and between wild-type and mutated IDH tumors were MKT and FA respectively (area under the curve 0.866 and 0.881). All diffusion metrics except FA showed significant correlation with Ki-67 LI, and MKI had the highest correlation coefficient (rs = 0.618). CONCLUSION DIVIDE is a promising technique for glioma characterization and diagnosis. KEY POINTS • DIVIDE metrics MKI is related to cell density heterogeneity while MKA and μFA are related to cell eccentricity. • DIVIDE metrics can effectively differentiate LGG from HGG and IDH mutation from wild-type tumor, and showed significant correlation with the Ki-67 labeling index. • MKI was larger than MKA which indicates predominant cell density heterogeneity in gliomas. • MKA and MKI increased with grade or degree of malignancy, however with a relatively larger increase in the cell eccentricity metric MKA in relation to the cell density heterogeneity metric MKI.
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Affiliation(s)
- Sirui Li
- Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | | | - Wenbo Sun
- Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | | | | | - Qing Wei
- United Imaging Healthcare, Shanghai, China
| | | | | | - Xiaoli Zhong
- Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Liang Wang
- Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Huan Li
- Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Yuxiang Cai
- Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Dan Xu
- Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Zhiqiang Li
- Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Qiang He
- United Imaging Healthcare, Shanghai, China
| | | | | | | | - Haibo Xu
- Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China.
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5
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Patel SH, Batchala PP, Muttikkal TJE, Ferrante SS, Patrie JT, Fadul CE, Schiff D, Lopes MB, Jain R. Fluid attenuation in non-contrast-enhancing tumor (nCET): an MRI Marker for Isocitrate Dehydrogenase (IDH) mutation in Glioblastoma. J Neurooncol 2021; 152:523-531. [PMID: 33661425 DOI: 10.1007/s11060-021-03720-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/12/2021] [Accepted: 02/15/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The WHO 2016 update classifies glioblastomas (WHO grade IV) according to isocitrate dehydrogenase (IDH) gene mutation status. We aimed to determine MRI-based metrics for predicting IDH mutation in glioblastoma. METHODS This retrospective study included glioblastoma cases (n = 199) with known IDH mutation status and pre-operative MRI (T1WI, T2WI, FLAIR, contrast-enhanced T1W1 at minimum). Two neuroradiologists determined the following MRI metrics: (1) primary lobe of involvement (frontal or non-frontal); (2) presence/absence of contrast-enhancement; (3) presence/absence of necrosis; (4) presence/absence of fluid attenuation in the non-contrast-enhancing tumor (nCET); (5) maximum width of peritumoral edema (cm); (6) presence/absence of multifocal disease. Inter-reader agreement was determined. After resolving discordant measurements, multivariate association between consensus MRI metrics/patient age and IDH mutation status was determined. RESULTS Among 199 glioblastomas, 16 were IDH-mutant. Inter-reader agreement was calculated for contrast-enhancement (ĸ = 0.49 [- 0.11-1.00]), necrosis (ĸ = 0.55 [0.34-0.76]), fluid attenuation in nCET (ĸ = 0.83 [0.68-0.99]), multifocal disease (ĸ = 0.55 [0.39-0.70]), and primary lobe (ĸ = 0.85 [0.80-0.91]). Mean difference for peritumoral edema width between readers was 0.3 cm [0.2-0.5], p < 0.001. Multivariate analysis uncovered significant associations between IDH-mutation and fluid attenuation in nCET (OR 82.9 [19.22, ∞], p < 0.001), younger age (OR 0.93 [0.86, 0.98], p = 0.009), frontal lobe location (OR 11.08 [1.14, 352.97], p = 0.037), and less peritumoral edema (OR 0.15 [0, 0.65], p = 0.044). CONCLUSIONS Conventional MRI metrics and patient age predict IDH-mutation status in glioblastoma. Among MRI markers, fluid attenuation in nCET represents a novel marker with high inter-reader agreement that is strongly associated with Glioblastoma, IDH-mutant.
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Affiliation(s)
- Sohil H Patel
- Department of Radiology and Medical Imaging, University of Virginia Health System, PO Box 800170, Charlottesville, VA, 22908, USA.
| | - Prem P Batchala
- Department of Radiology and Medical Imaging, University of Virginia Health System, PO Box 800170, Charlottesville, VA, 22908, USA
| | - Thomas J Eluvathingal Muttikkal
- Department of Radiology and Medical Imaging, University of Virginia Health System, PO Box 800170, Charlottesville, VA, 22908, USA
| | - Sergio S Ferrante
- Department of Radiology and Medical Imaging, University of Virginia Health System, PO Box 800170, Charlottesville, VA, 22908, USA
| | - James T Patrie
- Department of Public Health Sciences, University of Virginia Health System, Charlottesville, VA, USA
| | - Camilo E Fadul
- Division of Neuro-Oncology, Department of Neurology, University of Virginia Health System, Charlottesville, VA, USA
| | - David Schiff
- Division of Neuro-Oncology, Department of Neurology, University of Virginia Health System, Charlottesville, VA, USA
| | - M Beatriz Lopes
- Department of Pathology, Divisions of Neuropathology and Molecular Diagnostics, University of Virginia Health System, Charlottesville, VA, USA
| | - Rajan Jain
- Department of Radiology, New York University School of Medicine, 550 1st Avenue, New York, NY, 10016, USA.,Department of Neurosurgery, New York University School of Medicine, 550 1st Avenue, New York, NY, 10016, USA
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6
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Le Fèvre C, Lhermitte B, Ahle G, Chambrelant I, Cebula H, Antoni D, Keller A, Schott R, Thiery A, Constans JM, Noël G. Pseudoprogression versus true progression in glioblastoma patients: A multiapproach literature review: Part 1 - Molecular, morphological and clinical features. Crit Rev Oncol Hematol 2020; 157:103188. [PMID: 33307200 DOI: 10.1016/j.critrevonc.2020.103188] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 11/12/2020] [Accepted: 11/23/2020] [Indexed: 01/04/2023] Open
Abstract
With new therapeutic protocols, more patients treated for glioblastoma have experienced a suspicious radiologic image of progression (pseudoprogression) during follow-up. Pseudoprogression should be differentiated from true progression because the disease management is completely different. In the case of pseudoprogression, the follow-up continues, and the patient is considered stable. In the case of true progression, a treatment adjustment is necessary. Presently, a pseudoprogression diagnosis certainly needs to be pathologically confirmed. Some important efforts in the radiological, histopathological, and genomic fields have been made to differentiate pseudoprogression from true progression, and the assessment of response criteria exists but remains limited. The aim of this paper is to highlight clinical and pathological markers to differentiate pseudoprogression from true progression through a literature review.
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Affiliation(s)
- Clara Le Fèvre
- Department of Radiotherapy, ICANS, Institut Cancérologie Strasbourg Europe, 17 Rue Albert Calmette, 67200, Strasbourg Cedex, France
| | - Benoît Lhermitte
- Département of Pathology, Hautepierre University Hospital, 1, Avenue Molière, 67200, Strasbourg, France
| | - Guido Ahle
- Departement of Neurology, Hôpitaux Civils de Colmar, 39 Avenue de la Liberté, 68024, Colmar, France
| | - Isabelle Chambrelant
- Department of Radiotherapy, ICANS, Institut Cancérologie Strasbourg Europe, 17 Rue Albert Calmette, 67200, Strasbourg Cedex, France
| | - Hélène Cebula
- Departement of Neurosurgery, Hautepierre University Hospital, 1, Avenue Molière, 67200, Strasbourg, France
| | - Delphine Antoni
- Department of Radiotherapy, ICANS, Institut Cancérologie Strasbourg Europe, 17 Rue Albert Calmette, 67200, Strasbourg Cedex, France
| | - Audrey Keller
- Department of Radiotherapy, ICANS, Institut Cancérologie Strasbourg Europe, 17 Rue Albert Calmette, 67200, Strasbourg Cedex, France
| | - Roland Schott
- Departement of Medical Oncology, ICANS, Institut Cancérologie Strasbourg Europe, 17 rue Albert Calmette, 67200, Strasbourg Cedex, France
| | - Alicia Thiery
- Department of Public Health, ICANS, Institut Cancérologie Strasbourg Europe, 17 rue Albert Calmette, 67200, Strasbourg Cedex, France
| | - Jean-Marc Constans
- Department of Radiology, Amiens-Pïcardie University Hospital, 1 rond point du Professeur Christian Cabrol, 80054 Amiens Cedex 1, France
| | - Georges Noël
- Department of Radiotherapy, ICANS, Institut Cancérologie Strasbourg Europe, 17 Rue Albert Calmette, 67200, Strasbourg Cedex, France.
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