Conventional MRI at presentation does not predict clinical response to radiation therapy in children with diffuse pontine glioma

Liu, Arthur K.; Brandon, Jonathan; Foreman, Nicholas K.; Fenton, Laura Z.

doi:10.1007/s00247-009-1368-5

Cited by 25 publications

(20 citation statements)

References 13 publications

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“…This phenomenon has also been demonstrated by other investigators [5]. Previous reports show that conventional imaging parameters do not have predictive value for outcome and may, therefore, not be suitable surrogate imaging markers for longitudinal imaging evaluation of DIPG [6, 7]. Conversely, advanced MRI techniques, such as MRS or perfusion-weighted imaging, capture important biological aspects of the neoplastic process (e.g., cell proliferation, angiogenesis) [8].…”

Section: Introductionmentioning

confidence: 72%

“…This conclusion is further underscored by well documented data showing that conventional MRI metrics in DIPG have no value for prognostication or the prediction of response to treatment [6, 7]. The Response Assessment in Neuro-Oncology Criteria (RANO) [23, 24], and their modified version for pediatric tumors, Response Assessment in Pediatric Neuro-Oncology (RAPNO [25], continue to use conventional MRI-based criteria.…”

Section: Discussionmentioning

confidence: 99%

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Discrepant longitudinal volumetric and metabolic evolution of diffuse intrinsic Pontine gliomas during treatment: implications for current response assessment strategies

et al. 2016

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Introduction Based on clinical observations, we hypothesized that in infiltrative high-grade brainstem neoplasms, such as diffuse intrinsic pontine glioma (DIPG), longitudinal metabolic evaluation of the tumor by magnetic resonance spectroscopy (MRS) may be more accurate than volumetric data for monitoring the tumor’s biological evolution during standard treatment. Methods We evaluated longitudinal MRS data and corresponding tumor volumes of 31 children with DIPG. We statistically analyzed correlations between tumor volume and ratios of Cho:NAA, Cho:Cr, and NAA:Cr at key time points during the course of the disease through the end of the progression-free survival period. Results By the end of RT, tumor volume had significantly decreased from the baseline (P < .0001) and remained decreased through the last available follow-up magnetic resonance imaging study (P = .007632). However, the metabolic profile of the tumor tissue (Cho:Cr, NAA:Cr, and Cho:NAA ratios) did not change significantly over time. Conclusions Our data show that longitudinal tumor volume and metabolic profile changes are dissociated in patients with DIPG during progression-free survival. Volume changes, therefore, may not accurately reflect treatment-related changes in tumor burden. This study adds to the existing body of evidence that the value of conventional MRI metrics, including volumetric data, needs to be reevaluated critically and, in infiltrative tumors in particular, may not be useful as study end-points in clinical trials. We submit that advanced quantitative MRI data, including robust, MRS-based metabolic ratios and diffusion and perfusion metrics, may be better surrogate markers of key end-points in clinical trials.

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Section: Introductionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Discrepant longitudinal volumetric and metabolic evolution of diffuse intrinsic Pontine gliomas during treatment: implications for current response assessment strategies

et al. 2016

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“…One unique feature of this tumor is the infiltrative and nonfocal growth pattern and the sparse uptake of MR contrast agents. Critically, while MRI can be used for initially diagnosing DIPG, this approach has proven imperfect for defining the true tumor burden and monitoring of treatment response (14, 15). …”

Section: Introductionmentioning

confidence: 99%

Biomarker-Based PET Imaging of Diffuse Intrinsic Pontine Glioma in Mouse Models

et al. 2017

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Diffuse intrinsic pontine glioma (DIPG) is a childhood brainstem tumor with a universally poor prognosis. Here, we characterize on a positron emission tomography (PET) probe for imaging DIPG in vivo. In human histological tissues, the probes target, poly(ADP)ribose polymerase 1 (PARP1), was highly expressed in DIPG compared to normal brain. PET imaging allowed for the sensitive detection of DIPG in a genetically engineered mouse model (GEMM), and probe uptake correlated to histologically determined tumor infiltration. Imaging with the sister fluorescence agent revealed that uptake was confined to proliferating, PARP1 expressing cells. Comparison to other imaging technologies revealed remarkable accuracy of our biomarker approach. We subsequently demonstrated that serial imaging of DIPG in mouse models enables monitoring of tumor growth, as shown in modeling of tumor progression. Overall, this validated method for quantifying DIPG burden would serve useful in monitoring treatment response in early phase clinical trials.

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“…However, standard features such as lesion size or contrast accumulation at presentation generally do not correlate with disease course. [5][6][7][8] On the other hand, it has been reported that diffusion MR imaging provides information that complements conventional pre-and postcontrast anatomic imaging in gliomas in adults. [9][10][11][12][13] Specifically, the ADC has been reported to be a useful clinical prognostic biomarker for survival in patients with malignant supratentorial astrocytoma [14][15][16] and a more sensitive indicator for response to therapy than conventional imaging techniques.…”

mentioning

confidence: 99%

Apparent Diffusion and Fractional Anisotropy of Diffuse Intrinsic Brain Stem Gliomas

Chen¹,

Panigrahy²,

Dhall³

et al. 2010

AJNR Am J Neuroradiol

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Conventional MRI at presentation does not predict clinical response to radiation therapy in children with diffuse pontine glioma

Abstract: Conventional MRI at presentation does not predict clinical response in children with diffuse pontine glioma. Additional studies with larger numbers of patients and other imaging modalities are needed.

Cited by 25 publications

References 13 publications

Discrepant longitudinal volumetric and metabolic evolution of diffuse intrinsic Pontine gliomas during treatment: implications for current response assessment strategies

Discrepant longitudinal volumetric and metabolic evolution of diffuse intrinsic Pontine gliomas during treatment: implications for current response assessment strategies

Biomarker-Based PET Imaging of Diffuse Intrinsic Pontine Glioma in Mouse Models

Apparent Diffusion and Fractional Anisotropy of Diffuse Intrinsic Brain Stem Gliomas

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