Imaging of GBM in the Age of Molecular Markers and MRI Guided Adaptive Radiation Therapy

Abstract

Glioblastoma (GBM) continues to be one of the most lethal malignancies and is almost always fatal. In this review article, the role of radiation therapy, systemic therapy, as well as the molecular basis of classifying GBM is described. Technological advances in the treatment of GBM are outlined as well as the diagnostic imaging characteristics of this tumor. In addition, factors that affect prognosis such as differentiating progression from treatment effect is discussed. The role of MRI guided radiation therapy and how this technology may provide a mechanism to improve the care of patients with this disease are described.

Photodynamic therapy and associated targeting methods for treatment of brain cancer

“…The symptoms of the disease depend on the area of the brain affected by the tumor. These include: headaches and dizziness, nausea, vomiting, impaired cognitive functions, confusion, speech disorders (the most common symptoms), convulsions, persistent weakness and fatigue, numbness, loss of vision, impaired executive functions, mood disorders, changes in behavior and even personality or memory disorders ( Chaichana et al, 2009 ; Alexander and Cloughesy, 2017 ; Dajani et al, 2022 ). According to the WHO ( Louis et al, 2021 ) classification updated in 2016, GBM is divided into the following molecular subtypes (division due to the presence or absence of mutations in the isocitrate dehydrogenase gene IDH): I- wild type (without mutations) - about 90% of cases, it is primary or de novo and common in patients >55 years of age; II- GBM with IDH mutation (approximately 10% of cases), includes secondary GBM in patients with a history of previous low-grade glioma and often occurs in younger patients; this type has a better prognosis than type I; III- GBM, not otherwise specified (NOS) - a diagnosis intended for tumors for which a full IDH analysis cannot be performed ( Batash et al, 2017 ).…”

Biomolecules to Biomarkers? U87MG Marker Evaluation on the Path towards Glioblastoma Multiforme Pathogenesis

“…Ranging from 57 to 77 years, this group included female and males of unknown and mixed responsiveness, respectively, to temozolomide treatment. Histopathological analysis of brain tumor sections from these patients identified typical GBM characteristics [ 49 , 50 ]. These features included atypical cells with hyperchromic polymorphic nuclei [ 49 ] and the presence of necrotic regions coinciding with high cellular zones, potentially representative of tumor cell migration from degrading vasculature destined for further microvessel formation [ 51 ].…”

Impact of Postoperative Changes in Brain Anatomy on Target Volume Delineation for High-Grade Glioma

“…The integration of image-guided radiation therapy (IGRT) into clinical practice might further improve target volume coverage. Marked neuroanatomical changes during radiation treatment (e.g., resorption of subdural haematoma with subsequent regression of midline shift) can be readily visualised with cone beam computed tomography (CBCT), whereas more subtle changes (e.g., in FLAIR hyperintensities) can be assessed using MRI-guided radiotherapy (MRgRT), which might prompt adaptive radiation treatment planning [33,34]. In a prospective comparison, MRgRT resulted in reduced doses of healthy brain tissue [35].…”