Survival analysis in patients with newly diagnosed glioblastoma using pre- and postradiotherapy MR spectroscopic imaging†

Li, Yan; Lupo, Janine M.; Parvataneni, Rupa; Lamborn, Kathleen R.; Cha, Soonmee; Chang, Susan M.; Nelson, Sarah J.

doi:10.1093/neuonc/nos334

Cited by 61 publications

(57 citation statements)

References 36 publications

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“…Median initial BTV was 23.8 cm 3 , and median initial LBR max was 3.6; nearly identical values were seen in both cohorts (table 1 and table e-2). Initial TAC was decreasing in 59 of 74 tumors and increasing in 15 of 74 tumors.…”

supporting

confidence: 57%

“…14 The optimal threshold for favorable/unfavorable BTV after biopsy/surgery still needs elucidation and could not be precisely resolved by the design of this and other studies. 9 However, a postresection GD1 volume of approximately 0 cm 3 in the surgery group can harbor a BTV preRCx of up to 9.5 cm 3 . This might explain why survival in both cohorts was rather similar even though BTV preRCx was lower in the surgery group.…”

Section: Discussionmentioning

confidence: 98%

“…2 Evaluation of imaging biomarkers derived from PET and MRI might improve prognostic evaluation, adjustment of treatment strategies, and monitoring of treatment response. [3][4][5] So far, PET is mainly used in the setting of differential diagnosis of suspected gliomas, identification of anaplasia, or malignant progression. 6,7 In addition, it could modify/improve radiation treatment planning in combination with MRI.…”

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confidence: 99%

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Biological tumor volume in ¹⁸ FET-PET before radiochemotherapy correlates with survival in GBM

et al. 2015

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OBJECTIVE The aim of this prospective longitudinal study was to identify static and dynamic O-(2-[(18)F]fluoroethyl)-l-tyrosine PET ((18)FET-PET)-derived imaging biomarkers in patients with glioblastoma (GBM). METHODS Seventy-nine patients with newly diagnosed GBM were included; 42 patients underwent stereotactic biopsy (unresectable tumors) and 37 patients microsurgical tumor resection. All patients were scheduled to receive radiotherapy plus concomitant and adjuvant temozolomide (RCx/TMZ). (18)FET-PET evaluation using static and dynamic analysis was done before biopsy/resection, after resection, 4 to 6 weeks following RCx, and after 3 cycles of TMZ. Endpoints were survival and progression-free-survival. Prognostic factors were obtained from proportional hazards models. RESULTS Biological tumor volume before RCx (BTVpreRCx) was the most important (18)FET-PET-derived imaging biomarker and was independent of MGMT promoter methylation and clinical prognostic factors: patients with smaller BTVpreRCx had significantly longer progression-free and overall survival (OS). (18)FET time-activity curves (TACs) before treatment and their changes after RCx were also related to outcome; patients with initially increasing TACs experienced longer OS. CONCLUSION BTVpreRCx and TAC represent important (18)FET-PET-derived imaging biomarkers in GBM. Increasing TACs are associated with prolonged OS. The BTVpreRCx is a strong prognostic factor for progression-free survival and OS independent of the mode of surgery. Our data furthermore suggest that patients harboring resectable GBM might benefit from maximal PET-guided tumor resection. Originally published at: Suchorska, B; Jansen, N L; Linn, J; Kretzschmar, H; Janssen, H; Eigenbrod, S; Simon, M; Pöpperl, G; Kreth, F W; la Fougere, C; Weller, M; Tonn, J C (2015). Biological tumor volume in 18FET-PET before radiochemotherapy correlates with survival in GBM. Neurology, 84 (7)

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confidence: 57%

Section: Discussionmentioning

confidence: 98%

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confidence: 99%

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Biological tumor volume in ¹⁸ FET-PET before radiochemotherapy correlates with survival in GBM

et al. 2015

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“…22 Moreover, metabolic images can predict PFS and OS better than anatomical images. 5,16,20 Some studies 19,23 have shown that the Cho-NAA index (CNI) can provide more reliable information on the extent of tumor infiltration. In a previous study, we examined the relationship between the CNI and glioma infiltration by using needle biopsies performed under the guidance of neuronavigation.…”

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confidence: 99%

Metabolic approach for tumor delineation in glioma surgery: 3D MR spectroscopy image–guided resection

Zhang

Zhuang

Yao

et al. 2016

JNS

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G liomas are the most common primary brain tumors, accounting for 80% of malignant central nervous system tumors, and can be categorized into 4 grades according to their biological behavior. Patients with low-grade gliomas (LGGs) typically survive more than 5 years. 21 Those with high-grade gliomas (HGGs) have a survival time of approximately 1-3 years. An epidemiology study using primary brain tumor data collected from 1985 to 2005 showed that the 1-year survival rate of patients with malignant glioma is 53.9%, while that of paabbreviatioNs Cho = choline; CNI = choline-NAA index; CSI = chemical shift imaging; DICOM = digital imaging and communications in medicine; DTI = diffusion tensor imaging; EOR = extent of resection; fMRI = functional MR imaging; GTR = gross-total resection; 1 H-MRS = proton MR spectroscopy; HGG = high-grade glioma; LGG = low-grade glioma; MPRAGE = magnetization-prepared rapid gradient-echo; NAA = N-acetylaspartate; OS = overall survival; PFS = progression-free survival; PT = pyramidal tract; ROI = region of interest; STR = subtotal resection; VOI = volume of interest. obJective The extent of resection is one of the most essential factors that influence the outcomes of glioma resection. However, conventional structural imaging has failed to accurately delineate glioma margins because of tumor cell infiltration. Three-dimensional proton MR spectroscopy ( 1 H-MRS) can provide metabolic information and has been used in preoperative tumor differentiation, grading, and radiotherapy planning. Resection based on glioma metabolism information may provide for a more extensive resection and yield better outcomes for glioma patients. In this study, the authors attempt to integrate 3D 1 H-MRS into neuronavigation and assess the feasibility and validity of metabolically based glioma resection. methods Choline (Cho)-N-acetylaspartate (NAA) index (CNI) maps were calculated and integrated into neuronavigation. The CNI thresholds were quantitatively analyzed and compared with structural MRI studies. Glioma resections were performed under 3D 1 H-MRS guidance. Volumetric analyses were performed for metabolic and structural images from a low-grade glioma (LGG) group and high-grade glioma (HGG) group. Magnetic resonance imaging and neurological assessments were performed immediately after surgery and 1 year after tumor resection. results Fifteen eligible patients with primary cerebral gliomas were included in this study. Three-dimensional 1 H-MRS maps were successfully coregistered with structural images and integrated into navigational system. Volumetric analyses showed that the differences between the metabolic volumes with different CNI thresholds were statistically significant (p < 0.05). For the LGG group, the differences between the structural and the metabolic volumes with CNI thresholds of 0.5 and 1.5 were statistically significant (p = 0.0005 and 0.0129, respectively). For the HGG group, the differences between the structural and metabolic volumes with CNI thresholds of 0.5 and 1.0 were statistically ...

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“…30 In patients with HGGs, higher lipid and lactate levels measured by MRS associated with significantly worse OS have been observed. 31 Then, our finding that low levels of lipids-lactate/Cr ratio represent up to a 41.6% reduction in the risk of death is a reverse statement that augmented hypoxia within neoplastic cells is coupled with worse clinical results. 32 A significant predictor of clinical response is the time of life at diagnosis.…”

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confidence: 95%

Choline-to-N-acetyl aspartate and lipids-lactate-to-creatine ratios together with age assemble a significant Cox's proportional-hazards regression model for prediction of survival in high-grade gliomas

Roldan-Valadez¹,

Rı́os

Motola-Kuba³

et al. 2016

BJR

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S. Choline-to-N-acetyl aspartate and lipids-lactate-tocreatine ratios together with age assemble a significant Cox's proportional-hazards regression model for prediction of survival in high-grade gliomas. Br J Radiol 2016; 89: 20150502. FULL PAPERCholine-to-N-acetyl aspartate and lipids-lactate-to-creatine ratios together with age assemble a significant Cox's proportional-hazards regression model for prediction of survival in high-grade gliomas Objective: A long-lasting concern has prevailed for the identification of predictive biomarkers for high-grade gliomas (HGGs) using MRI. However, a consensus of which imaging parameters assemble a significant survival model is still missing in the literature; we investigated the significant positive or negative contribution of several MR biomarkers in this tumour prognosis. Methods: A retrospective cohort of supratentorial HGGs [11 glioblastoma multiforme (GBM) and 17 anaplastic astrocytomas] included 28 patients (9 females and 19 males, respectively, with a mean age of 50.4 years, standard deviation: 16.28 years; range: 13-85 years). Oedema and viable tumour measurements were acquired using regions of interest in T 1 weighted, T 2 weighted, fluid-attenuated inversion recovery, apparent diffusion coefficient (ADC) and MR spectroscopy (MRS). We calculated Kaplan-Meier curves and obtained Cox's proportional hazards.Results: During the follow-up period (3-98 months), 17 deaths were recorded. The median survival time was 1.73 years (range, 0.287-8.947 years). Only 3 out of 20 covariates (choline-to-N-acetyl aspartate and lipids-lactate-to-creatine ratios and age) showed significance in explaining the variability in the survival hazards model; score test: x 2 (3) 5 9.098, p 5 0.028. Conclusion: MRS metabolites overcome volumetric parameters of peritumoral oedema and viable tumour, as well as tumour region ADC measurements. Specific MRS ratios (Cho/Naa, L-L/Cr) might be considered in a regular follow-up for these tumours. Advances in knowledge: Cho/Naa ratio is the strongest survival predictor with a log-hazard function of 2.672 in GBM. Low levels of lipids-lactate/Cr ratio represent up to a 41.6% reduction in the risk of death in GBM.

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Survival analysis in patients with newly diagnosed glioblastoma using pre- and postradiotherapy MR spectroscopic imaging†

Abstract: Our study found more 3D MRSI parameters that predicted PFS6 and OS for patients with GBM than did anatomic, diffusion, or perfusion imaging, which were previously evaluated in the same population of patients.

Cited by 61 publications

References 36 publications

Biological tumor volume in ¹⁸ FET-PET before radiochemotherapy correlates with survival in GBM

Biological tumor volume in ¹⁸ FET-PET before radiochemotherapy correlates with survival in GBM

Metabolic approach for tumor delineation in glioma surgery: 3D MR spectroscopy image–guided resection

Choline-to-N-acetyl aspartate and lipids-lactate-to-creatine ratios together with age assemble a significant Cox's proportional-hazards regression model for prediction of survival in high-grade gliomas

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Survival analysis in patients with newly diagnosed glioblastoma using pre- and postradiotherapy MR spectroscopic imaging†

Abstract: Our study found more 3D MRSI parameters that predicted PFS6 and OS for patients with GBM than did anatomic, diffusion, or perfusion imaging, which were previously evaluated in the same population of patients.

Cited by 61 publications

References 36 publications

Biological tumor volume in 18 FET-PET before radiochemotherapy correlates with survival in GBM

Biological tumor volume in 18 FET-PET before radiochemotherapy correlates with survival in GBM

Metabolic approach for tumor delineation in glioma surgery: 3D MR spectroscopy image–guided resection

Choline-to-N-acetyl aspartate and lipids-lactate-to-creatine ratios together with age assemble a significant Cox's proportional-hazards regression model for prediction of survival in high-grade gliomas

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Biological tumor volume in ¹⁸ FET-PET before radiochemotherapy correlates with survival in GBM

Biological tumor volume in ¹⁸ FET-PET before radiochemotherapy correlates with survival in GBM