PMID- 24986746 OWN - NLM STAT- MEDLINE DCOM- 20141027 LR - 20211021 IS - 1879-355X (Electronic) IS - 0360-3016 (Print) IS - 0360-3016 (Linking) VI - 90 IP - 1 DP - 2014 Sep 1 TI - 3-Dimensional magnetic resonance spectroscopic imaging at 3 Tesla for early response assessment of glioblastoma patients during external beam radiation therapy. PG - 181-9 LID - S0360-3016(14)00612-9 [pii] LID - 10.1016/j.ijrobp.2014.05.014 [doi] AB - PURPOSE: To evaluate the utility of 3-dimensional magnetic resonance (3D-MR) proton spectroscopic imaging for treatment planning and its implications for early response assessment in glioblastoma multiforme. METHODS AND MATERIALS: Eighteen patients with newly diagnosed, histologically confirmed glioblastoma had 3D-MR proton spectroscopic imaging (MRSI) along with T2 and T1 gadolinium-enhanced MR images at simulation and at boost treatment planning after 17 to 20 fractions of radiation therapy. All patients received standard radiation therapy (RT) with concurrent temozolomide followed by adjuvant temozolomide. Imaging for response assessment consisted of MR scans every 2 months. Progression-free survival was defined by the criteria of MacDonald et al. MRSI images obtained at initial simulation were analyzed for choline/N-acetylaspartate ratios (Cho/NAA) on a voxel-by-voxel basis with abnormal activity defined as Cho/NAA >/=2. These images were compared on anatomically matched MRSI data collected after 3 weeks of RT. Changes in Cho/NAA between pretherapy and third-week RT scans were tested using Wilcoxon matched-pairs signed rank tests and correlated with progression-free survival, radiation dose and location of recurrence using Cox proportional hazards regression. RESULTS: After a median follow-up time of 8.6 months, 50% of patients had experienced progression based on imaging. Patients with a decreased or stable mean or median Cho/NAA values had less risk of progression (P<.01). Patients with an increase in mean or median Cho/NAA values at the third-week RT scan had a significantly greater chance of early progression (P<.01). An increased Cho/NAA at the third-week MRSI scan carried a hazard ratio of 2.72 (95% confidence interval, 1.10-6.71; P=.03). Most patients received the prescription dose of RT to the Cho/NAA >/=2 volume, where recurrence most often occurred. CONCLUSION: Change in mean and median Cho/NAA detected at 3 weeks was a significant predictor of early progression. The potential impact for risk-adaptive therapy based on early spectroscopic findings is suggested. CI - Published by Elsevier Inc. FAU - Muruganandham, Manickam AU - Muruganandham M AD - Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa. FAU - Clerkin, Patrick P AU - Clerkin PP AD - Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa. FAU - Smith, Brian J AU - Smith BJ AD - Department of Biostatistics, University of Iowa Hospitals and Clinics, Iowa City, Iowa. FAU - Anderson, Carryn M AU - Anderson CM AD - Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa. FAU - Morris, Ann AU - Morris A AD - Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa. FAU - Capizzano, Aristides A AU - Capizzano AA AD - Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa. FAU - Magnotta, Vincent AU - Magnotta V AD - Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa. FAU - McGuire, Sarah M AU - McGuire SM AD - Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa. FAU - Smith, Mark C AU - Smith MC AD - Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa. FAU - Bayouth, John E AU - Bayouth JE AD - Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa. FAU - Buatti, John M AU - Buatti JM AD - Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa. Electronic address: john-buatti@uiowa.edu. LA - eng GR - P30 CA086862/CA/NCI NIH HHS/United States GR - U01 CA140206/CA/NCI NIH HHS/United States GR - 1 U01 CA140206-01 A1/CA/NCI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20140628 PL - United States TA - Int J Radiat Oncol Biol Phys JT - International journal of radiation oncology, biology, physics JID - 7603616 RN - 0 (Antineoplastic Agents, Alkylating) RN - 0 (Biomarkers, Tumor) RN - 0 (Contrast Media) RN - 30KYC7MIAI (Aspartic Acid) RN - 7GR28W0FJI (Dacarbazine) RN - 997-55-7 (N-acetylaspartate) RN - AU0V1LM3JT (Gadolinium) RN - N91BDP6H0X (Choline) RN - YF1K15M17Y (Temozolomide) SB - IM MH - Adult MH - Aged MH - Antineoplastic Agents, Alkylating/therapeutic use MH - Aspartic Acid/analogs & derivatives/metabolism MH - Biomarkers, Tumor/analysis/metabolism MH - Brain Neoplasms/drug therapy/*metabolism/*radiotherapy MH - Chemoradiotherapy/methods MH - Choline/metabolism MH - Contrast Media MH - Dacarbazine/analogs & derivatives/therapeutic use MH - *Disease Progression MH - Disease-Free Survival MH - Female MH - Follow-Up Studies MH - Gadolinium MH - Glioblastoma/drug therapy/*metabolism/*radiotherapy MH - Humans MH - Imaging, Three-Dimensional/methods MH - Magnetic Resonance Imaging/methods MH - Magnetic Resonance Spectroscopy/*methods MH - Male MH - Matched-Pair Analysis MH - Middle Aged MH - Neoplasm Recurrence, Local/*metabolism MH - Proportional Hazards Models MH - Radiotherapy Dosage MH - Temozolomide MH - Time Factors PMC - PMC4183193 MID - NIHMS631604 EDAT- 2014/07/06 06:00 MHDA- 2014/10/28 06:00 PMCR- 2015/09/01 CRDT- 2014/07/03 06:00 PHST- 2014/02/07 00:00 [received] PHST- 2014/05/09 00:00 [revised] PHST- 2014/05/13 00:00 [accepted] PHST- 2014/07/03 06:00 [entrez] PHST- 2014/07/06 06:00 [pubmed] PHST- 2014/10/28 06:00 [medline] PHST- 2015/09/01 00:00 [pmc-release] AID - S0360-3016(14)00612-9 [pii] AID - 10.1016/j.ijrobp.2014.05.014 [doi] PST - ppublish SO - Int J Radiat Oncol Biol Phys. 2014 Sep 1;90(1):181-9. doi: 10.1016/j.ijrobp.2014.05.014. Epub 2014 Jun 28.