Jinrong Qu1, Lei Qin2, Suchun Cheng3, Katherine Leung4, Xiang Li5, Hailiang Li6, Jianping Dai7, Tao Jiang7, Ayca Akgoz4, Ravi Seethamraju8, Qifeng Wang9, Rifaquat Rahman4, Shaowu Li7, Lin Ai7, Tianzi Jiang9, Geoffrey S Young10. 1. Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China. Electronic address: qjryq@126.com. 2. Department of Radiology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA. 3. Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA. 4. Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA. 5. Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China; Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA. 6. Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China. 7. Departments of Neuroradiology (DJP, LSW, LA) and Neurosurgery (TJ), Beijing Tiantan Hospital, Capital Medical University, Beijing, China. 8. MR R&D, Siemens Medical Solutions, Inc., Boston, MA, USA. 9. Institute of Automation Chinese Academy of Sciences, Beijing, China. 10. Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA; Department of Radiology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA. Electronic address: gsyoung@partners.org.
Abstract
PURPOSE: We hypothesized that ADC and FA of enhancing tumor (ET) and/or non-enhancing tumor (NT) adjacent to the operative resection margin before and during temozolomide and/or chemoradiation may allow prediction of chemoradiation response and patient survival. MATERIAL AND METHODS: DTI was acquired in 37 patients with newly diagnosed HGG at two time points: after resection at the time of pre-RT planning MRI (Baseline) and after 30Gy of radiation therapy (mid-RT). ADC and FA at each time point and change in ADC and FA between the two time points were assessed by hot spot method in both residual ET and NT within 2cm of the resection margin and correlated with overall survival (OS) using receiver operating characteristics (ROC) area under curve (AUC) analysis and log-rank testing. RESULTS: At baseline NT ADC<104×10(-5)mm(2)/s was strongly correlated with shorter 15 month OS (95% CI: 227-412 days vs 492-695 days) compared to patients with higher ADC (AUC 0.82). There was good separation between the groups and significance at log-rank testing (p=0.0002). Baseline NT FA>0.257 also correlated with shorter OS (95% CI: 300-515 days vs 438-686 days), compared with patients with lower FA (AUC 0.74), but there was considerable overlap between the groups and non-significance at log-rank testing (p=0.089). Residual ET ADC increased significantly (p=0.0004) and FA decreased significantly (p=0.03) for all patients during early RT but the change in ADC and FA was less strongly correlated with OS than baseline NT metrics. CONCLUSION: Post-operative pre-radiation baseline low ADC in non-enhancing tumor at the resection margin correlates strongly with worse treatment response and decreased overall survival in a heterogeneous sample of high grade glioma patients treated with radiation and/or temozolamide chemoradiation.
PURPOSE: We hypothesized that ADC and FA of enhancing tumor (ET) and/or non-enhancing tumor (NT) adjacent to the operative resection margin before and during temozolomide and/or chemoradiation may allow prediction of chemoradiation response and patient survival. MATERIAL AND METHODS: DTI was acquired in 37 patients with newly diagnosed HGG at two time points: after resection at the time of pre-RT planning MRI (Baseline) and after 30Gy of radiation therapy (mid-RT). ADC and FA at each time point and change in ADC and FA between the two time points were assessed by hot spot method in both residual ET and NT within 2cm of the resection margin and correlated with overall survival (OS) using receiver operating characteristics (ROC) area under curve (AUC) analysis and log-rank testing. RESULTS: At baseline NT ADC<104×10(-5)mm(2)/s was strongly correlated with shorter 15 month OS (95% CI: 227-412 days vs 492-695 days) compared to patients with higher ADC (AUC 0.82). There was good separation between the groups and significance at log-rank testing (p=0.0002). Baseline NT FA>0.257 also correlated with shorter OS (95% CI: 300-515 days vs 438-686 days), compared with patients with lower FA (AUC 0.74), but there was considerable overlap between the groups and non-significance at log-rank testing (p=0.089). Residual ET ADC increased significantly (p=0.0004) and FA decreased significantly (p=0.03) for all patients during early RT but the change in ADC and FA was less strongly correlated with OS than baseline NT metrics. CONCLUSION: Post-operative pre-radiation baseline low ADC in non-enhancing tumor at the resection margin correlates strongly with worse treatment response and decreased overall survival in a heterogeneous sample of high grade gliomapatients treated with radiation and/or temozolamide chemoradiation.
Authors: Kunal S Patel; Richard G Everson; Jingwen Yao; Catalina Raymond; Jodi Goldman; Jacob Schlossman; Joseph Tsung; Caleb Tan; Whitney B Pope; Matthew S Ji; Nhung T Nguyen; Albert Lai; Phioanh L Nghiemphu; Linda M Liau; Timothy F Cloughesy; Benjamin M Ellingson Journal: Neurosurgery Date: 2020-10-15 Impact factor: 4.654
Authors: Frederic Carsten Schmeel; Birgit Simon; Julian Alexander Luetkens; Frank Träber; Carsten Meyer; Leonard Christopher Schmeel; Amir Sabet; Samer Ezziddin; Hans Heinz Schild; Dariusch Reza Hadizadeh Journal: J Cancer Res Clin Oncol Date: 2017-03-19 Impact factor: 4.553
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