Format

Send to

Choose Destination
J Neurooncol. 2016 Oct;130(1):171-179. Epub 2016 Aug 17.

Serial analysis of 3D H-1 MRSI for patients with newly diagnosed GBM treated with combination therapy that includes bevacizumab.

Author information

1
Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA. sarah.nelson@ucsf.edu.
2
Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA. sarah.nelson@ucsf.edu.
3
Department of Neurology, University of California, San Francisco, CA, USA. sarah.nelson@ucsf.edu.
4
Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, USA. sarah.nelson@ucsf.edu.
5
Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
6
Department of Neurological Surgery, University of California, San Francisco, CA, USA.
7
Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA.
8
Department of Neurology, University of California, San Francisco, CA, USA.

Abstract

Interpretation of changes in the T1- and T2-weighted MR images from patients with newly diagnosed glioblastoma (GBM) treated with standard of care in conjunction with anti-angiogenic agents is complicated by pseudoprogression and pseudoresponse. The hypothesis being tested in this study was that 3D H-1 magnetic resonance spectroscopic imaging (MRSI) provides estimates of levels of choline, creatine, N-acetylaspartate (NAA), lactate and lipid that change in response to treatment and that metrics describing these characteristics are associated with survival. Thirty-one patients with newly diagnosed GBM and being treated with radiation therapy (RT), temozolomide, erlotinib and bevacizumab were recruited to receive serial MR scans that included 3-D lactate edited MRSI at baseline, mid-RT, post-RT and at specific follow-up time points. The data were processed to provide estimates of metrics representing changes in metabolite levels relative to normal appearing brain. Cox proportional hazards analysis was applied to examine the relationship of these parameters with progression free survival (PFS) and overall survival (OS). There were significant reductions in parameters that describe relative levels of choline to NAA and creatine, indicating that the treatment caused a decrease in tumor cellularity. Changes in the levels of lactate and lipid relative to the NAA from contralateral brain were consistent with vascular normalization. Metabolic parameters from the first serial follow-up scan were associated with PFS and OS, when accounting for age and extent of resection. Integrating metabolic parameters into the assessment of patients with newly diagnosed GBM receiving therapies that include anti-angiogenic agents may be helpful for tracking changes in tumor burden, resolving ambiguities in anatomic images caused by non-specific treatment effects and for predicting outcome.

KEYWORDS:

Anti-angiogenic therapy; MRSI; Metabolic imaging; Newly diagnosed glioblastoma; Survival

PMID:
27535746
PMCID:
PMC5069332
DOI:
10.1007/s11060-016-2229-3
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Springer Icon for PubMed Central
Loading ...
Support Center