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Clinical investigation survival
prediction in high-grade gliomas by MRI perfusion before and during
early stage of RT
Cao Y, Tsien CI, Nagesh V, Junck L, Ten
Haken R, Ross BD, Chenevert TL, Lawrence TS
Department of Radiation Oncology, University of Michigan, Ann
Arbor, MI; Department of Radiology, University of Michigan, Ann Arbor,
MI.
Purpose. To determine whether cerebral blood volume
(CBV) and cerebral blood flow can predict the response of high-grade
gliomas to radiotherapy (RT) by taking into account spatial
heterogeneity and temporal changes in perfusion.
Methods and Materials.
Twenty-three patients with high-grade gliomas underwent conformal RT,
with magnetic resonance imaging perfusion before and at Weeks 1-2 and
3-4 during RT.
Tumor perfusion was classified as
high, medium, or low.
The prognostic values of pre-RT
perfusion and the changes during RT for early prediction of tumor
response to RT were evaluated.
Results. The fractional
high-CBV tumor volume before RT and the fluid-attenuated inversion
recovery imaging tumor volume were identified as predictors for
survival (p = 0.01).
Changes in tumor CBV during the
early treatment course also predicted for survival.
Better survival was predicted by a
decrease in the fractional low-CBV tumor volume at Week 1 of RT vs.
before RT, a decrease in the fractional high-CBV tumor volume at Week
3 vs. Week 1 of RT, and a smaller pre-RT fluid-attenuated inversion
recovery imaging tumor volume (p = 0.01).
Conclusion. Early
temporal changes during RT in heterogeneous regions of high and low
perfusion in gliomas might predict for different physiologic responses
to RT.
This might also open the
opportunity to identify tumor subvolumes that are radioresistant and
might benefit from intensified RT.
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