Patterns of Recurrence Analysis in Newly Diagnosed Glioblastoma Multiforme After Three-Dimensional Conformal Radiation Therapy With Respect to Pre-Radiation Therapy Magnetic Resonance Spectroscopic Findings

Journal Article · Mon Oct 01 04:00:00 EDT 2007 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2007.03.019· OSTI ID:21036238

Park, Ilwoo ^[1]; Tamai, Gregory; Lee, Michael C ^[1]; Chuang, Cynthia F ^[2]; Chang, Susan M; Berger, Mitchel S ^[3]; Nelson, Sarah J ^[1]; Pirzkall, Andrea ^[1]

---

1. Surbeck Laboratory of Advanced Imaging, Department of Radiology, University of California-San Francisco, San Francisco, CA (United States)
2. Department of Radiation Oncology, University of California-San Francisco, San Francisco, CA (United States)
3. Department of Neurological Surgery, University of California-San Francisco, San Francisco, CA (United States)

Purpose: To determine whether the combined magnetic resonance imaging (MRI) and magnetic resonance spectroscopy imaging (MRSI) before radiation therapy (RT) is valuable for RT target definition, and to evaluate the feasibility of replacing the current definition of uniform margins by custom-shaped margins based on the information from MRI and MRSI. Methods and Materials: A total of 23 glioblastoma multiforme (GBM) patients underwent MRI and MRSI within 4 weeks after surgery but before the initiation of RT and at 2-month follow-up intervals thereafter. The MRSI data were quantified on the basis of a Choline-to-NAA Index (CNI) as a measure of spectroscopic abnormality. A combined anatomic and metabolic region of interest (MRI/S) consisting of T2-weighted hyperintensity, contrast enhancement (CE), resection cavity, and CNI2 (CNI {>=} 2) based on the pre-RT imaging was compared to the extent of CNI2 and the RT dose distribution. The spatial relationship of the pre-RT MRI/S and the RT dose volume was compared with the extent of CE at each follow-up. Results: Nine patients showed new or increased CE during follow-up, and 14 patients were either stable or had decreased CE. New or increased areas of CE occurred within CNI2 that was covered by 60 Gy in 6 patients and within the CNI2 that was not entirely covered by 60 Gy in 3 patients. New or increased CE resided within the pre-RT MRI/S lesion in 89% (8/9) of the patients with new or increased CE. Conclusion: These data indicate that the definition of RT target volumes according to the combined morphologic and metabolic abnormality may be sufficient for RT targeting.

• OSTI ID: 21036238
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 2 Vol. 69; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
BRAIN
CHOLINE
GLIOMAS
MAGNETIC RESONANCE
NEUTRON ACTIVATION ANALYSIS
NMR IMAGING
PATIENTS
RADIATION DOSE DISTRIBUTIONS
RADIATION DOSES
RADIOTHERAPY
SPECTROSCOPY
SURGERY