Applying a Radiation Therapy Volume Analysis Pipeline to Determine the Utility of Spectroscopic MRI-Guided Adaptive Radiation Therapy for Glioblastoma.
Anuradha G TrivediSu Hyun KimKarthik K RameshAlexander S GiuffridaBrent D WeinbergEric A MellonLawrence R KleinbergPeter B BarkerHui HanHui-Kuo G ShuHyunsuk ShimEduard SchreibmannPublished in: Tomography (Ann Arbor, Mich.) (2023)
Accurate radiation therapy (RT) targeting is crucial for glioblastoma treatment but may be challenging using clinical imaging alone due to the infiltrative nature of glioblastomas. Precise targeting by whole-brain spectroscopic MRI, which maps tumor metabolites including choline (Cho) and N-acetylaspartate (NAA), can quantify early treatment-induced molecular changes that other traditional modalities cannot measure. We developed a pipeline to determine how spectroscopic MRI changes during early RT are associated with patient outcomes to provide insight into the utility of adaptive RT planning. Data were obtained from a study (NCT03137888) where glioblastoma patients received high-dose RT guided by the pre-RT Cho/NAA twice normal (Cho/NAA ≥ 2x) volume, and received spectroscopic MRI scans pre- and mid-RT. Overlap statistics between pre- and mid-RT scans were used to quantify metabolic activity changes after two weeks of RT. Log-rank tests were used to quantify the relationship between imaging metrics and patient overall and progression-free survival (OS/PFS). Patients with lower Jaccard/Dice coefficients had longer PFS ( p = 0.045 for both), and patients with lower Jaccard/Dice coefficients had higher OS trending towards significance ( p = 0.060 for both). Cho/NAA ≥ 2x volumes changed significantly during early RT, putting healthy tissue at risk of irradiation, and warranting further study into using adaptive RT planning.
Keyphrases
- radiation therapy
- contrast enhanced
- magnetic resonance imaging
- molecular docking
- high dose
- high resolution
- end stage renal disease
- free survival
- ejection fraction
- newly diagnosed
- magnetic resonance
- ms ms
- chronic kidney disease
- cancer therapy
- white matter
- deep learning
- blood brain barrier
- preterm birth
- high glucose
- patient reported outcomes
- photodynamic therapy
- radiation induced
- cerebral ischemia