Magnetic resonance spectroscopy imaging in radiotherapy planning for recurrent glioma

Se M. Ballangrud; Stella Lymberis; Sunitha B. Thakur; Sasan Karimi; Wei Huang; Lauren E. Abrey; Kathryn Beal; Fabio M. Iwamoto; Cameron Brennan; Philip H. Gutin; Jenghwa Chang

doi:10.1118/1.3574884

Magnetic resonance spectroscopy imaging in radiotherapy planning for recurrent glioma

Se M. Ballangrud, Stella Lymberis, Sunitha B. Thakur, Sasan Karimi, Wei Huang, Lauren E. Abrey, Kathryn Beal, Fabio M. Iwamoto, Cameron Brennan, Philip H. Gutin, Jenghwa Chang

Research output: Contribution to journal › Article › peer-review

6 Scopus citations

Abstract

Purpose: The purpose of this study was to investigate how incorporation of magnetic resonance spectroscopy imaging (MRSI) into radiotherapy planning would increase the target volume for patients with recurrent glioma. Methods: After prior standard radiotherapy, 25 patients with recurrent glioma were treated with bevacizumab and concurrent hypofractionated stereotactic radiotherapy (HFSRT), delivering 30 Gy in five fractions. MRSI were acquired for 12 patients. Areas with markedly higher choline levels relative to the levels of total creatine and N-acetylaspartate were identified and referred to as MRSI voxels with elevated metabolite ratios (EMR). Gross tumor volume (GTV) consisted of contrast-enhancing tumor on T1-weighted magnetic resonance images (MRI) and computed tomography. Clinical target volume (CTV) was GTV 5 mm margin and MRSI voxels with EMR. Overall survival (OS) and 6-month progression free survival (PFS) for these patients were reported in a prior publication Gutin, Int. J. Radiat. Oncol., Biol., Phys. 75(1), 156-163 (2009), and the outcome was correlated with the GTV and the volume of MRSI voxels with EMR in this study. Results: Seven of the 12 patients had MRSI voxels with EMR. If none of the MRSI voxels with EMR were included, the CTV would range from 9.2 to 73.0 cm ³ with a median of 31.0 cm³, whereas if all voxels were included, the CTV would range from 27.4 to 74.4 cm³ with a median of 35.0 cm³. For three of the seven patients, including the voxels with EMR, would have increased the CTV by 14-23. For one patient, where the MRSI voxels with EMR did not overlap the GTV, including these voxels would increase the CTV by 198. No correlation could be found between the OS and PFS and the GTV or the volume of MRSI voxels with EMR. Conclusions: Seven of 12 patients with recurrent glioma had MRSI voxels with EMR. For four of these seven patients, including the MRSI voxels with EMR, significantly increased the CTV. This study does not have statistical power to conclude on the importance of including areas with MRSI-suspect disease into the radiation target volume.

Original language	English (US)
Pages (from-to)	2724-2730
Number of pages	7
Journal	Medical Physics
Volume	38
Issue number	5
DOIs	https://doi.org/10.1118/1.3574884
State	Published - May 2011
Externally published	Yes

Keywords

MR spectroscopy
bevacizumab
radiotherapy
re-irradiation
recurrent glioma

ASJC Scopus subject areas

Biophysics
Radiology Nuclear Medicine and imaging

Access to Document

10.1118/1.3574884

Cite this

@article{ba052f4c214340f0a1ef0b1c1d23421f,

title = "Magnetic resonance spectroscopy imaging in radiotherapy planning for recurrent glioma",

abstract = "Purpose: The purpose of this study was to investigate how incorporation of magnetic resonance spectroscopy imaging (MRSI) into radiotherapy planning would increase the target volume for patients with recurrent glioma. Methods: After prior standard radiotherapy, 25 patients with recurrent glioma were treated with bevacizumab and concurrent hypofractionated stereotactic radiotherapy (HFSRT), delivering 30 Gy in five fractions. MRSI were acquired for 12 patients. Areas with markedly higher choline levels relative to the levels of total creatine and N-acetylaspartate were identified and referred to as MRSI voxels with elevated metabolite ratios (EMR). Gross tumor volume (GTV) consisted of contrast-enhancing tumor on T1-weighted magnetic resonance images (MRI) and computed tomography. Clinical target volume (CTV) was GTV 5 mm margin and MRSI voxels with EMR. Overall survival (OS) and 6-month progression free survival (PFS) for these patients were reported in a prior publication Gutin, Int. J. Radiat. Oncol., Biol., Phys. 75(1), 156-163 (2009), and the outcome was correlated with the GTV and the volume of MRSI voxels with EMR in this study. Results: Seven of the 12 patients had MRSI voxels with EMR. If none of the MRSI voxels with EMR were included, the CTV would range from 9.2 to 73.0 cm 3 with a median of 31.0 cm3, whereas if all voxels were included, the CTV would range from 27.4 to 74.4 cm3 with a median of 35.0 cm3. For three of the seven patients, including the voxels with EMR, would have increased the CTV by 14-23. For one patient, where the MRSI voxels with EMR did not overlap the GTV, including these voxels would increase the CTV by 198. No correlation could be found between the OS and PFS and the GTV or the volume of MRSI voxels with EMR. Conclusions: Seven of 12 patients with recurrent glioma had MRSI voxels with EMR. For four of these seven patients, including the MRSI voxels with EMR, significantly increased the CTV. This study does not have statistical power to conclude on the importance of including areas with MRSI-suspect disease into the radiation target volume.",

keywords = "MR spectroscopy, bevacizumab, radiotherapy, re-irradiation, recurrent glioma",

author = "Ballangrud, {Se M.} and Stella Lymberis and Thakur, {Sunitha B.} and Sasan Karimi and Wei Huang and Abrey, {Lauren E.} and Kathryn Beal and Iwamoto, {Fabio M.} and Cameron Brennan and Gutin, {Philip H.} and Jenghwa Chang",

year = "2011",

month = may,

doi = "10.1118/1.3574884",

language = "English (US)",

volume = "38",

pages = "2724--2730",

journal = "Medical Physics",

issn = "0094-2405",

publisher = "AAPM - American Association of Physicists in Medicine",

number = "5",

}

TY - JOUR

T1 - Magnetic resonance spectroscopy imaging in radiotherapy planning for recurrent glioma

AU - Ballangrud, Se M.

AU - Lymberis, Stella

AU - Thakur, Sunitha B.

AU - Karimi, Sasan

AU - Huang, Wei

AU - Abrey, Lauren E.

AU - Beal, Kathryn

AU - Iwamoto, Fabio M.

AU - Brennan, Cameron

AU - Gutin, Philip H.

AU - Chang, Jenghwa

PY - 2011/5

Y1 - 2011/5

N2 - Purpose: The purpose of this study was to investigate how incorporation of magnetic resonance spectroscopy imaging (MRSI) into radiotherapy planning would increase the target volume for patients with recurrent glioma. Methods: After prior standard radiotherapy, 25 patients with recurrent glioma were treated with bevacizumab and concurrent hypofractionated stereotactic radiotherapy (HFSRT), delivering 30 Gy in five fractions. MRSI were acquired for 12 patients. Areas with markedly higher choline levels relative to the levels of total creatine and N-acetylaspartate were identified and referred to as MRSI voxels with elevated metabolite ratios (EMR). Gross tumor volume (GTV) consisted of contrast-enhancing tumor on T1-weighted magnetic resonance images (MRI) and computed tomography. Clinical target volume (CTV) was GTV 5 mm margin and MRSI voxels with EMR. Overall survival (OS) and 6-month progression free survival (PFS) for these patients were reported in a prior publication Gutin, Int. J. Radiat. Oncol., Biol., Phys. 75(1), 156-163 (2009), and the outcome was correlated with the GTV and the volume of MRSI voxels with EMR in this study. Results: Seven of the 12 patients had MRSI voxels with EMR. If none of the MRSI voxels with EMR were included, the CTV would range from 9.2 to 73.0 cm 3 with a median of 31.0 cm3, whereas if all voxels were included, the CTV would range from 27.4 to 74.4 cm3 with a median of 35.0 cm3. For three of the seven patients, including the voxels with EMR, would have increased the CTV by 14-23. For one patient, where the MRSI voxels with EMR did not overlap the GTV, including these voxels would increase the CTV by 198. No correlation could be found between the OS and PFS and the GTV or the volume of MRSI voxels with EMR. Conclusions: Seven of 12 patients with recurrent glioma had MRSI voxels with EMR. For four of these seven patients, including the MRSI voxels with EMR, significantly increased the CTV. This study does not have statistical power to conclude on the importance of including areas with MRSI-suspect disease into the radiation target volume.

AB - Purpose: The purpose of this study was to investigate how incorporation of magnetic resonance spectroscopy imaging (MRSI) into radiotherapy planning would increase the target volume for patients with recurrent glioma. Methods: After prior standard radiotherapy, 25 patients with recurrent glioma were treated with bevacizumab and concurrent hypofractionated stereotactic radiotherapy (HFSRT), delivering 30 Gy in five fractions. MRSI were acquired for 12 patients. Areas with markedly higher choline levels relative to the levels of total creatine and N-acetylaspartate were identified and referred to as MRSI voxels with elevated metabolite ratios (EMR). Gross tumor volume (GTV) consisted of contrast-enhancing tumor on T1-weighted magnetic resonance images (MRI) and computed tomography. Clinical target volume (CTV) was GTV 5 mm margin and MRSI voxels with EMR. Overall survival (OS) and 6-month progression free survival (PFS) for these patients were reported in a prior publication Gutin, Int. J. Radiat. Oncol., Biol., Phys. 75(1), 156-163 (2009), and the outcome was correlated with the GTV and the volume of MRSI voxels with EMR in this study. Results: Seven of the 12 patients had MRSI voxels with EMR. If none of the MRSI voxels with EMR were included, the CTV would range from 9.2 to 73.0 cm 3 with a median of 31.0 cm3, whereas if all voxels were included, the CTV would range from 27.4 to 74.4 cm3 with a median of 35.0 cm3. For three of the seven patients, including the voxels with EMR, would have increased the CTV by 14-23. For one patient, where the MRSI voxels with EMR did not overlap the GTV, including these voxels would increase the CTV by 198. No correlation could be found between the OS and PFS and the GTV or the volume of MRSI voxels with EMR. Conclusions: Seven of 12 patients with recurrent glioma had MRSI voxels with EMR. For four of these seven patients, including the MRSI voxels with EMR, significantly increased the CTV. This study does not have statistical power to conclude on the importance of including areas with MRSI-suspect disease into the radiation target volume.

KW - MR spectroscopy

KW - bevacizumab

KW - radiotherapy

KW - re-irradiation

KW - recurrent glioma

UR - http://www.scopus.com/inward/record.url?scp=79959536594&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79959536594&partnerID=8YFLogxK

U2 - 10.1118/1.3574884

DO - 10.1118/1.3574884

M3 - Article

C2 - 21776809

AN - SCOPUS:79959536594

SN - 0094-2405

VL - 38

SP - 2724

EP - 2730

JO - Medical Physics

JF - Medical Physics

IS - 5

ER -

Magnetic resonance spectroscopy imaging in radiotherapy planning for recurrent glioma

Abstract

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this