Clinical investigation survival prediction in high-grade gliomas by MRI perfusion before and during early stage of RT

Yue Cao, Christina I. Tsien, Vijaya Nagesh, Larry Junck, Randall Ten Haken, Brian D. Ross, Thomas L. Chenevert, Theodore S. Lawrence

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    112 Scopus citations

    Abstract

    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.

    Original languageEnglish
    Pages (from-to)876-885
    Number of pages10
    JournalInternational Journal of Radiation Oncology Biology Physics
    Volume64
    Issue number3
    DOIs
    StatePublished - Mar 1 2006

    Keywords

    • Early prediction
    • Gliomas
    • Perfusion
    • Radiotherapy

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