A feasibility study to evaluate early treatment response of brain metastases one week after stereotactic radiosurgery using perfusion weighted imaging.
A feasibility study to evaluate early treatment response of brain metastases one week after stereotactic radiosurgery using perfusion weighted imaging.
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DOI：
10.1371/journal.pone.0241835
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发表时间：
2020
期刊：
影响因子：
3.7
通讯作者：
Benzinger T
中科院分区：
文献类型：
--
作者：
Huang J;Milchenko M;Rao YJ;LaMontagne P;Abraham C;Robinson CG;Huang Y;Shimony JS;Rich KM;Benzinger T
探讨早期灌注加权磁共振成像（PWI）是否可能是预测脑转移瘤立体定向放射外科手术（SRS）后局部复发（LR）的有前景的成像生物标志物。这是一项前瞻性初步研究，研究对象为接受SRS治疗并在治疗前和治疗1周后接受PWI成像的成人脑转移瘤患者。相对脑血容量（rCBV）参数图通过标准化为PWI上对侧白色物质的平均值来计算。进行考克斯回归以探索与LR时间相关的因素，Bonferroni校正p<0.0006用于多重检验校正。采用Kaplan-Meier法估计LR率，并采用对数秩检验进行比较。2013年至2016年入组了23例患者，16例患者有22处可评价病变。中位随访13.1个月（范围：3.0-53.7）后，5处病变（21%）在中位3.4个月（范围：2.3-5.7）后发生LR。单因素分析显示，肿瘤体积越大，（HR 1.48，95% CI 1.02-2.15，p = 0.04），较低SRS剂量（HR 0.45，95% CI 0.21-0.97，p = 0.04），第1周rCBV较高（HR 1.07，95% CI 1.003-1.14，p = 0.04）与LR时间较短存在临界相关性。肿瘤> 2.0 cm 3的LR显著高于≤ 2.0 cm 3：1年时分别为54% vs 0%，p = 0.008。一项未来的研究，以确认早期PWI和LR的关联的高风险队列的病变> 2.0立方厘米，估计需要258名患者。SRS后第1周PWI与LR可能存在临界相关性。<2.0cm3的肿瘤在SRS后LR的风险较低，并且对于预测性生物标志物研究可能是低产量的。关于样本量和未来成像生物标志物研究的潜在挑战的信息可以从该初步研究中收集。
To explore if early perfusion-weighted magnetic resonance imaging (PWI) may be a promising imaging biomarker to predict local recurrence (LR) of brain metastases after stereotactic radiosurgery (SRS). This is a prospective pilot study of adult brain metastasis patients who were treated with SRS and imaged with PWI before and 1 week later. Relative cerebral blood volume (rCBV) parameter maps were calculated by normalizing to the mean value of the contralateral white matter on PWI. Cox regression was conducted to explore factors associated with time to LR, with Bonferroni adjusted p<0.0006 for multiple testing correction. LR rates were estimated with the Kaplan-Meier method and compared using the log-rank test. Twenty-three patients were enrolled from 2013 through 2016, with 22 evaluable lesions from 16 patients. After a median follow-up of 13.1 months (range: 3.0–53.7), 5 lesions (21%) developed LR after a median of 3.4 months (range: 2.3–5.7). On univariable analysis, larger tumor volume (HR 1.48, 95% CI 1.02–2.15, p = 0.04), lower SRS dose (HR 0.45, 95% CI 0.21–0.97, p = 0.04), and higher rCBV at week 1 (HR 1.07, 95% CI 1.003–1.14, p = 0.04) had borderline association with shorter time to LR. Tumors >2.0cm3 had significantly higher LR than if ≤2.0cm3: 54% vs 0% at 1 year, respectively, p = 0.008. A future study to confirm the association of early PWI and LR of the high-risk cohort of lesions >2.0cm3 is estimated to require 258 patients. PWI at week 1 after SRS may have borderline association with LR. Tumors <2.0cm3 have low risk of LR after SRS and may be low-yield for predictive biomarker studies. Information regarding sample size and potential challenges for future imaging biomarker studies may be gleaned from this pilot study.
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