Case report: Fractional brain tumor burden magnetic resonance mapping to assess response to pulsed low-dose-rate radiotherapy in newly-diagnosed glioblastoma.
Case report: Fractional brain tumor burden magnetic resonance mapping to assess response to pulsed low-dose-rate radiotherapy in newly-diagnosed glioblastoma.
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DOI：
10.3389/fonc.2022.1066191
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发表时间：
2022
影响因子：
4.7
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中科院分区：
文献类型：
--
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脉冲低剂量率放疗（pLDR）是复发性胶质瘤的常用再照射技术，但其与替莫唑胺（TMZ）的前期使用后，胶质母细胞瘤的主要切除术目前正在调查中。由于标准磁共振成像（MRI）在此类应用中区分治疗效果与肿瘤进展方面存在局限性，因此灌注加权MRI（PWI）可用于创建部分肿瘤负荷（FTB）图，以在空间上区分活动性肿瘤与治疗相关效果。我们对4例胶质母细胞瘤患者在再次切除前进行了PWI，这些患者接受了前期pLDR和TMZ，在pLDR后中位时间3个月（0-5个月或0-143天）时放射学怀疑肿瘤进展。将病理诊断与回顾性生成的FTB图进行比较。中位患者年龄为55.5岁（50-60岁）。所有患者均为男性，具有IDH野生型（n=4）和O 6-甲基鸟嘌呤-DNA甲基转移酶（MGMT）高甲基化（n=1）分子标记。病理诊断显示治疗效果（n=2）、存活肿瘤和治疗效果的混合物（n=1）或存活肿瘤（n=1）。在4例病例中的3例中，FTB图表明病变体积主要由治疗效果组成，肿瘤体积增强由中位数为6.8%的血管肿瘤组成（6.4-16.4%）。该病例系列提供了对前期pLDR和TMZ的放射学反应的见解，以及FTB映射在再次手术前和放疗后20周内区分肿瘤进展与治疗效果的作用。
Pulsed low-dose-rate radiotherapy (pLDR) is a commonly used reirradiation technique for recurrent glioma, but its upfront use with temozolomide (TMZ) following primary resection of glioblastoma is currently under investigation. Because standard magnetic resonance imaging (MRI) has limitations in differentiating treatment effect from tumor progression in such applications, perfusion-weighted MRI (PWI) can be used to create fractional tumor burden (FTB) maps to spatially distinguish active tumor from treatment-related effect. We performed PWI prior to re-resection in four patients with glioblastoma who had undergone upfront pLDR concurrent with TMZ who had radiographic suspicion for tumor progression at a median of 3 months (0-5 months or 0-143 days) post-pLDR. The pathologic diagnosis was compared to retrospectively-generated FTB maps. The median patient age was 55.5 years (50-60 years). All were male with IDH-wild type (n=4) and O6-methylguanine-DNA methyltransferase (MGMT) hypermethylated (n=1) molecular markers. Pathologic diagnosis revealed treatment effect (n=2), a mixture of viable tumor and treatment effect (n=1), or viable tumor (n=1). In 3 of 4 cases, FTB maps were indicative of lesion volumes being comprised predominantly of treatment effect with enhancing tumor volumes comprised of a median of 6.8% vascular tumor (6.4-16.4%). This case series provides insight into the radiographic response to upfront pLDR and TMZ and the role for FTB mapping to distinguish tumor progression from treatment effect prior to redo-surgery and within 20 weeks post-radiation.
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