Developing a Pipeline for Multiparametric MRI-Guided Radiation Therapy: Initial Results from a Phase II Clinical Trial in Newly Diagnosed Glioblastoma
Developing a Pipeline for Multiparametric MRI-Guided Radiation Therapy: Initial Results from a Phase II Clinical Trial in Newly Diagnosed Glioblastoma
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DOI：
10.18383/j.tom.2018.00035
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发表时间：
2019-03-01
期刊：
影响因子：
1.9
通讯作者：
Cao, Yue
中科院分区：
文献类型：
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作者：
Kim, Michelle M.;Parmar, Hemant A.;Cao, Yue
胶质母细胞瘤的高灌注区和高细胞区的定量标测已被提出，以提高传统放射治疗后局部复发风险的肿瘤区域的清晰度。由于多参数动态对比增强(DCE-)和弥散加权(DW-)磁共振成像(MRI)数据的处理需要超出标准靶区定义的步骤，因此我们试图设计一种工作流程来支持患者的及时计划和治疗。启动了一项第二阶段研究，该研究实施了一项多参数成像生物标记物，用于诊断肿瘤的高灌注和高细胞密度，包括DCE-MRI和高b值DW-MRI，以指导新诊断的胶质母细胞瘤患者的强化(75Gy30次)放射治疗(RT)。在这份报告中，描述了前12名患者的工作流程和初步成像结果。在所有前12名患者中，在手术后6周内和模拟后2周内开始治疗。平均而言，合并的高细胞体积和高脑血容量/肿瘤灌注量比T1异常小1.8倍，比FLAIR异常小10倍。高细胞体积和高脑血容量/肿瘤灌注量分别显示了大致不同的区域，并显示57%与增强异常重叠，在FLAIR之外几乎没有延伸。这些结果表明，将多参数磁共振引导放射治疗的工作流程实施到临床试验中是可行的，该工作流程由一个协调的多学科团队以及通过组合高b值DW-MRI和DCE-MRI确定的独特和互补的肿瘤亚区来实现。
Quantitative mapping of hyperperfused and hypercellular regions of glioblastoma has been proposed to improve definition of tumor regions at risk for local recurrence following conventional radiation therapy. As the processing of the multiparametric dynamic contrast-enhanced (DCE-) and diffusion-weighted (DW-) magnetic resonance imaging (MRI) data for delineation of these subvolumes requires additional steps that go beyond the standard practices of target definition, we sought to devise a workflow to support the timely planning and treatment of patients. A phase II study implementing a multiparametric imaging biomarker for tumor hyperperfusion and hypercellularity consisting of DCE-MRI and high b-value DW-MRI to guide intensified (75 Gy/30 fractions) radiation therapy (RT) in patients with newly diagnosed glioblastoma was launched. In this report, the workflow and the initial imaging outcomes of the first 12 patients are described. Among all the first 12 patients, treatment was initiated within 6 weeks of surgery and within 2 weeks of simulation. On average, the combined hypercellular volume and high cerebral blood volume/tumor perfusion volume were 1.8 times smaller than the T1 gadolinium abnormality and 10 times smaller than the FLAIR abnormality. Hypercellular volume and high cerebral blood volume/tumor perfusion volume each identified largely distinct regions and showed 57% overlap with the enhancing abnormality, and minimal-to-no extension outside of the FLAIR. These results show the feasibility of implementing a workflow for multiparametric magnetic resonance-guided radiation therapy into clinical trials with a coordinated multidisciplinary team, and the unique and complementary tumor subregions identified by the combination of high b-value DW-MRI and DCE-MRI.