SPECTRO GLIO trial aftermath: Where do we go from here?
SPECTRO GLIO trial aftermath: Where do we go from here?
复制标题
SPECTRO GLIO 试验后果：我们该何去何从？
DOI：
10.1093/neuonc/noad166
复制
发表时间：
2024
期刊：
影响因子：
15.9
通讯作者：
Shim,Hyunsuk
中科院分区：
文献类型：
--
作者：
Shu,Hui-KuoG;Shim,Hyunsuk
编辑165个先进的全脑3D sMRI序列，以指导RT剂量递增（75戈伊，30次），中位OS为23个月（N= 30，在3家机构入组）。3此外，其他先进的成像方法，包括Kim等人的扩散/灌注MRI和Laack等人的18 F-DOPA PET，用于指导GBM的RT剂量递增（分别为75戈伊和76戈伊，30次），已在单个机构水平进行了临床评价，结果类似。9，10有趣的是，SPECTRO GLIO试验中MGMT甲基化患者的OS曲线在24个月后似乎分离，有利于HD RT。1这让人想起Laack等人的报告，其中MGMT甲基化患者在接受18F-DOPA治疗时似乎获得更大的生存获益。这些有趣的结果表明，MGMT甲基化的存在可以定义GBM亚组，其从高级成像引导的RT剂量递增中获得更多益处。然而，这些结果并不是确定的，只能被认为是在这个节骨眼上产生的假设，需要在未来的试验中进行更严格的评估。最后，我们需要谨慎，不要仅仅因为评估一种方法的初始随机试验是阴性的，就忽视所有先进的定量成像技术作为指导GBM HD RT的手段。然而，可以从这一努力中吸取许多经验教训，包括在各机构之间协调定量成像模式的获取和使用方面取得的成功，以及在确定识别高危疾病的最佳阈值方面的潜在问题。我们希望进一步努力利用其他先进的成像方式，甚至更复杂的版本的MRSI，如全脑
Editorial 165 advanced whole-brain 3D sMRI sequence to guide RT dose escalation (75 Gy in 30 fractions) which yielded a median OS of 23 months (N= 30, enrolled at 3 institutions). 3 Furthermore, additional advanced imaging approaches including diffusion/perfusion MRI by Kim et al. and 18F-DOPA PET by Laack et al. to guide RT dose escalation (75 Gy and 76 Gy in 30 fractions, respectively) for GBMs have been evaluated clinically at the single institutional levels with similarly promising results. 9, 10 Interestingly, MGMT methylated patients on the SPECTRO GLIO trial had OS curves that appeared to separate after 24 months favoring HD RT. 1 This is reminiscent of the report by Laack et al. where MGMT methylated patients appear to derive greater survival benefit when treated with 18F-DOPA-guided HD RT. 10 These intriguing results suggest that the presence of MGMT methylation may define a GBM subgroup that gains more benefit from advanced imaging-guided RT dose escalation. However, these results are not definitive and can only be considered hypothesis-generating at this juncture with need for more rigorous assessment in future trials. In closing, we need to be cautious not to discount all advanced quantitative imaging techniques as a means of guiding HD RT for GBM just because the initial randomized trial assessing one such approach is negative. However, many lessons can be learned from this effort including the successes with harmonizing acquisition and use of a quantitative imaging modality across institutions as well as potential issues with determining the best threshold for identifying high-risk diseases. We hope that further efforts to utilize other advanced imaging modalities, or even more sophisticated versions of MRSI such as whole brain