NOVEL BIOMARKERS OF MALIGNANT PROGRESSION IN RECURRENT LOW GRADE GLIOMA

这项研究的目的是评估非侵入性成像参数作为肿瘤生物标志物的作用。 恶性转化的弥漫性低级别胶质瘤，并使用这些参数来选择区域， 表征与复发性疾病相关的基因突变。这些研究将对 通过提供客观标准来预测病变何时发生， 转化为更恶性的表型，是否以及在何处进行手术干预以及如何选择 下一步治疗这是一个重要的问题，因为患有先前LGG复发的肿瘤的患者 根据组织学亚型、分级和分子/细胞遗传学特征，具有不同的结果。的 恶性转化的机制尚不清楚，治疗策略往往是追求没有 组织学证实肿瘤复发。在我们之前的SPORE项目中，我们将磁共振技术 成像（MRI）和光谱成像（MRS！）在切除肿瘤前评估125例患者， 被认为是之前LGG的复发。体内MR测量的显著差异为 与未发生恶性转化的肿瘤相比，体外分析 提供的图像引导组织样本的组织学状态、IDHI突变和离体NMR光谱 新的信息，导致新的假设正在调查的具体目标1。扩建这幢 通过使用图像引导组织样本的下一代测序来定义突变谱的方法 将增加识别导致恶性转化的突变的可能性 并首次解决了与治疗效果和自然免疫相关的肿瘤基因组进化问题。 具体目标1将使体内MR参数与恶性肿瘤相关， 临床结局和特定目标2将使用来自病变的配对样本， 恶性转化的特征，以及来自当前和随后的配对样本 手术检查突变谱的演变。获得的知识将产生重大影响 患者护理。 相关性（参见说明）; 这个新的项目将整合非侵入性的成像标记，预测恶性转化， 评估存在以下疾病的患者的基因突变变化的空间和时间模式： 低级别胶质瘤初始诊断的复发性疾病。这将有助于了解 恶性转化，并将促进发展战略，以防止或治疗复发。

The goal of the proposed study is to evaluate the role of noninvasive imaging parameters as biomarkers of malignant transformation in diffuse low grade glioma and to use these parameters to select regions for characterizing the genetic mutations associated with recurrent disease. The studies will have a significant impact on the management of these patients by providing objective criteria to predict when a lesion transforms to a more malignant phenotype, whether and where to intervene surgically and how to select the next line therapy. This is an important problem because patients with tumors that recur from a prior LGG have different outcomes depending on histological subtype, grade, and molecular/cytogenetic features. The mechanisms of malignant transformation are unclear and treatment strategies are often pursued without histological confirmation of recurrent tumor. In our previous SPORE Project, we applied magnetic resonance imaging (MRi) and spectroscopic imaging (MRS!) to evaluate 125 patients prior to resection of tumors that were thought to have recurred from a prior LGG. Significant differences in the in vivo MR measures were seen for tumors with malignant transformation compared to those that did not. Ex vivo analysis of the histological status, IDHI mutations and ex-vivo NMR spectra from the image guided tissue samples provided new information that resulted in novel hypotheses being investigated in Specific Aim 1. Extending this approach by defining the mutation profile using next-generation sequencing of image guided tissue samples with defined histology will increase the probability of identifying mutations that drive malignant transformation and address, for the first time, the tumor genome evolution associated with treatment effects and the natural history of the disease.Specific Aim 1 will relate in-vivo MR parameters to malignant transfomriation and clinical outcome and Specific Aim 2 will use paired samples from lesions that either do or do not have the characteristics of malignant transformation, as well as paired samples from the current and subsequent surgery to examine the evolution of the mutation profile. The knowledge gained will make a major impact upon patient care. RELEVANCE (See instructions); This novel project will integrate non-invasive imaging markers that predict malignant transformation with an evaluation of the spatial and temporal patterns of changes in genetic mutations of patients who present with recurrent disease from an original diagnosis of low grade glioma. This will inform on the mechanisms of malignant transformation and will facilitate the development of strategies to prevent or treat the recurrence.