Survival prediction in high-grade gliomas by MRI perfusion before and during early stage of RT [corrected].
OBJECTIVE
To determine whether cerebral blood volume (CBV) and cerebral blood flow can predict the response of high-grade gliomas to radiotherapy (RT) by taking into account spatial heterogeneity and temporal changes in perfusion.


METHODS
Twenty-three patients with high-grade gliomas underwent conformal RT, with magnetic resonance imaging perfusion before and at Weeks 1-2 and 3-4 during RT. Tumor perfusion was classified as high, medium, or low. The prognostic values of pre-RT perfusion and the changes during RT for early prediction of tumor response to RT were evaluated.


RESULTS
The fractional high-CBV tumor volume before RT and the fluid-attenuated inversion recovery imaging tumor volume were identified as predictors for survival (p = 0.01). Changes in tumor CBV during the early treatment course also predicted for survival. Better survival was predicted by a decrease in the fractional low-CBV tumor volume at Week 1 of RT vs. before RT, a decrease in the fractional high-CBV tumor volume at Week 3 vs. Week 1 of RT, and a smaller pre-RT fluid-attenuated inversion recovery imaging tumor volume (p = 0.01).


CONCLUSIONS
Early temporal changes during RT in heterogeneous regions of high and low perfusion in gliomas might predict for different physiologic responses to RT. This might also open the opportunity to identify tumor subvolumes that are radioresistant and might benefit from intensified RT.
Cao
Yue
Y
Department of Radiation Oncology, University of Michigan, Ann Arbor, MI 48109-0010, USA. yuecao@med.umich.edu
Tsien
Christina I
CI
Nagesh
Vijaya
V
Junck
Larry
L
Ten Haken
Randall
R
Ross
Brian D
BD
Chenevert
Thomas L
TL
Lawrence
Theodore S
TS
D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000494:pharmacology; D001254:Astrocytoma / Q000098:blood supply* / Q000401:mortality / Q000532:radiotherapy*; D001810:Blood Volume; D001921:Brain / Q000098:blood supply / Q000528:radiation effects; D001932:Brain Neoplasms / Q000098:blood supply* / Q000401:mortality / Q000532:radiotherapy*; D002560:Cerebrovascular Circulation / Q000187:drug effects; D003907:Dexamethasone / Q000494:pharmacology; D005260:Female; D005909:Glioblastoma / Q000098:blood supply / Q000401:mortality / Q000532:radiotherapy; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012044:Regression Analysis
D000893:Anti-Inflammatory Agents; D003907:Dexamethasone