title: Patterns of recurrence analysis in newly diagnosed glioblastoma multiforme after three-dimensional conformal radiation therapy with respect to pre-radiation therapy magnetic resonance spectroscopic findings.
abstract: OBJECTIVE
  To determine whether the combined magnetic resonance imaging (MRI) and magnetic resonance spectroscopy imaging (MRSI) before radiation therapy (RT) is valuable for RT target definition, and to evaluate the feasibility of replacing the current definition of uniform margins by custom-shaped margins based on the information from MRI and MRSI.
  
  
  METHODS
  A total of 23 glioblastoma multiforme (GBM) patients underwent MRI and MRSI within 4 weeks after surgery but before the initiation of RT and at 2-month follow-up intervals thereafter. The MRSI data were quantified on the basis of a Choline-to-NAA Index (CNI) as a measure of spectroscopic abnormality. A combined anatomic and metabolic region of interest (MRI/S) consisting of T2-weighted hyperintensity, contrast enhancement (CE), resection cavity, and CNI2 (CNI >or= 2) based on the pre-RT imaging was compared to the extent of CNI2 and the RT dose distribution. The spatial relationship of the pre-RT MRI/S and the RT dose volume was compared with the extent of CE at each follow-up.
  
  
  RESULTS
  Nine patients showed new or increased CE during follow-up, and 14 patients were either stable or had decreased CE. New or increased areas of CE occurred within CNI2 that was covered by 60 Gy in 6 patients and within the CNI2 that was not entirely covered by 60 Gy in 3 patients. New or increased CE resided within the pre-RT MRI/S lesion in 89% (8/9) of the patients with new or increased CE.
  
  
  CONCLUSIONS
  These data indicate that the definition of RT target volumes according to the combined morphologic and metabolic abnormality may be sufficient for RT targeting.
authors.affiliation: Surbeck Laboratory of Advanced Imaging, Department of Radiology, University of California-San Francisco, San Francisco, CA, USA.
authors.forename: Ilwoo
authors.initials: I
authors.lastname: Park
authors.forename: Gregory
authors.initials: G
authors.lastname: Tamai
authors.forename: Michael C
authors.initials: MC
authors.lastname: Lee
authors.forename: Cynthia F
authors.initials: CF
authors.lastname: Chuang
authors.forename: Susan M
authors.initials: SM
authors.lastname: Chang
authors.forename: Mitchel S
authors.initials: MS
authors.lastname: Berger
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Nelson
authors.forename: Andrea
authors.initials: A
authors.lastname: Pirzkall
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000528:radiation effects; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000532:radiotherapy / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D005909:Glioblastoma / Q000175:diagnosis* / Q000378:metabolism / Q000532:radiotherapy / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D011832:Radiation Injuries / Q000517:prevention & control; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal; D012189:Retrospective Studies