title: MR imaging assessment of tumor perfusion and 3D segmented volume at baseline, during treatment, and at tumor progression in children with newly diagnosed diffuse intrinsic pontine glioma.
abstract: OBJECTIVE
  DIPG is among the most devastating brain tumors in children, necessitating the development of novel treatment strategies and advanced imaging markers such as perfusion to adequately monitor clinical trials. This study investigated tumor perfusion and 3D segmented tumor volume as predictive markers for outcome in children with newly diagnosed DIPG.
  
  
  METHODS
  Imaging data were assessed at baseline, during, and after RT, and every other month thereafter until tumor progression for 35 patients (ages 2-16 years) with newly diagnosed DIPG enrolled in the phase I clinical study, NCT00472017. Patients were treated with conformal RT and vandetanib, a vascular endothelial growth factor receptor 2 inhibitor.
  
  
  RESULTS
  Tumor perfusion increased and tumor volume decreased during combined RT and vandetanib therapy. These changes slowly diminished in follow-up scans until tumor progression. However, increased tumor perfusion and decreased tumor volume during combined therapy were associated with longer PFS. Apart from a longer OS for patients who showed elevated tumor perfusion after RT, there was no association for tumor volume and other perfusion variables with OS.
  
  
  CONCLUSIONS
  Our results suggest that tumor perfusion may be a useful predictive marker for the assessment of treatment response and tumor progression in children with DIPG treated with both RT and vandetanib. The assessment of tumor perfusion yields valuable information about tumor microvascular status and its response to therapy, which may help better understand the biology of DIPGs and monitor novel treatment strategies in future clinical trials.
authors: Department of Radiological Sciences, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA.
authors: J
authors: J
authors: Sedlacik
authors: A
authors: A
authors: Winchell
authors: M
authors: M
authors: Kocak
authors: R B
authors: RB
authors: Loeffler
authors: A
authors: A
authors: Broniscer
authors: C M
authors: CM
authors: Hillenbrand
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001810:Blood Volume / Q000187:drug effects / Q000528:radiation effects; D020295:Brain Stem Neoplasms / Q000175:diagnosis* / Q000503:physiopathology / Q000532:radiotherapy; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D018450:Disease Progression; D017352:Echo-Planar Imaging / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000175:diagnosis* / Q000503:physiopathology / Q000532:radiotherapy; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D020360:Neoadjuvant Therapy; D059906:Neuroimaging / Q000379:methods*; D010880:Piperidines / Q000627:therapeutic use; D011446:Prospective Studies; D011799:Quinazolines / Q000627:therapeutic use; D020266:Radiotherapy, Conformal / Q000379:methods; D040262:Receptors, Vascular Endothelial Growth Factor / Q000037:antagonists & inhibitors; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D010880:Piperidines; D011799:Quinazolines; D040262:Receptors, Vascular Endothelial Growth Factor; C452423:vandetanib