Prognostic Value of MRS Metabolites in Postoperative Irradiated High Grade Gliomas.
OBJECTIVE
We studied the prognostic significance of Magnetic Resonance Spectroscopy (MRS) in operated high grade gliomas.


METHODS
Twelve patients were treated with radiotherapy and Temozolomide. The MRS data were taken four weeks after operation (before radiotherapy) and every six months after the completion of RT. The N-acetyl aspartate, choline, creatine, and myo-inositol parameters were quantified, analyzed, and correlated to recurrence-free survival (RFS).


RESULTS
The median RFS was 26.06 months. RFS was significantly worse in elderly patients (P = 0.001) along with the higher choline/creatine ratios at either baseline (P = 0.003) or six months post Radiotherapy (P = 0.042). Median RFS was 23 months in high choline/creatine levels ≥ 2 at 6 months after radiotherapy and 11 months for those with < 2 choline/creatine levels. There was a significant correlation of maximum difference of choline/creatine ratio with RFS (rho = 0.64, P = 0.045).


CONCLUSIONS
Age and choline/creatine ratio are strong independent prognostic factors in high grade gliomas.
2nd Department of Radiology, Radiation Oncology Unit, Medical School, Attikon University Hospital, 1 Rimini Street, Haidari, 12462 Athens, Greece.
Maria
M
Tolia
Encefalos Radiology Center, 3 Rizareiou & Chrisostomou Smirnis Street, Chalandri, 15233 Athens, Greece.
Dimitrios
D
Verganelakis
Medical Oncology Unit, 401 General Army Hospital, 10-12 Gennimata Street, Ampelokipi, 11524 Athens, Greece.
Nikolaos
N
Tsoukalas
School of Health Sciences, Faculty of Medicine, Department of Radiotherapy, University of Thessaly, Biopolis, 41110 Larissa, Greece.
George
G
Kyrgias
2nd Department of Radiology, Radiation Oncology Unit, Medical School, Attikon University Hospital, 1 Rimini Street, Haidari, 12462 Athens, Greece.
Matilda
M
Papathanasiou
2nd Department of Radiology, Radiation Oncology Unit, Medical School, Attikon University Hospital, 1 Rimini Street, Haidari, 12462 Athens, Greece.
Eftichia
E
Mosa
1st Department of Radiology, Radiation Oncology Unit, Medical School, Aretaieion University Hospital, Vas Sofias 104 Avenue, 11521 Athens, Greece.
Ioannis
I
Kokakis
1st Department of Radiology, Radiation Oncology Unit, Medical School, Aretaieion University Hospital, Vas Sofias 104 Avenue, 11521 Athens, Greece.
John R
JR
Kouvaris
Radiotherapy Department, Alexandra Hospital, 11521 Athens, Greece.
George
G
Pissakas
Department of Radiation Oncology, AHEPA Hospital, Aristotle University of Thessaloniki, 1 Kyriakidi Street, 54636 Thessaloniki, Greece.
Kyriaki
K
Pistevou-Gombaki
2nd Department of Radiology, Radiation Oncology Unit, Medical School, Attikon University Hospital, 1 Rimini Street, Haidari, 12462 Athens, Greece.
Nikolaos
N
Kelekis
2nd Department of Radiology, Radiation Oncology Unit, Medical School, Attikon University Hospital, 1 Rimini Street, Haidari, 12462 Athens, Greece.
Vasileios
V
Kouloulias
D000328:Adult; D000367:Age Factors; D000368:Aged; D002794:Choline / Q000097:blood; D003401:Creatine / Q000097:blood; D018572:Disease-Free Survival; D005260:Female; D005910:Glioma / Q000097:blood* / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000097:blood* / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D011184:Postoperative Period; D011379:Prognosis
D003401:Creatine; D002794:Choline