Applying a Radiation Therapy Volume Analysis Pipeline to Determine the Utility of Spectroscopic MRI-Guided Adaptive Radiation Therapy for Glioblastoma

• Published in: Tomography (Ann Arbor) Vol. 9; no. 3; pp. 1052 - 1061
• Main Authors: Trivedi, Anuradha G, Kim, Su Hyun, Ramesh, Karthik K, Giuffrida, Alexander S, Weinberg, Brent D, Mellon, Eric A, Kleinberg, Lawrence R, Barker, Peter B, Han, Hui, Shu, Hui-Kuo G, Shim, Hyunsuk, Schreibmann, Eduard
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 21-05-2023; MDPI
• Subjects: adaptive radiation therapy planning; Brain Neoplasms - diagnostic imaging; Brain Neoplasms - drug therapy; Brain Neoplasms - radiotherapy; Brain tumors; Care and treatment; glioblastoma; Glioblastoma - diagnostic imaging; Glioblastoma - drug therapy; Glioblastoma - radiotherapy; Glioblastoma multiforme; Humans; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Magnetic Resonance Spectroscopy - methods; Medical research; Medicine, Experimental; Metabolites; Pipe lines; Radiation; Radiotherapy; Radiotherapy Planning, Computer-Assisted; spectroscopic MRI; survival biomarkers; glioblastoma; adaptive radiation therapy planning; survival biomarkers; spectroscopic MRI
• ISSN: 2379-139X; 2379-1381; 2379-139X
• DOI: 10.3390/tomography9030086

Accurate radiation therapy (RT) targeting is crucial for glioblastoma treatment but may be challenging using clinical imaging alone due to the infiltrative nature of glioblastomas. Precise targeting by whole-brain spectroscopic MRI, which maps tumor metabolites including choline (Cho) and N-acetylaspartate (NAA), can quantify early treatment-induced molecular changes that other traditional modalities cannot measure. We developed a pipeline to determine how spectroscopic MRI changes during early RT are associated with patient outcomes to provide insight into the utility of adaptive RT planning. Data were obtained from a study (NCT03137888) where glioblastoma patients received high-dose RT guided by the pre-RT Cho/NAA twice normal (Cho/NAA ≥ 2x) volume, and received spectroscopic MRI scans pre- and mid-RT. Overlap statistics between pre- and mid-RT scans were used to quantify metabolic activity changes after two weeks of RT. Log-rank tests were used to quantify the relationship between imaging metrics and patient overall and progression-free survival (OS/PFS). Patients with lower Jaccard/Dice coefficients had longer PFS (
= 0.045 for both), and patients with lower Jaccard/Dice coefficients had higher OS trending towards significance (
= 0.060 for both). Cho/NAA ≥ 2x volumes changed significantly during early RT, putting healthy tissue at risk of irradiation, and warranting further study into using adaptive RT planning.