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Magnetic resonance spectroscopy as an early indicator of response to anti-angiogenic therapy in patients with recurrent glioblastoma: RTOG 0625/ACRIN 6677.

Publication ,  Journal Article
Ratai, E-M; Zhang, Z; Snyder, BS; Boxerman, JL; Safriel, Y; McKinstry, RC; Bokstein, F; Gilbert, MR; Sorensen, AG; Barboriak, DP
Published in: Neuro Oncol
July 2013

BACKGROUND: The prognosis for patients with recurrent glioblastoma remains poor. The purpose of this study was to assess the potential role of MR spectroscopy as an early indicator of response to anti-angiogenic therapy. METHODS: Thirteen patients with recurrent glioblastoma were enrolled in RTOG 0625/ACRIN 6677, a prospective multicenter trial in which bevacizumab was used in combination with either temozolomide or irinotecan. Patients were scanned prior to treatment and at specific timepoints during the treatment regimen. Postcontrast T1-weighted MRI was used to assess 6-month progression-free survival. Spectra from the enhancing tumor and peritumoral regions were defined on the postcontrast T1-weighted images. Changes in the concentration ratios of n-acetylaspartate/creatine (NAA/Cr), choline-containing compounds (Cho)/Cr, and NAA/Cho were quantified in comparison with pretreatment values. RESULTS: NAA/Cho levels increased and Cho/Cr levels decreased within enhancing tumor at 2 weeks relative to pretreatment levels (P = .048 and P = .016, respectively), suggesting a possible antitumor effect of bevacizumab with cytotoxic chemotherapy. Nine of the 13 patients were alive and progression free at 6 months. Analysis of receiver operating characteristic curves for NAA/Cho changes in tumor at 8 weeks revealed higher levels in patients progression free at 6 months (area under the curve = 0.85), suggesting that NAA/Cho is associated with treatment response. Similar results were observed for receiver operating characteristic curve analyses against 1-year survival. In addition, decreased Cho/Cr and increased NAA/Cr and NAA/Cho in tumor periphery at 16 weeks posttreatment were associated with both 6-month progression-free survival and 1-year survival. CONCLUSION: Changes in NAA and Cho by MR spectroscopy may potentially be useful as imaging biomarkers in assessing response to anti-angiogenic treatment.

Duke Scholars

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Published In

Neuro Oncol

DOI

EISSN

1523-5866

Publication Date

July 2013

Volume

15

Issue

7

Start / End Page

936 / 944

Location

England

Related Subject Headings

  • Temozolomide
  • Survival Rate
  • Prospective Studies
  • Prognosis
  • Oncology & Carcinogenesis
  • Neovascularization, Pathologic
  • Neoplasm Recurrence, Local
  • Magnetic Resonance Spectroscopy
  • Irinotecan
  • Humans
 

Citation

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Ratai, E.-M., Zhang, Z., Snyder, B. S., Boxerman, J. L., Safriel, Y., McKinstry, R. C., … Barboriak, D. P. (2013). Magnetic resonance spectroscopy as an early indicator of response to anti-angiogenic therapy in patients with recurrent glioblastoma: RTOG 0625/ACRIN 6677. Neuro Oncol, 15(7), 936–944. https://doi.org/10.1093/neuonc/not044
Ratai, Eva-Maria, Zheng Zhang, Bradley S. Snyder, Jerrold L. Boxerman, Yair Safriel, Robert C. McKinstry, Felix Bokstein, Mark R. Gilbert, A Gregory Sorensen, and Daniel P. Barboriak. “Magnetic resonance spectroscopy as an early indicator of response to anti-angiogenic therapy in patients with recurrent glioblastoma: RTOG 0625/ACRIN 6677.Neuro Oncol 15, no. 7 (July 2013): 936–44. https://doi.org/10.1093/neuonc/not044.
Ratai E-M, Zhang Z, Snyder BS, Boxerman JL, Safriel Y, McKinstry RC, et al. Magnetic resonance spectroscopy as an early indicator of response to anti-angiogenic therapy in patients with recurrent glioblastoma: RTOG 0625/ACRIN 6677. Neuro Oncol. 2013 Jul;15(7):936–44.
Ratai, Eva-Maria, et al. “Magnetic resonance spectroscopy as an early indicator of response to anti-angiogenic therapy in patients with recurrent glioblastoma: RTOG 0625/ACRIN 6677.Neuro Oncol, vol. 15, no. 7, July 2013, pp. 936–44. Pubmed, doi:10.1093/neuonc/not044.
Ratai E-M, Zhang Z, Snyder BS, Boxerman JL, Safriel Y, McKinstry RC, Bokstein F, Gilbert MR, Sorensen AG, Barboriak DP. Magnetic resonance spectroscopy as an early indicator of response to anti-angiogenic therapy in patients with recurrent glioblastoma: RTOG 0625/ACRIN 6677. Neuro Oncol. 2013 Jul;15(7):936–944.
Journal cover image

Published In

Neuro Oncol

DOI

EISSN

1523-5866

Publication Date

July 2013

Volume

15

Issue

7

Start / End Page

936 / 944

Location

England

Related Subject Headings

  • Temozolomide
  • Survival Rate
  • Prospective Studies
  • Prognosis
  • Oncology & Carcinogenesis
  • Neovascularization, Pathologic
  • Neoplasm Recurrence, Local
  • Magnetic Resonance Spectroscopy
  • Irinotecan
  • Humans