1
|
Kim EY, Vavere AL, Snyder SE, Chiang J, Li Y, Patni T, Qaddoumi I, Merchant TE, Robinson GW, Holtrop JL, Shulkin BL, Bag AK. [11C]-methionine positron emission tomography in the evaluation of pediatric low-grade gliomas. Neurooncol Adv 2024; 6:vdae056. [PMID: 38680989 PMCID: PMC11055465 DOI: 10.1093/noajnl/vdae056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024] Open
Abstract
Background [11C]-Methionine positron emission tomography (PET; [11C]-MET-PET) is principally used for the evaluation of brain tumors in adults. Although amino acid PET tracers are more commonly used in the evaluation of pediatric brain tumors, data on [11C]-MET-PET imaging of pediatric low-grade gliomas (pLGG) is scarce. This study aimed to investigate the roles of [11C]-MET-PET in the evaluation of pLGGs. Methods Eighteen patients with newly diagnosed pLGG and 26 previously treated pLGG patients underwent [11C]-MET-PET met the inclusion and exclusion criteria. Tumor-to-brain uptake ratio (TBR) and metabolic tumor volumes were assessed for diagnostic performances (newly diagnosed, 15; previously treated 26), change with therapy (newly diagnosed, 9; previously treated 7), and variability among different histology (n = 12) and molecular markers (n = 7) of pLGGs. Results The sensitivity of [11C]-MET-PET for diagnosing pLGG, newly diagnosed, and previously treated combined was 93% for both TBRmax and TBRpeak, 76% for TBRmean, and 95% for qualitative evaluation. TBRmax showed a statistically significant reduction after treatment, while other PET parameters showed a tendency to decrease. Median TBRmax, TBRpeak, and TBRmean values were slightly higher in the BRAFV600E mutated tumors compared to the BRAF fused tumors. Median TBRmax, and TBRpeak in diffuse astrocytomas were higher compared to pilocytic astrocytomas, but median TBRmean, was slightly higher in pilocytic astrocytomas. However, formal statistical analysis was not done due to the small sample size. Conclusions Our study shows that [11C]-MET-PET reliably characterizes new and previously treated pLGGs. Our study also shows that quantitative parameters tend to decrease with treatment, and differences may exist between various pLGG types.
Collapse
Affiliation(s)
- Emily Y Kim
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Amy L Vavere
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Scott E Snyder
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Jason Chiang
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Yimei Li
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Tushar Patni
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Ibrahim Qaddoumi
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Thomas E Merchant
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Giles W Robinson
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Joseph L Holtrop
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Barry L Shulkin
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Asim K Bag
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| |
Collapse
|
2
|
Stock A, Hancken CV, Kandels D, Kortmann RD, Dietzsch S, Timmermann B, Pietsch T, Bison B, Schmidt R, Pham M, Gnekow AK, Warmuth-Metz M. Pseudoprogression is frequent following front-line radiotherapy in pediatric low-grade glioma - results from the German LGG cohort. Int J Radiat Oncol Biol Phys 2021; 112:1190-1202. [PMID: 34933039 DOI: 10.1016/j.ijrobp.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/03/2021] [Accepted: 12/08/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Expansion of MRI T2- and/or T1-tumor lesion volume after radiotherapy (RT) may indicate pseudoprogression (PsPD). The differentiation between true progression and PsPD is a clinical challenge and under-investigated in pediatric low-grade glioma (LGG). We evaluated radiological criteria for PsPD following front-line RT and investigated the frequency and duration of PsPD following three RT-modalities within the framework of the [Anonymized for Review] LGG-studies. METHODS Baseline and follow-up MRI-scans of 136 patients (72 [52.9%] male, median age at start of RT 11.3 years [range 0.8-25.9]) of the [Anonymized for Review] cohorts (125iodine-interstitial RT [IS; n=51], photon-beam [XRT; n=60] or proton-beam RT [PBT; n=25]) were centrally evaluated for: Increasing 1) total tumor-associated T2-lesion, 2) focal tumor-associated T2-lesion and 3) contrast-enhancing tumor over a period of 24 months following RT. The pattern of these criteria initiated "suspicion" of PsPD, their evolution determined "definite" PsPD. RESULTS Definite PsPD was radiologically determined in 54/136 (39.7%) without differences in frequency between RT-modalities: IS 22/48 vs. XRT 24/54 vs. PBT 11/20; p=0.780. Definite PsPD occurred at median 6.3 months (IS 7.2 months; XRT 4.4 months; PBT 6.5 months) after RT-initiation and persisted for median 7.2 months (IS 8.5 months; XRT 7 months; PBT 7.4 months). Appearance of necrosis within the focal tumor-associated T2-lesion proved to be a relevant associated predictor of definite PsPD (p<0.001). CONCLUSIONS PsPD is frequent following irradiation of pediatric LGG and independent of the RT-modality (IS vs. XRT vs. PBT). Adequate identification of PsPD versus true progression is imperative to prevent unneeded salvage treatment.
Collapse
Affiliation(s)
- Annika Stock
- Department of Neuroradiology, University Hospital Wuerzburg, Wuerzburg, Germany; Neuroradiological Reference Center for the pediatric brain tumor (HIT) studies of the German Society of Pediatric Oncology and Hematology, University Hospital Wuerzburg (until 2020), University Augsburg, Faculty of Medicine (since 2021), Germany.
| | | | - Daniela Kandels
- Swabian Children's Cancer Center, Faculty of Medicine, University Augsburg, Augsburg, Germany
| | | | - Stefan Dietzsch
- Department of Radiation Oncology, University Leipzig, Leipzig, Germany
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Centre (WTZ), German Cancer Consortium (DKTK), Germany
| | - Torsten Pietsch
- Institute of Neuropathology, DGNN Brain Tumor Reference Center, University of Bonn Medical Center, Bonn, Germany
| | - Brigitte Bison
- Department of Neuroradiology, University Hospital Wuerzburg, Wuerzburg, Germany; Neuroradiological Reference Center for the pediatric brain tumor (HIT) studies of the German Society of Pediatric Oncology and Hematology, University Hospital Wuerzburg (until 2020), University Augsburg, Faculty of Medicine (since 2021), Germany
| | - Rene Schmidt
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany.
| | - Mirko Pham
- Department of Neuroradiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Astrid Katharina Gnekow
- Swabian Children's Cancer Center, Faculty of Medicine, University Augsburg, Augsburg, Germany
| | - Monika Warmuth-Metz
- Department of Neuroradiology, University Hospital Wuerzburg, Wuerzburg, Germany; Neuroradiological Reference Center for the pediatric brain tumor (HIT) studies of the German Society of Pediatric Oncology and Hematology, University Hospital Wuerzburg (until 2020), University Augsburg, Faculty of Medicine (since 2021), Germany
| |
Collapse
|
3
|
Trunin YY, Golanov AV, Konovalov AN, Pronin IN, Zagirov RI, Ryzhova MV, Kadyrov SU, Igoshina EN. [Stereotactic irradiation in the complex treatment of patients with intracranial pilocytic astrocytoma]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2021; 85:34-46. [PMID: 33864667 DOI: 10.17116/neiro20218502134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Complex management of patients with intracranial pilocytic astrocytoma (PA) consists of surgical treatment, drug therapy (mainly in young children) and radiotherapy. For many years, radiotherapy (RT) has been a standard for residual tumors, recurrence or continued growth of PA. Currently, stereotactic radiosurgery and radiotherapy are preferred for PA, because these procedures are characterized by high conformity and selectivity, precise irradiation of tumor with minimal damage to surrounding intact tissues. Stereotaxic approach is very important since PAs are localized near functionally significant and radiosensitive brain structures in most cases. There is significant experience of single-center studies devoted to radiotherapy of patients with PA at the Department of Neuroradiosurgery of the Burdenko Neurosurgery Center. In this research, the authors analyzed the results of stereotactic irradiation of 430 patients with PA for the period from 2005 to 2018.
Collapse
Affiliation(s)
| | - A V Golanov
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - I N Pronin
- Burdenko Neurosurgical Center, Moscow, Russia
| | - R I Zagirov
- Burdenko Neurosurgical Center, Moscow, Russia
| | - M V Ryzhova
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | | |
Collapse
|
4
|
Alves I, Bodi I, Jarosz J, Mandeville H, Zebian B, Carceller F. Radiological pseudoprogression post-radiotherapy in a child with pineal germ cell tumour. Pediatr Blood Cancer 2020; 67:e28407. [PMID: 32426927 DOI: 10.1002/pbc.28407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 04/02/2020] [Accepted: 04/26/2020] [Indexed: 11/08/2022]
Abstract
Little is known about pseudoprogression in brain tumours other than gliomas. A 9-year-old male child with a pineal teratoma/germinoma underwent surgical resection followed by adjuvant chemo-radiotherapy. The magnetic resonance imaging scan 4 months post-radiotherapy showed a contrast-enhancing lesion within the surgical cavity suspicious of recurrence. These radiological findings subsequently resolved without any specific intervention. The child continues in remission 2 years post-treatment. This case illustrates the occurrence of pseudoprogression post-radiotherapy in intracranial GCT and highlights an unmet need for greater implementation of functional imaging techniques in paediatric neuro-oncology to avoid undue discontinuation of effective treatments or inappropriate enrolment in clinical trials.
Collapse
Affiliation(s)
- Inês Alves
- Children & Young People's Unit, The Royal Marsden NHS Foundation Trust, London, UK.,Department of Paediatric Oncology, University Hospital Centre of São João, Porto, Portugal
| | - Istvan Bodi
- Department of Neuropathology, King's College Hospital NHS Foundation Trust, London, UK
| | - Jozef Jarosz
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Henry Mandeville
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK.,Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | - Bassel Zebian
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Fernando Carceller
- Children & Young People's Unit, The Royal Marsden NHS Foundation Trust, London, UK.,Division of Clinical Studies, The Institute of Cancer Research, London, UK
| |
Collapse
|
5
|
Lu VM, Welby JP, Laack NN, Mahajan A, Daniels DJ. Pseudoprogression after radiation therapies for low grade glioma in children and adults: A systematic review and meta-analysis. Radiother Oncol 2020; 142:36-42. [DOI: 10.1016/j.radonc.2019.07.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/09/2019] [Indexed: 02/06/2023]
|
6
|
Trunin YY, Golanov AV, Konovalov AN, Pronin IN. [Pseudoprogression of intracranial pilocytic astrocytomas and other low-grade gliomas. Literature review and case report]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2020; 84:105-111. [PMID: 33306307 DOI: 10.17116/neiro202084061105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Tumor pseudoprogression is characterized by temporary tumor enlargement following radiotherapy with subsequent stabilization or regression without additional treatment. This phenomenon has been comprehensively described in patients with malignant gliomas. However, this phenomenon has not been sufficiently studied in patients with low-grade gliomas including pilocytic astrocytomas. In recent years, more and more researches devoted to this problem have appeared in the literature. It seems relevant to conduct a meta-analysis of these data in the modern literature.
Collapse
Affiliation(s)
| | - A V Golanov
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - I N Pronin
- Burdenko Neurosurgical Center, Moscow, Russia
| |
Collapse
|
7
|
Slater JM, Shih HA. Pseudoprogression in low-grade glioma. Transl Cancer Res 2019; 8:S580-S584. [PMID: 35117135 PMCID: PMC8798295 DOI: 10.21037/tcr.2019.11.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 11/04/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Jason M Slater
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Helen A Shih
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
8
|
Roberts KW, Wan Chan Tseung HS, Eckel LJ, Harmsen WS, Beltran C, Laack NN. Biologic Dose and Imaging Changes in Pediatric Brain Tumor Patients Receiving Spot Scanning Proton Therapy. Int J Radiat Oncol Biol Phys 2019; 105:664-673. [PMID: 31301328 DOI: 10.1016/j.ijrobp.2019.06.2534] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the incidence of imaging changes in our pediatric brain tumor population treated with spot-scanning proton therapy and analyze the spatial correlation of imaging changes with a novel biologic dose model. METHODS AND MATERIALS All pediatric patients treated during the first year of our institution's experience who received a minimum treatment planning dose (TPD) of 5040 cGyE with available follow-up magnetic resonance imaging scans were selected for analysis. Posttreatment magnetic resonance imaging scans were fused with the treatment planning computed tomography. All T1 post-gadolinium enhancement, T2 fluid attenuated inversion recovery changes, TPD, and biologic dose (BD) volumes outside of the original gross tumor volume were contoured for analysis. RESULTS Thirty patients were included in the analysis, 7 of whom developed posttreatment radiologic changes. The volumetric overlap of the T2 fluid attenuated inversion recovery changes and BD volumes was significantly greater than the overlap with the TPD volumes. Median volumetric overlaps of 85%, 18%, and 0% were observed with the BD105%, BD110%, and TPD105%, respectively. A nonsignificant increase in the volumetric overlap of the T1C+ changes and BD volumes was also observed. No correlation was observed between the total volume of BD110%, BD105%, or physical dose 105% and the development of imaging changes. CONCLUSIONS Within our pediatric brain tumor population treated with spot-scanning proton therapy, our BD model demonstrated superior volumetric overlap with posttreatment T2 changes compared with the TPD model. Using a BD model in treatment planning for spot-scanning proton therapy may help avoid delivery of excessive BD to critical structures and may help minimize the risk of radiation-related late effects.
Collapse
Affiliation(s)
| | | | | | | | - Chris Beltran
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Nadia N Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
| |
Collapse
|
9
|
Ludmir EB, Mahajan A, Paulino AC, Jones JY, Ketonen LM, Su JM, Grosshans DR, McAleer MF, McGovern SL, Lassen-Ramshad YA, Adesina AM, Dauser RC, Weinberg JS, Chintagumpala MM. Increased risk of pseudoprogression among pediatric low-grade glioma patients treated with proton versus photon radiotherapy. Neuro Oncol 2019; 21:686-695. [PMID: 30753704 PMCID: PMC6502497 DOI: 10.1093/neuonc/noz042] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Pseudoprogression (PsP) is a recognized phenomenon after radiotherapy (RT) for high-grade glioma but is poorly characterized for low-grade glioma (LGG). We sought to characterize PsP for pediatric LGG patients treated with RT, with particular focus on the role of RT modality using photon-based intensity-modulated RT (IMRT) or proton beam therapy (PBT). METHODS Serial MRI scans from 83 pediatric LGG patients managed at 2 institutions between 1998 and 2017 were evaluated. PsP was scored when a progressive lesion subsequently decreased or stabilized for at least a year without therapy. RESULTS Thirty-two patients (39%) were treated with IMRT, and 51 (61%) were treated with PBT. Median RT dose for the cohort was 50.4 Gy(RBE) (range, 45-59.4 Gy[RBE]). PsP was identified in 31 patients (37%), including 8/32 IMRT patients (25%) and 23/51 PBT patients (45%). PBT patients were significantly more likely to have post-RT enlargement (hazard ratio [HR] 2.15, 95% CI: 1.06-4.38, P = 0.048). RT dose >50.4 Gy(RBE) similarly predicted higher rates of PsP (HR 2.61, 95% CI: 1.20-5.68, P = 0.016). Multivariable analysis confirmed the independent effects of RT modality (P = 0.03) and RT dose (P = 0.01) on PsP incidence. Local progression occurred in 10 patients: 7 IMRT patients (22%) and 3 PBT patients (6%), with a trend toward improved local control for PBT patients (HR 0.34, 95% CI: 0.10-1.18, P = 0.099). CONCLUSIONS These data highlight substantial rates of PsP among pediatric LGG patients, particularly those treated with PBT. PsP should be considered when assessing response to RT in LGG patients within the first year after RT.
Collapse
Affiliation(s)
- Ethan B Ludmir
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anita Mahajan
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Mayo Clinic, Rochester, Minnesota, USA
| | - Arnold C Paulino
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Texas Children’s Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Jeremy Y Jones
- Texas Children’s Cancer Center, Baylor College of Medicine, Houston, Texas, USA
- Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Leena M Ketonen
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jack M Su
- Texas Children’s Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - David R Grosshans
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Susan L McGovern
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Adekunle M Adesina
- Texas Children’s Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Robert C Dauser
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | | |
Collapse
|
10
|
What Neuroradiologists Need to Know About Radiation Treatment for Neural Tumors. Top Magn Reson Imaging 2019; 28:37-47. [PMID: 31022047 DOI: 10.1097/rmr.0000000000000196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Radiation oncologists and radiologists have a unique and mutually dependent relationship. Radiation oncologists rely on diagnostic imaging to locate the tumor and define the treatment target volume, evaluation of response to therapy, and follow-up. Accurate interpretation of post-treatment imaging requires diagnostic radiologists to have a basic understanding of radiation treatment planning and delivery. There are various radiation treatment modalities such as 3D conformal radiation therapy, intensity modulated radiation therapy and stereotactic radiosurgery as well as different radiation modalities such as photons and protons that can be used for treatment. All of these have subtle differences in how the treatment is planned and how the imaging findings might be affected. This paper provides an overview of the basic principles of radiation oncology, different radiation treatment modalities, how radiation therapy is planned and delivered, how knowledge of this process can help interpretation of images, and how the radiologist can contribute to this process.
Collapse
|
11
|
Increase of pseudoprogression and other treatment related effects in low-grade glioma patients treated with proton radiation and temozolomide. J Neurooncol 2018; 142:69-77. [DOI: 10.1007/s11060-018-03063-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 11/24/2018] [Indexed: 12/22/2022]
|
12
|
Cherlow JM, Shaw DWW, Margraf LR, Bowers DC, Huang J, Fouladi M, Onar-Thomas A, Zhou T, Pollack IF, Gajjar A, Kessel SK, Cullen PL, McMullen K, Wellons JC, Merchant TE. Conformal Radiation Therapy for Pediatric Patients with Low-Grade Glioma: Results from the Children's Oncology Group Phase 2 Study ACNS0221. Int J Radiat Oncol Biol Phys 2018; 103:861-868. [PMID: 30419305 DOI: 10.1016/j.ijrobp.2018.11.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/29/2018] [Accepted: 11/02/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE To determine the rate of marginal relapse, progression-free survival (PFS), and overall survival (OS) in patients with pediatric low-grade glioma (PLGG) treated with conformal radiation therapy (CRT) with a clinical target volume (CTV) margin of 5 mm in the Children's Oncology Group trial ACNS0221. METHODS AND MATERIALS Patients aged 3 to 21 years with unresectable progressive, recurrent, or residual PLGG were eligible for this study. Patients younger than 10 years were required to have received at least 1 chemotherapy course. Patients with neurofibromatosis type I were not eligible. All patients underwent magnetic resonance imaging-based planning and received 54 Gy CRT in 30 fractions with a 5-mm CTV margin. RESULTS Of 85 eligible patients (median age, 13.6 years) treated between March 2006 and December 2010, 14 were younger than 10 years and 36 received prior chemotherapy. Sixty-six had pilocytic astrocytoma, 15 had other histologic subtypes, and 4 had unbiopsied chiasmatic lesions. Events included 23 relapses (19 central, 4 distant, and no marginal) and 7 deaths. At a median follow-up of 5.15 years, 5-year PFS was 71% ± 6% and OS was 93% ± 4%. Male sex (P = .068) and large tumor size (P = .050) trended toward significance for association with decreased PFS. Age, histology, tumor location, time between diagnosis and study entry, and MIB-1 status were not associated with PFS. OS was negatively associated with male sex (P = .064), non-pilocytic astrocytoma histology (P = .010), and large tumor size (P = .0089). CONCLUSIONS For patients with PLGG, CRT with a CTV margin of 5 mm yields an acceptable PFS and does not lead to a high rate of marginal relapse.
Collapse
Affiliation(s)
- Joel M Cherlow
- Department of Radiation Oncology, MemorialCare Long Beach Medical Center Long Beach, California
| | - Dennis W W Shaw
- Department of Diagnostic Imaging, Seattle Children's Hospital, Seattle, Washington
| | - Linda R Margraf
- Department of Pathology, Cook Children's Medical Center, Ft. Worth, Texas
| | - Daniel C Bowers
- Department of Pediatrics, UT Southwestern Medical School, Dallas, Texas
| | - Jie Huang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Maryam Fouladi
- Department of Hematology/Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Arzu Onar-Thomas
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Tianni Zhou
- Department of Mathematics, California State University, Long Beach, California
| | - Ian F Pollack
- Department of Neurosurgery, Children's Hospital of Pittsburgh of UMPC, Pittsburgh, Pennsylvania
| | - Amar Gajjar
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Sandy K Kessel
- Imaging and Radiation Oncology Core Rhode Island, Lincoln, Rhode Island
| | - Patricia L Cullen
- Rueckert-Hartman College for Health Professions, Regis University, Denver, Colorado
| | - Kevin McMullen
- Department of Radiation Oncology, Columbus Regional Health, Columbus, Indiana
| | - John C Wellons
- Department of Neurosurgery, Vanderbilt University/Ingram Cancer Center, Nashville, Tennessee
| | - Thomas E Merchant
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
| |
Collapse
|
13
|
Pseudoprogression successfully treated with bevacizumab in a child with spinal pilocytic astrocytoma. Childs Nerv Syst 2018; 34:2305-2308. [PMID: 29804214 DOI: 10.1007/s00381-018-3841-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 05/14/2018] [Indexed: 10/16/2022]
Abstract
CLINICAL CASE We report on a 7-year-old female with spinal pilocytic astrocytoma complicated by pseudoprogression 1 month after completion of radiation therapy. Although she was initially treated with high-dose steroids, her clinical symptoms did not completely resolve, and magnetic resonance imaging (MRI) revealed extension of the lesions into the medulla oblongata. Treatment with bevacizumab was commenced, followed by rapid resolution of the clinical symptoms and improvements in the MRI findings. CONCLUSION This case highlights the efficacy and tolerability of bevacizumab for the treatment of pseudoprogression in children with spinal low-grade gliomas.
Collapse
|
14
|
van West SE, de Bruin HG, van de Langerijt B, Swaak-Kragten AT, van den Bent MJ, Taal W. Incidence of pseudoprogression in low-grade gliomas treated with radiotherapy. Neuro Oncol 2018; 19:719-725. [PMID: 28453748 DOI: 10.1093/neuonc/now194] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 08/01/2016] [Indexed: 11/14/2022] Open
Abstract
Background As the incidence of pseudo-progressive disease (psPD), or pseudoprogression, in low-grade glioma (LGG) is unknown, we retrospectively investigated this phenomenon in a cohort of LGG patients given radiotherapy (RT). Methods All MRI scans and clinical data from patients with histologically proven LGG treated with radiation between 2000 and 2011 were reviewed. PsPD was scored when a new enhancing lesion occurred after RT and subsequently disappeared or remained stable for at least a year without therapy, including dexamethasone. Results Sixty-three out of 71 patients who received RT for LGG were deemed eligible for evaluation of psPD. The median follow-up was 5 years (range 1‒10 y). PsPD was seen in 13 patients (20.6%). PsPD occurred after a median of 12 months with a range of 3-78 months. The median duration of psPD was 6 months, with a range of 2-26 months and always occurred within the RT high dose fields of at least 45 Gy. The area of the enhancement at the time of psPD was significantly smaller compared with the area of enhancement during "true" progression (median size 54mm2 [range 12-340mm2] vs 270mm2 [range 30-3420mm2], respectively; P = .009). Conclusions PsPD occurs frequently in LGG patients receiving RT. This supports the policy to postpone a new line of treatment until progression is evident, especially when patients have small contrast enhancing lesions within the RT field.
Collapse
Affiliation(s)
- Sophie E van West
- Department of Neuro-oncology/Neurology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Hein G de Bruin
- Department of Radiology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Bart van de Langerijt
- Department of Neuro-oncology/Neurology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Annemarie T Swaak-Kragten
- Department of Radiation Oncology, Erasmus MC/Daniel den Hoed Cancer Centre, Rotterdam, The Netherlands
| | - Martin J van den Bent
- Department of Neuro-oncology/Neurology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Walter Taal
- Department of Neuro-oncology/Neurology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| |
Collapse
|
15
|
Villanueva-Meyer JE, Mabray MC, Cha S. Current Clinical Brain Tumor Imaging. Neurosurgery 2017; 81:397-415. [PMID: 28486641 PMCID: PMC5581219 DOI: 10.1093/neuros/nyx103] [Citation(s) in RCA: 194] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 02/23/2017] [Indexed: 01/12/2023] Open
Abstract
Neuroimaging plays an ever evolving role in the diagnosis, treatment planning, and post-therapy assessment of brain tumors. This review provides an overview of current magnetic resonance imaging (MRI) methods routinely employed in the care of the brain tumor patient. Specifically, we focus on advanced techniques including diffusion, perfusion, spectroscopy, tractography, and functional MRI as they pertain to noninvasive characterization of brain tumors and pretreatment evaluation. The utility of both structural and physiological MRI in the post-therapeutic brain evaluation is also reviewed with special attention to the challenges presented by pseudoprogression and pseudoresponse.
Collapse
Affiliation(s)
- Javier E. Villanueva-Meyer
- Department of Radiology and Biomedical Imaging, Neuroradiology Section, University of California San Francisco, San Francisco, California
| | - Marc C. Mabray
- Department of Radiology and Biomedical Imaging, Neuroradiology Section, University of California San Francisco, San Francisco, California
| | - Soonmee Cha
- Department of Radiology and Biomedical Imaging, Neuroradiology Section, University of California San Francisco, San Francisco, California
| |
Collapse
|
16
|
Pseudoprogression in pediatric low-grade glioma after irradiation. J Neurooncol 2017; 135:371-379. [DOI: 10.1007/s11060-017-2583-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 07/23/2017] [Indexed: 10/19/2022]
|
17
|
Galante JR, Rodriguez F, Grossman SA, Strowd RE. Late post-treatment radiographic changes 3 years following chemoradiation for glioma: the importance of histopathology. CNS Oncol 2017; 6:195-201. [PMID: 28718307 PMCID: PMC6009212 DOI: 10.2217/cns-2016-0040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 01/18/2017] [Indexed: 11/21/2022] Open
Abstract
Treatment-related changes can mimic brain tumor progression both clinically and radiographically. Distinguishing these two entities represents a major challenge in neuro-oncology. No single imaging modality is capable of reliably achieving such distinction. While histopathology remains the gold standard, definitive pathological criteria are also lacking which can further complicate such cases. We report a patient with high-grade glioma who, after initially presenting with histopathologically confirmed pseudoprogression 10 months following treatment, re-presented 3 years following concurrent chemoradiation with clinical and radiographic changes that were most consistent with progressive disease but for which histopathology revealed treatment effects without active glioma. This case highlights the potential late onset of treatment-related changes and underscores the importance of histopathologic assessment even years following initial therapy.
Collapse
Affiliation(s)
- Joao R Galante
- Poznan University of Medical Sciences, 41 Jackowskiego Street, 60-512 Poznan, Poland
- Department of Oncology, Johns Hopkins University School of Medicine, 733 North Broadway Street, Baltimore, MD 21205, USA
| | - Fausto Rodriguez
- Department of Pathology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, David H. Koch Cancer Research Bldg II, 1550 Orleans Street, Room 1M16, Baltimore, MD 21287, USA
| | - Stuart A Grossman
- Medical Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, David H. Koch Cancer Research Bldg II, 1550 Orleans Street, Room 1M16, Baltimore, MD 21287, USA
| | - Roy E Strowd
- Department of Neurology and Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston Salem, NC 27157, USA
| |
Collapse
|
18
|
Trunin Y, Golanov AV, Kostjuchenko VV, Galkin M, Konovalov AN. Pilocytic Astrocytoma Enlargement Following Irradiation: Relapse or Pseudoprogression? Cureus 2017; 9:e1045. [PMID: 28367384 PMCID: PMC5360383 DOI: 10.7759/cureus.1045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pilocytic astrocytomas are the most common gliomas (World Health Organization (WHO) grade 1) in children. According to many authors, stereotactic irradiation (radiotherapy and radiosurgery) is an effective method that provides a prolonged, recurrence-free survival in patients who have had partial tumor removal or in patients with an unresectable tumor. We present a case of a patient with midbrain pilocytic astrocytoma that enlarged considerably in the first six months after irradiation and then diminished in size during the next six months without any antitumor treatment. The clinical and radiological follow-up data for this patient, the surgery results for similar patients, and the data from other authors led us to the conclusion that early tumor volume enlargement after irradiation is usually pseudoprogression.
Collapse
Affiliation(s)
- Yury Trunin
- Radiology and Radiosurgery, Burdenko Neurosurgery Institute
| | - Andrey V Golanov
- Department of Radiation Oncology, Burdenko Neurosurgery Institute
| | | | - Mikhail Galkin
- Department of Radiation Oncology, Burdenko Neurosurgical Institute
| | | |
Collapse
|
19
|
Mannina EM, Bartlett GK, McMullen KP. Extended Volumetric Follow-up of Juvenile Pilocytic Astrocytomas Treated with Proton Beam Therapy. Int J Part Ther 2016; 3:291-299. [PMID: 31772980 DOI: 10.14338/ijpt-16-00020.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 09/12/2016] [Indexed: 11/21/2022] Open
Abstract
Purpose To describe volume changes following proton beam therapy (PBT) for juvenile pilocytic astrocytoma (JPA), we analyzed post-PBT magnetic resonance imaging (MRI) to clarify survivorship, response rate, and the concept of pseudoprogression. Materials and Methods Pediatric patients with a histologic diagnosis of JPA after a biopsy or subtotal resection and at least 4 post-PBT MRIs were retrospectively reviewed. After PBT, tumors were contoured on follow-up T1-contrasted MRIs, and 3-dimensional volumes were plotted against time, with thresholds for progressive disease and partial response. Patterns of response, pseudoprogression, and progression were uncovered. Post-PBT clinical course was described by the need for further intervention and survivorship. Results Fifteen patients with a median of 10 follow-up MRIs made up this report: 60% were heavily pretreated with multiple lines of chemotherapy, and 67% had undergone subtotal resection. With a median follow-up of 55.3 months after a median of 5400 centigray equivalents PBT, estimates of 5-year overall survival and intervention-free survival were 93% and 72%, respectively. The crude response rate of 73% included pseudoprogressing patients, who comprised 20% of the entire cohort; the phenomenon peaked between 3 and 8 months and resolved by 18 months. One nonresponder expired from progression. Post-PBT intervention was required in 53% of patients, with 1 patient resuming chemotherapy. There were no further resections or radiotherapy. One patient developed acute lymphoblastic leukemia, and another developed biopsy-proven radionecrosis. Conclusion The PBT for inoperable/progressive JPA provided 72% 5-year intervention-free survival in heavily pretreated patients. Although most patients responded, 20% demonstrated pseudoprogression. The need for post-PBT surveillance for progression and treatment-induced sequelae should not be underestimated in this extended survivorship cohort.
Collapse
Affiliation(s)
- Edward M Mannina
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Greg K Bartlett
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kevin P McMullen
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
| |
Collapse
|
20
|
Khan MN, Sharma AM, Pitz M, Loewen SK, Quon H, Poulin A, Essig M. High-grade glioma management and response assessment-recent advances and current challenges. ACTA ACUST UNITED AC 2016; 23:e383-91. [PMID: 27536188 DOI: 10.3747/co.23.3082] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The management of high-grade gliomas (hggs) is complex and ever-evolving. The standard of care for the treatment of hggs consists of surgery, chemotherapy, and radiotherapy. However, treatment options are influenced by multiple factors such as patient age and performance status, extent of tumour resection, biomarker profile, and tumour histology and grade. Follow-up cranial magnetic resonance imaging (mri) to differentiate treatment response from treatment effect can be challenging and affects clinical decision-making. An assortment of advanced radiologic techniques-including perfusion imaging with dynamic susceptibility contrast mri, dynamic contrast-enhanced mri, diffusion-weighted imaging, proton spectroscopy, mri subtraction imaging, and amino acid radiotracer imaging-can now incorporate novel physiologic data, providing new methods to help characterize tumour progression, pseudoprogression, and pseudoresponse. In the present review, we provide an overview of current treatment options for hgg and summarize recent advances and challenges in imaging technology.
Collapse
Affiliation(s)
- M N Khan
- Department of Radiology, University of Manitoba, Winnipeg, MB
| | - A M Sharma
- Department of Radiology, University of Manitoba, Winnipeg, MB;; Department of Radiation Oncology, CancerCare Manitoba, Winnipeg, MB
| | - M Pitz
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB;; Department of Haematology and Medical Oncology, University of Manitoba, Winnipeg, MB
| | - S K Loewen
- Department of Radiology, University of Manitoba, Winnipeg, MB;; Department of Radiation Oncology, CancerCare Manitoba, Winnipeg, MB
| | - H Quon
- Department of Radiology, University of Manitoba, Winnipeg, MB;; Department of Radiation Oncology, CancerCare Manitoba, Winnipeg, MB
| | - A Poulin
- Department of Radiology, University of Manitoba, Winnipeg, MB;; Department of Radiology, Laval University, Quebec City, QC
| | - M Essig
- Department of Radiology, University of Manitoba, Winnipeg, MB
| |
Collapse
|
21
|
Abstract
Primary CNS tumors consist of a diverse group of neoplasms originating from various cell types in the CNS. Brain tumors are the most common solid malignancy in children under the age of 15 years and the second leading cause of cancer death after leukemia. The most common brain neoplasms in children differ consistently from those in older age groups. Pediatric brain tumors demonstrate distinct patterns of occurrence and biologic behavior according to sex, age, and race. This chapter highlights the imaging features of the most common tumors that affect the child's CNS (brain and spinal cord).
Collapse
Affiliation(s)
- Andre D Furtado
- Department of Radiology, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
| | - Ashok Panigrahy
- Department of Radiology, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Charles R Fitz
- Department of Radiology, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
22
|
Lassen-Ramshad Y, Petersen JBB, Tietze A, Borghammer P, Mahajan A, McGovern SL. Pseudoprogression after proton radiotherapy for pediatric low grade glioma. Acta Oncol 2015; 54:1701-2. [PMID: 26368788 DOI: 10.3109/0284186x.2015.1078498] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | | | - Anna Tietze
- c Department of Neuroradiology , Aarhus University Hospital , Denmark
| | - Per Borghammer
- d Department of Nuclear Medicine , Aarhus University Hospital , Denmark
| | - Anita Mahajan
- e Department of Radiation Oncology , MD Anderson Cancer Center , USA
| | - Susan L McGovern
- e Department of Radiation Oncology , MD Anderson Cancer Center , USA
| |
Collapse
|