1
|
Yu Y, Liu Q, Ran Q, Cao F. Overexpression of PPM1B inhibited chemoresistance to temozolomide and proliferation in glioma cells. Cell Biol Int 2024; 48:143-153. [PMID: 37798941 DOI: 10.1002/cbin.12092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 08/02/2023] [Accepted: 09/16/2023] [Indexed: 10/07/2023]
Abstract
Protein phosphatase magnesium-dependent 1B (PPM1B) functions as IKKβ phosphatases to terminate nuclear factor kappa B (NF-κB) signaling. NF-κB signaling was constitutively activated in glioma cells. At present, little is known about the role of PPM1B in glioma. In the current study, we found that the expression of PPM1B was reduced in glioma tissues and cells, and decreased expression of PPM1B was related to poor overall survival of patients. Overexpression of PPM1B inhibited the proliferation and promoted apoptosis of glioma cells. Moreover, PPM1B overexpression reduced the phosphorylation of IKKβ and inhibited the nuclear localization of NF-κBp65. PDTC, an inhibitor of NF-κB signaling, reversed PPM1B-knockdown-induced cell proliferation. Furthermore, overexpression of PPM1B enhanced the sensitivity of glioma cells to temozolomide. In vivo experiments showed that overexpression of PPM1B could inhibit tumor growth, improve the survival rate of nude mice, and enhance the sensitivity to temozolomide. In conclusion, PPM1B suppressed glioma cell proliferation and the IKKβ-NF-κB signaling pathway, and enhanced temozolomide sensitivity of glioma cells.
Collapse
Affiliation(s)
- Yunhu Yu
- Neurosurgery Department, People's Hospital of Honghuagang District of Zunyi, Zunyi, China
- Department of Neurosurgery, The Third Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Qian Liu
- Department of Neurosurgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Qishan Ran
- Department of Neurosurgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Fang Cao
- Department of Neurosurgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| |
Collapse
|
2
|
Baek HM. Experimental Basis Sets of Quantification of Brain 1H-Magnetic Resonance Spectroscopy at 3.0 T. Metabolites 2023; 13:metabo13030368. [PMID: 36984808 PMCID: PMC10056301 DOI: 10.3390/metabo13030368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/09/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
In vivo short echo time (TE) proton magnetic resonance spectroscopy (1H-MRS) is a useful method for the quantification of human brain metabolites. The purpose of this study was to evaluate the performance of an in-house, experimentally measured basis set and compare it with the performance of a vendor-provided basis set. A 3T clinical scanner with 32-channel receive-only phased array head coil was used to generate 16 brain metabolites for the metabolite basis set. For voxel localization, point-resolved spin-echo sequence (PRESS) was used with volume of interest (VOI) positioned at the center of the phantoms. Two different basis sets were subjected to linear combination of model spectra of metabolite solutions in vitro (LCModel) analysis to evaluate the in-house acquired in vivo 1H-MR spectra from the left prefrontal cortex of 22 healthy subjects. To evaluate the performance of the two basis sets, the Cramer-Rao lower bounds (CRLBs) of each basis set were compared. The LCModel quantified the following metabolites and macromolecules: alanine (Ala), aspartate (Asp), γ-amino butyric acid (GABA), glucose (Glc), glutamine (Gln), glutamate (Glu), glutathione (GHS), Ins (myo-Inositol), lactate (Lac), N-acetylaspartate (NAA), N-acetylaspartylglutamate (NAAG), taurine (Tau), phosphoryl-choline + glycerol-phosphoryl-choline (tCho), N-acetylaspartate + N-acetylaspartylglutamate (tNA), creatine + phosphocreatine (tCr), Glu + Gln (Glx) and Lip13a, Lip13b, Lip09, MM09, Lip20, MM20, MM12, MM14, MM17, Lip13a + Lip13b, MM14 + Lip13a + Lip13b + MM12, MM09 + Lip09, MM20 + Lip20. Statistical analysis showed significantly different CRLBs: Asp, GABA, Gln, GSH, Ins, Lac, NAA, NAAG, Tau, tCho, tNA, Glx, MM20, MM20 + Lip20 (p < 0.001), tCr, MM12, MM17 (p < 0.01), and Lip20 (p < 0.05). The estimated ratio of cerebrospinal fluid (CSF) in the region of interest was calculated to be about 5%. Fitting performances are better, for the most part, with the in-house basis set, which is more precise than the vendor-provided basis set. In particular, Asp is expected to have reliable CRLB (<30%) at high field (e.g., 3T) in the left prefrontal cortex of human brain. The quantification of Asp was difficult, due to the inaccuracy of Asp fitting with the vendor-provided basis set.
Collapse
Affiliation(s)
- Hyeon-Man Baek
- Department of Health Sciences and Technology, GAIHST, Gachon University, Incheon 21999, Republic of Korea; ; Tel.: +82-32-899-6678
- Department of Molecular Medicine, Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon 21999, Republic of Korea
| |
Collapse
|
3
|
Abstract
Abstract
Purpose
Gliomas, the most common primary brain tumours, have recently been re-classified incorporating molecular aspects with important clinical, prognostic, and predictive implications. Concurrently, the reprogramming of metabolism, altering intracellular and extracellular metabolites affecting gene expression, differentiation, and the tumour microenvironment, is increasingly being studied, and alterations in metabolic pathways are becoming hallmarks of cancer. Magnetic resonance spectroscopy (MRS) is a complementary, non-invasive technique capable of quantifying multiple metabolites. The aim of this review focuses on the methodology and analysis techniques in proton MRS (1H MRS), including a brief look at X-nuclei MRS, and on its perspectives for diagnostic and prognostic biomarkers in gliomas in both clinical practice and preclinical research.
Methods
PubMed literature research was performed cross-linking the following key words: glioma, MRS, brain, in-vivo, human, animal model, clinical, pre-clinical, techniques, sequences, 1H, X-nuclei, Artificial Intelligence (AI), hyperpolarization.
Results
We selected clinical works (n = 51), preclinical studies (n = 35) and AI MRS application papers (n = 15) published within the last two decades. The methodological papers (n = 62) were taken into account since the technique first description.
Conclusions
Given the development of treatments targeting specific cancer metabolic pathways, MRS could play a key role in allowing non-invasive assessment for patient diagnosis and stratification, predicting and monitoring treatment responses and prognosis. The characterization of gliomas through MRS will benefit of a wide synergy among scientists and clinicians of different specialties within the context of new translational competences. Head coils, MRI hardware and post-processing analysis progress, advances in research, experts’ consensus recommendations and specific professionalizing programs will make the technique increasingly trustworthy, responsive, accessible.
Collapse
|
4
|
Lu J, Li Y, Li YA, Wang L, Zeng AR, Ma XL, Qiang JW. In vivo detection of dysregulated choline metabolism in paclitaxel-resistant ovarian cancers with proton magnetic resonance spectroscopy. J Transl Med 2022; 20:92. [PMID: 35168606 PMCID: PMC8845351 DOI: 10.1186/s12967-022-03292-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 02/02/2022] [Indexed: 02/07/2023] Open
Abstract
Background Chemoresistance gradually develops during treatment of epithelial ovarian cancer (EOC). Metabolic alterations, especially in vivo easily detectable metabolites in paclitaxel (PTX)-resistant EOC remain unclear. Methods Xenograft models of the PTX-sensitive and PTX-resistant EOCs were built. Using a combination of in vivo proton-magnetic resonance spectroscopy (1H-MRS), metabolomics and proteomics, we investigated the in vivo metabolites and dysregulated metabolic pathways in the PTX-resistant EOC. Furthermore, we analyzed the RNA expression to validate the key enzymes in the dysregulated metabolic pathway. Results On in vivo 1H-MRS, the ratio of (glycerophosphocholine + phosphocholine) to (creatine + phosphocreatine) ((GPC + PC) to (Cr + PCr))(i.e. Cho/Cr) in the PTX-resistant tumors (1.64 [0.69, 4.18]) was significantly higher than that in the PTX-sensitive tumors (0.33 [0.10, 1.13]) (P = 0.04). Forty-five ex vivo metabolites were identified to be significantly different between the PTX-sensitive and PTX-resistant tumors, with the majority involved of lipids and lipid-like molecules. Spearman’s correlation coefficient analysis indicated in vivo and ex vivo metabolic characteristics were highly consistent, exhibiting the highest positive correlation between in vivo GPC + PC and ex vivo GPC (r = 0.885, P < 0.001). These metabolic data suggested that abnormal choline concentrations were the results from the dysregulated glycerophospholipid metabolism, especially choline metabolism. The proteomics data indicated that the expressions of key enzymes glycerophosphocholine phosphodiesterase 1 (GPCPD1) and glycerophosphodiester phosphodiesterase 1 (GDE1) were significantly lower in the PTX-resistant tumors compared to the PTX-sensitive tumors (both P < 0.01). Decreased expressions of GPCPD1 and GDE1 in choline metabolism led to an increased GPC levels in the PTX-resistant EOCs, which was observed as an elevated total choline (tCho) on in vivo 1H-MRS. Conclusions These findings suggested that dysregulated choline metabolism was associated with PTX-resistance in EOCs and the elevated tCho on in vivo 1H-MRS could be as an indicator for the PTX-resistance in EOCs. Supplementary Information The online version contains supplementary material available at 10.1186/s12967-022-03292-z.
Collapse
Affiliation(s)
- Jing Lu
- Department of Radiology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201508, People's Republic of China
| | - Ying Li
- Department of Radiology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201508, People's Republic of China
| | - Yong Ai Li
- Department of Radiology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201508, People's Republic of China
| | - Li Wang
- Department of Pathology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201508, People's Republic of China
| | - An Rong Zeng
- Department of Radiology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201508, People's Republic of China
| | - Xiao Liang Ma
- Department of Radiology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201508, People's Republic of China
| | - Jin Wei Qiang
- Department of Radiology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201508, People's Republic of China.
| |
Collapse
|
5
|
Subramani E, Radoul M, Najac C, Batsios G, Molloy AR, Hong D, Gillespie AM, Santos RD, Viswanath P, Costello JF, Pieper RO, Ronen SM. Glutamate Is a Noninvasive Metabolic Biomarker of IDH1-Mutant Glioma Response to Temozolomide Treatment. Cancer Res 2020; 80:5098-5108. [PMID: 32958546 PMCID: PMC7669718 DOI: 10.1158/0008-5472.can-20-1314] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 08/11/2020] [Accepted: 09/16/2020] [Indexed: 02/04/2023]
Abstract
Although lower grade gliomas are driven by mutations in the isocitrate dehydrogenase 1 (IDH1) gene and are less aggressive than primary glioblastoma, they nonetheless generally recur. IDH1-mutant patients are increasingly being treated with temozolomide, but early detection of response remains a challenge and there is a need for complementary imaging methods to assess response to therapy prior to tumor shrinkage. The goal of this study was to determine the value of magnetic resonance spectroscopy (MRS)-based metabolic changes for detection of response to temozolomide in both genetically engineered and patient-derived mutant IDH1 models. Using 1H MRS in combination with chemometrics identified several metabolic alterations in temozolomide-treated cells, including a significant increase in steady-state glutamate levels. This was confirmed in vivo, where the observed 1H MRS increase in glutamate/glutamine occurred prior to tumor shrinkage. Cells labeled with [1-13C]glucose and [3-13C]glutamine, the principal sources of cellular glutamate, showed that flux to glutamate both from glucose via the tricarboxylic acid cycle and from glutamine were increased following temozolomide treatment. In line with these results, hyperpolarized [5-13C]glutamate produced from [2-13C]pyruvate and hyperpolarized [1-13C]glutamate produced from [1-13C]α-ketoglutarate were significantly higher in temozolomide-treated cells compared with controls. Collectively, our findings identify 1H MRS-detectable elevation of glutamate and hyperpolarized 13C MRS-detectable glutamate production from either pyruvate or α-ketoglutarate as potential translatable metabolic biomarkers of response to temozolomide treatment in mutant IDH1 glioma. SIGNIFICANCE: These findings show that glutamate can be used as a noninvasive, imageable metabolic marker for early assessment of tumor response to temozolomide, with the potential to improve treatment strategies for mutant IDH1 patients.
Collapse
Affiliation(s)
- Elavarasan Subramani
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Marina Radoul
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Chloe Najac
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Georgios Batsios
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Abigail R Molloy
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Donghyun Hong
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Anne Marie Gillespie
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Romelyn Delos Santos
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Pavithra Viswanath
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Joseph F Costello
- Department of Neurological Surgery, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Russell O Pieper
- Department of Neurological Surgery, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
- Brain Tumor Research Center, University of California San Francisco, San Francisco, California
| | - Sabrina M Ronen
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California.
- Brain Tumor Research Center, University of California San Francisco, San Francisco, California
| |
Collapse
|
6
|
Beloueche-Babari M, Casals Galobart T, Delgado-Goni T, Wantuch S, Parkes HG, Tandy D, Harker JA, Leach MO. Monocarboxylate transporter 1 blockade with AZD3965 inhibits lipid biosynthesis and increases tumour immune cell infiltration. Br J Cancer 2020; 122:895-903. [PMID: 31937921 PMCID: PMC7078321 DOI: 10.1038/s41416-019-0717-x] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 11/25/2019] [Accepted: 12/16/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Monocarboxylate transporter 1 (MCT1) is a regulator of cell metabolism and a therapeutic target for cancer treatment. Understanding the changes in tumour function accompanying MCT1 inhibition will better characterise the anti-tumour effects of MCT1 inhibitors, potentially enabling the identification of pharmacodynamic biomarkers for the clinical development of these agents. METHODS We assessed the impact of the MCT1 inhibitor AZD3965 on tumour metabolism and immune cell infiltration as key determinants of tumour biological function in the MCT1-dependent Raji B cell lymphoma model. RESULTS Treatment of Raji xenograft-bearing severe combined immunodeficiency mice with AZD3965 led to inhibition of tumour growth paralleled with a decrease in tumour choline, as detected by non-invasive in vivo proton nuclear magnetic resonance spectroscopy. This effect was attributed to inhibition of phosphocholine de novo synthesis following decreased choline kinase α protein and messenger RNA expression that correlated with the AZD3965-induced build-up in intracellular lactate. These changes were concomitant with increased tumour immune cell infiltration involving dendritic and natural killer cells. CONCLUSIONS Our data provide new insights into the metabolic and cellular changes that occur in the tumour microenvironment following MCT1 blockade, which may contribute to the anti-tumour activity of AZD3965 and could have potential as pharmacodynamic biomarkers of MCT1 inhibition.
Collapse
Affiliation(s)
- Mounia Beloueche-Babari
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, SW7 3RP, UK.
| | - Teresa Casals Galobart
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, SW7 3RP, UK
| | - Teresa Delgado-Goni
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, SW7 3RP, UK
| | - Slawomir Wantuch
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, SW7 3RP, UK
| | - Harold G Parkes
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, SW7 3RP, UK
| | - Debbie Tandy
- Cancer Research UK Cancer Therapeutics Unit, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, SW7 3RP, London, UK
| | - James A Harker
- National Heart and Lung Institute, Imperial College London, SW7 2AZ, London, UK
| | - Martin O Leach
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, SW7 3RP, UK.
| |
Collapse
|
7
|
Agliano A, Balarajah G, Ciobota DM, Sidhu J, Clarke PA, Jones C, Workman P, Leach MO, Al-Saffar NMS. Pediatric and adult glioblastoma radiosensitization induced by PI3K/mTOR inhibition causes early metabolic alterations detected by nuclear magnetic resonance spectroscopy. Oncotarget 2017; 8:47969-47983. [PMID: 28624789 PMCID: PMC5564619 DOI: 10.18632/oncotarget.18206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 04/29/2017] [Indexed: 11/25/2022] Open
Abstract
Poor outcome for patients with glioblastomas is often associated with radioresistance. PI3K/mTOR pathway deregulation has been correlated with radioresistance; therefore, PI3K/mTOR inhibition could render tumors radiosensitive. In this study, we show that NVP-BEZ235, a dual PI3K/mTOR inhibitor, potentiates the effects of irradiation in both adult and pediatric glioblastoma cell lines, resulting in early metabolic changes detected by nuclear magnetic resonance (NMR) spectroscopy. NVP-BEZ235 radiosensitises cells to X ray exposure, inducing cell death through the inhibition of CDC25A and the activation of p21cip1(CDKN1A). Lactate and phosphocholine levels, increased with radiation, are decreased after NVP-BEZ235 and combination treatment, suggesting that inhibiting the PI3K/mTOR pathway reverses radiation induced metabolic changes. Importantly, NVP-BEZ235 potentiates the effects of irradiation in a xenograft model of adult glioblastoma, where we observed a decrease in lactate and phosphocholine levels after seven days of combination treatment. Although tumor size was not affected due to the short length of the treatment, a significant increase in CASP3 mRNA was observed in the combination group. Taken together, our data suggest that NMR metabolites could be used as biomarkers to detect an early response to combination therapy with PI3K/mTOR inhibitors and radiotherapy in adult and pediatric glioblastoma patients.
Collapse
Affiliation(s)
- Alice Agliano
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Geetha Balarajah
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- The Centre for Molecular Pathology, Division of Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
| | - Daniela M Ciobota
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Jasmin Sidhu
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Paul A Clarke
- Cancer Research UK Cancer Therapeutics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Chris Jones
- Divisions of Cancer Therapeutics and Molecular Pathology, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Paul Workman
- Cancer Research UK Cancer Therapeutics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Martin O Leach
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Nada M S Al-Saffar
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| |
Collapse
|
8
|
Al-Saffar NMS, Agliano A, Marshall LV, Jackson LE, Balarajah G, Sidhu J, Clarke PA, Jones C, Workman P, Pearson ADJ, Leach MO. In vitro nuclear magnetic resonance spectroscopy metabolic biomarkers for the combination of temozolomide with PI3K inhibition in paediatric glioblastoma cells. PLoS One 2017; 12:e0180263. [PMID: 28704425 PMCID: PMC5509135 DOI: 10.1371/journal.pone.0180263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 06/13/2017] [Indexed: 11/18/2022] Open
Abstract
Recent experimental data showed that the PI3K pathway contributes to resistance to temozolomide (TMZ) in paediatric glioblastoma and that this effect is reversed by combination treatment of TMZ with a PI3K inhibitor. Our aim is to assess whether this combination results in metabolic changes that are detectable by nuclear magnetic resonance (NMR) spectroscopy, potentially providing metabolic biomarkers for PI3K inhibition and TMZ combination treatment. Using two genetically distinct paediatric glioblastoma cell lines, SF188 and KNS42, in vitro 1H-NMR analysis following treatment with the dual pan-Class I PI3K/mTOR inhibitor PI-103 resulted in a decrease in lactate and phosphocholine (PC) levels (P<0.02) relative to control. In contrast, treatment with TMZ caused an increase in glycerolphosphocholine (GPC) levels (P≤0.05). Combination of PI-103 with TMZ showed metabolic effects of both agents including a decrease in the levels of lactate and PC (P<0.02) while an increase in GPC (P<0.05). We also report a decrease in the protein expression levels of HK2, LDHA and CHKA providing likely mechanisms for the depletion of lactate and PC, respectively. Our results show that our in vitro NMR-detected changes in lactate and choline metabolites may have potential as non-invasive biomarkers for monitoring response to combination of PI3K/mTOR inhibitors with TMZ during clinical trials in children with glioblastoma, subject to further in vivo validation.
Collapse
Affiliation(s)
- Nada M. S. Al-Saffar
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Alice Agliano
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Lynley V. Marshall
- Divisions of Cancer Therapeutics and Molecular Pathology, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Divisions of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - L. Elizabeth Jackson
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Geetha Balarajah
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Jasmin Sidhu
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Paul A. Clarke
- Cancer Research UK Cancer Therapeutics Unit, Division of Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
| | - Chris Jones
- Divisions of Cancer Therapeutics and Molecular Pathology, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Paul Workman
- Cancer Research UK Cancer Therapeutics Unit, Division of Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
| | - Andrew D. J. Pearson
- Divisions of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Martin O. Leach
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
9
|
Brandão LA, Castillo M. Adult Brain Tumors: Clinical Applications of Magnetic Resonance Spectroscopy. Magn Reson Imaging Clin N Am 2017; 24:781-809. [PMID: 27742117 DOI: 10.1016/j.mric.2016.07.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Proton magnetic resonance spectroscopy (H-MRS) may be helpful in suggesting tumor histology and tumor grade and may better define tumor extension and the ideal site for biopsy compared with conventional magnetic resonance (MR) imaging. A multifunctional approach with diffusion-weighted imaging, perfusion-weighted imaging, and permeability maps, along with H-MRS, may enhance the accuracy of the diagnosis and characterization of brain tumors and estimation of therapeutic response. Integration of advanced imaging techniques with conventional MR imaging and the clinical history help to improve the accuracy, sensitivity, and specificity in differentiating tumors and nonneoplastic lesions.
Collapse
Affiliation(s)
- Lara A Brandão
- Clínica Felippe Mattoso, Av. Das Américas 700, sala 320, Barra da Tijuca, Rio de Janeiro 30112011, Brazil; Clínica IRM- Ressonância Magnética, Rua Capitão Salomão 44 Humaitá, Rio de Janeiro 22271040, Brazil.
| | - Mauricio Castillo
- Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, Room 3326, Old Infirmary Building, Manning Drive, Chapel Hill, NC 27599-7510, USA
| |
Collapse
|
10
|
Kimura M, da Cruz LCH. Multiparametric MR Imaging in the Assessment of Brain Tumors. Magn Reson Imaging Clin N Am 2016; 24:87-122. [PMID: 26613877 DOI: 10.1016/j.mric.2015.09.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Functional MR imaging methods make possible the quantification of dynamic physiologic processes that occur in the brain. Moreover, the use of these advanced imaging techniques in the setting of oncologic treatment of the brain is widely accepted and has found worldwide routine clinical use.
Collapse
Affiliation(s)
- Margareth Kimura
- Magnetic Resonance Department of Clínica de Diagnóstico por Imagem (CDPI), Centro Médico Barrashopping, Av. das Américas, 4666, grupo 325, Barra da Tijuca, Rio de Janeiro, RJ, CEP: 22649-900, Brazil.
| | - L Celso Hygino da Cruz
- Magnetic Resonance Department of Clínica de Diagnóstico por Imagem (CDPI), IRM Ressonância Magnética, Av. das Américas, 4666, grupo 325, Barra da Tijuca, Rio de Janeiro, RJ, CEP: 22649-900, Brazil
| |
Collapse
|
11
|
Abstract
Magnetic resonance spectroscopy (MRS) is a noninvasive functional technique to evaluate the biochemical behavior of human tissues. This property has been widely used in assessment and therapy monitoring of brain tumors. MRS studies can be implemented outside the brain, with successful and promising results in the evaluation of prostate and breast cancer, although still with limited reproducibility. As a result of technical improvements, malignancies of the musculoskeletal system and abdominopelvic organs can benefit from the molecular information that MRS provides. The technical challenges and main applications in oncology of (1)H MRS in a clinical setting are the focus of this review.
Collapse
|
12
|
Abstract
The revolution in cancer genomics has uncovered a variety of clinically relevant mutations in primary brain tumours, creating an urgent need to develop non-invasive imaging biomarkers to assess and integrate this genetic information into the clinical management of patients. Metabolic reprogramming is a central hallmark of cancer, including brain tumours; indeed, many of the molecular pathways implicated in the pathogenesis of brain tumours result in reprogramming of metabolism. This relationship provides the opportunity to devise in vivo metabolic imaging modalities to improve diagnosis, patient stratification, and monitoring of treatment response. Metabolic phenomena, such as the Warburg effect and altered mitochondrial metabolism, can be leveraged to image brain tumours using techniques including PET and MRI. Moreover, genetic alterations, such as mutations affecting isocitrate dehydrogenase, are associated with unique metabolic signatures that can be detected using magnetic resonance spectroscopy. The need to translate our understanding of the molecular features of brain tumours into imaging modalities with clinical utility is growing; metabolic imaging provides a unique platform to achieve this objective. In this Review, we examine the molecular basis for metabolic reprogramming in brain tumours, and examine current non-invasive metabolic imaging strategies that can be used to interrogate these molecular characteristics with the ultimate goal of guiding and improving patient care.
Collapse
|
13
|
Ziu M, Kalkanis SN, Gilbert M, Ryken TC, Olson JJ. The role of initial chemotherapy for the treatment of adults with diffuse low grade glioma : A systematic review and evidence-based clinical practice guideline. J Neurooncol 2015; 125:585-607. [PMID: 26530261 DOI: 10.1007/s11060-015-1931-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 09/07/2015] [Indexed: 11/26/2022]
Abstract
TARGET POPULATION Adult patients (older than 18 years of age) with newly diagnosed World Health Organization (WHO) Grade II gliomas (Oligodendroglioma, astrocytoma, mixed oligoastrocytoma). QUESTION Is there a role for chemotherapy as adjuvant therapy of choice in treatment of patients with newly diagnosed low-grade gliomas? RECOMMENDATIONS LEVEL III Chemotherapy is recommended as a treatment option to postpone the use of radiotherapy, to slow tumor growth and to improve progression free survival (PFS), overall survival (OS) and clinical symptoms in adult patients with newly diagnosed LGG. QUESTION Who are the patients with newly diagnosed LGG that would benefit the most from chemotherapy? RECOMMENDATION LEVEL III Chemotherapy is recommended as an optional component alone or in combination with radiation as the initial adjuvant therapy for all patients who cannot undergo gross total resection (GTR) of a newly diagnosed LGG. Patient with residual tumor >1 cm on post-operative MRI, presenting diameter of >4 cm or older than 40 years of age should be considered for adjuvant therapy as well. QUESTION Are there tumor markers that can predict which patients can benefit the most from initial treatment with chemotherapy? RECOMMENDATION LEVEL III The addition of chemotherapy to standard RT is recommended in LGG patients that carry IDH mutation. In addition, temozolomide (TMZ) is recommended as a treatment option to slow tumor growth in patients who harbor the 1p/19q co-deletion. QUESTION How soon should the chemotherapy be started once the diagnosis of LGG is confirmed? RECOMMENDATION There is insufficient evidence to make a definitive recommendation on the timing of starting chemotherapy after surgical/pathological diagnosis of LGG has been made. However, using the 12 weeks mark as the latest timeframe to start adjuvant chemotherapy is suggested. It is recommended that patients be enrolled in properly designed clinical trials to assess the timing of chemotherapy initiation once diagnosis is confirmed for this target population. QUESTION What chemotherapeutic agents should be used for treatment of newly diagnosed LGG? RECOMMENDATION There is insufficient evidence to make a recommendation of one particular regimen. Enrollment of subjects in properly designed trials comparing the efficacy of these or other agents is recommended so as to determine which of these regimens is superior. QUESTION What is the optimal duration and dosing of chemotherapy as initial treatment for LGG? RECOMMENDATION Insufficient evidence exists regarding the duration of any specific cytotoxic drug regimen for treatment of newly diagnosed LGG. Enrollment of subjects in properly designed clinical investigations assessing the optimal duration of this therapy is recommended. QUESTION Should chemotherapy be given alone or in conjunction with RT as initial therapy for LGG? RECOMMENDATION Insufficient evidence exists to make recommendations in this regard. Hence, enrollment of patients in properly designed clinical trials assessing the difference between chemotherapy alone, RT alone or a combination of them is recommended. QUESTION Should chemotherapy be given in addition to other type of adjuvant therapy to patients with newly diagnosed LGG? RECOMMENDATION Level II: It is recommended that chemotherapy be added to the RT in patients with unfavorable LGG to improve their progression free survival.
Collapse
Affiliation(s)
- Mateo Ziu
- Department of Neurosurgery, Seton Brain and Spine Institute, 1400 N IH-35, Suite 300, Austin, TX, 78701, USA.
| | - Steven N Kalkanis
- Department of Neurosurgery, Henry Ford Health System, Detroit, MI, USA
| | - Mark Gilbert
- Center for Cancer Research, Neuro-Oncology Branch at National Cancer Institute, Bethesda, MD, USA
| | - Timothy C Ryken
- Department of Neurosurgery, Kansas University Medical Center, Kansas City, KS, USA
| | - Jeffrey J Olson
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
14
|
Andronesi OC, Loebel F, Bogner W, Marjańska M, Vander Heiden MG, Iafrate AJ, Dietrich J, Batchelor TT, Gerstner ER, Kaelin WG, Chi AS, Rosen BR, Cahill DP. Treatment Response Assessment in IDH-Mutant Glioma Patients by Noninvasive 3D Functional Spectroscopic Mapping of 2-Hydroxyglutarate. Clin Cancer Res 2015; 22:1632-41. [PMID: 26534967 DOI: 10.1158/1078-0432.ccr-15-0656] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 10/13/2015] [Indexed: 01/08/2023]
Abstract
PURPOSE Measurements of objective response rates are critical to evaluate new glioma therapies. The hallmark metabolic alteration in gliomas with mutant isocitrate dehydrogenase (IDH) is the overproduction of oncometabolite 2-hydroxyglutarate (2HG), which plays a key role in malignant transformation. 2HG represents an ideal biomarker to probe treatment response in IDH-mutant glioma patients, and we hypothesized a decrease in 2HG levels would be measureable by in vivo magnetic resonance spectroscopy (MRS) as a result of antitumor therapy. EXPERIMENTAL DESIGN We report a prospective longitudinal imaging study performed in 25 IDH-mutant glioma patients receiving adjuvant radiation and chemotherapy. A newly developed 3D MRS imaging was used to noninvasively image 2HG. Paired Student t test was used to compare pre- and posttreatment tumor 2HG values. Test-retest measurements were performed to determine the threshold for 2HG functional spectroscopic maps (fSM). Univariate and multivariate regression were performed to correlate 2HG changes with Karnofsky performance score (KPS). RESULTS We found that mean 2HG (2HG/Cre) levels decreased significantly (median = 48.1%; 95% confidence interval = 27.3%-56.5%;P= 0.007) in the posttreatment scan. The volume of decreased 2HG correlates (R(2)= 0.88,P= 0.002) with clinical status evaluated by KPS. CONCLUSIONS We demonstrate that dynamic measurements of 2HG are feasible by 3D fSM, and the decrease of 2HG levels can monitor treatment response in patients with IDH-mutant gliomas. Our results indicate that quantitative in vivo 2HG imaging may be used for precision medicine and early response assessment in clinical trials of therapies targeting IDH-mutant gliomas.
Collapse
Affiliation(s)
- Ovidiu C Andronesi
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Franziska Loebel
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. Department of Neurosurgery, Charité Medical University, Berlin, Germany
| | - Wolfgang Bogner
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, 1090 Vienna, Austria
| | - Małgorzata Marjańska
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota
| | - Matthew G Vander Heiden
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - A John Iafrate
- Center for Integrated Diagnostics, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jorg Dietrich
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Division of Hematology/Oncology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tracy T Batchelor
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Division of Hematology/Oncology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Elizabeth R Gerstner
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Division of Hematology/Oncology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Andrew S Chi
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Division of Hematology/Oncology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Bruce R Rosen
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel P Cahill
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
15
|
Chaumeil MM, Lupo JM, Ronen SM. Magnetic Resonance (MR) Metabolic Imaging in Glioma. Brain Pathol 2015; 25:769-80. [PMID: 26526945 PMCID: PMC8029127 DOI: 10.1111/bpa.12310] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 08/25/2015] [Indexed: 12/25/2022] Open
Abstract
This review is focused on describing the use of magnetic resonance (MR) spectroscopy for metabolic imaging of brain tumors. We will first review the MR metabolic imaging findings generated from preclinical models, focusing primarily on in vivo studies, and will then describe the use of metabolic imaging in the clinical setting. We will address relatively well-established (1) H MRS approaches, as well as (31) P MRS, (13) C MRS and emerging hyperpolarized (13) C MRS methodologies, and will describe the use of metabolic imaging for understanding the basic biology of glioma as well as for improving the characterization and monitoring of brain tumors in the clinic.
Collapse
Affiliation(s)
| | - Janine M. Lupo
- Department of Radiology and Biomedical ImagingMission Bay Campus
| | - Sabrina M. Ronen
- Department of Radiology and Biomedical ImagingMission Bay Campus
- Brain Tumor Research CenterUniversity of CaliforniaSan FranciscoCA
| |
Collapse
|
16
|
Kim MM, Lawrence TS, Cao Y. Advances in Magnetic Resonance and Positron Emission Tomography Imaging: Assessing Response in the Treatment of Low-Grade Glioma. Semin Radiat Oncol 2015; 25:172-80. [PMID: 26050587 DOI: 10.1016/j.semradonc.2015.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Following combined-modality therapy for the treatment of low-grade gliomas, the assessment of treatment response and the evaluation of disease progression are uniformly challenging. In this article, we review existing response criteria, and discuss the limitations of conventional magnetic resonance imaging to distinguish between progression and treatment effect. We review the data on advanced imaging techniques including positron emission tomography and functional magnetic resonance imaging, which may enhance the interpretation of posttreatment changes, and enable the earlier assessment of the efficacy and toxicity of therapy in these patients with prolonged survival.
Collapse
Affiliation(s)
- Michelle M Kim
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI.
| | | | - Yue Cao
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI; Department of Radiology, University of Michigan, Ann Arbor, MI; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI
| |
Collapse
|
17
|
Guillevin R, Herpe G, Verdier M, Guillevin C. Low-grade gliomas: the challenges of imaging. Diagn Interv Imaging 2014; 95:957-63. [PMID: 25195186 DOI: 10.1016/j.diii.2014.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
WHO grade II gliomas are a major challenge for magnetic resonance imaging (MRI) due to their delayed anaplastic transformation. Today it is possible to individually characterize tumor progression from diagnosis to anaplastic transformation based on the many parameters identified in studies in the literature and the possibility of integrating these data into mathematical models. Early identification of negative morphological and metabolic factors, as well as treatment follow-up, help identify predictive factors of tumor progression, as well as determine treatment response to adapt management of this disease.
Collapse
Affiliation(s)
- R Guillevin
- Laboratoire DACTIM, service de radiologie, université de Poitiers, centre hospitalier universitaire de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France.
| | - G Herpe
- Laboratoire DACTIM, service de radiologie, université de Poitiers, centre hospitalier universitaire de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - M Verdier
- Laboratoire DACTIM, service de radiologie, université de Poitiers, centre hospitalier universitaire de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - C Guillevin
- Laboratoire DACTIM, service de radiologie, université de Poitiers, centre hospitalier universitaire de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| |
Collapse
|
18
|
Al-Saffar NMS, Marshall LV, Jackson LE, Balarajah G, Eykyn TR, Agliano A, Clarke PA, Jones C, Workman P, Pearson ADJ, Leach MO. Lactate and choline metabolites detected in vitro by nuclear magnetic resonance spectroscopy are potential metabolic biomarkers for PI3K inhibition in pediatric glioblastoma. PLoS One 2014; 9:e103835. [PMID: 25084455 PMCID: PMC4118961 DOI: 10.1371/journal.pone.0103835] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 07/02/2014] [Indexed: 01/09/2023] Open
Abstract
The phosphoinositide 3-kinase (PI3K) pathway is believed to be of key importance in pediatric glioblastoma. Novel inhibitors of the PI3K pathway are being developed and are entering clinical trials. Our aim is to identify potential non-invasive biomarkers of PI3K signaling pathway inhibition in pediatric glioblastoma using in vitro nuclear magnetic resonance (NMR) spectroscopy, to aid identification of target inhibition and therapeutic response in early phase clinical trials of PI3K inhibitors in childhood cancer. Treatment of SF188 and KNS42 human pediatric glioblastoma cell lines with the dual pan-Class I PI3K/mTOR inhibitor PI-103, inhibited the PI3K signaling pathway and resulted in a decrease in phosphocholine (PC), total choline (tCho) and lactate levels (p<0.02) as detected by phosphorus (31P)- and proton (1H)-NMR. Similar changes were also detected using the pan-Class I PI3K inhibitor GDC-0941 which lacks significant mTOR activity and is entering Phase II clinical trials. In contrast, the DNA damaging agent temozolomide (TMZ), which is used as current frontline therapy in the treatment of glioblastoma postoperatively (in combination with radiotherapy), increased PC, glycerophosphocholine (GPC) and tCho levels (p<0.04). PI-103-induced NMR changes were associated with alterations in protein expression levels of regulatory enzymes involved in glucose and choline metabolism including GLUT1, HK2, LDHA and CHKA. Our results show that by using NMR we can detect distinct biomarkers following PI3K pathway inhibition compared to treatment with the DNA-damaging anti-cancer agent TMZ. This is the first study reporting that lactate and choline metabolites are potential non-invasive biomarkers for monitoring response to PI3K pathway inhibitors in pediatric glioblastoma.
Collapse
Affiliation(s)
- Nada M. S. Al-Saffar
- Cancer Research UK and EPSRC Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Lynley V. Marshall
- Division of Molecular Pathology, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Cancer Therapeutics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Clinical Studies. The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - L. Elizabeth Jackson
- Cancer Research UK and EPSRC Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Geetha Balarajah
- Cancer Research UK and EPSRC Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Thomas R. Eykyn
- Cancer Research UK and EPSRC Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, London, United Kingdom
| | - Alice Agliano
- Cancer Research UK and EPSRC Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Paul A. Clarke
- Division of Cancer Therapeutics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Cancer Research UK Cancer Therapeutics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Chris Jones
- Division of Molecular Pathology, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Cancer Therapeutics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Paul Workman
- Division of Cancer Therapeutics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Cancer Research UK Cancer Therapeutics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Andrew D. J. Pearson
- Division of Cancer Therapeutics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Clinical Studies. The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Martin O. Leach
- Cancer Research UK and EPSRC Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
19
|
Abstract
Medical therapies are an important part of adjunctive therapy for gliomas. In this chapter we will review the chemotherapeutic and targeted agents that have been evaluated in clinical trials in grade II-IV gliomas in the last decade. A number of randomized phase III trials were completed and reported. There has been a clear success in oligodendroglial tumors and low grade glioma. Although some progress has been made in glioblastoma, considerable work involving the multidisciplinary collaboration of basic science, translational and clinical investigators needs to be done to improve the outcome of patients with anaplastic astrocytoma and glioblastoma. In addition, tailoring treatment based on molecular cytogenetic characteristics is a major focus of research into precision based medicine for glioma.
Collapse
Affiliation(s)
- Manmeet S Ahluwalia
- The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | | |
Collapse
|
20
|
Öz G, Alger JR, Barker PB, Bartha R, Bizzi A, Boesch C, Bolan PJ, Brindle KM, Cudalbu C, Dinçer A, Dydak U, Emir UE, Frahm J, González RG, Gruber S, Gruetter R, Gupta RK, Heerschap A, Henning A, Hetherington HP, Howe FA, Hüppi PS, Hurd RE, Kantarci K, Klomp DWJ, Kreis R, Kruiskamp MJ, Leach MO, Lin AP, Luijten PR, Marjańska M, Maudsley AA, Meyerhoff DJ, Mountford CE, Nelson SJ, Pamir MN, Pan JW, Peet AC, Poptani H, Posse S, Pouwels PJW, Ratai EM, Ross BD, Scheenen TWJ, Schuster C, Smith ICP, Soher BJ, Tkáč I, Vigneron DB, Kauppinen RA. Clinical proton MR spectroscopy in central nervous system disorders. Radiology 2014; 270:658-79. [PMID: 24568703 PMCID: PMC4263653 DOI: 10.1148/radiol.13130531] [Citation(s) in RCA: 411] [Impact Index Per Article: 41.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A large body of published work shows that proton (hydrogen 1 [(1)H]) magnetic resonance (MR) spectroscopy has evolved from a research tool into a clinical neuroimaging modality. Herein, the authors present a summary of brain disorders in which MR spectroscopy has an impact on patient management, together with a critical consideration of common data acquisition and processing procedures. The article documents the impact of (1)H MR spectroscopy in the clinical evaluation of disorders of the central nervous system. The clinical usefulness of (1)H MR spectroscopy has been established for brain neoplasms, neonatal and pediatric disorders (hypoxia-ischemia, inherited metabolic diseases, and traumatic brain injury), demyelinating disorders, and infectious brain lesions. The growing list of disorders for which (1)H MR spectroscopy may contribute to patient management extends to neurodegenerative diseases, epilepsy, and stroke. To facilitate expanded clinical acceptance and standardization of MR spectroscopy methodology, guidelines are provided for data acquisition and analysis, quality assessment, and interpretation. Finally, the authors offer recommendations to expedite the use of robust MR spectroscopy methodology in the clinical setting, including incorporation of technical advances on clinical units.
Collapse
Affiliation(s)
- Gülin Öz
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Jeffry R. Alger
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Peter B. Barker
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Robert Bartha
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Alberto Bizzi
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Chris Boesch
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Patrick J. Bolan
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Kevin M. Brindle
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Cristina Cudalbu
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Alp Dinçer
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Ulrike Dydak
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Uzay E. Emir
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Jens Frahm
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Ramón Gilberto González
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Stephan Gruber
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Rolf Gruetter
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Rakesh K. Gupta
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Arend Heerschap
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Anke Henning
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Hoby P. Hetherington
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Franklyn A. Howe
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Petra S. Hüppi
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Ralph E. Hurd
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Kejal Kantarci
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Dennis W. J. Klomp
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Roland Kreis
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Marijn J. Kruiskamp
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Martin O. Leach
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Alexander P. Lin
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Peter R. Luijten
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Małgorzata Marjańska
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Andrew A. Maudsley
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Dieter J. Meyerhoff
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Carolyn E. Mountford
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Sarah J. Nelson
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - M. Necmettin Pamir
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Jullie W. Pan
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Andrew C. Peet
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Harish Poptani
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Stefan Posse
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Petra J. W. Pouwels
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Eva-Maria Ratai
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Brian D. Ross
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Tom W. J. Scheenen
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Christian Schuster
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Ian C. P. Smith
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Brian J. Soher
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Ivan Tkáč
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | - Daniel B. Vigneron
- From the Center for Magnetic Resonance Research, University of Minnesota,
2021 6th St SE, Minneapolis, MN 55455 (G.O.)
| | | |
Collapse
|
21
|
Pisanu ME, Ricci A, Paris L, Surrentino E, Liliac L, Bagnoli M, Canevari S, Mezzanzanica D, Podo F, Iorio E, Canese R. Monitoring response to cytostatic cisplatin in a HER2(+) ovary cancer model by MRI and in vitro and in vivo MR spectroscopy. Br J Cancer 2013; 110:625-35. [PMID: 24335926 PMCID: PMC3915124 DOI: 10.1038/bjc.2013.758] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 11/01/2013] [Accepted: 11/07/2013] [Indexed: 01/25/2023] Open
Abstract
Background: Limited knowledge is available on alterations induced by cytostatic drugs on magnetic resonance spectroscopy (MRS) and imaging (MRI) parameters of human cancers, in absence of apoptosis or cytotoxicity. We here investigated the effects of a cytostatic cisplatin (CDDP) treatment on 1H MRS and MRI of HER2-overexpressing epithelial ovarian cancer (EOC) cells and in vivo xenografts. Methods: High-resolution MRS analyses were performed on in vivo passaged SKOV3.ip cells and cell/tissue extracts (16.4 or 9.4 T). In vivo MRI/MRS quantitative analyses (4.7 T) were conducted on xenografts obtained by subcutaneous implantation of SKOV3.ip cells in SCID mice. The apparent diffusion coefficient (ADC) and metabolite levels were measured. Results: CDDP-induced cytostatic effects were associated with a metabolic shift of cancer cells towards accumulation of MRS-detected neutral lipids, whereas the total choline profile failed to be perturbed in both cultured cells and xenografts. In vivo MRI examinations showed delayed tumour growth in the CDDP-treated group, associated with early reduction of the ADC mean value. Conclusion: This study provides an integrated set of information on cancer metabolism and physiology for monitoring the response of an EOC model to a cytostatic chemotherapy, as a basis for improving the interpretation of non-invasive MR examinations of EOC patients.
Collapse
Affiliation(s)
- M E Pisanu
- Department of Cell Biology and Neurosciences, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Roma, Italy
| | - A Ricci
- Department of Cell Biology and Neurosciences, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Roma, Italy
| | - L Paris
- Department of Cell Biology and Neurosciences, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Roma, Italy
| | - E Surrentino
- Department of Cell Biology and Neurosciences, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Roma, Italy
| | - L Liliac
- 1] Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Amadeo 42, 20133 Milano, Italy [2] Department of Histology, University of Medicine and Pharmacy 'Grigore T. Popa', Iasi, Romania
| | - M Bagnoli
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Amadeo 42, 20133 Milano, Italy
| | - S Canevari
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Amadeo 42, 20133 Milano, Italy
| | - D Mezzanzanica
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Amadeo 42, 20133 Milano, Italy
| | - F Podo
- Department of Cell Biology and Neurosciences, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Roma, Italy
| | - E Iorio
- Department of Cell Biology and Neurosciences, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Roma, Italy
| | - R Canese
- Department of Cell Biology and Neurosciences, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Roma, Italy
| |
Collapse
|
22
|
A radiologist's guide to treatment response criteria in oncologic imaging: functional, molecular, and disease-specific imaging biomarkers. AJR Am J Roentgenol 2013; 201:246-56. [PMID: 23883206 DOI: 10.2214/ajr.12.9878] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This article reviews the functional, molecular, and disease-specific imaging biomarkers of treatment response. CONCLUSION Substantial progress has been made in the evolution of drugs directed at specific targets of the tumor lifecycle. These novel agents are predominantly cytostatic, and their efficacy may be optimally evaluated by functional, molecular, and disease-specific imaging biomarkers.
Collapse
|
23
|
|
24
|
Kwee TC, Donswijk ML. Application of Advanced MR Imaging Techniques and the Evolving Role of PET/MR Imaging in Neuro-oncology. PET Clin 2013; 8:183-99. [DOI: 10.1016/j.cpet.2012.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
25
|
Caivano R, Lotumolo A, Rabasco P, Zandolino A, D'Antuono F, Villonio A, Lancellotti MI, Macarini L, Cammarota A. 3 Tesla magnetic resonance spectroscopy: cerebral gliomas vs. metastatic brain tumors. Our experience and review of the literature. Int J Neurosci 2013; 123:537-43. [PMID: 23390934 DOI: 10.3109/00207454.2013.774395] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of the present study is to report about the value of magnetic resonance spectroscopy (MRS) in differentiating brain metastases, primary high-grade gliomas (HGG) and low-grade gliomas (LGG). MRI (magnetic resonance imaging) and MRS were performed in 60 patients with histologically verified brain tumors: 32 patients with HGG (28 glioblastomas multiforme [GBM] and 4 anaplastic astrocytomas), 14 patients with LGG (9 astrocytomas and 5 oligodendrogliomas) and 14 patients with metastatic brain tumors. The Cho/Cr (choline-containing compounds/creatine-phosphocreatine complex), Cho/NAA (N-acetyl aspartate) and NAA/Cr ratios were assessed from spectral maps in the tumoral core and peritumoral edema. The differences in the metabolite ratios between LGG, HGG and metastases were analyzed statistically. Lipids/lactate contents were also analyzed. Significant differences were noted in the tumoral and peritumoral Cho/Cr, Cho/NAA and NAA/Cr ratios between LGG, HGG and metastases. Lipids and lactate content revealed to be useful for discriminating gliomas and metastases. The results of this study demonstrate that MRS can differentiate LGG, HGG and metastases, therefore diagnosis could be allowed even in those patients who cannot undergo biopsy.
Collapse
Affiliation(s)
- R Caivano
- Radiology Department, I.R.C.C.S. -C.R.O.B., Rionero in Vulture, Potenza, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Affiliation(s)
- Oswald Quehenberger
- Departments of Medicine and Pharmacology, School of Medicine, University of California, San Diego, La Jolla, CA 92093-0601, USA
| | | |
Collapse
|
27
|
Treatment monitoring in gliomas: comparison of dynamic susceptibility-weighted contrast-enhanced and spectroscopic MRI techniques for identifying treatment failure. Invest Radiol 2011; 46:390-400. [PMID: 21285888 DOI: 10.1097/rli.0b013e31820e1511] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate whether dynamic susceptibility-weighted contrast-enhanced (DSC), dynamic contrast-enhanced (DCE), and proton spectroscopic imaging ((1)H-MRSI) can identify progression and predict treatment failure during follow-up before tumor size changes, contrast agent uptake, or when new lesions become obvious. The aim was also to find out which of the aforementioned techniques had the best diagnostic performance compared with each other and standard magnetic resonance imaging (MRI). MATERIALS AND METHODS Thirty-seven patients with gliomas (21 women, 16 men; mean age at inclusion, 48 ± 14 years [standard deviation]) were assessed prospectively by (1)H-MRSI (point-resolved spectroscopy), DCE, and DSC perfusion MRI, each after a single dose of gadobenate dimeglumine during follow-up. Histology was available in all cases (resection, N = 18; biopsy, N = 19). All patients with low-grade gliomas (n = 20) did not receive any radio- or chemotherapy after partial resection (n = 7) or biopsy (n = 13), whereas 17 patients with high-grade gliomas had received adjuvant radiotherapy immediately after surgery. Tumor progression (progressive disease, PD) was defined as increase in longest glioma diameter by at least 20% (Response Evaluation Criteria in Solid Tumors), appearance of new lesions, or new contrast-enhancement. DSC, DCE, and MRSI image analyses comprised a detailed semiquantitative region of interest (ROI) analysis of the different parameters. Wilcoxon signed-rank test, Wilcoxon rank sum test, and Cox regression were used for statistical analysis. RESULTS The median follow-up time was 607 days. Twenty patients showed PD (54%), 8 of 20 with low-grade (40%) and 12 of 17 with high-grade gliomas (71%). In PD, significant positive differences between log2-transformed ROI ratios at the last measurement in comparison to the first measurement (baseline) could be detected for tumor blood flow (P < 0.006) and volume (P < 0.001) derived from DSC and for maximum choline within tumor tissue (P = 0.0029) and Cho/Cr (P = 0.032) but not choline/N-acetyl-aspartate (P = 0.37) derived from MRSI. In contrast, these parameters were not significantly higher at last measurement in stable disease. Also, the differences between last value and baseline were significantly different between PD and stable disease for tumor blood flow (P < 0.004) and volume (P < 0.002) as well as for maximum choline within tumor tissue (P = 0.0011). The best prognostic parameter for PD at Cox analysis was time-dependent difference to baseline of log2 of relative regional cerebral blood flow normalized on gray matter (hazard ratio, 2.67; 95% confidence interval, 1.25-6.08; P = 0.01), while a prognostic value of MRS parameters could not be demonstrated. CONCLUSION DSC perfusion imaging can identify progression and can predict treatment failure during follow-up of gliomas with the best diagnostic performance.
Collapse
|
28
|
Guillevin R, Menuel C, Taillibert S, Capelle L, Costalat R, Abud L, Habas C, De Marco G, Hoang-Xuan K, Chiras J, Vallée JN. Predicting the outcome of grade II glioma treated with temozolomide using proton magnetic resonance spectroscopy. Br J Cancer 2011; 104:1854-61. [PMID: 21610707 PMCID: PMC3111204 DOI: 10.1038/bjc.2011.174] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: This study was designed to evaluate proton magnetic resonance spectroscopy (1H-MRS) for monitoring the WHO grade II glioma (low-grade glioma (LGG)) treated with temozolomide (TMZ). Methods: This prospective study included adult patients with progressive LGG that was confirmed by magnetic resonance imaging (MRI). Temozolomide was administered at every 28 days. Response to TMZ was evaluated by monthly MRI examinations that included MRI with volumetric calculations and 1H-MRS for assessing Cho/Cr and Cho/NAA ratios. Univariate, multivariate and receiver-operating characteristic statistical analyses were performed on the results. Results: A total of 21 LGGs from 31 patients were included in the study, and followed for at least n=14 months during treatment. A total of 18 (86%) patients experienced a decrease in tumour volume with a greater decrease of metabolic ratios. Subsequently, five (28%) of these tumours resumed growth despite the continuation of TMZ administration with an earlier increase of metabolic ratios of 2 months. Three (14%) patients did not show any volume or metabolic change. The evolutions of the metabolic ratios, mean(Cho/Cr)n and mean(Cho/NAA)n, were significantly correlated over time (Spearman ρ=+0.95) and followed a logarithmic regression (P>0.001). The evolutions over time of metabolic ratios, mean(Cho/Cr)n and mean(Cho/NAA)n, were significantly correlated with the evolution of the mean relative decrease of tumour volume, mean(ΔVn/Vo), according to a linear regression (P<0.001) in the ‘response/no relapse’ patient group, and with the evolution of the mean tumour volume (meanVn), according to an exponential regression (P<0.001) in the ‘response/relapse’ patient group. The mean relative decrease of metabolic ratio, mean(Δ(Cho/Cr)n/(Cho/Cr)o), at n=3 months was predictive of tumour response over the 14 months of follow-up. The mean relative change between metabolic ratios, mean((Cho/NAA)n−(Cho/Cr)n)/(Cho/NAA)n, at n=4 months was predictive of tumour relapse with a significant cutoff of 0.046, a sensitivity of 60% and a specificity of 100% (P=0.004). Conclusions: The 1H-MRS profile changes more widely and rapidly than tumour volume during the response and relapse phases, and represents an early predictive factor of outcome over 14 months of follow-up. Thus, 1H-MRS may be a promising, non-invasive tool for predicting and monitoring the clinical response to TMZ.
Collapse
Affiliation(s)
- R Guillevin
- Department of Neuroradiology, Pitié-Sapêtrière Hospital, Functional Imaging Laboratory, INSERM U678, UPMC University Paris 6, 47-83 Boulevard de l'Hôpital, 75013 Paris, France.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Abstract
Cancer treatment strategies have changed considerably over the past two decades, with increasing emphasis on cancer-specific biological therapies. This situation has led to the incorporation of biomarkers, including those obtained by medical imaging, into trial designs to better understand mechanisms of action and, hopefully, to provide early evidence of treatment efficacy at a molecular or physiological level. Unlike blood tests and tissue samples, an imaging biomarker allows assessment of treatment in the whole tumor, in all tumors in the body, and at multiple time points. This situation has increased the complexity of clinical trials, as each imaging modality has issues related to cost, ease of use, patient compatibility, data analysis, and interpretation. This article reviews strengths and limitations of the current imaging methods available in clinical cancer trials, including MRI, CT, PET, and ultrasonography. The information gained by each test, and the difficulties in acquiring the data and interpreting it are also discussed in order to help researchers plan imaging in clinical trials and interpret data from such studies.
Collapse
|
30
|
Busch M, Liebenrodt K, Gottfried S, Weiland E, Vollmann W, Mateiescu S, Winter S, Lange S, Sahinbas H, Baier J, van Leeuwen P, Grönemeyer D. Influence of brain tumors on the MR spectra of healthy brain tissue. Magn Reson Med 2011; 65:18-27. [PMID: 20859993 DOI: 10.1002/mrm.22612] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The neurochemical environment of nontumorous white matter tissue was investigated in 135 single voxel spectra of "healthy" white matter regions of 43 tumor patients and 129 spectra of 52 healthy subjects. Spectra were acquired with short TE and TR values. With the data of tumor patients, it was examined whether differences were caused by the tumor itself or aggressive tumor therapies as confounding factors. Comparing the spectra of both classes, an excellent differentiation was possible based on the metabolite peak of N-acetylaspartate (P ≈ 0) and myoinositol (P < 0.03). The area under curve of the receiver operating characteristic was calculated as 0.86 and 0.62, respectively. With linear discriminant analysis using combinations of integrals, a prediction was possible, whether a spectrum belonged to the patient or the healthy subject class with an overall accuracy above 80%. The confounding factors could be ruled out as source of the differences. The results show strong evidence for an influence of malignant growth on the biochemical environment of nontumorous white matter tissue. Because of the T(1) weighting, the measured differences between both classes were most likely concentration changes interfered by T(1) effects. The underlying processes will be subject of future studies.
Collapse
Affiliation(s)
- M Busch
- Department for Radiology and Microtherapy, Grönemeyer Institute for Microtherapy, University Witten/Herdecke, Bochum, Germany.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Response assessment in neuro-oncology (a report of the RANO group): assessment of outcome in trials of diffuse low-grade gliomas. Lancet Oncol 2011; 12:583-93. [PMID: 21474379 DOI: 10.1016/s1470-2045(11)70057-2] [Citation(s) in RCA: 385] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Although low-grade gliomas (LGG) have a less aggressive course than do high-grade gliomas, the outcome of these tumours is ultimately fatal in most patients. Both the tumour and its treatment can cause disabling morbidity, particularly of cognitive functions. Because many patients present with seizures only, with no other signs and symptoms, maintenance of quality of life and function constitutes a particular challenge in LGG. The slow growth pattern of most LGG, and the rare radiological true responses despite a favourable clinical response to treatment, interferes with the use of progression-free survival as the primary endpoint in trials. Overall survival as an endpoint brings logistical challenges, and is sensitive to other non-investigational salvage therapies. Clinical trials for LGG need to consider other measures of patient benefit such as cognition, symptom burden, and seizure activity, to establish whether improved survival is reflected in prolonged wellbeing. This Review investigates clinical and imaging endpoints in trials of LGG, and provides response assessment in neuro-oncology (RANO) criteria for non-enhancing tumours. Additionally, other measures for patients with brain tumours that assess outcome are described. Similar considerations are relevant for trials of high-grade gliomas, although for these tumours survival is shorter and survival endpoints generally have more value than they do for LGG.
Collapse
|
32
|
Proton magnetic resonance spectroscopy in differentiating glioblastomas from primary cerebral lymphomas and brain metastases. J Comput Assist Tomogr 2011; 34:836-41. [PMID: 21084897 DOI: 10.1097/rct.0b013e3181ec554e] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To differentiate glioblastomas, primary cerebral lymphomas (PCLs), and brain metastases using multivoxel proton magnetic resonance (MR) spectroscopic imaging. METHODS A total of 56 patients with brain neoplasms underwent MR imaging and proton MR spectroscopic imaging. The data were analyzed from contrast-enhancing and peritumoral regions (PTR). N-acetylaspartate/creatine (Cr), choline (Cho)/Cr, glutamate+glutamine/Cr, myo-inositol/Cr, and lipids+lactate/Cr ratios were computed, and pairwise comparisons between neoplasms were made using Mann-Whitney U tests. RESULTS The PTR demonstrated most significant differences in metabolite ratios. The Cho/Cr ratio in glioblastomas (0.46 [0.01]) was significantly higher than that in metastases (0.38 [0.02], P = 0.01). Significantly elevated Cho/Cr levels were also noted in PCLs (0.48 [0.03]) compared with those in metastases (P = 0.04). In addition, PCLs also demonstrated significantly higher lipids+lactate/Cr levels (11.83 [2.59]) compared with glioblastomas (4.50 [0.59], P = 0.003) and metastases (2.79 [0.33], P = 0.001). CONCLUSIONS Proton MR spectroscopic imaging from PTR may assist in the differentiation of glioblastomas, metastases, and PCLs.
Collapse
|
33
|
Horská A, Barker PB. Imaging of brain tumors: MR spectroscopy and metabolic imaging. Neuroimaging Clin N Am 2010; 20:293-310. [PMID: 20708548 DOI: 10.1016/j.nic.2010.04.003] [Citation(s) in RCA: 194] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The utility of magnetic resonance spectroscopy (MRS) in diagnosis and evaluation of treatment response to human brain tumors has been widely documented. The role of MRS in tumor classification, tumors versus nonneoplastic lesions, prediction of survival, treatment planning, monitoring of therapy, and post-therapy evaluation is discussed. This article delineates the need for standardization and further study in order for MRS to become widely used as a routine clinical tool.
Collapse
Affiliation(s)
- Alena Horská
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | | |
Collapse
|
34
|
Dhermain FG, Hau P, Lanfermann H, Jacobs AH, van den Bent MJ. Advanced MRI and PET imaging for assessment of treatment response in patients with gliomas. Lancet Neurol 2010; 9:906-20. [PMID: 20705518 DOI: 10.1016/s1474-4422(10)70181-2] [Citation(s) in RCA: 268] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Imaging techniques are important for accurate diagnosis and follow-up of patients with gliomas. T1-weighted MRI, with or without gadolinium, is the gold standard method. However, this technique only reflects biological activity of the tumour indirectly by detecting the breakdown of the blood-brain barrier. Therefore, especially for low-grade glioma or after treatment, T1-weighted MRI enhanced with gadolinium has substantial limitations. Development of more advanced imaging methods to improve outcomes for individual patients is needed. New imaging methods based on MRI and PET can be employed in various stages of disease to target the biological activity of the tumour cells (eg, increased uptake of aminoacids or nucleoside analogues), the changes in diffusivity through the interstitial space (diffusion-weighted MRI), the tumour-induced neovascularisation (perfusion-weighted MRI or contrast-enhanced MRI, or increased uptake of aminoacids in endothelial wall), and the changes in concentrations of metabolites (magnetic resonance spectroscopy). These techniques have advantages and disadvantages, and should be used in conjunction to best help individual patients. Advanced imaging techniques need to be validated in clinical trials to ensure standardisation and evidence-based implementation in routine clinical practice.
Collapse
Affiliation(s)
- Frederic G Dhermain
- Department of Radiation Oncology and Physics, Institut Gustave Roussy, Villejuif Cedex, Paris, France
| | | | | | | | | |
Collapse
|
35
|
Al-Saffar NMS, Jackson LE, Raynaud FI, Clarke PA, Ramírez de Molina A, Lacal JC, Workman P, Leach MO. The phosphoinositide 3-kinase inhibitor PI-103 downregulates choline kinase alpha leading to phosphocholine and total choline decrease detected by magnetic resonance spectroscopy. Cancer Res 2010; 70:5507-17. [PMID: 20551061 DOI: 10.1158/0008-5472.can-09-4476] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The phosphoinositide 3-kinase (PI3K) pathway is a major target for cancer drug development. PI-103 is an isoform-selective class I PI3K and mammalian target of rapamycin inhibitor. The aims of this work were as follows: first, to use magnetic resonance spectroscopy (MRS) to identify and develop a robust pharmacodynamic (PD) biomarker for target inhibition and potentially tumor response following PI3K inhibition; second, to evaluate mechanisms underlying the MRS-detected changes. Treatment of human PTEN null PC3 prostate and PIK3CA mutant HCT116 colon carcinoma cells with PI-103 resulted in a concentration- and time-dependent decrease in phosphocholine (PC) and total choline (tCho) levels (P < 0.05) detected by phosphorus ((31)P)- and proton ((1)H)-MRS. In contrast, the cytotoxic microtubule inhibitor docetaxel increased glycerophosphocholine and tCho levels in PC3 cells. PI-103-induced MRS changes were associated with alterations in the protein expression levels of regulatory enzymes involved in lipid metabolism, including choline kinase alpha (ChoK(alpha)), fatty acid synthase (FAS), and phosphorylated ATP-citrate lyase (pACL). However, a strong correlation (r(2) = 0.9, P = 0.009) was found only between PC concentrations and ChoK(alpha) expression but not with FAS or pACL. This study identified inhibition of ChoK(alpha) as a major cause of the observed change in PC levels following PI-103 treatment. We also showed the capacity of (1)H-MRS, a clinically well-established technique with higher sensitivity and wider applicability compared with (31)P-MRS, to assess response to PI-103. Our results show that monitoring the effects of PI3K inhibitors by MRS may provide a noninvasive PD biomarker for PI3K inhibition and potentially of tumor response during early-stage clinical trials with PI3K inhibitors.
Collapse
Affiliation(s)
- Nada M S Al-Saffar
- Cancer Research UK and EPSRC Cancer Imaging Centre, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom.
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Abstract
Imaging plays a key role in the management of low-grade gliomas. The traditional view of these tumours as non-enhancing areas of increased signal on T2-weighted imaging is now accepted as being incorrect. Using new MR and PET techniques that can probe the pathological changes with in these tumours by assessing vascularity (perfusion MR), cellularity and infiltration (diffusion weighted and diffusion tensor MR), metabolism (MR spectroscopy and FDG PET) and proliferation (MR spectroscopy, methionine PET and 18F-fluorothymidine FLT PET). These tools will allow improvements in tumour grading, biopsy/therapy guidance and earlier assessment of the response to therapy.
Collapse
Affiliation(s)
- Stephen J Price
- Academic Neurosurgery Division, Department of Clinical Neurosciences, Addenbrooke's Hospital, Cambridge, UK
| |
Collapse
|
37
|
Monitoring of treatment response after chemoradiotherapy for head and neck cancer using in vivo 1H MR spectroscopy. Eur Radiol 2009; 20:165-72. [DOI: 10.1007/s00330-009-1531-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Revised: 06/05/2009] [Accepted: 06/13/2009] [Indexed: 10/20/2022]
|
38
|
Waldman AD, Jackson A, Price SJ, Clark CA, Booth TC, Auer DP, Tofts PS, Collins DJ, Leach MO, Rees JH. Quantitative imaging biomarkers in neuro-oncology. Nat Rev Clin Oncol 2009; 6:445-54. [PMID: 19546864 DOI: 10.1038/nrclinonc.2009.92] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Conventional structural imaging provides limited information on tumor characterization and prognosis. Advances in neurosurgical techniques, radiotherapy planning and novel drug treatments for brain tumors have generated increasing need for reproducible, noninvasive, quantitative imaging biomarkers. This Review considers the role of physiological MRI and PET molecular imaging in understanding metabolic processes associated with tumor growth, blood flow and ultrastructure. We address the utility of various techniques in distinguishing between tumors and non-neoplastic processes, in tumor grading, in defining anatomical relationships between tumor and eloquent brain regions and in determining the biological substrates of treatment response. Much of the evidence is derived from limited case series in individual centers. Despite their 'added value', the effect of these techniques as an adjunct to structural imaging in clinical research and practice remains limited.
Collapse
|
39
|
Ruiz J, Lesser GJ. Low-Grade Gliomas. Curr Treat Options Oncol 2009; 10:231-42. [DOI: 10.1007/s11864-009-0096-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Accepted: 03/16/2009] [Indexed: 12/15/2022]
|
40
|
Chernov MF, Hayashi M, Izawa M, Nakaya K, Tamura N, Ono Y, Abe K, Usukura M, Yoshida S, Nakamura R, Suzuki T, Muragaki Y, Iseki H, Kubo O, Hori T, Takakura K. Dynamics of metabolic changes in intracranial metastases and distant normal-appearing brain tissue after stereotactic radiosurgery: a serial proton magnetic resonance spectroscopy study. Neuroradiol J 2009; 22:58-71. [PMID: 24206954 DOI: 10.1177/197140090902200109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Accepted: 12/06/2008] [Indexed: 11/16/2022] Open
Abstract
The present study evaluated the dynamics of metabolic changes in intracranial metastases and distant normal-appearing brain after stereotactic radiosurgery (SRS). Forty neoplasms were evaluated with single-voxel proton magnetic resonance spectroscopy ((1)H-MRS) both before and after treatment. From one to six examinations (median, 3) were done in each individual case during follow-up. At the time of each investigation additional (1)H-MRS was obtained from the normal-appearing brain distant from the radiosurgical target. Investigated metabolites included N-acetylaspartate (NAA), choline-containing compounds (Cho), creatine (Cr), and mobile lipids (Lip). Within the first month after SRS responded tumors showed a statistically significant increase in NAA/Cho ratio, and decrease of Cho content and Lip-to-normal brain Cr (nCr) ratio. By contrast, statistically significant metabolic alterations were not detected in stabilized tumors. Statistically significant volumetric and metabolic changes were not marked between three and 12 months after treatment in non-progressing lesions. Alternatively, decrease of NAA/Cho ratio, NAA content and Cr content, and increase in Lip/nCr ratio and Cho content were evident in progressive neoplasms, and subtle metabolic alterations could be revealed even before the increase in the lesion volume. Metabolic characteristics of normal-appearing brain distant from the radiosurgical target did not show statistically significant changes within the first year after treatment. In conclusion, additional use of serial (1)H-MRS during follow-up after SRS for intracranial metastases permits detailed evaluation of the metabolic tumor response and may be potentially helpful for early prediction of recurrence.
Collapse
Affiliation(s)
- M F Chernov
- International Research and Educational Institute for Integrated Medical Sciences (IREIIMS); Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science; Departments of Neurosurgery, Neurological Institute; Tokyo Women's Medical University, Tokyo, Japan -
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Weber MA, Giesel FL, Stieltjes B. MRI for identification of progression in brain tumors: from morphology to function. Expert Rev Neurother 2008; 8:1507-25. [PMID: 18928344 DOI: 10.1586/14737175.8.10.1507] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
For monitoring of brain tumors, it is crucial to identify progression or treatment failure early during follow-up to change treatment schemes and, thereby, optimize patient outcome. In the past years, several areas within the field of magnetic resonance (MR) have seen considerable advances: modern contrast media, advanced morphologic approaches and several functional techniques, for example, in the visualization of tumor perfusion or tumor cell metabolism. This review presents these recent advances by introducing the different techniques and outlining their benefit for identification of progression in brain tumors, with a focus on gliomas, metastases and meningiomas. After radiotherapy, MR spectroscopy helps to more accurately discriminate between radiation necrosis and glioma progression. In low-grade gliomas, perfusion MR techniques enable a more sensitive detection of anaplastic transformation than conventional MRI. Modern contrast media, as well as diffusion tensor imaging, allow for an improved tumor delineation and assessment of tumor extension. We will also highlight the biological background of these techniques, their applicability and current limitations. In conclusion, modern MRI techniques have been developed that are on the doorstep to be integrated in clinical routine.
Collapse
Affiliation(s)
- Marc-André Weber
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 10, D-69120 Heidelberg, Germany.
| | | | | |
Collapse
|
42
|
Guillevin R, Menuel C, Sanson M, Hoang-Xuan K, Chiras J. [The advantage of photon magnetic resonance spectroscopy in brain tumors]. Rev Neurol (Paris) 2008; 164 Spec No 3:F191-201. [PMID: 18992579 DOI: 10.1016/s0035-3787(08)74099-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- R Guillevin
- Service de neuroradiologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
| | | | | | | | | |
Collapse
|
43
|
Marcus CD, Ladam-Marcus V, Cucu C, Bouché O, Lucas L, Hoeffel C. Imaging techniques to evaluate the response to treatment in oncology: current standards and perspectives. Crit Rev Oncol Hematol 2008; 72:217-38. [PMID: 18760935 DOI: 10.1016/j.critrevonc.2008.07.012] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Revised: 07/04/2008] [Accepted: 07/17/2008] [Indexed: 02/07/2023] Open
Abstract
Response evaluation in solid tumours currently uses radiological imaging techniques to measure changes under treatment. Imaging requires a well-defined anatomical lesion to be viewed and relies on the measurement of a reduction in tumour size during treatment as the basis for presumed clinical benefit. However, with the development of anti-angiogenesis agents, anatomical imaging has became inappropriate as certain tumours would not reduce in size. Functional studies are therefore necessary and dynamic contrast enhanced magnetic resonance imaging (DCE-MRI), DCE-computed tomography (CT) and DCE-ultrasonography (US) are currently being evaluated for monitoring treatments. Diffusion-weighted MR imaging (DW-MRI) and magnetic resonance spectroscopy (MRS) are also capable of detecting changes in cell density and metabolite content within tumours. In this article, we review anatomical and functional criteria currently used for monitoring therapy. We review the published data on DCE-MRI, DCE-CT, DCE-US, DW-MRI and MRS. This literature review covers the following area: basic principles of the technique, clinical studies, reproducibility and repeatability, limits and perspectives in monitoring therapy. Anatomical criteria such as response evaluation criteria in solid tumours (RECIST) will require adaptation to employ not only new tools but also different complementary techniques such as functional imaging in order to monitor therapeutic effects of conventional and new anti-cancer agents.
Collapse
Affiliation(s)
- C D Marcus
- Department of Radiology, Robert-Debre Hospital, University of Reims, France.
| | | | | | | | | | | |
Collapse
|
44
|
Sankar T, Caramanos Z, Assina R, Villemure JG, Leblanc R, Langleben A, Arnold DL, Preul MC. Prospective serial proton MR spectroscopic assessment of response to tamoxifen for recurrent malignant glioma. J Neurooncol 2008; 90:63-76. [PMID: 18600428 DOI: 10.1007/s11060-008-9632-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Accepted: 06/06/2008] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Early prediction of imminent failure during chemotherapy for malignant glioma has the potential to guide proactive alterations in treatment before frank tumor progression. We prospectively followed patients with recurrent malignant glioma receiving tamoxifen chemotherapy using proton magnetic resonance spectroscopic imaging ((1)H-MRSI) to identify intratumoral metabolic changes preceding clinical and radiological failure. METHODS We performed serial (1)H-MRSI examinations to assess intratumoral metabolite intensities in 16 patients receiving high-dose oral tamoxifen monotherapy for recurrent malignant glioma (WHO grade III or IV) as part of a phase II clinical trial. Patients were followed until treatment failure, death, or trial termination. RESULTS Patients were officially classified as responders (7 patients) or non-responders (9 patients) 8 weeks into treatment. At 8 weeks, responders and non-responders had different intratumoral intensities across all measured metabolites except choline. Beyond 8 weeks, metabolite intensities remained stable in all responders, but changed again with approaching disease progression. Choline, lipid, choline/NAA, and lactate/NAA were significantly elevated (P < 0.02), while creatine (P < 0.04) was significantly reduced, compared to stabilized levels on average 4 weeks prior to failure. Lactate was significantly elevated (P = 0.036) fully 8 weeks prior to failure. In one patient who was still responding to tamoxifen at the conclusion of the trial, metabolite intensities never deviated from 8-week levels for the duration of follow-up. CONCLUSIONS Characteristic global intratumoral metabolic changes, detectable on serial (1)H-MRSI studies, occur in response to chemotherapy for malignant glioma and may predict imminent treatment failure before actual clinical and radiological disease progression.
Collapse
Affiliation(s)
- Tejas Sankar
- Neurosurgery Research Laboratory, Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 W. Thomas Road, Phoenix, AZ 85013, USA
| | | | | | | | | | | | | | | |
Collapse
|
45
|
(1)H MR spectroscopy of human brain tumours: a practical approach. Eur J Radiol 2008; 67:268-274. [PMID: 18406554 DOI: 10.1016/j.ejrad.2008.02.036] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Accepted: 02/29/2008] [Indexed: 10/22/2022]
Abstract
Magnetic resonance spectroscopy (MRS) is proposed in addition to magnetic resonance imaging (MRI) to help in the characterization of brain tumours by detecting metabolic alterations that may be indicative of the tumour class. MRS can be routinely performed on clinical magnets, within a reasonable acquisition time and if performed under adequate conditions, MRS is reproducible and thus can be used for longitudinal follow-up of treatment. MRS can also be performed in clinical practice to guide the neurosurgeon into the most aggressive part of the lesions or to avoid unnecessary surgery, which may furthermore decrease the risk of surgical morbidity.
Collapse
|
46
|
Chung YL, Griffiths JR. Using metabolomics to monitor anticancer drugs. ERNST SCHERING FOUNDATION SYMPOSIUM PROCEEDINGS 2008:55-78. [PMID: 18811053 DOI: 10.1007/2789_2008_089] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The metabolome of a cancer cell is likely to show changes after responding to an anticancer drug. These changes could be used to decide whether to continue treatment or, in the context of a drug trial, to indicate whether the drug is working and perhaps its mechanism of action. (Nuclear) magnetic resonance spectroscopy (NMR/MRS) methods can offer important insights into novel anticancer agents in order to accelerate the drug development process including time-course studies on the effect of a drug on its site of action (termed pharmacodynamics), in this case the cancer. In addition, some classes of anticancer agents currently under development (e.g. antiangiogenics) are designed to be used in combination with other drugs and will not cause tumour shrinkage when used as single agents in Phase 1 clinical trials. Thus NMR/MRS may have a special role in monitoring the pharmacodynamic actions of such drugs in early-phase clinical trials. This review focuses on the use of ex vivo NMR and in vivo MRS methods for monitoring the effect of some novel anticancer drugs on the cancer metabolome. Ex vivo NMR methods are complementary to in vivo measurements, as they can provide additional information and help in the interpretation of the in vivo data.
Collapse
Affiliation(s)
- Y-L Chung
- St. George's University of London, UK
| | | |
Collapse
|
47
|
Abstract
Techniques for human brain imaging have undergone rapid developments in recent years. Technological progress has enabled the assessment of many physiological parameters in vivo that are highly relevant for tumour grading, tissue characterisation, definition of the extent and infiltration of tumours, and planning and monitoring of therapy. In this review, we provide a brief overview of advanced MRI and molecular-tracer techniques that have many potential clinical uses. A broad range of techniques, including dynamic MRI, PET, and single photon emission computed tomography, provide measurements of various features of tumour blood flow and microvasculature. Using PET to measure glucose consumption enables visualisation of tumour metabolism, and magnetic resonance spectroscopy techniques provide complementary information on energy metabolism. Changes in protein and DNA synthesis can be assessed through uptake of labelled amino acids and nucleosides. Advanced imaging techniques can be used to assess tumour malignancy, extent, and infiltration, and might provide diagnostic clues to distinguish between lesion types and between recurrent tumour and necrosis. Stereotactic biopsies should be taken from the most malignant part of tumours, which can be identified by changes in microvascular structure and metabolic activity. Functional and metabolic imaging can improve the planning and monitoring of radiation and chemotherapy and contribute to the development of new therapies.
Collapse
Affiliation(s)
- Karl Herholz
- Wolfson Molecular Imaging Centre, University of Manchester, Oxford Road, Manchester, UK.
| | | | | |
Collapse
|
48
|
McConville P, Hambardzumyan D, Moody JB, Leopold WR, Kreger AR, Woolliscroft MJ, Rehemtulla A, Ross BD, Holland EC. Magnetic resonance imaging determination of tumor grade and early response to temozolomide in a genetically engineered mouse model of glioma. Clin Cancer Res 2007; 13:2897-904. [PMID: 17504989 DOI: 10.1158/1078-0432.ccr-06-3058] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The median survival for patients diagnosed with glioblastoma multiforme, the most common type of brain tumor, is less than 1 year. Animal glioma models that are more predictive of therapeutic response in human patients than traditional models and that are genetically and histologically accurate are an unmet need. The nestin tv-a (Ntv-a) genetically engineered mouse spontaneously develops glioma when infected with ALV-A expressing platelet-derived growth factor, resulting in autocrine platelet-derived growth factor signaling. EXPERIMENTAL DESIGN In the Ntv-a genetically engineered mouse model, T2-weighted and T1-weighted, contrast-enhanced magnetic resonance images were correlated with histology, glioma grade (high or low), and survival. Magnetic resonance imaging (MRI) was therefore used to enroll mice with high-grade gliomas into a second study that tested efficacy of the current standard of care for glioma, temozolomide (100 mg/kg qdx5 i.p., n=13). RESULTS The Ntv-a model generated a heterogeneous group of gliomas, some with high-grade growth rate and histologic characteristics and others with characteristics of lower-grade gliomas. We showed that MRI could be used to predict tumor grade and survival. Temozolomide treatment of high-grade tv-a gliomas provided a 14-day growth delay compared with vehicle controls. Diffusion MRI measurement of the apparent diffusion coefficient showed an early decrease in cellularity with temozolomide, similar to that observed in humans. CONCLUSIONS The use of MRI in the Ntv-a model allows determination of glioma grade and survival prediction, distribution of mice with specific tumor types into preclinical trials, and efficacy determination both by tumor growth and early apparent diffusion coefficient response.
Collapse
|
49
|
Galanaud D, Nicoli F, Confort-Gouny S, Le Fur Y, Dormont D, Girard N, Ranjeva J, Cozzone P. [Brain magnetic resonance spectroscopy]. ACTA ACUST UNITED AC 2007; 88:483-96. [PMID: 17457259 DOI: 10.1016/s0221-0363(07)89848-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
MR spectroscopy (MRS) sequences allow noninvasive exploration of brain metabolism during a MRI examination. Their day-to-day use in a clinical setting has recently been improved by simple programming of sequences and automated quantification of metabolites. However, a few simple rules should be observed in the choice of sequences and the location of the voxels so as to obtain an informative, high-quality examination. The research applications of MR spectroscopy, where use of this examination seeks to better understand the pathophysiology of the disease, must be distinguished from its clinical indications, where MRS provides information that can be used directly in patient management. The most significant of the clinical uses are imaging intracranial tumors (positive and differential diagnosis, extension, treatment follow-up), diffuse brain injury, encephalopathies (especially hepatic and HIV-related), and the diagnosis of metabolic disorders.
Collapse
Affiliation(s)
- D Galanaud
- Service de Neuroradiologie, Hôpital La Pitié Salpêtrière, 47, boulevard de l'Hôpital, 75651 Paris cedex 13.
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Galanaud D, Nicoli F, Confort-Gouny S, Le Fur Y, Ranjeva JP, Viola A, Girard N, Cozzone PJ. [Indications for cerebral MR proton spectroscopy in 2007]. Rev Neurol (Paris) 2007; 163:287-303. [PMID: 17404517 DOI: 10.1016/s0035-3787(07)90402-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Magnetic resonance spectroscopy (MRS) is being increasingly performed alongside the more conventional MRI sequences in the exploration of neurological disorders. It is however important to clearly differentiate its clinical applications aiming at improving the differential diagnosis or the prognostic evaluation of the patient, from the research protocols, when MRS can contribute to a better understanding of the pathophysiology of the disease or to the evaluation of new treatments. The most important applications in clinical practice are intracranial space occupying lesions (especially the positive diagnosis of intracranial abscesses and gliomatosis cerebri and the differential diagnosis between edema and tumor infiltration), alcoholic, hepatic, and HIV-related encephalopathies and the exploration of metabolic diseases. Among the research applications, MRS is widely used in multiple sclerosis, ischemia and brain injury, epilepsy and neuro degenerative diseases.
Collapse
Affiliation(s)
- D Galanaud
- Centre de Résonance Magnétique Biologique et Médicale (CRMBM), UMR CNRS 6612, Faculté de Médecine et Hôpital La Timone, Marseille, France
| | | | | | | | | | | | | | | |
Collapse
|