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Stadlbauer A, Roessler K, Zimmermann M, Buchfelder M, Kleindienst A, Doerfler A, Heinz G, Oberndorfer S. Predicting Glioblastoma Response to Bevacizumab Through MRI Biomarkers of the Tumor Microenvironment. Mol Imaging Biol 2019; 21:747-57. [PMID: 30361791 DOI: 10.1007/s11307-018-1289-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE Glioblastoma (GB) is one of the most vascularized of all solid tumors and, therefore, represents an attractive target for antiangiogenic therapies. Many lesions, however, quickly develop escape mechanisms associated with changes in the tumor microenvironment (TME) resulting in rapid treatment failure. To prevent patients from adverse effects of ineffective therapy, there is a strong need to better predict and monitor antiangiogenic treatment response. PROCEDURES We utilized a novel physiological magnetic resonance imaging (MRI) method combining the visualization of oxygen metabolism and neovascularization for classification of five different TME compartments: necrosis, hypoxia with/without neovascularization, oxidative phosphorylation, and aerobic glycolysis. This approach, termed TME mapping, was used to monitor changes in tumor biology and pathophysiology within the TME in response to bevacizumab treatment in 18 patients with recurrent GB. RESULTS We detected dramatic changes in the TME by rearrangement of its compartments after the onset of bevacizumab treatment. All patients showed a decrease in active tumor volume and neovascularization as well as an increase in hypoxia and necrosis in the first follow-up after 3 months. We found that recurrent GB with a high percentage of neovascularization and active tumor before bevacizumab onset showed a poor or no treatment response. CONCLUSIONS TME mapping might be useful to develop strategies for patient stratification and response prediction before bevacizumab onset.
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Juan-Albarracín J, Fuster-Garcia E, García-Ferrando GA, García-Gómez JM. ONCOhabitats: A system for glioblastoma heterogeneity assessment through MRI. Int J Med Inform 2019; 128:53-61. [DOI: 10.1016/j.ijmedinf.2019.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 04/30/2019] [Accepted: 05/05/2019] [Indexed: 01/19/2023]
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Kebir S, Schaub C, Junold N, Hattingen E, Schäfer N, Steinbach JP, Weyerbrock A, Hau P, Goldbrunner R, Galldiks N, Weller J, Mack F, Tzaridis T, Bähr O, Seidel C, Schlegel U, Schmidt-graf F, Rohde V, Borchers C, Tabatabai G, Hänel M, Sabel M, Gerlach R, Krex D, Belka C, Vatter H, Proescholdt M, Glas M, Herrlinger U. Baseline T1 hyperintense and diffusion-restricted lesions are not linked to prolonged survival in bevacizumab-treated glioblastoma patients of the GLARIUS trial. J Neurooncol 2019; 144:501-9. [DOI: 10.1007/s11060-019-03246-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/15/2019] [Indexed: 10/26/2022]
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Juan-Albarracín J, Fuster-Garcia E, Pérez-Girbés A, Aparici-Robles F, Alberich-Bayarri Á, Revert-Ventura A, Martí-Bonmatí L, García-Gómez JM. Glioblastoma: Vascular Habitats Detected at Preoperative Dynamic Susceptibility-weighted Contrast-enhanced Perfusion MR Imaging Predict Survival. Radiology 2018; 287:944-954. [DOI: 10.1148/radiol.2017170845] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Javier Juan-Albarracín
- From the Instituto Universitario de Aplicaciones de las Tecnologías de la Información y de las Comunicaciones Avanzadas, Universitat Politècnica de València, Camino de Vera s/n, 46022 Valencia, Spain
| | - Elies Fuster-Garcia
- From the Instituto Universitario de Aplicaciones de las Tecnologías de la Información y de las Comunicaciones Avanzadas, Universitat Politècnica de València, Camino de Vera s/n, 46022 Valencia, Spain
| | - Alexandre Pérez-Girbés
- From the Instituto Universitario de Aplicaciones de las Tecnologías de la Información y de las Comunicaciones Avanzadas, Universitat Politècnica de València, Camino de Vera s/n, 46022 Valencia, Spain
| | - Fernando Aparici-Robles
- From the Instituto Universitario de Aplicaciones de las Tecnologías de la Información y de las Comunicaciones Avanzadas, Universitat Politècnica de València, Camino de Vera s/n, 46022 Valencia, Spain
| | - Ángel Alberich-Bayarri
- From the Instituto Universitario de Aplicaciones de las Tecnologías de la Información y de las Comunicaciones Avanzadas, Universitat Politècnica de València, Camino de Vera s/n, 46022 Valencia, Spain
| | - Antonio Revert-Ventura
- From the Instituto Universitario de Aplicaciones de las Tecnologías de la Información y de las Comunicaciones Avanzadas, Universitat Politècnica de València, Camino de Vera s/n, 46022 Valencia, Spain
| | - Luis Martí-Bonmatí
- From the Instituto Universitario de Aplicaciones de las Tecnologías de la Información y de las Comunicaciones Avanzadas, Universitat Politècnica de València, Camino de Vera s/n, 46022 Valencia, Spain
| | - Juan M. García-Gómez
- From the Instituto Universitario de Aplicaciones de las Tecnologías de la Información y de las Comunicaciones Avanzadas, Universitat Politècnica de València, Camino de Vera s/n, 46022 Valencia, Spain
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Stadlbauer A, Zimmermann M, Oberndorfer S, Doerfler A, Buchfelder M, Heinz G, Roessler K. Vascular Hysteresis Loops and Vascular Architecture Mapping in Patients with Glioblastoma treated with Antiangiogenic Therapy. Sci Rep 2017; 7:8508. [PMID: 28819189 PMCID: PMC5561153 DOI: 10.1038/s41598-017-09048-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 07/19/2017] [Indexed: 01/06/2023] Open
Abstract
In this study, we investigated the variability of vascular hysteresis loop (VHL) shapes and the spatial heterogeneity of neovascularization and microvascular alterations using vascular architecture mapping (VAM) in patients with recurrent glioblastoma during bevacizumab mono-therapy. VAM data were acquired in 13 patients suffering from recurrent glioblastoma prior to and 3 months after bevacizumab treatment onset using a dual contrast agent injections approach as part of routine MRI. Two patients were additionally examined after the first cycle of bevacizumab to check for early treatment response. VHLs were evaluated as biomarker maps of neovascularization activity: microvessel type indicator (MTI) and curvature (Curv) of the VHL-long-axis. Early response to bevacizumab was dominated by reduction of smaller microvasculature (around 10 µm). In the 3-month follow-up, responding tumors additionally showed a reduction in larger microvasculature (>20 µm). VAM biomarker images revealed spatially heterogeneous microvascular alterations during bevacizumab treatment. Responding, non-responding, progressive, and remote-progressive tumor areas were observed. MTI may be useful to predict responding and non-responding tumor regions, and Curv to assess severity of vasogenic edema. Analysis of VHLs in combination with VAM biomarkers may lead to a new perspective on investigating the spatial heterogeneity of neovascularization and microvascular alterations in glioblastoma during antiangiogenic therapy.
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Affiliation(s)
- Andreas Stadlbauer
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany. .,Institute of Medical Radiology, University Clinic of St. Pölten, St. Pölten, Austria.
| | - Max Zimmermann
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Stefan Oberndorfer
- Department of Neurology, University Clinic of St. Pölten, St. Pölten, Austria
| | - Arnd Doerfler
- Department of Neuroradiology, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Gertraud Heinz
- Institute of Medical Radiology, University Clinic of St. Pölten, St. Pölten, Austria
| | - Karl Roessler
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany
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Manni I, Di Rocco G, Fusco S, Leone L, Barbati SA, Carapella CM, Grassi C, Piaggio G, Toietta G. Monitoring the Response of Hyperbilirubinemia in the Mouse Brain by In Vivo Bioluminescence Imaging. Int J Mol Sci 2016; 18:ijms18010050. [PMID: 28036021 PMCID: PMC5297685 DOI: 10.3390/ijms18010050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 12/18/2016] [Accepted: 12/22/2016] [Indexed: 01/02/2023] Open
Abstract
Increased levels of unconjugated bilirubin are neurotoxic, but the mechanism leading to neurological damage has not been completely elucidated. Innovative strategies of investigation are needed to more precisely define this pathological process. By longitudinal in vivo bioluminescence imaging, we noninvasively visualized the brain response to hyperbilirubinemia in the MITO-Luc mouse, in which light emission is restricted to the regions of active cell proliferation. We assessed that acute hyperbilirubinemia promotes bioluminescence in the brain region, indicating an increment in the cell proliferation rate. Immunohistochemical detection in brain sections of cells positive for both luciferase and the microglial marker allograft inflammatory factor 1 suggests proliferation of microglial cells. In addition, we demonstrated that brain induction of bioluminescence was altered by pharmacological displacement of bilirubin from its albumin binding sites and by modulation of the blood-brain barrier permeability, all pivotal factors in the development of bilirubin-induced neurologic dysfunction. We also determined that treatment with minocycline, an antibiotic with anti-inflammatory and neuroprotective properties, or administration of bevacizumab, an anti-vascular endothelial growth factor antibody, blunts bilirubin-induced bioluminescence. Overall the study supports the use of the MITO-Luc mouse as a valuable tool for the rapid response monitoring of drugs aiming at preventing acute bilirubin-induced neurological dysfunction.
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Affiliation(s)
- Isabella Manni
- Department of Research, Advanced Diagnostic, and Technological Innovation, Regina Elena National Cancer Institute, 00144 Rome, Italy.
| | - Giuliana Di Rocco
- Department of Research, Advanced Diagnostic, and Technological Innovation, Regina Elena National Cancer Institute, 00144 Rome, Italy.
| | - Salvatore Fusco
- Institute of Human Physiology, Medical School, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
| | - Lucia Leone
- Institute of Human Physiology, Medical School, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
| | - Saviana Antonella Barbati
- Institute of Human Physiology, Medical School, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
| | | | - Claudio Grassi
- Institute of Human Physiology, Medical School, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
| | - Giulia Piaggio
- Department of Research, Advanced Diagnostic, and Technological Innovation, Regina Elena National Cancer Institute, 00144 Rome, Italy.
| | - Gabriele Toietta
- Department of Research, Advanced Diagnostic, and Technological Innovation, Regina Elena National Cancer Institute, 00144 Rome, Italy.
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Netto JP, Schwartz D, Varallyay C, Fu R, Hamilton B, Neuwelt EA. Misleading early blood volume changes obtained using ferumoxytol-based magnetic resonance imaging perfusion in high grade glial neoplasms treated with bevacizumab. Fluids Barriers CNS 2016; 13:23. [PMID: 27998280 PMCID: PMC5175388 DOI: 10.1186/s12987-016-0047-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 12/05/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neovascularization, a distinguishing trait of high-grade glioma, is a target for anti-angiogenic treatment with bevacizumab (BEV). This study sought to use ferumoxytol-based dynamic susceptibility contrast magnetic resonance imaging (MRI) to clarify perfusion and relative blood volume (rCBV) changes in glioma treated with BEV and to determine potential impact on clinical management. METHODS 16 high grade glioma patients who received BEV following post-chemoradiation radiographic or clinical progression were included. Ferumoxytol-based MRI perfusion measurements were taken before and after BEV. Lesions were defined at each timepoint by gadolinium-based contrast agent (GBCA)-enhancing area. Lesion volume and rCBV were compared pre and post-BEV in the lesion and rCBV "hot spot" (mean of the highest rCBV in a 1.08 cm2 area in the enhancing volume), as well as hypoperfused and hyperperfused subvolumes within the GBCA-enhancing lesion. RESULTS GBCA-enhancing lesion volumes decreased 39% (P = 0.01) after BEV. Mean rCBV in post-BEV GBCA-enhancing area did not decrease significantly (P = 0.227) but significantly decreased in the hot spot (P = 0.046). Mean and hot spot rCBV decreased (P = 0.039 and 0.007) when post-BEV rCBV was calculated over the pre-BEV GBCA-enhancing area. Hypoperfused pixel count increased from 24% to 38 (P = 0.007) and hyperperfused decreased from 39 to 28% (P = 0.017). Mean rCBV decreased in 7/16 (44%) patients from >1.75 to <1.75, the cutoff for pseudoprogression diagnosis. CONCLUSIONS Decreased perfusion after BEV significantly alters rCBV measurements when using ferumoxytol. BEV treatment response hinders efforts to differentiate true progression from pseudoprogression using blood volume measurements in malignant glioma, potentially impacting patient diagnosis and management.
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Affiliation(s)
- Joao Prola Netto
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.,Department of Neuroradiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Daniel Schwartz
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.,Advanced Imaging Research Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Csanad Varallyay
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Rongwei Fu
- School of Public Health, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.,Emergency Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Bronwyn Hamilton
- Department of Neuroradiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Edward A Neuwelt
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA. .,Department of Veterans Affairs Medical Center, 3710 SW U.S. Veterans Hospital Road, Portland, OR, 97239, USA. .,Department of Neurosurgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L603, Portland, OR, 97239, USA.
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Barajas RF, Krohn KA, Link JM, Hawkins RA, Clarke JL, Pampaloni MH, Cha S. Glioma FMISO PET/MR Imaging Concurrent with Antiangiogenic Therapy: Molecular Imaging as a Clinical Tool in the Burgeoning Era of Personalized Medicine. Biomedicines 2016; 4:biomedicines4040024. [PMID: 28536391 PMCID: PMC5344267 DOI: 10.3390/biomedicines4040024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 10/27/2016] [Accepted: 10/29/2016] [Indexed: 01/17/2023] Open
Abstract
The purpose of this article is to provide a focused overview of the current use of positron emission tomography (PET) molecular imaging in the burgeoning era of personalized medicine in the treatment of patients with glioma. Specifically, we demonstrate the utility of PET imaging as a tool for personalized diagnosis and therapy by highlighting a case series of four patients with recurrent high grade glioma who underwent 18F-fluoromisonidazole (FMISO) PET/MR (magnetic resonance) imaging through the course of antiangiogenic therapy. Three distinct features were observed from this small cohort of patients. First, the presence of pseudoprogression was retrospectively associated with the absence of hypoxia. Second, a subgroup of patients with recurrent high grade glioma undergoing bevacizumab therapy demonstrated disease progression characterized by an enlarging nonenhancing mass with newly developed reduced diffusion, lack of hypoxia, and preserved cerebral blood volume. Finally, a reduction in hypoxic volume was observed concurrent with therapy in all patients with recurrent tumor, and markedly so in two patients that developed a nonenhancing reduced diffusion mass. This case series demonstrates how medical imaging has the potential to influence personalized medicine in several key aspects, especially involving molecular PET imaging for personalized diagnosis, patient specific disease prognosis, and therapeutic monitoring.
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Affiliation(s)
- Ramon F Barajas
- Department of Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA.
- Advanced Imaging Research Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA.
| | - Kenneth A Krohn
- Department of Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA.
- Radiochemistry Research Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA.
| | - Jeanne M Link
- Department of Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA.
- Radiochemistry Research Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA.
| | - Randall A Hawkins
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, M-391, San Francisco, CA 94143-0628, USA.
| | - Jennifer L Clarke
- Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave., Room 779 M, San Francisco, CA 94143-0112, USA.
| | - Miguel H Pampaloni
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, M-391, San Francisco, CA 94143-0628, USA.
| | - Soonmee Cha
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, M-391, San Francisco, CA 94143-0628, USA.
- Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave., Room 779 M, San Francisco, CA 94143-0112, USA.
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Eilaghi A, Yeung T, d'Esterre C, Bauman G, Yartsev S, Easaw J, Fainardi E, Lee TY, Frayne R. Quantitative Perfusion and Permeability Biomarkers in Brain Cancer from Tomographic CT and MR Images. Biomark Cancer 2016; 8:47-59. [PMID: 27398030 PMCID: PMC4933536 DOI: 10.4137/bic.s31801] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 11/03/2015] [Accepted: 11/06/2015] [Indexed: 12/28/2022]
Abstract
Dynamic contrast-enhanced perfusion and permeability imaging, using computed tomography and magnetic resonance systems, are important techniques for assessing the vascular supply and hemodynamics of healthy brain parenchyma and tumors. These techniques can measure blood flow, blood volume, and blood-brain barrier permeability surface area product and, thus, may provide information complementary to clinical and pathological assessments. These have been used as biomarkers to enhance the treatment planning process, to optimize treatment decision-making, and to enable monitoring of the treatment noninvasively. In this review, the principles of magnetic resonance and computed tomography dynamic contrast-enhanced perfusion and permeability imaging are described (with an emphasis on their commonalities), and the potential values of these techniques for differentiating high-grade gliomas from other brain lesions, distinguishing true progression from posttreatment effects, and predicting survival after radiotherapy, chemotherapy, and antiangiogenic treatments are presented.
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Affiliation(s)
- Armin Eilaghi
- Department of Radiology, University of Calgary, Calgary, AB, Canada.; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.; Seaman Family MR Centre, Foothills Medical Centre, Calgary, AB, Canada
| | - Timothy Yeung
- Lawson Health Research Institute and Robarts Research Institute, London, ON, Canada
| | - Christopher d'Esterre
- Department of Radiology, University of Calgary, Calgary, AB, Canada.; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.; Seaman Family MR Centre, Foothills Medical Centre, Calgary, AB, Canada
| | - Glenn Bauman
- Lawson Health Research Institute and Robarts Research Institute, London, ON, Canada
| | - Slav Yartsev
- Lawson Health Research Institute and Robarts Research Institute, London, ON, Canada
| | - Jay Easaw
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Enrico Fainardi
- Neuroradiology Unit, Department of Neurosciences and Rehabilitation, Azienda Ospedaliero-Universitaria, Arcispedale S. Anna, Ferrara, Italy.; Neuroradiology Unit, Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Ting-Yim Lee
- Lawson Health Research Institute and Robarts Research Institute, London, ON, Canada
| | - Richard Frayne
- Department of Radiology, University of Calgary, Calgary, AB, Canada.; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.; Seaman Family MR Centre, Foothills Medical Centre, Calgary, AB, Canada
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Sun C, Yu Y, Wang L, Wu B, Xia L, Feng F, Ling Z, Wang S. Additive antiangiogenesis effect of ginsenoside Rg3 with low-dose metronomic temozolomide on rat glioma cells both in vivo and in vitro. J Exp Clin Cancer Res 2016; 35:32. [PMID: 26872471 PMCID: PMC4752767 DOI: 10.1186/s13046-015-0274-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 12/17/2015] [Indexed: 11/23/2022]
Abstract
Background Glioblastoma is the most common and deadly primary brain tumor in adults. Low-dose,metronomic (LDM) temozolomide (TMZ) displays improved efficacy in the treatment of glioblastoma by targeting angiogenesis, but has a limited effect on recurrence. The antiangiogenesis drug ginsenoside Rg3 (RG3) is the main active ingredient of ginseng, a popular herbal medicine. Methods Using an in vitro and a rat model of an orthotopic glioma allograft, this study was to determine whether RG3 enhanced the antiangiogenesis activity of LDM TMZ in the treatment of glioblastoma. Results Our results showed that combined use of TMZ with RG3 displayed additive inhibition on proliferation of both human umbilical vein endothelial cells (HUVEC) and rat C6 glioma cells in vitro. They additively arrested cell cycle, increased apoptosis, and decreased VEGF-A and BCL-2 expression in HUVEC. Antiangiogenesis effect was also evaluated in the rat model of orthotopic glioma allograft, based upon markers including relative cerebral blood volume (rCBV) by magnetic resonance imaging (MRI), VEGF levels and microvessel density (MVD)/CD34 staining. LDM TMZ alone was potent in suppressing angiogenesis and tumor growth, whereas RG3 alone only had modest antiangiogenesis effects. Combined treatment significantly and additively suppressed angiogenesis, without additive inhibitory effects on allografted tumor growth. Conclusions These data provide evidence showing the efficacy of LDM TMZ on glioma treatment. The combined additive antiangiogenesis effect suggests that RG3 has the potential to further increase the efficacy of LDM TMZ in the treatment of glioblastoma. Electronic supplementary material The online version of this article (doi:10.1186/s13046-015-0274-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Caixing Sun
- Department of Neurosurgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, 310022, China.
| | - Yang Yu
- Department of Neurosurgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, 310022, China.
| | - Lizhen Wang
- Department of Neurosurgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, 310022, China.
| | - Bin Wu
- Department of Neurosurgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, 310022, China.
| | - Liang Xia
- Department of Neurosurgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, 310022, China.
| | - Fang Feng
- Department of Neurosurgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, 310022, China.
| | - Zhiqiang Ling
- Zhejiang Cancer Research Institute, Zhejiang Cancer Hospital, 38 Guangji Road, Hangzhou, Zhejiang, 310022, China.
| | - Shihua Wang
- Department of Cancer Biology, Wake Forest School of Medicine, Medical Center Boulevard, NC, 27157, USA.
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Piludu F, Marzi S, Pace A, Villani V, Fabi A, Carapella CM, Terrenato I, Antenucci A, Vidiri A. Early biomarkers from dynamic contrast-enhanced magnetic resonance imaging to predict the response to antiangiogenic therapy in high-grade gliomas. Neuroradiology 2015; 57:1269-80. [PMID: 26364181 DOI: 10.1007/s00234-015-1582-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 08/14/2015] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The aim of this study is to investigate whether early changes in tumor volume and perfusion measurements derived from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) may predict response to antiangiogenic therapy in recurrent high-grade gliomas. METHODS Twenty-seven patients who received bevacizumab every 3 weeks were enrolled in the study. For each patient, three MRI scans were performed: at baseline, after the first dose, and after the fourth dose of bevacizumab. The entire tumor volume (V(tot)), as well as contrast-enhanced and noncontrast-enhanced tumor subvolumes (V(CE-T1) and V(NON-CE-T1), respectively) were outlined using post-contrast T1-weighted images as a guide for the tumor location. Histogram analysis of normalized IAUGC (nIAUGC) and transfer constant K(trans) maps were performed. Each patient was classified as a responder patient if he/she had a partial response or a stable disease or as a nonresponder patient if he/she had progressive disease. RESULTS Responding patients showed a larger reduction in V(NON-CE-T1) after a single dose, compared to nonresponding patients. Tumor subvolumes with increased values of nIAUGC and K(trans), after a single dose, significantly differed between responders and nonresponders. The radiological response was found to be significantly associated to the clinical outcome. After a single dose, V(tot) was predictive of overall survival (OS), while V(CE-T1) showed a tendency of correlation with OS. CONCLUSION Tumor subvolumes with increased nIAUGC and K(trans) showed the potential for improving the diagnostic accuracy of DCE. Early assessments of the entire tumor volume, including necrotic areas, may provide complementary information of tumor behavior in response to anti-VEGF therapies and is worth further investigation.
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Affiliation(s)
- Francesca Piludu
- Radiology and Diagnostic Imaging Department, Regina Elena National Cancer Institute, Rome, Italy
| | - Simona Marzi
- Medical Physics Laboratory, Regina Elena National Cancer Institute, Via Elio Chianesi 53, Rome, 00144, Italy.
| | - Andrea Pace
- Neurology Division, Regina Elena National Cancer Institute, Rome, Italy
| | - Veronica Villani
- Neurology Division, Regina Elena National Cancer Institute, Rome, Italy
| | - Alessandra Fabi
- Oncology Department, Regina Elena National Cancer Institute, Rome, Italy
| | | | - Irene Terrenato
- Biostatistics-Scientific Direction, Regina Elena National Cancer Institute, Rome, Italy
| | - Anna Antenucci
- Clinical Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Antonello Vidiri
- Radiology and Diagnostic Imaging Department, Regina Elena National Cancer Institute, Rome, Italy
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Radbruch A, Hattingen E. [Towards more precision in the therapy of brain tumors. Possibilities and limits of MRI]. Nervenarzt 2015; 86:701-2, 704-9. [PMID: 26017379 DOI: 10.1007/s00115-015-4313-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Due to the introduction of advanced functional and spectroscopic magnetic resonance (MR) sequences, MR imaging has gained significant importance in neuro-oncology. In contrast to recent years when neuro-oncological imaging was mostly limited to contrast-enhanced T1-weighted images, advanced MR methods provide direct visualization and assessment of tumor pathophysiology. This article summarizes the most relevant MR methods for neuro-oncological imaging and highlights the pathophysiological background as well as potential clinical applications. Ultimately, this article gives a glimpse into the future and introduces potential applications of ultra-high field MRI.
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Sepulveda-Sanchez J, Ramos A, Hilario A, DE Velasco G, Castellano D, Garcia DE LA Torre M, Rodon J, Lahn MF. Brain perfusion and permeability in patients with advanced, refractory glioblastoma treated with lomustine and the transforming growth factor-β receptor I kinase inhibitor LY2157299 monohydrate. Oncol Lett 2015; 9:2442-2448. [PMID: 26137087 DOI: 10.3892/ol.2015.3106] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 03/04/2015] [Indexed: 11/06/2022] Open
Abstract
Transforming growth factor-β (TGF-β) signaling is associated with tumor progression and vascularization in malignant glioma. In the present study, magnetic resonance imaging was used to evaluate changes in the size and vascularity of glioblastomas in 12 patients who were treated with lomustine and the novel inhibitor of TGF-β signaling, LY2157299 monohydrate. A response in tumor size was observed in 2 of the 12 patients; in 1 of these 2 patients, a reduction in vascular permeability and perfusion was also detected. The effect was observed following 4 cycles of treatment (~3 months). Changes in vascularity have not previously been attributed to treatment with lomustine; therefore, the effect may be associated with LY2157299 treatment. LY2157299 does not appear to have an anti-angiogenic effect when combined with lomustine, and hence may have a different mechanism of action profile compared with anti-angiogenic drugs.
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Affiliation(s)
| | - Ana Ramos
- Department of Neuroradiology, University Hospital October 12, Madrid 28041, Spain
| | - Amaya Hilario
- Department of Neuroradiology, University Hospital October 12, Madrid 28041, Spain
| | - Guillermo DE Velasco
- Department of Medical Oncology, University Hospital October 12, Madrid 28041, Spain
| | - Daniel Castellano
- Department of Medical Oncology, University Hospital October 12, Madrid 28041, Spain
| | | | - Jordi Rodon
- Department of Medical Oncology, Vall d'Hebron University Hospital and The Autonomous University of Barcelona, Barcelona 08999, Spain
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Lu-Emerson C, Duda DG, Emblem KE, Taylor JW, Gerstner ER, Loeffler JS, Batchelor TT, Jain RK. Lessons from anti-vascular endothelial growth factor and anti-vascular endothelial growth factor receptor trials in patients with glioblastoma. J Clin Oncol 2015; 33:1197-213. [PMID: 25713439 PMCID: PMC4517055 DOI: 10.1200/jco.2014.55.9575] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Treatment of glioblastoma (GBM), the most common primary malignant brain tumor in adults, remains a significant unmet need in oncology. Historically, cytotoxic treatments provided little durable benefit, and tumors recurred within several months. This has spurred a substantial research effort to establish more effective therapies for both newly diagnosed and recurrent GBM. In this context, antiangiogenic therapy emerged as a promising treatment strategy because GBMs are highly vascular tumors. In particular, GBMs overexpress vascular endothelial growth factor (VEGF), a proangiogenic cytokine. Indeed, many studies have demonstrated promising radiographic response rates, delayed tumor progression, and a relatively safe profile for anti-VEGF agents. However, randomized phase III trials conducted to date have failed to show an overall survival benefit for antiangiogenic agents alone or in combination with chemoradiotherapy. These results indicate that antiangiogenic agents may not be beneficial in unselected populations of patients with GBM. Unfortunately, biomarker development has lagged behind in the process of drug development, and no validated biomarker exists for patient stratification. However, hypothesis-generating data from phase II trials that reveal an association between increased perfusion and/or oxygenation (ie, consequences of vascular normalization) and survival suggest that early imaging biomarkers could help identify the subset of patients who most likely will benefit from anti-VEGF agents. In this article, we discuss the lessons learned from the trials conducted to date and how we could potentially use recent advances in GBM biology and imaging to improve outcomes of patients with GBM who receive antiangiogenic therapy.
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Affiliation(s)
- Christine Lu-Emerson
- All authors, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA
| | - Dan G Duda
- All authors, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA
| | - Kyrre E Emblem
- All authors, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA
| | - Jennie W Taylor
- All authors, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA
| | - Elizabeth R Gerstner
- All authors, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA
| | - Jay S Loeffler
- All authors, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA
| | - Tracy T Batchelor
- All authors, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA
| | - Rakesh K Jain
- All authors, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA.
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Stadlbauer A, Pichler P, Karl M, Brandner S, Lerch C, Renner B, Heinz G. Quantification of serial changes in cerebral blood volume and metabolism in patients with recurrent glioblastoma undergoing antiangiogenic therapy. Eur J Radiol 2015; 84:1128-36. [PMID: 25795194 DOI: 10.1016/j.ejrad.2015.02.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 02/04/2015] [Accepted: 02/22/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To evaluate the usefulness of quantitative advanced magnetic resonance imaging (MRI) methods for assessment of antiangiogenic therapy (AAT) response in recurrent glioblastoma multiforme (GBM). METHODS Eighteen patients with recurrent GBM received bevacizumab and 18 patients served as control group. Baseline MRI and two follow-up examinations were acquired every 3-5 months using dynamic susceptibility-weighted contrast (DSC) perfusion MRI and (1)H-MR spectroscopic imaging ((1)H-MRSI). Maps of absolute cerebral blood volume (aCBV) were coregistered with choline (Cho) and N-acetyl-aspartate (NAA) concentrations and compared to usually used relative parameters as well as controls. RESULTS Perfusion significantly decreased in responding and pseudoresponding GBMs but also in normal appearing brain after AAT onset. Cho and NAA concentrations were superior to Cr-ratios in lesion differentiation and showed a clear gap between responding and pseudoresponding lesions. Responders to AAT exceptionally frequently (6 out of 8 patients) showed remote GBM progression. CONCLUSIONS Quantification of CBV reveals changes in normal brain perfusion due to AAT, which were not described so far. DSC perfusion MRI seems not to be suitable for differentiation between response and pseudoresponse to AAT. However, absolute quantification of brain metabolites may allow for distinction due to a clear gap at 6-9 months after therapy onset.
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Affiliation(s)
- Andreas Stadlbauer
- Institute of Medical Radiology, University Clinic of St. Pölten, Propst Führer-Straße 4, A-3100 St. Pölten, Austria; Department of Neurosurgery, University of Erlangen-Nuremberg, Schwabachanlage 6, D-91054 Erlangen, Germany; Department of Radiology and Nuclear Medicine, Medical University Vienna, Währinger Gürtel 18-20, A-1097 Vienna, Austria.
| | - Petra Pichler
- First Department of Internal Medicine, University Clinic of St. Pölten, Propst Führer-Straße 4, A-3100 St. Poelten, Austria
| | - Marianne Karl
- Institute of Medical Radiology, University Clinic of St. Pölten, Propst Führer-Straße 4, A-3100 St. Pölten, Austria
| | - Sebastian Brandner
- Department of Neurosurgery, University of Erlangen-Nuremberg, Schwabachanlage 6, D-91054 Erlangen, Germany
| | - Claudia Lerch
- Institute of Medical Radiology, University Clinic of St. Pölten, Propst Führer-Straße 4, A-3100 St. Pölten, Austria
| | - Bertold Renner
- Institute of Experimental and Clinical Pharmacology and Toxicology, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Gertraud Heinz
- Institute of Medical Radiology, University Clinic of St. Pölten, Propst Führer-Straße 4, A-3100 St. Pölten, Austria
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Fack F, Espedal H, Keunen O, Golebiewska A, Obad N, Harter PN, Mittelbronn M, Bähr O, Weyerbrock A, Stuhr L, Miletic H, Sakariassen PØ, Stieber D, Rygh CB, Lund-Johansen M, Zheng L, Gottlieb E, Niclou SP, Bjerkvig R. Bevacizumab treatment induces metabolic adaptation toward anaerobic metabolism in glioblastomas. Acta Neuropathol 2015; 129:115-31. [PMID: 25322816 PMCID: PMC4282692 DOI: 10.1007/s00401-014-1352-5] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 09/30/2014] [Accepted: 10/01/2014] [Indexed: 10/29/2022]
Abstract
Anti-angiogenic therapy in glioblastoma (GBM) has unfortunately not led to the anticipated improvement in patient prognosis. We here describe how human GBM adapts to bevacizumab treatment at the metabolic level. By performing (13)C6-glucose metabolic flux analysis, we show for the first time that the tumors undergo metabolic re-programming toward anaerobic metabolism, thereby uncoupling glycolysis from oxidative phosphorylation. Following treatment, an increased influx of (13)C6-glucose was observed into the tumors, concomitant to increased lactate levels and a reduction of metabolites associated with the tricarboxylic acid cycle. This was confirmed by increased expression of glycolytic enzymes including pyruvate dehydrogenase kinase in the treated tumors. Interestingly, L-glutamine levels were also reduced. These results were further confirmed by the assessment of in vivo metabolic data obtained by magnetic resonance spectroscopy and positron emission tomography. Moreover, bevacizumab led to a depletion in glutathione levels indicating that the treatment caused oxidative stress in the tumors. Confirming the metabolic flux results, immunohistochemical analysis showed an up-regulation of lactate dehydrogenase in the bevacizumab-treated tumor core as well as in single tumor cells infiltrating the brain, which may explain the increased invasion observed after bevacizumab treatment. These observations were further validated in a panel of eight human GBM patients in which paired biopsy samples were obtained before and after bevacizumab treatment. Importantly, we show that the GBM adaptation to bevacizumab therapy is not mediated by clonal selection mechanisms, but represents an adaptive response to therapy.
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Affiliation(s)
- Fred Fack
- NorLux Neuro-Oncology Laboratory, Department of Oncology, Centre de Recherche Public de la Santé, Strassen, Luxembourg
| | - Heidi Espedal
- NorLux Neuro-Oncology, Department of Biomedicine, University of Bergen, Jonas Lies vei 91, 5019 Bergen, Norway
| | - Olivier Keunen
- NorLux Neuro-Oncology Laboratory, Department of Oncology, Centre de Recherche Public de la Santé, Strassen, Luxembourg
| | - Anna Golebiewska
- NorLux Neuro-Oncology Laboratory, Department of Oncology, Centre de Recherche Public de la Santé, Strassen, Luxembourg
| | - Nina Obad
- NorLux Neuro-Oncology, Department of Biomedicine, University of Bergen, Jonas Lies vei 91, 5019 Bergen, Norway
| | - Patrick N. Harter
- Edinger Institute, Institute of Neurology, Goethe University, Hospital Frankfurt, Frankfurt am Main, Germany
| | - Michel Mittelbronn
- Edinger Institute, Institute of Neurology, Goethe University, Hospital Frankfurt, Frankfurt am Main, Germany
| | - Oliver Bähr
- Dr. Senckenberg Institute of Neurooncology, Goethe University, Hospital Frankfurt, Frankfurt am Main, Germany
| | - Astrid Weyerbrock
- Department of Neurosurgery, University Hospital Freiburg, Freiburg, Germany
| | - Linda Stuhr
- Matrix Biology Group, Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Hrvoje Miletic
- NorLux Neuro-Oncology, Department of Biomedicine, University of Bergen, Jonas Lies vei 91, 5019 Bergen, Norway
- Department of Pathology, Haukeland University Hospital, The Gade Institute, Bergen, Norway
- KG Jebsen Brain Tumour Research Center, University of Bergen, Bergen, Norway
| | - Per Ø. Sakariassen
- NorLux Neuro-Oncology, Department of Biomedicine, University of Bergen, Jonas Lies vei 91, 5019 Bergen, Norway
| | - Daniel Stieber
- NorLux Neuro-Oncology Laboratory, Department of Oncology, Centre de Recherche Public de la Santé, Strassen, Luxembourg
| | - Cecilie B. Rygh
- Department of Biomedicine, Molecular Imaging Center, University of Bergen, Bergen, Norway
| | - Morten Lund-Johansen
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
- KG Jebsen Brain Tumour Research Center, University of Bergen, Bergen, Norway
| | - Liang Zheng
- Cancer Research UK, Beatson Institute, Glasgow, Scotland, UK
| | - Eyal Gottlieb
- Cancer Research UK, Beatson Institute, Glasgow, Scotland, UK
| | - Simone P. Niclou
- NorLux Neuro-Oncology Laboratory, Department of Oncology, Centre de Recherche Public de la Santé, Strassen, Luxembourg
- KG Jebsen Brain Tumour Research Center, University of Bergen, Bergen, Norway
| | - Rolf Bjerkvig
- NorLux Neuro-Oncology Laboratory, Department of Oncology, Centre de Recherche Public de la Santé, Strassen, Luxembourg
- NorLux Neuro-Oncology, Department of Biomedicine, University of Bergen, Jonas Lies vei 91, 5019 Bergen, Norway
- KG Jebsen Brain Tumour Research Center, University of Bergen, Bergen, Norway
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Hutterer M, Hattingen E, Palm C, Proescholdt MA, Hau P. Current standards and new concepts in MRI and PET response assessment of antiangiogenic therapies in high-grade glioma patients. Neuro Oncol 2014; 17:784-800. [PMID: 25543124 DOI: 10.1093/neuonc/nou322] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 10/30/2014] [Indexed: 12/20/2022] Open
Abstract
Despite multimodal treatment, the prognosis of high-grade gliomas is grim. As tumor growth is critically dependent on new blood vessel formation, antiangiogenic treatment approaches offer an innovative treatment strategy. Bevacizumab, a humanized monoclonal antibody, has been in the spotlight of antiangiogenic approaches for several years. Currently, MRI including contrast-enhanced T1-weighted and T2/fluid-attenuated inversion recovery (FLAIR) images is routinely used to evaluate antiangiogenic treatment response (Response Assessment in Neuro-Oncology criteria). However, by restoring the blood-brain barrier, bevacizumab may reduce T1 contrast enhancement and T2/FLAIR hyperintensity, thereby obscuring the imaging-based detection of progression. The aim of this review is to highlight the recent role of imaging biomarkers from MR and PET imaging on measurement of disease progression and treatment effectiveness in antiangiogenic therapies. Based on the reviewed studies, multimodal imaging combining standard MRI with new physiological MRI techniques and metabolic PET imaging, in particular amino acid tracers, may have the ability to detect antiangiogenic drug susceptibility or resistance prior to morphological changes. As advances occur in the development of therapies that target specific biochemical or molecular pathways and alter tumor physiology in potentially predictable ways, the validation of physiological and metabolic imaging biomarkers will become increasingly important in the near future.
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Affiliation(s)
- Markus Hutterer
- Department of Neurology and Wilhelm-Sander Neuro-Oncology Unit, University Hospital and Medical School, Regensburg, Germany (M.H., P.H.); Neuroradiology, Department of Radiology, University Hospital Bonn, Bonn, Germany (E.H.); Regensburg Medical Image Computing, Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany (C.P.); Department of Neurosurgery, University Hospital and Medical School, Regensburg, Germany (M.P.)
| | - Elke Hattingen
- Department of Neurology and Wilhelm-Sander Neuro-Oncology Unit, University Hospital and Medical School, Regensburg, Germany (M.H., P.H.); Neuroradiology, Department of Radiology, University Hospital Bonn, Bonn, Germany (E.H.); Regensburg Medical Image Computing, Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany (C.P.); Department of Neurosurgery, University Hospital and Medical School, Regensburg, Germany (M.P.)
| | - Christoph Palm
- Department of Neurology and Wilhelm-Sander Neuro-Oncology Unit, University Hospital and Medical School, Regensburg, Germany (M.H., P.H.); Neuroradiology, Department of Radiology, University Hospital Bonn, Bonn, Germany (E.H.); Regensburg Medical Image Computing, Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany (C.P.); Department of Neurosurgery, University Hospital and Medical School, Regensburg, Germany (M.P.)
| | - Martin Andreas Proescholdt
- Department of Neurology and Wilhelm-Sander Neuro-Oncology Unit, University Hospital and Medical School, Regensburg, Germany (M.H., P.H.); Neuroradiology, Department of Radiology, University Hospital Bonn, Bonn, Germany (E.H.); Regensburg Medical Image Computing, Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany (C.P.); Department of Neurosurgery, University Hospital and Medical School, Regensburg, Germany (M.P.)
| | - Peter Hau
- Department of Neurology and Wilhelm-Sander Neuro-Oncology Unit, University Hospital and Medical School, Regensburg, Germany (M.H., P.H.); Neuroradiology, Department of Radiology, University Hospital Bonn, Bonn, Germany (E.H.); Regensburg Medical Image Computing, Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany (C.P.); Department of Neurosurgery, University Hospital and Medical School, Regensburg, Germany (M.P.)
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Kim JI, Lee HJ, Kim YJ, Kim KG, Lee KW, Lee JH, Lee HJ, Lee WW. Multiparametric monitoring of early response to antiangiogenic therapy: a sequential perfusion CT and PET/CT study in a rabbit VX2 tumor model. ScientificWorldJournal 2014; 2014:701954. [PMID: 25383376 DOI: 10.1155/2014/701954] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 08/19/2014] [Accepted: 09/01/2014] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES To perform dual analysis of tumor perfusion and glucose metabolism using perfusion CT and FDG-PET/CT for the purpose of monitoring the early response to bevacizumab therapy in rabbit VX2 tumor models and to assess added value of FDG-PET to perfusion CT. METHODS Twenty-four VX2 carcinoma tumors implanted in bilateral back muscles of 12 rabbits were evaluated. Serial concurrent perfusion CT and FDG-PET/CT were performed before and 3, 7, and 14 days after bevacizumab therapy (treatment group) or saline infusion (control group). Perfusion CT was analyzed to calculate blood flow (BF), blood volume (BV), and permeability surface area product (PS); FDG-PET was analyzed to calculate SUVmax, SUVmean, total lesion glycolysis (TLG), entropy, and homogeneity. The flow-metabolic ratio (FMR) was also calculated and immunohistochemical analysis of microvessel density (MVD) was performed. RESULTS On day 14, BF and BV in the treatment group were significantly lower than in the control group. There were no significant differences in all FDG-PET-derived parameters between both groups. In the treatment group, FMR prominently decreased after therapy and was positively correlated with MVD. CONCLUSIONS In VX2 tumors, FMR could provide further insight into the early antiangiogenic effect reflecting a mismatch in intratumor blood flow and metabolism.
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Trevisan E, Bertero L, Bosa C, Magistrello M, Pellerino A, Rudà R, Soffietti R. Antiangiogenic therapy of brain tumors: the role of bevacizumab. Neurol Sci 2014; 35:507-14. [DOI: 10.1007/s10072-014-1627-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 01/03/2014] [Indexed: 12/18/2022]
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