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

• Type of Material: Article
• Authors: Anuradha G Trivedi, Emory University; Su Hyun Kim, Emory University; Karthik K Ramesh, Emory University; Alexander S Giuffrida, Emory University; Brent Weinberg, Emory University; Eric A Mellon, University of Miami; Lawrence R Kleinberg, Johns Hopkins University; Peter B Barker, Johns Hopkins University; Hui Han, Cedars Sinai Med Ctr; Hui-Kuo Shu, Emory University; Hyunsuk Shim, Emory University; Eduard Schreibmann, Emory University
• Language: English
• Date: 2023-06-01
• Publisher: MDPI
• Publication Version: Final Published Version
• Copyright Statement: © 2023 by the authors.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3390/tomography9030086
• Title of Journal or Parent Work: TOMOGRAPHY
• Volume: 9
• Issue: 3
• Start Page: 1052
• End Page: 1061
• Grant/Funding Information: This research was funded by NIH U01 CA264039 (E.A.M. and H.S.), NIH F31 CA247564 (K.K.R.), and NIH R01 NS121544 (H.H.).
• Keywords: Life Sciences & Biomedicine; glioblastoma; ADJUVANT TEMOZOLOMIDE; TRIAL; RADIOTHERAPY; Radiology, Nuclear Medicine & Medical Imaging; DISTRIBUTIONS; adaptive radiation therapy planning; spectroscopic MRI; SURVIVAL; Science & Technology; CONCOMITANT; survival biomarkers
• Research Categories: Engineering, Biomedical; Health Sciences, Oncology; Health Sciences, Radiology

Abstract

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