多参数 MRI 用于免疫检查点抑制剂治疗复发性胶质母细胞瘤的早期疗效评估。
Multiparametric MRI for early identification of therapeutic response in recurrent glioblastoma treated with immune checkpoint inhibitors.
机构信息
Icahn School of Medicine at Mount Sinai, Department of Radiology (Neuroimaging Advanced and Exploratory Lab), New York, New York.
Department of Neurology, Medicine (Div Hem Onc), The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
出版信息
Neuro Oncol. 2020 Nov 26;22(11):1658-1666. doi: 10.1093/neuonc/noaa066.
BACKGROUND
Physiologic changes quantified by diffusion and perfusion MRI have shown utility in predicting treatment response in glioblastoma (GBM) patients treated with cytotoxic therapies. We aimed to investigate whether quantitative changes in diffusion and perfusion after treatment by immune checkpoint inhibitors (ICIs) would determine 6-month progression-free survival (PFS6) in patients with recurrent GBM.
METHODS
Inclusion criteria for this retrospective study were: (i) diagnosis of recurrent GBM treated with ICIs and (ii) availability of diffusion and perfusion in pre and post ICI MRI (iii) at ≥6 months follow-up from treatment. After co-registration, mean values of the relative apparent diffusion coefficient (rADC), Ktrans (volume transfer constant), Ve (extravascular extracellular space volume) and Vp (plasma volume), and relative cerebral blood volume (rCBV) were calculated from a volume-of-interest of the enhancing tumor. Final assignment of stable/improved versus progressive disease was determined on 6-month follow-up using modified Response Assessment in Neuro-Oncology criteria.
RESULTS
Out of 19 patients who met inclusion criteria and follow-up (mean ± SD: 7.8 ± 1.4 mo), 12 were determined to have tumor progression, while 7 had treatment response after 6 months of ICI treatment. Only interval change of rADC was suggestive of treatment response. Patients with treatment response (6/7: 86%) had interval increased rADC, while 11/12 (92%) with tumor progression had decreased rADC (P = 0.001). Interval change in rCBV, Ktrans, Vp, and Ve were not indicative of treatment response within 6 months.
CONCLUSIONS
In patients with recurrent GBM, interval change in rADC is promising in assessing treatment response versus progression within the first 6 months following ICI treatment.
KEY POINTS
• In recurrent GBM treated with ICIs, interval change in rADC suggests early treatment response.• Interval change in rADC can be used as an imaging biomarker to determine PFS6.• Interval change in MR perfusion and permeability measures do not suggest ICI treatment response.
背景
扩散和灌注 MRI 量化的生理学变化已被证明可用于预测接受细胞毒性治疗的胶质母细胞瘤（GBM）患者的治疗反应。我们旨在研究免疫检查点抑制剂（ICI）治疗后扩散和灌注的定量变化是否会确定复发性 GBM 患者的 6 个月无进展生存期（PFS6）。
方法
本回顾性研究的纳入标准为：（i）诊断为复发性 GBM，接受 ICI 治疗，（ii）ICI 前后 MRI 存在扩散和灌注（iii）治疗后随访时间≥6 个月。在配准后，从增强肿瘤的感兴趣区计算相对表观扩散系数（rADC）、Ktrans（容积转移常数）、Ve（血管外细胞外空间容积）和 Vp（血浆容积）以及相对脑血容量（rCBV）的平均值。根据改良神经肿瘤学反应评估标准，在 6 个月的随访时最终确定稳定/改善与进展性疾病的分配。
结果
在符合纳入标准和随访条件的 19 名患者中（平均±标准差：7.8±1.4 个月），有 12 名患者被确定为肿瘤进展，而有 7 名患者在 ICI 治疗后 6 个月有治疗反应。只有 rADC 的间隔变化提示治疗反应。有治疗反应的患者（6/7：86%）的 rADC 间隔增加，而肿瘤进展的患者（11/12：92%）的 rADC 间隔减少（P=0.001）。rCBV、Ktrans、Vp 和 Ve 的间隔变化在 6 个月内不能提示治疗反应。
结论
在接受 ICI 治疗的复发性 GBM 患者中，rADC 的间隔变化在评估 ICI 治疗后前 6 个月内的治疗反应与进展方面具有前景。
关键要点
在接受 ICI 治疗的复发性 GBM 中，rADC 的间隔变化提示早期治疗反应。
rADC 的间隔变化可用作预测 6 个月无进展生存期的影像学生物标志物。
MR 灌注和渗透性测量的间隔变化不能提示 ICI 治疗反应。
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