Department of Radiation Oncology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, 42 Baiziting Road, Nanjing, Jiangsu Province, China.
Department of Radiology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, 42 Baiziting Road, Nanjing, Jiangsu Province, China.
Biomed Res Int. 2020 Aug 10;2020:8718097. doi: 10.1155/2020/8718097. eCollection 2020.
The tumor volume of high-grade glioma (HGG) after surgery is usually determined by contrast-enhanced MRI (CE-MRI), but the clinical target volume remains controversial. Functional magnetic resonance imaging (multimodality MRI) techniques such as magnetic resonance perfusion-weighted imaging (PWI) and diffusion-tensor imaging (DTI) can make up for CE-MRI. This study explored the survival outcomes and failure patterns of patients with HGG by comparing the combination of multimodality MRI and CE-MRI imaging with CE-MRI alone.
102 patients with postoperative HGG between 2012 and 2016 were included. 50 were delineated based on multimodality MRI (PWI, DTI) and CE-MRI (enhanced T1), and the other 52 were delineated based on CE-MRI as control.
The median survival benefit was 6 months. The 2-year overall survival, progression-free survival, and local-regional control rates were 48% vs. 25%, 42% vs. 13.46%, and 40% vs. 13.46% for the multimodality MRI and CE-MRI cohorts, respectively. The two cohorts had similar rates of disease progression and recurrence but different proportions of failure patterns. The univariate analysis shows that characteristics of patients such as combined with epilepsy, the dose of radiotherapy, the selection of MRI were significant influence factors for 2-year overall survival. However, in multivariate analyses, only the selection of MRI was an independent significant predictor of overall survival.
This study was the first to explore the clinical value of multimodality MRI in the delineation of radiotherapy target volume for HGG. The conclusions of the study have positive reference significance to the combination of multimodality MRI and CE-MRI in guiding the delineation of the radiotherapy target area for HGG patients.
高级别胶质瘤（HGG）术后肿瘤体积通常由对比增强磁共振成像（CE-MRI）确定，但临床靶区仍存在争议。磁共振灌注加权成像（PWI）和弥散张量成像（DTI）等功能磁共振成像（多模态 MRI）技术可以弥补 CE-MRI 的不足。本研究通过比较多模态 MRI（PWI、DTI）与 CE-MRI 联合和 CE-MRI 单独对 HGG 患者的生存结果和失败模式，探讨了多模态 MRI 在 HGG 患者放疗靶区勾画中的应用价值。
纳入 2012 年至 2016 年间术后 HGG 患者 102 例。50 例基于多模态 MRI（PWI、DTI）和 CE-MRI（增强 T1）勾画靶区，另 52 例基于 CE-MRI 勾画靶区作为对照。
中位生存获益为 6 个月。多模态 MRI 和 CE-MRI 组的 2 年总生存率、无进展生存率和局部区域控制率分别为 48%和 25%、42%和 13.46%、40%和 13.46%。两组疾病进展和复发率相似，但失败模式比例不同。单因素分析显示，患者的特征如合并癫痫、放疗剂量、MRI 选择等均为 2 年总生存率的显著影响因素。然而，多因素分析显示，仅 MRI 选择是总生存率的独立显著预测因素。
本研究首次探讨了多模态 MRI 在 HGG 放疗靶区勾画中的临床价值。该研究结论对多模态 MRI 与 CE-MRI 联合在指导 HGG 患者放疗靶区勾画方面具有积极的参考意义。
