Division of Radiation Oncology, University of Alberta, Edmonton, Canada.
Division of Medical Physics, University of Alberta, Edmonton, Canada.
Anticancer Res. 2022 May;42(5):2665-2673. doi: 10.21873/anticanres.15744.
The purpose of this study was to evaluate the association of specific threshold values for changes in metabolic metrics measured from 1H magnetic resonance spectroscopic imaging (MRSI) to survival of patients with high-grade glioma treated with multimodality therapy.
Forty-four patients with newly diagnosed high-grade glioma were prospectively enrolled. Serial MRI and MRSI scans provided measures of tumor choline, creatine, and N-acetylaspartate (NAA). Cox regression analyses adjusted for patient age, KPS, and delivery of concurrent chemotherapy were used to assess the association of changes in metabolic metrics with survival.
Median follow-up time for patients at risk was 13.4 years. Overall survival (OS) was longer in patients with ≤20% increase (vs. >20%) in normalized choline (p=0.024) or choline/NAA (p=0.024) from baseline to week 4 of RT. During this period, progression-free survival (PFS) was longer in patients with ≤40% increase (vs. >40%) in normalized choline (p=0.013). Changes in normalized creatine, choline/creatine, and NAA/creatine from baseline to mid-RT were not associated with OS. From baseline to post-RT, changes in metabolic metrics were not associated with OS or PFS.
Threshold values for serial changes in choline metrics on mid-RT MRSI associated with OS and PFS were identified. Metabolic metrics at post-RT did not predict for these survival endpoints. These findings suggest a potential clinical role for MRSI to provide an early assessment of treatment response and could enable risk-adapted therapy in clinical trial development and clinical practice.
本研究旨在评估从 1H 磁共振波谱成像（MRSI）测量的代谢指标变化的特定阈值与接受多模态治疗的高级别胶质瘤患者生存的相关性。
前瞻性纳入 44 例新诊断的高级别胶质瘤患者。连续 MRI 和 MRSI 扫描提供了肿瘤胆碱、肌酸和 N-乙酰天冬氨酸（NAA）的测量值。Cox 回归分析调整了患者年龄、KPS 和同期化疗的实施，用于评估代谢指标变化与生存的相关性。
有风险的患者中位随访时间为 13.4 年。与基线至 RT 第 4 周时的正常化胆碱（p=0.024）或胆碱/NAA（p=0.024）增加≤20%的患者相比，总生存期（OS）更长。在此期间，正常化胆碱增加≤40%（p=0.013）的患者无进展生存期（PFS）更长。从基线到中程 RT，正常化肌酸、胆碱/肌酸和 NAA/肌酸的变化与 OS 无关。从基线到 RT 后，代谢指标的变化与 OS 或 PFS 无关。
确定了与 OS 和 PFS 相关的中程 RT MRSI 上连续变化的胆碱指标的阈值值。RT 后代谢指标与这些生存终点无关。这些发现表明 MRSI 有可能用于提供治疗反应的早期评估，并能够在临床试验开发和临床实践中实现风险适应性治疗。
