TY - JOUR
T1 - Imaging After GliaSite Brachytherapy
T2 - Prognostic MRI Indicators of Disease Control and Recurrence
AU - Kleinberg, Lawrence
AU - Yoon, Geoffrey
AU - Weingart, John D.
AU - Parisi, Michele
AU - Olivi, Alessandro
AU - Detorie, Nicholas A.
AU - Chan, Timothy A.
N1 - Copyright:
Copyright 2010 Elsevier B.V., All rights reserved.
PY - 2009/12/1
Y1 - 2009/12/1
N2 - Purpose: In this study, we analyzed the magnetic resonance imaging (MRI) changes in patients after GliaSite treatment and characterized the prognostic MRI indicators in these patients. Methods and Materials: A total of 25 patients with recurrent glioblastoma multiforme were treated with the GliaSite Radiation Therapy System. Patients at the Johns Hopkins Hospital with recurrent glioblastoma multiforme underwent surgical resection followed by GliaSite balloon implantation. Available MRI scans for 20 patients were obtained throughout the post-GliaSite treatment course. These were reviewed and analyzed for prognostic significance. Results: After GliaSite treatment, all patients developed some degree of T1-weighted contrast and T2-weighted hyperintensity around the resection cavity. The development of enhancement on T1-weighted contrast-enhanced imaging and the size of these lesions, in the absence of increasing T2-weighted hyperintensity, before clinical progression was not associated with decreased survival. Patients with T1-weighted enhancement >1 cm had a median survival of 13.6 months and those with T1-weighted lesions ≤1 cm had a median survival of 8.5 months (p = .014). In contrast, the development of larger areas of T2-weighted hyperintensity surrounding the resection cavity was significantly associated with poorer survival (p = .027). Conclusion: After GliaSite treatment, characteristic T1- and T2-weighted changes are seen on MRI. Greater T1-weighted changes in the absence of increasing edema appears not to indicate disease progression; however, greater T2-weighted changes were associated with decreased survival. These findings suggest that T1-weighted enhancement in the absence of concomitant edema after GliaSite treatment might represent pseudoprogression. Conversely, increasing T2-weighted hyperintensity might reflect infiltrative disease progression. These results provide a framework for the analysis of disease control in future prospective studies of GliaSite treatment.
AB - Purpose: In this study, we analyzed the magnetic resonance imaging (MRI) changes in patients after GliaSite treatment and characterized the prognostic MRI indicators in these patients. Methods and Materials: A total of 25 patients with recurrent glioblastoma multiforme were treated with the GliaSite Radiation Therapy System. Patients at the Johns Hopkins Hospital with recurrent glioblastoma multiforme underwent surgical resection followed by GliaSite balloon implantation. Available MRI scans for 20 patients were obtained throughout the post-GliaSite treatment course. These were reviewed and analyzed for prognostic significance. Results: After GliaSite treatment, all patients developed some degree of T1-weighted contrast and T2-weighted hyperintensity around the resection cavity. The development of enhancement on T1-weighted contrast-enhanced imaging and the size of these lesions, in the absence of increasing T2-weighted hyperintensity, before clinical progression was not associated with decreased survival. Patients with T1-weighted enhancement >1 cm had a median survival of 13.6 months and those with T1-weighted lesions ≤1 cm had a median survival of 8.5 months (p = .014). In contrast, the development of larger areas of T2-weighted hyperintensity surrounding the resection cavity was significantly associated with poorer survival (p = .027). Conclusion: After GliaSite treatment, characteristic T1- and T2-weighted changes are seen on MRI. Greater T1-weighted changes in the absence of increasing edema appears not to indicate disease progression; however, greater T2-weighted changes were associated with decreased survival. These findings suggest that T1-weighted enhancement in the absence of concomitant edema after GliaSite treatment might represent pseudoprogression. Conversely, increasing T2-weighted hyperintensity might reflect infiltrative disease progression. These results provide a framework for the analysis of disease control in future prospective studies of GliaSite treatment.
KW - Brachytherapy
KW - GliaSite
KW - Glioblastoma multiforme
KW - Imaging
KW - Recurrent glioma
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U2 - 10.1016/j.ijrobp.2008.12.074
DO - 10.1016/j.ijrobp.2008.12.074
M3 - Article
C2 - 19394153
AN - SCOPUS:71649086308
SN - 0360-3016
VL - 75
SP - 1385
EP - 1391
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
IS - 5
ER -