The response to treatment of high-grade glioma (HGG) in adult patients appears clearer when using advanced neuroimaging MRI, researchers say in a study published in the American Journal of Roentgenology (AJR), compared to results from conventional MRI.
High-grade gliomas (HGG) are primary malignant brain tumors with poor prognosis, with a 1-year relative survival of 42.9% and a 5-year relative survival of 6.9%. Neuroimaging is used to noninvasively monitor treatment response in patients with HGG in the absence of a validated molecular biomarker for this purpose.
Advanced neuroimaging techniques to assess treatment response in high-grade glioma
Given the limited capacity of conventional MRI systems to distinguish progression from treatment effects, new imaging criteria improve the reliability of the modality for tumor assessment, including neuro-oncology response assessment 2.0 or brain tumor data reporting systems.
Advanced neuroimaging techniques have also been used to facilitate the differentiation of tumor progression from treatment effects, such as perfusion MRI for the identification of structurally aberrant blood vessels as well as increased cerebral blood volume, flow, and capillary permeability, or MR spectroscopy to distinguish treatment response by detecting local metabolic signatures.
US researchers launch study to compare exploration of treatment response by conventional MRI and advanced MRI neuroimaging
The diagnostic accuracy of these advanced neuroimaging techniques for the assessment of brain tumors after treatment is well established. However, their impact on clinical decision-making in neuro-oncology remains understudied while advanced neuroimaging is increasingly integrated into routine HGG follow-up protocols, despite being costly, increasing acquisition time, and requiring specialized expertise from MERMs and neuroradiologists.
A study published in the American Journal of Roentgenology (AJR) aims to evaluate the impact of advanced MRI-based neuroimaging on clinical decision-making in patients with HGG post-treatment. “The impact of advanced neuroimaging techniques on clinical decisions supports their incorporation into imaging protocols for treatment monitoring in adult patients with HGG,” said corresponding author Melissa M. Chen, MD, Department of Neuroradiology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Undersized support plans compared to results obtained by advanced MRI neuroimaging
Conducted at the Brain and Spine Institute of a cancer center from March 1, 2017 to October 31, 2020, this prospective study included adult patients treated with chemotherapy and radiotherapy for grade 4 diffuse glioma who underwent advanced MRI neuroimaging (in particular perfusion and spectroscopy) to compare them with the results of conventional MRI regarding tumor progression in relation to the effect of treatment.
Prescribing neuro-oncologists completed surveys before and after each advanced neuroimaging session. The percentage of episodes of care with a change between the intended and actual management plan in surveys conducted before and after advanced neuroimaging, respectively, was calculated and compared to a previously published percentage using independently sampled proportions.
The results of this work show that neuro-oncologists’ intended and actual management plans before and after advanced neuroimaging, respectively, differed in 44% (31/70) of episodes of care for patients with HGG and equivocal post-treatment findings on conventional MRI. Neuro-oncologists found advanced neuroimaging to be helpful in 93% (65/70) of episodes.
Paolo Royan
