Evaluation of Physiologic-Based Mr Markers That Predict Clinical Outcome in Patients with High-Grade Gliomas Treated with Gliadel Wafer

  • Toh, Cheng-Hong (PI)
  • Wei, Kuo-Chen Cheng (CoPI)

Project: National Science and Technology CouncilNational Science and Technology Council Academic Grants

Project Details

Abstract

High-grade gliomas are the most common and lethal brain tumors in adults. Despite advances in the surgical and adjuvant treatment of malignant astrocytoma over the past few decades, median survival remains < 15 months. Local interstitial chemotherapy with implantation of gradual-release carmustine (BCNU) wafers (Gliadel Wafer) into surgical resection cavity circumvents the obstacle of the blood-brain barrier, depositing a high dose of BCNU directly into the affected region of the brain over 3 to 4 weeks. Even though implantation of Gliadel wafers has been reported to extend the median survival for patients with newly diagnosed and recurrent malignant astrocytoma, there is considerable heterogeneity in outcome between different patients receiving Gliadel wafers treatment, with a wide range of survival times. Unfortunately, there are no established clinical or radiological criteria for baseline risk stratification, early treatment response assessment and outcome prediction in patients treated with Gliadel wafers implantation. In this 3-year prospective study, we will use both preoperative and serial postoperative physiologic-based MRI including diffusion-tensor imaging (DTI), dynamic susceptibility contrast-enhanced perfusion-weighted imaging (DSC-PWI) and MR spectroscopy (MRS) to evaluate patients with high-grade gliomas treated with Gliadel wafers implantation. We will correlate the imaging findings with radiographic response at 6 months after the start of treatment, overall survival and time-to-progression in patients receiving Gliadel wafer implantation. We aim to: 1) identify preoperative MR parameters derived from DTI, PWI and MRS that can predict clinical outcome of patients with high-grade gliomas treated with Gliadel wafers implantation, 2) determine whether DTI, PWI and MRS can serve as surrogate markers for therapeutic response assessment and clinical outcome prediction within the first 3 months after Gliadel wafer implantation, 3) select the best time point to perform imaging study and the best imaging modality for therapeutic response assessment and clinical outcome prediction in terms of cost-effectiveness, and 4) determine if functional diffusion map (fDM) can detect changes of the internal characteristics in residual tumor and brain parenchyma surrounding resection cavity within the first 3 months after Gliadel wafer implantation.

Project IDs

Project ID:PC9808-0786
External Project ID:NSC98-2314-B182-064-MY3
StatusFinished
Effective start/end date01/08/0931/07/10

Keywords

  • High-grade glioma
  • Gliadel wafer
  • Magnetic resonance spectroscopy
  • Dynamic susceptibility contrast-enhanced perfusion-weighted imaging
  • diffusion-tensor imaging

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