Clinical value of magnetic resonance spectroscopy in assessment of early curing impact of concurrent chemoradiotherapy after high-grade glioma surgery

Yu  Gao; Wen-Ming Yan; Hong-Wei  Wang; Xin-Hong  Li; Ru-Tao  Zhang; Yu-Bo  Dong; Wei-Han  Zhang; Qi-Wei  Guo

doi:10.2298/VSP240109041G

Yu Gao The Affiliated Hospital of Inner Mongolia Medical University, Department of Radiotherapy, Hohhot, China
Wen-Ming Yan The Affiliated Hospital of Inner Mongolia Medical University, Department of Radiotherapy, Hohhot, China
Hong-Wei Wang The Affiliated Hospital of Inner Mongolia Medical University, Department of Radiotherapy, Hohhot, China
Xin-Hong Li The Affiliated Hospital of Inner Mongolia Medical University, Department of Radiotherapy, Hohhot, China
Ru-Tao Zhang The Affiliated Hospital of Inner Mongolia Medical University, Department of Radiotherapy, Hohhot, China
Yu-Bo Dong The Affiliated Hospital of Inner Mongolia Medical University, Department of Radiotherapy, Hohhot, China
Wei-Han Zhang The Affiliated Hospital of Inner Mongolia Medical University, Department of Radiotherapy, Hohhot, China
Qi-Wei Guo Togtoh County Hospital, Department of Radiotherapy, Hohhot, China

DOI: https://doi.org/10.2298/VSP240109041G

Keywords: biomarkers;, chemoradiotherapy;, chemotherapy, adjuvant;, glioma;, magnetic resonance spectroscopy;, prognosis;, surgery

Abstract

Background/Aim. High-grade glioma (HGG) is an interstitial cell-derived primary tumor of the nervous system. The current guidelines for the diagnosis and treatment of glioma recommend the maximum safe range of tumor resection for treatment methods. Adjuvant concurrent chemoradiotherapy is recommended after surgery, followed by six cycles of single-drug chemotherapy, temozolomide. Evaluation of the early efficacy of concurrent chemoradiotherapy after HGG surgery, especially for patients with a high risk of recurrence, is a crucial step in enhancing the treatment efficiency for patients diagnosed with HGG. In this study, we investigated the clinical utility of magnetic resonance (MR) spectroscopy (MRS) in assessing the early curing impact of concurrent chemoradiotherapy following HGG surgery. Methods. A total of 50 patients with incomplete resection or suspected residual postoperative HGG, treated in the radiotherapy department of our hospital between January 2016 and June 2021, were selected for routine concurrent chemoradiotherapy. Conventional MR imaging and MRS were performed one week prior to treatment and one month after treatment to assess changes in specific brain metabolites. All 50 patients were followed up for 6 to 12 months. Based on the follow-up results, the patients were divided into two groups: the tumor recurrence group and the tumor suppression group. One month after the end of the treatment, the differences in levels of brain metabolites between the two groups were analyzed using MRS. Results. The levels of N-acetylaspartate (NAA) and creatine (Cr) increased after radiotherapy, while choline (Cho) peak value, and Cho/Cr, NAA/Cr, and Cho/NAA ratios decreased compared to pre-treatment levels. There were statistically significant differences in the NAA peak value, and Cho/Cr, and Cho/NAA ratios in the tumor enhancement area before and after treatment (p < 0.05). There were also statistically significant differences in Cho/Cr ratio in the peritumoral edema area before and after treatment (p < 0.05). Conclusion. After concurrent chemoradiotherapy, MRS can be used to detect early metabolic changes in the tumor enhancement and peritumoral edema areas of HGG.

References

Pandey R, Caflisch L, Lodi A, Brenner AJ, Tiziani S. Metabo-lomic signature of brain cancer. Mol Carcinog 2017; 56(11): 2355–71.

Amin A, Moustafa H, Ahmed E, El-Toukhy M. Glioma residual or recurrence versus radiation necrosis: accuracy of pentava-lent technetium-99m-dimercaptosuccinic acid [Tc-99m (V) DMSA] brain SPECT compared to proton magnetic resonance spectroscopy (1H-MRS): initial results. J Neurooncol 2012; 106(3): 579–87.

Nabors LB, Portnow J, Ahluwalia M, Baehring J, Brem H, Brem S, et al. Central Nervous System Cancers, Version 3.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020; 18(11): 1537–70.

Xu YJ, Cui Y, Li HX, Shi WQ, Li FY, Wang JZ, et al. Nonin-vasive evaluation of radiation-enhanced glioma cells invasive-ness by ultra-high-field (1)H-MRS in vitro. Magn Reson Imag-ing 2016; 34(8): 1121–7.

Lotumolo A, Caivano R, Rabasco P, Iannelli G, Villonio A, D' An-tuono F, et al. Comparison between magnetic resonance spec-troscopy and diffusion weighted imaging in the evaluation of gliomas response after treatment. Eur J Radiol 2015; 84(12): 2597–604.

Wen PY, Macdonald DR, Reardon DA, Cloughesy TF, Sorensen AG, Galanis E, et al. Updated response assessment criteria for high-grade gliomas: response assessment in neuro-oncology working group. J Clin Oncol 2010; 28(11): 1963–72.

Zhang Z, Zeng Q, Liu Y, Li C, Feng D, Wang J. Assessment of the intrinsic radiosensitivity of glioma cells and monitoring of metabolite ratio changes after irradiation by 14.7-T high-resolution ¹H MRS. NMR Biomed 2014; 27(5): 547–52.

Sauwen N, Acou M, Van Cauter S, Sima DM, Veraart J, Maes F, et al. Comparison of unsupervised classification methods for brain tumor segmentation using multi-parametric MRI. Neu-roimage Clin 2016; 12: 753–64.

Anselmi M, Catalucci A, Felli V, Vellucci V, Di Sibio A, Gravina GL, et al. Diagnostic accuracy of proton magnetic resonance spectroscopy and perfusion-weighted imaging in brain gliomas follow-up: a single institutional experience. Neuroradiol J 2017; 30(3): 240–52.

Chuang MT, Liu YS, Tsai YS, Chen YC, Wang CK. Differenti-ating Radiation-Induced Necrosis from Recurrent Brain Tu-mor Using MR Perfusion and Spectroscopy: A Meta-Analysis. PLoS One 2016; 11(1): e0141438.

Crain ID, Elias PS, Chapple K, Scheck AC, Karis JP, Preul MC. Improving the utility of 1H-MRS for the differentiation of glioma recurrence from radiation necrosis. J Neurooncol 2017; 133(1): 97–105.

Thust SC, van den Bent MJ, Smits M. Pseudoprogression of brain tumors. J Magn Reson Imaging 2018; 48(3): 571–89.