Imaging After GliaSite Brachytherapy: Prognostic MRI Indicators of Disease Control and Recurrence

Lawrence Kleinberg, Geoffrey Yoon, John D. Weingart, Michele Parisi, Alessandro Olivi, Nicholas A. Detorie, Timothy A. Chan

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1385-1391
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume75
Issue number5
DOIs
StatePublished - Dec 1 2009

Keywords

  • Brachytherapy
  • GliaSite
  • Glioblastoma multiforme
  • Imaging
  • Recurrent glioma

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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