Early magnetic resonance imaging biomarkers to predict local control after high dose stereotactic body radiotherapy for patients with sarcoma spine metastases

Daniel E. Spratt, Julio Arevalo-Perez, Jonathan E. Leeman, Naamit K. Gerber, Michael Folkert, Neil K. Taunk, Kaled M. Alektiar, Sasan Karimi, John K. Lyo, William D. Tap, Mark H. Bilsky, Ilya Laufer, Yoshiya Yamada, Joseph R. Osborne

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background Context: Recent advances in image guidance and stereotactic body radiotherapy (SBRT) have resulted in unprecedented local control for spinal metastases of all histologies. However, little is known about early imaging biomarkers of local control. Purpose: This study aimed to identify early magnetic resonance imaging (MRI) biomarkers to predict local control after SBRT for patients with sarcoma spine metastases. Study Design/Setting: This study used a retrospective case series at a large tertiary cancer center. Patient Sample: From 2011 to 2014, 9 consecutive patients with 12 metastatic sarcoma lesions to the spine were treated with SBRT and underwent evaluation with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) both pre- and post-SBRT. Outcome Measure: Changes in perfusion metrics, including the wash-in rate constant (Ktrans), plasma volume (Vp), composite multiparametric magnetic resonance imaging (mpMRI) score, bi-dimensional tumor size, and a graded response assessment were performed and correlated to local control. Methods: All measurements were independent and blinded by two neuroradiologists. R2 statistics were performed to document correlation, and two-tailed t tests were used to compare groups. p2=0.84). The mpMRI score had 100% accuracy in predicting local control at time of last follow-up. There was no apparent correlation with size changes compared with the mpMRI score change post-SBRT (R2=0.026). Conclusions: We report the first analysis on the utility of DCE-MRI for metastatic sarcoma spine metastases treated with SBRT. We demonstrate that early assessment at 2 months post-SBRT using size and subjective neuroradiology impressions is insufficient to judge ultimate disease progression, and that a combination of perfusion parameters provides excellent correlation to local control.

Original languageEnglish (US)
JournalSpine Journal
DOIs
StateAccepted/In press - Feb 19 2015

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Radiosurgery
Sarcoma
Spine
Biomarkers
Magnetic Resonance Imaging
Neoplasm Metastasis
Perfusion
Plasma Volume
Disease Progression
Neoplasms
Histology
Outcome Assessment (Health Care)

Keywords

  • Imaging
  • Metastases
  • MRI
  • Radiotherapy
  • Sarcoma
  • Spine
  • Stereotactic radiotherapy

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Early magnetic resonance imaging biomarkers to predict local control after high dose stereotactic body radiotherapy for patients with sarcoma spine metastases. / Spratt, Daniel E.; Arevalo-Perez, Julio; Leeman, Jonathan E.; Gerber, Naamit K.; Folkert, Michael; Taunk, Neil K.; Alektiar, Kaled M.; Karimi, Sasan; Lyo, John K.; Tap, William D.; Bilsky, Mark H.; Laufer, Ilya; Yamada, Yoshiya; Osborne, Joseph R.

In: Spine Journal, 19.02.2015.

Research output: Contribution to journalArticle

Spratt, DE, Arevalo-Perez, J, Leeman, JE, Gerber, NK, Folkert, M, Taunk, NK, Alektiar, KM, Karimi, S, Lyo, JK, Tap, WD, Bilsky, MH, Laufer, I, Yamada, Y & Osborne, JR 2015, 'Early magnetic resonance imaging biomarkers to predict local control after high dose stereotactic body radiotherapy for patients with sarcoma spine metastases', Spine Journal. https://doi.org/10.1016/j.spinee.2015.08.041
Spratt, Daniel E. ; Arevalo-Perez, Julio ; Leeman, Jonathan E. ; Gerber, Naamit K. ; Folkert, Michael ; Taunk, Neil K. ; Alektiar, Kaled M. ; Karimi, Sasan ; Lyo, John K. ; Tap, William D. ; Bilsky, Mark H. ; Laufer, Ilya ; Yamada, Yoshiya ; Osborne, Joseph R. / Early magnetic resonance imaging biomarkers to predict local control after high dose stereotactic body radiotherapy for patients with sarcoma spine metastases. In: Spine Journal. 2015.
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abstract = "Background Context: Recent advances in image guidance and stereotactic body radiotherapy (SBRT) have resulted in unprecedented local control for spinal metastases of all histologies. However, little is known about early imaging biomarkers of local control. Purpose: This study aimed to identify early magnetic resonance imaging (MRI) biomarkers to predict local control after SBRT for patients with sarcoma spine metastases. Study Design/Setting: This study used a retrospective case series at a large tertiary cancer center. Patient Sample: From 2011 to 2014, 9 consecutive patients with 12 metastatic sarcoma lesions to the spine were treated with SBRT and underwent evaluation with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) both pre- and post-SBRT. Outcome Measure: Changes in perfusion metrics, including the wash-in rate constant (Ktrans), plasma volume (Vp), composite multiparametric magnetic resonance imaging (mpMRI) score, bi-dimensional tumor size, and a graded response assessment were performed and correlated to local control. Methods: All measurements were independent and blinded by two neuroradiologists. R2 statistics were performed to document correlation, and two-tailed t tests were used to compare groups. p2=0.84). The mpMRI score had 100{\%} accuracy in predicting local control at time of last follow-up. There was no apparent correlation with size changes compared with the mpMRI score change post-SBRT (R2=0.026). Conclusions: We report the first analysis on the utility of DCE-MRI for metastatic sarcoma spine metastases treated with SBRT. We demonstrate that early assessment at 2 months post-SBRT using size and subjective neuroradiology impressions is insufficient to judge ultimate disease progression, and that a combination of perfusion parameters provides excellent correlation to local control.",
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AU - Spratt, Daniel E.

AU - Arevalo-Perez, Julio

AU - Leeman, Jonathan E.

AU - Gerber, Naamit K.

AU - Folkert, Michael

AU - Taunk, Neil K.

AU - Alektiar, Kaled M.

AU - Karimi, Sasan

AU - Lyo, John K.

AU - Tap, William D.

AU - Bilsky, Mark H.

AU - Laufer, Ilya

AU - Yamada, Yoshiya

AU - Osborne, Joseph R.

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Y1 - 2015/2/19

N2 - Background Context: Recent advances in image guidance and stereotactic body radiotherapy (SBRT) have resulted in unprecedented local control for spinal metastases of all histologies. However, little is known about early imaging biomarkers of local control. Purpose: This study aimed to identify early magnetic resonance imaging (MRI) biomarkers to predict local control after SBRT for patients with sarcoma spine metastases. Study Design/Setting: This study used a retrospective case series at a large tertiary cancer center. Patient Sample: From 2011 to 2014, 9 consecutive patients with 12 metastatic sarcoma lesions to the spine were treated with SBRT and underwent evaluation with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) both pre- and post-SBRT. Outcome Measure: Changes in perfusion metrics, including the wash-in rate constant (Ktrans), plasma volume (Vp), composite multiparametric magnetic resonance imaging (mpMRI) score, bi-dimensional tumor size, and a graded response assessment were performed and correlated to local control. Methods: All measurements were independent and blinded by two neuroradiologists. R2 statistics were performed to document correlation, and two-tailed t tests were used to compare groups. p2=0.84). The mpMRI score had 100% accuracy in predicting local control at time of last follow-up. There was no apparent correlation with size changes compared with the mpMRI score change post-SBRT (R2=0.026). Conclusions: We report the first analysis on the utility of DCE-MRI for metastatic sarcoma spine metastases treated with SBRT. We demonstrate that early assessment at 2 months post-SBRT using size and subjective neuroradiology impressions is insufficient to judge ultimate disease progression, and that a combination of perfusion parameters provides excellent correlation to local control.

AB - Background Context: Recent advances in image guidance and stereotactic body radiotherapy (SBRT) have resulted in unprecedented local control for spinal metastases of all histologies. However, little is known about early imaging biomarkers of local control. Purpose: This study aimed to identify early magnetic resonance imaging (MRI) biomarkers to predict local control after SBRT for patients with sarcoma spine metastases. Study Design/Setting: This study used a retrospective case series at a large tertiary cancer center. Patient Sample: From 2011 to 2014, 9 consecutive patients with 12 metastatic sarcoma lesions to the spine were treated with SBRT and underwent evaluation with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) both pre- and post-SBRT. Outcome Measure: Changes in perfusion metrics, including the wash-in rate constant (Ktrans), plasma volume (Vp), composite multiparametric magnetic resonance imaging (mpMRI) score, bi-dimensional tumor size, and a graded response assessment were performed and correlated to local control. Methods: All measurements were independent and blinded by two neuroradiologists. R2 statistics were performed to document correlation, and two-tailed t tests were used to compare groups. p2=0.84). The mpMRI score had 100% accuracy in predicting local control at time of last follow-up. There was no apparent correlation with size changes compared with the mpMRI score change post-SBRT (R2=0.026). Conclusions: We report the first analysis on the utility of DCE-MRI for metastatic sarcoma spine metastases treated with SBRT. We demonstrate that early assessment at 2 months post-SBRT using size and subjective neuroradiology impressions is insufficient to judge ultimate disease progression, and that a combination of perfusion parameters provides excellent correlation to local control.

KW - Imaging

KW - Metastases

KW - MRI

KW - Radiotherapy

KW - Sarcoma

KW - Spine

KW - Stereotactic radiotherapy

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