MRI as a central component of clinical trials analysis in brainstem glioma: A report from the Pediatric Brain Tumor Consortium (PBTC)

Tina Young Poussaint, Mehmet Kocak, Sridhar Vajapeyam, Roger I. Packer, Richard L. Robertson, Russell Geyer, Daphne Haas-Kogan, Ian F. Pollack, Gilbert Vezina, Robert Zimmerman, Soonmee Cha, Zoltan Patay, James M. Boyett, Larry E. Kun

Research output: Contribution to journalArticle

59 Scopus citations

Abstract

We report MRI findings from 2 pediatric clinical trials of diffuse intrinsic brainstem glioma (BSG) incorporating concurrent radiation therapy (RT) with molecularly targeted agents (gefitinib and tipifarnib). We determined associations of MRI variables with progression-free survival and overall survival and investigated effects of treatment on these variables. MRI (including diffusion and perfusion) was done before treatment, every 8 weeks (first year), every 12 weeks (thereafter), and at the end of treatment or disease progression. Reduced tumor volume (P < .0001) and tumor diffusion values (P<.0001) were apparent on the first post-RT/drug studies. Decreases in tumor volume correlated with pre-RT volume (P < .0001) and pre-RT diffusion values (P < .0001); larger decreases were noted for tumors with higher volumes and diffusion values. Patients with larger pre-RT tumors had longer progression-free survival (P < .0001). Patients with ≥25% decrease in tumor volume and diffusion values after RT had longer progression-free survival (P - .028) and overall survival (P - .0009). Enhancement at baseline and over time was significantly associated with shorter survival. Tumor diffusion values with baseline enhancement were significantly lower than those without (P - .0002). RT of BSG is associated with decreased tumor volume and intralesional diffusion values; patients with ≥25% decrease in values post-RT had relatively longer survival intervals, apparently providing an early imaging-based surrogate for relative outcomes. Patients with larger tumors and greater decreases in tumor volume and diffusion values had longer survival intervals. Tumor enhancement was associated with shorter survival, lower tumor diffusion values (increased cellularity), and a smaller drop in diffusion values after RT (P - .006). These associations justify continued investigation in other large clinical trials of brainstem glioma patients.

Original languageEnglish (US)
Pages (from-to)417-427
Number of pages11
JournalNeuro-oncology
Volume13
Issue number4
DOIs
StatePublished - Apr 2011

Keywords

  • Brain tumor
  • Brainstem glioma
  • MRI
  • Pediatric
  • Radiation

ASJC Scopus subject areas

  • Oncology
  • Clinical Neurology
  • Cancer Research

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    Poussaint, T. Y., Kocak, M., Vajapeyam, S., Packer, R. I., Robertson, R. L., Geyer, R., Haas-Kogan, D., Pollack, I. F., Vezina, G., Zimmerman, R., Cha, S., Patay, Z., Boyett, J. M., & Kun, L. E. (2011). MRI as a central component of clinical trials analysis in brainstem glioma: A report from the Pediatric Brain Tumor Consortium (PBTC). Neuro-oncology, 13(4), 417-427. https://doi.org/10.1093/neuonc/noq200