Isabelle Catalaa

Survival analysis in patients with glioblastoma multiforme: Predictive value of choline-to-n-acetylaspartate index, apparent diffusion coefficient, and relative cerebral blood volume

To investigate the potential value of pre‐external‐beam radiation therapy (XRT) choline‐to‐NAA (N‐acetylaspartate) index (CNI), apparent diffusion coefficient (ADC), and relative cerebral blood volume (rCBV) for predicting survival in newly diagnosed patients with glioblastoma multiforme (GBM).

PROTON MAGNETIC RESONANCE SPECTROSCOPIC IMAGING IN NEWLY DIAGNOSED GLIOBLASTOMA : PREDICTIVE VALUE FOR THE SITE OF POSTRADIOTHERAPY RELAPSE IN A PROSPECTIVE LONGITUDINAL STUDY

PURPOSE To investigate the association between magnetic resonance spectroscopic imaging (MRSI)-defined, metabolically abnormal tumor regions and subsequent sites of relapse in data from patients treated with radiotherapy (RT) in a prospective clinical trial. METHODS AND MATERIALS Twenty-three examinations were performed prospectively for 9 patients with newly diagnosed glioblastoma multiforme studied in a Phase I trial combining Tipifarnib and RT. The patients underwent magnetic resonance imaging (MRI) and MRSI before treatment and every 2 months until relapse. The MRSI data were categorized by the choline (Cho)/N-acetyl-aspartate (NAA) ratio (CNR) as a measure of spectroscopic abnormality. CNRs corresponding to T1 and T2 MRI for 1,207 voxels were evaluated before RT and at recurrence. RESULTS Before treatment, areas of CNR2 (CNR > or =2) represented 25% of the contrast-enhancing (T1CE) regions and 10% of abnormal T2 regions outside T1CE (HyperT2). The presence of CNR2 was often an early indicator of the site of relapse after therapy. In fact, 75% of the voxels within the T1CE+CNR2 before therapy continued to exhibit CNR2 at relapse, compared with 22% of the voxels within the T1CE with normal CNR (p < 0.05). The location of new contrast enhancement with CNR2 corresponded in 80% of the initial HyperT2+CNR2 vs. 20.7% of the HyperT2 voxels with normal CNR (p < 0.05). CONCLUSION Metabolically active regions represented a small percentage of pretreatment MRI abnormalities and were predictive for the site of post-RT relapse. The incorporation of MRSI data in the definition of RT target volumes for selective boosting may be a promising avenue leading to increased local control of glioblastomas.

OC-0615: Voxel-based perfusion normalisation in GBM patients included in a phase I-II trial of RT/Tipifarnib combination

2.7%, p= 0.041). In the Capox-RT group, 85.7% (191/223) patients received radiotherapy on schedule and 74.9% (166/223) with concurrent chemotherapy on schedule, as did 94.1% (238/253) and 92.1% (233/353) in the Cap-RT group, respectively. Grade 3-4 acute toxicity was observed in 38.1% of patients in the Capox-RT group and in 29.2% in the Cap-RT group (p = 0.041). Grade 3–4 tenesmus was more common in the Capox-RT group than in the Cap-RT group (5.4% vs. 2.0%), as were grade 3–4 nausea (2.2% vs. 0%), grade 3–4 vomiting (1.8% vs. 0%), and grade 3–4 fatigue (3.1% vs. 0.4%). Conclusions: The interim analysis revealed that inclusion of oxaliplatin into capecitabine based postoperative chemoradiotherapy was feasible and could decrease cumulative locoregional recurrence rate for patients with locally advanced rectal cancer.

Glioma di alto grado: astrocitoma anaplastico e glioblastoma

Gli astrocitomi anaplastici e i glioblastomi rappresentano i tumori maligni primitivi piu frequenti e piu aggressivi del sistema nervoso centrale. Essi colpiscono dei pazienti giovani e la loro prognosi, anche se notevolmente migliorata negli ultimi anni, resta drammatica. Il loro trattamento costituisce una sfida fondamentale per la neuro-oncologia. Sul piano della diagnostica per immagini, la risonanza magnetica (RM) morfologica resta lo standard attuale per la diagnosi e il follow-up di questi tumori. Tuttavia, numerosissimi studi insistono sull’apporto della diagnostica per immagini multimodale (sequenza di perfusione, di diffusione in RM e spettroscopia RM in particolare) per migliorare il nostro approccio diagnostico e la valutazione terapeutica. D’altronde, importanti progressi sono stati realizzati negli ultimi anni in biologia molecolare, permettendo di affinare la diagnosi e di individuare degli indicatori prognostici. Anche sul piano terapeutico, sono stati osservati importanti progressi, sia a livello delle tecniche chirurgiche che a livello di quelle mediche, che permettono di migliorare la mediana di sopravvivenza, la qualita della vita e le capacita funzionali di questi pazienti. Il trattamento postoperatorio di prima linea si basa sull’associazione chemioterapia-radioterapia nella maggioranza dei casi. Il trattamento di seconda linea e meno ben codificato: tuttavia, numerosi studi hanno dimostrato l’apporto del bevacizumab in questa indicazione. Peraltro, nuove molecole e/o strategie terapeutiche sono attualmente in corso di valutazione, permettendo di sperare in un miglioramento della prognosi e della qualita della vita in futuro.