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Prospective serial proton MR spectroscopic assessment of response to tamoxifen for recurrent malignant glioma
Prospective serial proton MR spectroscopic assessment of response to tamoxifen for recurrent malignant glioma
- Source :
- Journal of Neuro-Oncology. 90:63-76
- Publication Year :
- 2008
- Publisher :
- Springer Science and Business Media LLC, 2008.
-
Abstract
- Objective Early prediction of imminent failure during chemotherapy for malignant glioma has the potential to guide proactive alterations in treatment before frank tumor progression. We prospectively followed patients with recurrent malignant glioma receiving tamoxifen chemotherapy using proton magnetic resonance spectroscopic imaging (1H-MRSI) to identify intratumoral metabolic changes preceding clinical and radiological failure. Methods We performed serial 1H-MRSI examinations to assess intratumoral metabolite intensities in 16 patients receiving high-dose oral tamoxifen monotherapy for recurrent malignant glioma (WHO grade III or IV) as part of a phase II clinical trial. Patients were followed until treatment failure, death, or trial termination. Results Patients were officially classified as responders (7 patients) or non-responders (9 patients) 8 weeks into treatment. At 8 weeks, responders and non-responders had different intratumoral intensities across all measured metabolites except choline. Beyond 8 weeks, metabolite intensities remained stable in all responders, but changed again with approaching disease progression. Choline, lipid, choline/NAA, and lactate/NAA were significantly elevated (P < 0.02), while creatine (P < 0.04) was significantly reduced, compared to stabilized levels on average 4 weeks prior to failure. Lactate was significantly elevated (P = 0.036) fully 8 weeks prior to failure. In one patient who was still responding to tamoxifen at the conclusion of the trial, metabolite intensities never deviated from 8-week levels for the duration of follow-up. Conclusions Characteristic global intratumoral metabolic changes, detectable on serial 1H-MRSI studies, occur in response to chemotherapy for malignant glioma and may predict imminent treatment failure before actual clinical and radiological disease progression.
- Subjects :
- Adult
Male
Cancer Research
medicine.medical_specialty
Pathology
Magnetic Resonance Spectroscopy
Antineoplastic Agents, Hormonal
medicine.medical_treatment
Urology
Creatine
Choline
chemistry.chemical_compound
Glioma
medicine
Humans
Lactic Acid
Aged
Aspartic Acid
Chemotherapy
medicine.diagnostic_test
Brain Neoplasms
business.industry
Magnetic resonance imaging
Middle Aged
medicine.disease
Clinical trial
Tamoxifen
Neurology
Oncology
chemistry
Tumor progression
Disease Progression
Female
Neurology (clinical)
Protons
business
medicine.drug
Subjects
Details
- ISSN :
- 15737373 and 0167594X
- Volume :
- 90
- Database :
- OpenAIRE
- Journal :
- Journal of Neuro-Oncology
- Accession number :
- edsair.doi.dedup.....677325b6b0a1fde0eda479150fd6f589
- Full Text :
- https://doi.org/10.1007/s11060-008-9632-3