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Use of magnetic resonance spectroscopy (MRS) in malignant gliomas treated with temozolomide (TMZ) MRS may increase sensitivity of traditional MRI techniques for detecting tumor progression or response and our observations of tumor response by MRI suggest that multi-voxel MRS is crucial to evaluating response for inhomogeneous tumors (such as oligodendrogliomas).


Posted on: 05/26/2002

Use of magnetic resonance spectroscopy (MRS) in malignant gliomas treated with temozolomide (TMZ)

Susan Pannullo, D. C Shungu, R. L DeLaPaz, M. Odaimi, J. Serventi, L. Heller, C. M Balmaceda, Staten Island University Hospital, New York, NY; Columbia Presbyterian Medcl Ctr, New York, NY; Integrated Therapeutics, Kenilworth, NJ.

Background: Clinicians generally continue chemotherapy for patients demonstrating complete response, partial response, or stable disease on MRI; those with progressive disease are usually removed from most protocols. Thus, early detection of tumor response is crucial. We speculate MRS may be complementary to MRI in detecting tumor progression and response. Our objective was to evaluate the use of MRS, structural MRI, and clinical assessment in patients with recurrent malignant gliomas treated with TMZ.

Methods: In a multi-institutional trial, patients received an oral bolus of TMZ 200 mg/m2 followed by 9 doses of 90 mg/m2 every 12 hours, repeated every 28 days. Response by MRI and MRS was determined by a blinded neuro-radiologist; clinical response was assessed by a blinded neuro-oncologist.

Results: Three patients were studied (1 with glioblastoma multiforme/2 with anaplastic oligodendroglioma (AO); average age 44 years (39-50)). One patient showed progressive disease on MRI while the MRS and patient„Ss clinical condition suggested response. Another patient showed MRS changes suggestive of progression 2 months prior to progressive disease on MRI and the clinician„Ss impression of clinical decline. MRS in 1 patient with AO revealed improvement of some regions of interest with respect to tumor markers while the MRI remained stable.

Conclusions: Our observations of these few patients with gliomas suggest that MRS has a complementary role to MRI in determining response to chemotherapy. MRS may increase sensitivity of traditional MRI techniques for detecting tumor progression or response. Additionally, our observations of tumor response by MRI suggest that multi-voxel MRS is crucial to evaluating response for inhomogeneous tumors (such as oligodendrogliomas). These findings warrant validation in MRS studies of patients treated with chemotherapy-only protocols.

Source: ASCO 2002 Annual Conference
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