The DWMRI/MRS Glioma Imaging Protocol Faculty Research Meeting

The DWMRI/MRS Glioma Imaging Protocol Faculty Research Meeting

The DWMRI/MRS Glioma Imaging Protocol Faculty Research Meeting 6/23/08 Lars Ewell University of Arizona Medical Center Department of Radiation Oncology The DWMRI/MRS Glioma Imaging Protocol I. II. Introduction Radiation Induced Necrosis/Disease III. Imaging Protocol

IV. Initial Data V. Conclusion 2 The DWMRI/MRS Glioma Imaging Protocol: Introduction Designed to study whether or not Diffusion Weighted MRI and Magnetic Resonance Spectroscopy (MRS) can differentiate between radiation necrosis and recurrent disease. Enrolled first patient 3/23/07. See http://www.u.arizona.edu/~lewell/protocol/index.html 3 DWMRI/MRS Protocol: Enrollment Criteria Patients eligible to enroll if they have a

reasonable risk of suffering from RIN. Published data1 indicate that patients receiving a dose of 60Gy in 30 Fx have between a 5 and 24% chance of developing RIN. 1) Kumar et al., Malignant Gliomas: MR Imaging Spectrum of Radiation Therapy and Chemotherapy Induced Necrosis of the Brain After Treatment, Radiology, 217, 2, November 2000. 4 Imaging Protocol: Enrollment Criteria Biological Equivalent Dose (BED) used to determine enrollment criteria for hypofractionation and SRS. d / BED = nd(1 +

) with n the number of fractions, d the dose, and the linear quadratic constants. 5 x 6Gy required for hypo fractionation, 21Gy for SRS. 5 Imaging Protocol: Enrollment Criteria Radiation Type Number of Fractions Minimum Radiation (Gy) SRS

1 21 Hypo-fraction 5 30 Normal Fraction 30 60

Re-treatment varies varies 6 Imaging Protocol: Scan Data Three MRS slices, one cm/slice: One centered on lesion, one superior and one inferior. Voxel size ~ 4cc. Set of three diffrad DWMRI scans with b-values: 0, 520 and 850 s/mm2. Set of two echo planar DWMRI scans with b-values: 0, 1000 s/mm2. Scan time approximately < one hour.

7 Total Enrollment Protocol Enrollment 16.00 14.00 12.00 10.00 8.00 6.00 4.00 2.00 0.00 1/18/07 4/28/07

8/6/07 11/14/07 Enrollment Date 2/22/08 6/1/08 Protocol Patient Events Characteristic Deceased Withdrew One Scan Two Scans

Three Scans Four Scans Biopsy Number of Patients 7 3 16 9 3 2 1

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