Characterization of High-Grade Glioma and Solitary Metastasis: An Approach towards Spectroscopy and Advanced Magnetic Resonance Techniques | Chapter 2 | Advancement and New Understanding in Medical Science Vol. 10

 Aim: The purpose of this article is to analyze different advanced MRI parameters and characterize the efficacy of each one of them in the differentiation of these two pathologies.

 

Background: The differentiation by means of magnetic resonance between high-grade gliomas and intracranial solitary single metastasis is of the utmost importance since they condition both surgical and complementary treatment. For decades, different methods have been devised to try to differentiate both, given that the final result of surgery and complementary treatment differs substantially between the two. What's more, knowing the possible diagnosis in advance would improve the prognosis of both pathologies.

 

Methods: Retrospective study that analyzes the parameters of advanced magnetic resonance imaging: spectroscopy, diffusion and perfusion, specifically focused on the differences in the coefficients of the metabolites Cho/Cr, Cho/ NAA and NAA/Cr in peritumoral edema between high-grade gliomas and metastases. The data have been statistically analyzed using ROC (receiver operating characteristic) curves, and cutoff values were obtained.

 

Results: A total of 79 patients with histologically analyzed tumors were analyzed: 49 high-grade gliomas (40 multiform glioblastomas and 9 anaplastic astrocytomas) and 30 metastases. A statistically significant mean difference was obtained in the three metabolite ratios. The area under the curve for the Cho/NAA ratio was 0.958 (CI: 0.903–1), for Cho/Cr 0.922 (CI: 0.859–0.985) and for NAA/Cr 0.163 (CI: 0.068–0.258; p < 0.001). The cutoff values were 1.115 for Cho/NAA (sensitivity 93.87%, specificity 93.33%, global precision 93.67%); 1.18 for the Cho/Cr ratio (sensitivity 89.79%, specificity 93.33% and precision 91.13%) and 1.155 for the NAA/Cr ratio (sensitivity 67.34%, specificity 93.33%, global precision 44.30%).

 

Conclusion:  The results of the study support the premise that spectroscopy at the level of peritumoral edema is able to differentiate between high-grade gliomas and metastases by showing tumor infiltration in peritumoral edema. This difference allows not only tumor diagnosis but also the possibility of performing high-grade glioma surgery guided by spectroscopy to find tumor infiltration in apparently healthy tissue.

Author(s) Details:

Arévalo-Sáenz, Alejandra A.,
San Carlos University Hospital, Madrid, Spain.

Pujante Ferrández, Borja,
San Carlos University Hospital, Madrid, Spain.

Rascón-Ramírez, Fernando J.,
San Carlos University Hospital, Madrid, Spain.

Please see the link here: https://stm.bookpi.org/ANUMS-V10/article/view/13922

Temozolomide and Radiotherapy versus Radiotherapy Alone in High Grade Gliomas: A Very Long Term Comparative Study and Literature Review Up-to-date | Chapter 6 | Innovations in Science and Technology Vol. 6

  The goal of this study is to compare the outcomes of 31 patients who received RT and adjuvant TMZ (group A) from January 1997 to June 1999 versus 33 patients who received RT and concomitant TMZ (group B) from July 1999 to November 2001, as well as to compare the subjects who received both RT and TMZ with the historical group (group C) who received only radiotherapy. The first-line treatment for high-grade gliomas is temozolomide (TMZ). In the treatment of brain gliomas, the combination of TMZ and radiotherapy is more successful than radiotherapy alone. The goal of this study is to compare the survival of glioma patients treated with radiation alone versus radiotherapy plus TMZ over a long period of time (>10 years).

Materials and Methods: From April 1994 to November 2001, we retrospectively analysed the outcomes of 128 consecutive patients diagnosed with high-grade gliomas who were referred to our institutions. The first 64 patients were given RT alone, whereas the remaining 64 were given a combination of RT and adjuvant or concurrent TMZ.

Grade 3 (G3) haematological damage was observed in 6 (9%) of the 64 patients who received RT with TMZ. There was no evidence of G4 haematological harm. Age, histology, and TMZ treatment were all statistically significant prognostic variables for overall survival at 2 years (OS). PFS was 9 months for GBM and 11 months for AA.

Conclusions: In glioma patients, combining RT with TMZ increases long-term survival. Our findings demonstrate the combination's long-term advantage.

Author(s) Details:

Salvatore Parisi,
Unit of Radiation Therapy of IRCCS “Casa Sollievo Della Sofferenza”, 71013 San Giovanni Rotondo, Italy and Radiotherapy Unit, Scientific Institute “Casa Sollievo Della Sofferenza”, Viale Cappuccini, 71013 San Giovanni Rotondo, Italy.


Pietro Corsa,
Unit of Radiation Therapy of IRCCS “Casa Sollievo Della Sofferenza”, 71013 San Giovanni Rotondo, Italy.


Arcangela Raguso,
Unit of Radiation Therapy of IRCCS “Casa Sollievo Della Sofferenza”, 71013 San Giovanni Rotondo, Italy.


Antonio Perrone,
Unit of Radiation Therapy of IRCCS “Casa Sollievo Della Sofferenza”, 71013 San Giovanni Rotondo, Italy.


Sabrina Cossa,
Unit of Radiation Therapy of IRCCS “Casa Sollievo Della Sofferenza”, 71013 San Giovanni Rotondo, Italy.


Tindara Munafò,
Unit of Radiation Therapy of IRCCS “Casa Sollievo Della Sofferenza”, 71013 San Giovanni Rotondo, Italy.


Gerardo Sanpaolo,
Unit of Radiation Therapy of IRCCS “Casa Sollievo Della Sofferenza”, 71013 San Giovanni Rotondo, Italy.


Elisa Donno,
Unit of Radiation Therapy of IRCCS “Casa Sollievo Della Sofferenza”, 71013 San Giovanni Rotondo, Italy.


Maria Antonietta Clemente,
Unit of Radiation Therapy of IRCCS “Casa Sollievo Della Sofferenza”, 71013 San Giovanni Rotondo, Italy.


Michele Piombino,
Unit of Radiation Therapy of Policlinico, 70124 Bari, Italy.


Federico Parisi,
University of Chieti, 66100 Chieti, Italy.


Guido Valle,
Unit of Nuclear Medicine of IRCCS “Casa Sollievo Della Sofferenza”, San Giovanni Rotondo, Italy.

Please see the link here: https://stm.bookpi.org/IST-V6/article/view/6036