Additive Value of MR Simulation Prior to Chemoradiation in Evaluating Treatment Response and Pseudoprogression in High-Grade Gliomas

Divya Yadav; Rituraj Upadhyay; Vinodh A Kumar; Melissa M Chen; Jason M Johnson; Holly Langshaw; Brandon J Curl; Maguy Farhat; Wasif Talpur; Thomas H Beckham; Debra N Yeboa; Todd A Swanson; Amol J Ghia; Jing Li; Caroline Chung

doi:10.1016/j.prro.2024.04.009

Additive Value of MR Simulation Prior to Chemoradiation in Evaluating Treatment Response and Pseudoprogression in High-Grade Gliomas

Pract Radiat Oncol. 2024 Apr 27:S1879-8500(24)00089-4. doi: 10.1016/j.prro.2024.04.009. Online ahead of print.

Authors

Affiliations

¹ Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
² Department of Radiation Oncology, James Comprehensive Cancer Hospital, The Ohio State University, Columbus, OH, USA.
³ Department of Radiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
⁴ Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA. Electronic address: cchung3@mdanderson.org.

PMID: 38685448
DOI: 10.1016/j.prro.2024.04.009

Abstract

Background: A dedicated MRI Simulation(MRsim) for radiation treatment(RT) planning in high-grade glioma(HGG) patients can detect early radiological changes, including tumor progression after surgery and before standard of care chemoradiation. This study aimed to determine the impact of using post-op MRI vs. MRsim as the baseline for response assessment and reporting pseudo-progression on follow-up imaging at one month(FU1) after chemoradiation.

Methods: Histologically confirmed HGG patients were planned for six weeks of RT in a prospective study for adaptive RT planning. All patients underwent post-op MRI, MRsim, and follow-up MRI scans every 2-3 months. Tumor response was assessed by three independent blinded reviewers using Response Assessment in Neuro-Oncology(RANO) criteria when baseline was either post-op MRI or MRsim. Interobserver agreement was calculated using light's kappa.

Results: 30 patients (median age 60.5 years; IQR 54.5-66.3) were included. Median interval between surgery and RT was 34 days (IQR 27-41). Response assessment at FU1 differed in 17 patients (57%) when the baseline was post-op MRI vs. MRsim, including true progression vs. partial response(PR) or stable disease(SD) in 11 (37%) and SD vs. PR in 6 (20%) patients. True progression was reported in 19 patients (63.3%) on FU1 when the baseline was post-op MRI vs 8 patients (26.7%) when the baseline was MRsim (p=.004). Pseudo-progression was observed at FU1 in 12 (40%) vs. 4 (13%) patients, when the baseline was post-op MRI vs. MRsim (p=.019). Interobserver agreement between observers was moderate (κ = 0.579; p<0.001).

Conclusions: Our study demonstrates the value of acquiring an updated MR closer to RT in patients with HGG to improve response assessment, and accuracy in evaluation of pseudo-progression even at the early time point of first follow-up after RT. Earlier identification of patients with true progression would enable more timely salvage treatments including potential clinical trial enrolment to improve patient outcomes.