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Relationship between apparent diffusion coefficient and survival as a function of distance from gross tumor volume on radiation planning MRI in newly diagnosed glioblastoma

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Abstract

Purpose

To investigate the changes in apparent diffusion coefficient (ADC) within incrementally-increased margins beyond the gross tumor volume (GTV) on post-operative radiation planning MRI and their prognostic utility in glioblastoma.

Methods

Radiation planning MRIs of adult patients with newly diagnosed glioblastoma from 2017 to 2020 were assessed. The ADC values were normalized to contralateral normal white matter (nADC). Using 1 mm isotropic incremental margin increases from the GTV, the nADC values were calculated at each increment. Age, ECOG performance status, extent of resection and MGMT promoter methylation status were obtained from medical records. Using univariate and multivariable Cox regression analysis, association of nADC to progression-free and overall survival (PFS, OS) was assessed at each increment.

Results

Seventy consecutive patients with mean age of 53.6 ± 10.3 years, were evaluated. The MGMT promoter was methylated in 31 (44.3%), unmethylated in 36 (51.6%) and unknown in 3 (4.3%) patients. 11 (16%) underwent biopsy, 41 (44%) subtotal resection and 18 (26%) gross total resection. For each 1 mm increase in distance from GTV, the nADC decreased by 0.16% (p < 0.0001). At 1–5 mm increment, the nADC was associated with OS (p < 0.01). From 6 to 11 mm increment the nADC was associated with OS with the p-value gradually increasing from 0.018 to 0.046. nADC was not associated with PFS.

Conclusion

The nADC values at 1–11 mm increments from the GTV margin were associated with OS. Future prospective multicenter studies are needed to validate the findings and to pave the way for the utilization of ADC for margin reduction in radiation planning.

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Abbreviations

GBM:

Glioblastoma

GTV:

Gross tumor volume

CTV:

Clinical target volume

DWI:

Diffusion-weighted imaging

nADC:

Normalized apparent diffusion coefficient

PFS:

Progression free survival

OS:

Overall survival

ECOG:

Eastern Cooperative Oncology Group

BBB:

Blood-brain barrier

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Authors and Affiliations

  1. Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada

    Pejman Jabehdar Maralani, Shivaprakash Hiremath & Chinthaka Heyn

  2. Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Canada

    James Stewart, Liam Lawrence, Rachel Chan, Angus Lau, Hanbo Chen, Aimee Chan, Liang K. Zeng, Chia-Lin Tseng, Sten Myrehaug, Hany Soliman, Jay Detsky & Arjun Sahgal

  3. Division of Neurology, Department of Medicine, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Canada

    MaryJane Lim Fat

  4. Division of Neurosurgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada

    Nir Lipsman

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Contributions

All authors who appear on the title page contributed to this work in accordance with the authorship guidelines of the journal and: All authors: Made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work; Drafted the work or revised it critically for important intellectual content; Approved the version to be published; and Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Pejman Jabehdar Maralani.

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Jabehdar Maralani, P., Stewart, J., Hiremath, S. et al. Relationship between apparent diffusion coefficient and survival as a function of distance from gross tumor volume on radiation planning MRI in newly diagnosed glioblastoma. J Neurooncol 164, 597–605 (2023). https://doi.org/10.1007/s11060-023-04440-1

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