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Magnetic resonance spectroscopy imaging in radiotherapy planning for recurrent gliomaa)
a)This study was presented in part at the 49th Annual Meeting of the American Society of Therapeutic Radiology and Oncology, Los Angeles, October 28-November 1, 2007.
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10.1118/1.3574884
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    Affiliations:
    1 Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York 10021
    2 Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021
    3 Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York 10021
    4 Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021
    5 Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York 10021
    6 Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021
    7 Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021
    8 Department of Neurology, Memorial Sloan-Kettering Cancer Center and The Brain Tumor Center, New York, New York 10021
    9 Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center and The Brain Tumor Center, New York, New York 10021
    10 Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York 10021
    b) Dr. Lauren E. Abrey and Dr. Philip A. Gutin received research support and consultation fees from Genentech.
    c) Author to whom correspondence should be addressed. Electronic mail: ballanga@mskcc.org
    d) Current address: New York University, New York, NY.
    e) Current address: Oregon Health and Science University, Portland, OR.
    f) Current address: New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY.
    Med. Phys. 38, 2724 (2011); http://dx.doi.org/10.1118/1.3574884
/content/aapm/journal/medphys/38/5/10.1118/1.3574884
http://aip.metastore.ingenta.com/content/aapm/journal/medphys/38/5/10.1118/1.3574884

Figures

Image of FIG. 1.
FIG. 1.

MRSI voxels overlaid contrast enhanced T1-weighted MRI for patient 4 acquired (a) before the first cycle of bevacizumab. MRSI voxels with EMR were marked by the radiologist (). (b) Target definitions on an axial slice overlaid contrast enhanced T1-weighted MRI acquired before starting bevacizumab. The GTV (dark pink) is defined by the contrast enhancement on the CT and the pre- and post-T1-weighted MRI. MRSIpre (pink) and MRSIpost (green) are outline of MRSI voxels with EMR as determined from the pre- and post-MRSI. CTV (orange) is the CTV used for radiation treatment planning while “CTV per protocol” (purple) is the intended clinical target volume if no size limitation of the final treatment volume was considered.

Image of FIG. 2.
FIG. 2.

Target volumes shown for all patients. The GTV, treatment CTV, and treatment PTV are the actual volumes used for HFSRT. Combined MRSI pre & post is the total volume of the MRSI voxels with EMR from the scans acquired before and after the first cycle of bevacizumab. Protocol CTV is given by GTV plus 5 mm margin plus all MRSI voxels with EMR.

Image of FIG. 3.
FIG. 3.

Percent increase in CTV if all MRSI voxels with elevated metabolite ratios were included in the CTV.

Tables

Generic image for table
TABLE I.

Maximum dose to critical structures from previous and current radiation treatment plans.

Generic image for table
TABLE II.

Volume of MRSI voxels with EMR before (MRSIpre) and after (MRSIpos t) the first cycle of bevacizumab and GTV determined as the composite of the contrast enhancement on T1-weighted MRI before and after bevacizumab and the planning CT. GTVpos t is the contrast enhancement on T1-weighted MRI after bevacizumab. The GTVpos t volume was inside the GTV for all patients. The volume of MRSI voxels pre- and postbevacizumab outside the GTV + 5 mm (= CTV if no voxels showed EMR) are shown in the last two columns. Patients 8–12 had no MRSI voxels with EMR.

Generic image for table
TABLE III.

Pathology, 6-month PFS and OS for all 12 patients. Patients 1–7 had MRSI voxels with EMR, while patients 8–12 did not have any MRSI voxels with EMR on either of the MRSI scans.

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/content/aapm/journal/medphys/38/5/10.1118/1.3574884
2011-05-09
2014-04-25
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752b84549af89a08dbdd7fdb8b9568b5 journal.articlezxybnytfddd
Scitation: Magnetic resonance spectroscopy imaging in radiotherapy planning for recurrent gliomaa)
http://aip.metastore.ingenta.com/content/aapm/journal/medphys/38/5/10.1118/1.3574884
10.1118/1.3574884
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