Predictive efficacy of magnetic resonance spectroscopy in patients with glioblastoma multiforme during and after postoperative radiotherapy with concomitant/adjuvant temozolomide / 中华神经医学杂志

ABSTRACT

Objective To explore the predictive ability of magnetic resonance spectroscopy (MRS) in overall survival (OS) and progression-free survival (PFS) of patients with glioblastoma multiforme (GBM) before,during,and 2 months after radiotherapy with concomitant/adjuvant temozolomide (TMZ).Methods GBM patients,admitted to our hospital from January 2011 to January 2016 and confirmed by pathology,were chosen in our study;all patients underwent postoperative three-dimensional conformal radiotherapy with concomitant/adjuvant TMZ.And 3D-MRS was performed before,during,and 2 months after radiotherapy,the levels of N-acetyl-aspartic acid (NAA),choline (Cho) and creatine (Cr),and ratios of Cho/NAA,Cho/Cr and NAA/Cr in the GBM/edge of surgery side and the normal brain tissues were observed.The survival curve,median overall survival (mOS) and median progression free survival (mPFS) of patients with standardized Cho decreased＜30％ and patients with standardized Cho decreased＞30％ 2 months after radiotherapy were compared.Results Twenty-one patients finished the scheduled MRS for 3 times.Until the end of our study,16 patients died and 5 survived.Standardized Cho gradually decreased before,during,and 2 months after radiotherapy (2.08±0.22,1.45 ±0.21 and 1.16±0.18),with significant differences (P＜0.05).Standardized Cho after radiotherapy was significantly decreased as compared with that before radiotherapy (P＜0.05).Ratios of Cho/NAA and Cho/Cr in the GBM/edge of surgery side were significantly higher than those in the normal brain tissues (P＜0.05),and ratio of NAA/Cr in the GBM/edge of surgery side was significantly lower than that in the normal brain tissues (P＜0.05).Ratio of Cho/NAA gradually decreased before,during,and 2 months after radiotherapy,with significant differences (P＜0.05).As compared with patients with standardized Cho decreased＜30％ 2 months after radiotherapy,patients with standardized Cho decreased＞30％ 2 months after radiotherapy had significantly decreased rates of OS and PFS,and statistically shorter mPFS and mOS (4.5 vs.13.5,10.9 vs.25.3,P＜0.05).Conclusion The changes of standardized Cho 2 months after radiotherapy have high prognostic significance for PFS and OS.