Regarding the focal treatment of prostate cancer: Inference of the Gleason grade from magnetic resonance spectroscopic imaging Journal Article

   

Authors:	Brame, R. S.; Zaider, M.; Zakian, K. L.; Koutcher, J. A.; Shukla-Dave, A.; Reuter, V. E.; Zelefsky, M. J.; Scardino, P. T.; Hricak, H.
Article Title:	Regarding the focal treatment of prostate cancer: Inference of the Gleason grade from magnetic resonance spectroscopic imaging
Abstract:	Purpose: To quantify, as a function of average magnetic resonance spectroscopy (MRS) score and tumor volume, the probability that a cancer-suspected lesion has an elevated Gleason grade. Methods and Materials: The data consist of MRS imaging ratios R stratified by patient, lesion (contiguous abnormal voxels), voxels, biopsy and pathologic Gleason grade, and lesion volume. The data were analyzed using a logistic model. Results: For both low and high Gleason score biopsy lesions, the probability of pathologic Gleason score ≥4+3 increases with lesion volume. At low values of R a lesion volume of at least 15-20 voxels is needed to reach a probability of success of 80%; the biopsy result helps reduce the prediction uncertainty. At larger MRS ratios (R > 6) the biopsy result becomes essentially uninformative once the lesion volume is >12 voxels. With the exception of low values of R, for lesions with low Gleason score at biopsy, the MRS ratios serve primarily as a selection tool for assessing lesion volumes. Conclusions: In patients with biopsy Gleason score ≥4+3, high MRS imaging tumor volume and (creatine + choline)/citrate ratio may justify the initiation of voxel-specific dose escalation. This is an example of biologically motivated focal treatment for which intensity-modulated radiotherapy and especially brachytherapy are ideally suited. © 2009 Elsevier Inc. All rights reserved.
Keywords:	intensity modulated radiation therapy; treatment planning; radiation dose; tumor volume; logistic models; algorithms; biopsy; prostate cancer; gleason score; prostatic neoplasms; prostate; tumors; tumor burden; prostate biopsy; focal treatment; gleason grade; magnetic resonance spectroscopic imaging; brachytherapy; dose escalations; gleason scores; intensity-modulated radiotherapies; lesion volumes; prediction uncertainties; probability of success; tumor volumes; focusing; magnetic resonance; spin polarization; magnetic resonance spectroscopy; choline; citric acid; creatine; nuclear magnetic resonance spectroscopy
Journal Title:	International Journal of Radiation Oncology, Biology, Physics
Volume:	74
Issue:	1
ISSN:	0360-3016
Publisher:	Elsevier Inc.
Date Published:	2009-05-01
Start Page:	110
End Page:	114
Language:	English
DOI:	10.1016/j.ijrobp.2008.07.055
PUBMED:	18990509
PROVIDER:	scopus
PMCID:	PMC2692099
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-64049111012&partnerID=40&md5=5ad521c38214a0b9a584ba3ffe844338
Notes:	--- - "Cited By (since 1996): 4" - "Export Date: 30 November 2010" - "CODEN: IOBPD" - "Source: Scopus"

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