Home  |  About the Book  |  Table of Contents  |  Search  |  Archive  |  Order  |  Visit JCO  |  Visit ASCO.org
ASCO Educational Book; 2009
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Purchase Article
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar content in this book
Right arrow Download to citation manager
Right arrowRights & Permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Chang, S. M.
Right arrow Articles by Wen, P.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Chang, S. M.
Right arrow Articles by Wen, P.

Novel Imaging Response Assessment for Drug Therapies in Recurrent Malignant Glioma

Susan M. Chang, MD, Jennifer Clarke, MD, MPH, and Patrick Wen, MD

From the Department of Neurological Surgery, University of California San Francisco Medical Center (S.M.C., J.C.), and Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA (P.W.)

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

Address reprint requests to Susan Chang, Division of Neuro-Oncology, UCSF, 400 Parnassus Ave A808, SF CA, 94143; e-mail: changs{at}neurosurg.ucsf.edu

Overview: Current criteria in neuro-oncology to assess response to cytotoxic agents were based on computerized tomography (CT) findings in conjunction with clinical factors. The most common measure of antitumor activity used in the early clinical evaluation of chemotherapeutic agents for recurrent malignant glioma is duration of tumor control that is associated with clinical stability or improvement. There are clear limitations to the utility of the currently used CT-based criteria for response assessment, which only addresses the contrast-enhancing component of the tumor. Antiangiogenic strategies have been associated with moderate radiographic response rates as defined by a rapid decrease in contrast enhancement on magnetic resonance imaging (MRI) and unusual patterns of tumor recurrence, often with an increase in the nonenhancing component depicted on T2/FLAIR sequences. The recognition that contrast enhancement is nonspecific and that changes in this parameter, either an increase or a decrease, may not be a surrogate of tumor response, and taking into consideration the need to account for the nonenhancing component of the tumor, mandates that new criteria be generated to assist with the accurate assessment of the efficacy of therapeutic modalities. We present novel imaging response assessments of therapies in recurrent malignant glioma incorporating MRI characteristics. These recommendations were generated as part of an international neuro-oncology effort with consensus building, and they are an initial attempt to develop standardized assessment criteria that should be incorporated into clinical trial design of agents for recurrent malignant glioma.