Image Guided Therapy in the Treatment of Gliomas

Image Guided Adaptive Multi-modality Therapy in the Treatment of Gliomas

RATIONALE: New imaging techniques using magnetic resonance imaging give better tumor definition, thus may lead to better tumor targeting and avoid damaging critical parts of normal brain.

PURPOSE: This phase I/II trial is studying how well image-guided therapy works in treating patients with newly diagnosed intracranial glioma.

PRIMARY OBJECTIVES:

I. To correlate the imaging findings with pathological grade following surgery in patients with newly diagnosed intra-cranial gliomas.

SECONDARY OBJECTIVES:

I. To determine the feasibility of defining the optimal target volume for radiation therapy using MR spectroscopy, diffusion, perfusion and functional imaging. II. To monitor therapeutic responses following treatment using MR spectroscopy, diffusion imaging and perfusion study.

III. To monitor changes in neurocognitive functioning following image guided therapy.

OUTLINE: Patients undergo magnetic resonance spectroscopic imaging, functional magnetic resonance imaging (MRI), diffusion-weighted MRI, and perfusion-weighted MRI. Patients then undergo maximum surgical resection followed by intensity-modulated radiation therapy (IMRT) 5 days a week for 6 weeks. After completion of study treatment, patients are followed up every 3 months for the first year then every 6 months for another year.

Inclusion Criteria:

• Histologically confirmed, newly diagnosed intracranial glioma
• A diagnostic contrast enhanced CT/MRI demonstrating the lesion prior to registration
• Karnofsky performance status >= 60
• Ability to undergo MR imaging with the use of Gadolinium dye
• Patient must sign a study specific informed consent form; if the patient's mental status precludes his/her giving informed consent, written informed consent may be given by the patient's legal representative

Exclusion Criteria:

• Inability to obtain histological proof of glioma
• Allergy to Gadolinium contrast
• Any condition including metallic implants or cardiac pace makers that make the candidate ineligible for MR imaging
• Any medical condition including renal or cardiac insufficiency that make the candidate a high risk for gadolinium contrast administration
• Karnofsky performance status of =< 50
• Prior history of radiation therapy to the brain
• Pregnancy