Glioblastoma Clinical Trial
Official title:
Quantitative Blood Oxygenation Level Dependent (qBOLD) MR Imaging of Glioblastoma Multiforme for Assessment of Tumor Hypoxia.
Glioblastoma multiforme (GBM) is the most common primary malignant brain neoplasm in adults.
Despite recent diagnostic and therapeutic advances, including aggressive surgical resection
and chemoradiation, the prognosis of GBM has improved only slightly over the past two
decades, with median survival of approximately 15 months. Tumor hypoxia is a feature of GBM
that contributes to poor outcome through multiple mechanisms such as 1) overexpression of
enzymes that play roles in temozolomide resistance, the main chemotherapeutic agent in GBM
and 2) increase expression of cancer stem cells which are more resistant to radiation.
Hypoxic tumour regions are associated with higher rates of progression and recurrence.
In this study the investigators will use an advanced MRI technique called qBOLD to
non-invasively measure oxygenation in GBM and obtain targeted biopsies. The investigators
take advantage of physical characteristics of Ferumoxytol (Feraheme®) which is an iron
supplement, and utilize two recent technical advances not previously used in human tumours to
quantitatively measure oxygenation in GBM.
Prior knowledge of hypoxia can assist in prognostication and individualization of treatment
planning with special focus on hypoxic regions by targeted radiation dose or regimen
modulation; consideration of more intensive chemotherapy regimens; more aggressive and
targeted surgical resection and closer short-term clinical and imaging follow-ups.
We propose a study to demonstrate quantitative oxygen saturation estimation in GBM is
feasible with qBOLD and it correlates with established histopathological markers of hypoxia
and angiogenesis, and targeted intraoperative oxygen measurement.
All patients will undergo surgery as part of their standard treatment. By coregistering the
hypoxia map on presurgical MRI we will be able to do the following:
1. Obtain targeted biopsies of the hypoxic areas and none hypoxic areas and correlate them
with gold standard marker of tissue hypoxia by immunohistochemistry for hypoxia induced
factor-1α (HIF-1α).
2. Draw Volumes of interests (VOI) over areas >0.5-cm3 (amenable to accurate
intra-operative O2 measurement) with the lowest and highest oxygen saturation (SO2)
values. VOIs will be then imported into the neuronavigation system (Stryker) for
targeted placement of clinically approved Licox® oxygen-sensing probe (Integra
NeuroSciences).
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