A Pilot Study of 1H-Nuclear Magnetic Resonance Spectroscopic Imaging in Pediatric Patients With Primary and Metastatic Brain Tumors

Background:

• Brain tumors represent the most common solid tumor of childhood. Treatment generally includes surgery and radiation, but recurrences are frequent, particularly for high-grade lesions.
• Chemotherapy is often used in an adjuvant setting, to delay radiation therapy or for resistant disease.
• Children with brain tumors are generally followed by imaging studies, such as CT or MRI.
• Difficulty arises in trying to distinguish tumor regrowth from treatment related edema, necrosis or radiation injury.
• Proton Nuclear Magnetic Resonance Spectroscopic (NMRS) Imaging is a non-invasive method of detecting and measuring cellular metabolites in vivo.

Objective:

• To determine NMRS imaging patterns before, during and after chemotherapy in pediatric patients with primary or metastatic brain tumors
• To identify and characterize specific patterns of metabolites related to tumor regrowth, tumor response to therapy, edema or necrosis.

Eligibility:

• Age less than or equal to 21 years.
• Patients entered on this trial will also be entered on one of the Branch s primary brain tumor treatment trials.
• Histologically confirmed primary or metastatic brain tumor. Patients with a brainstem glioma or optic pathway gliomas are not required to have a histologic diagnosis.
• Measurable or evaluable tumor at the time of study entry.

Design:

• This is intended to be a pilot study to define metabolite patterns associated with tumor growth, tumor edema and tumor necrosis as seen on standard MRI; and determine the feasibility of using metabolite patterns to predict response to therapy in pediatric patients with brain tumors.
• Contalateral spectroscopic analysis of normal appearing brain will also be performed when feasible.
• Analysis of results will be stratified according to type of tumor, and prior history of radiation therapy or surgery.