Early tumor growth between initial resection and radiotherapy of glioblastoma: incidence and impact on clinical outcomes
Tóm tắt
Early tumor growth, or increased contrast-enhancing tumor not related to evolving post-surgical injury, in the interval between surgical resection and initiation of radiotherapy has implications for treatment planning and clinical outcomes. In this study we evaluated the incidence of early tumor growth, correlated tumor growth with survival outcome measures, and assessed predictors of early tumor growth in glioblastoma. We reviewed the records of patients with newly-diagnosed glioblastoma who underwent surgical resection and chemoradiotherapy at our institution. Patients with preoperative, immediate postoperative, and preradiotherapy MRI were included. Conventional MRI and DWI features were assessed. The correlation between early tumor growth and extent of resection with survival was assessed with Kaplan–Meier analysis. Logistic regression was carried out to evaluate predictors of early tumor growth. Of 140 included patients, sixty-seven cases (48%) had new or increased contrast enhancement attributed to early tumor growth. Median progression free survival (PFS) and overall survival (OS) were shorter in patients with early tumor growth compared to those without early tumor growth (p < 0.001 for both). Additionally, PFS and OS were longer in patients who underwent gross total resection of enhancing tumor (p = 0.016 and <0.001, respectively). Of the evaluated predictors of early growth, subtotal resection was most likely to result in early growth (p < 0.001). Imaging evidence of early tumor growth is often observed at preradiotherapy MRI and is associated with shorter survival. Gross total resection of contrast enhancing tumor decreases likelihood of early tumor growth.
Tài liệu tham khảo
Johnson DR, O’Neill BP (2011) Glioblastoma survival in the United States before and during the temozolomide era. J Neurooncol 107:359–364. doi:10.1007/s11060-011-0749-4
Ostrom QT, Bauchet L, Davis FG et al (2014) The epidemiology of glioma in adults: a “state of the science” review. Neuro-oncol 16:896–913. doi:10.1093/neuonc/nou087
Ammirati M, Vick N, Liao YL et al (1987) Effect of the extent of surgical resection on survival and quality of life in patients with supratentorial glioblastomas and anaplastic astrocytomas. Neurosurgery 21:201–206
Sanai N, Polley M-Y, McDermott MW et al (2011) An extent of resection threshold for newly diagnosed glioblastomas. J Neurosurg 115:3–8. doi:10.3171/2011.2.jns10998
Almeida JP, Chaichana KL, Rincon-Torroella J, Quiñones-Hinojosa A (2014) The value of extent of resection of glioblastomas: clinical evidence and current approach. Curr Neurol Neurosci Rep 15:517. doi:10.1007/s11910-014-0517-x
Hervey-Jumper SL, Berger MS (2016) Maximizing safe resection of low- and high-grade glioma. J Neurooncol. doi:10.1007/s11060-016-2110-4
Brown TJ, Brennan MC, Li M et al (2016) Association of the extent of resection with survival in glioblastoma. JAMA Oncol. doi:10.1001/jamaoncol.2016.1373
Stupp R, Mason WP, van den Bent MJ et al (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352:987–996. doi:10.1056/NEJMoa043330
Weller M, van den Bent M, Hopkins K et al (2014) EANO guideline for the diagnosis and treatment of anaplastic gliomas and glioblastoma. Lancet Oncol 15:e395–e403. doi:10.1016/S1470-2045(14)70011-7
Bush NAO, Chang SM, Berger MS (2016) Current and future strategies for treatment of glioma. Neurosurg Rev. doi:10.1007/s10143-016-0709-8
Wen PY, Macdonald DR, Reardon DA et al (2010) Updated response assessment criteria for high-grade gliomas: response assessment in neuro-oncology working group. J Clin Oncol 28:1963–1972. doi:10.1200/JCO.2009.26.3541
Pirzkall A, McGue C, Saraswathy S et al (2009) Tumor regrowth between surgery and initiation of adjuvant therapy in patients with newly diagnosed glioblastoma. Neuro-oncol 11:842–852. doi:10.1215/15228517-2009-005
Farace P, Amelio D, Ricciardi GK et al (2012) Early MRI changes in glioblastoma in the period between surgery and adjuvant therapy. J Neurooncol 111:177–185. doi:10.1007/s11060-012-0997-y
Majos C, Cos M, Castaner S et al (2016) Preradiotherapy MR imaging: A prospective pilot study of the usefulness of performing an mr examination shortly before radiation therapy in patients with glioblastoma. Am J Neuroradiol. doi:10.3174/ajnr.A4917
Valduvieco I, Verger E, Bruna J et al (2012) Impact of radiotherapy delay on survival in glioblastoma. Clin Transl Oncol 15:278–282. doi:10.1007/s12094-012-0916-x
Sun MZ, Oh T, Ivan ME et al (2015) Survival impact of time to initiation of chemoradiotherapy after resection of newly diagnosed glioblastoma. J Neurosurg 122:1144–1150. doi:10.3171/2014.9.JNS14193
Han SJ, Englot DJ, Birk H et al (2015) Impact of timing of concurrent chemoradiation for newly diagnosed glioblastoma. Neurosurgery 62:160–165. doi:10.1227/NEU.0000000000000801
Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174
Louis DN, Perry A, Reifenberger G et al (2016) The 2016 World health organization classification of tumors of the central nervous system: a summary. Acta Neuropathol 131:803–820. doi:10.1007/s00401-016-1545-1