Dataset Information

Incidence and extent of disease progression on MRI between surgery and initiation of radiotherapy in glioblastoma patients.

ABSTRACT:

Background

A post-operative MRI (MRI_post-op) performed within 72 h is routinely used for radiation treatment planning in glioblastoma (GBM) patients, with radiotherapy starting about 4-6 weeks after surgery. Some patients undergo an additional pre-radiotherapy MRI (MRI_pre-RT) about 2-6 weeks after surgery. We sought to analyze the incidence of rapid early progression (REP) between surgery and initiation of radiotherapy seen on MRI_pre-RT and the impact on radiation target volumes.

Methods

Patients with GBM diagnosed between 2018 and 2020 who had an MRI_post-op and MRI_pre-RT were retrospectively identified. Criteria for REP was based on Modified RANO criteria. Radiation target volumes were created and compared using the MRI_post-op and MRI_pre-RT.

Results

Fifty patients met inclusion criteria. The median time between MRI_post-op and MRI_pre-RT was 26 days. Indications for MRI_pre-RT included clinical trial enrollment in 41/50 (82%), new symptoms in 5/50 (10%), and unspecified in 4/50 (8%). REP was identified in 35/50 (70%) of patients; 9/35 (26%) had disease progression outside of the MRI_post-op-based high dose treatment volumes. Treatment planning with MRI_post-op yielded a median undertreatment of 27.1% of enhancing disease and 11.2% of surrounding subclinical disease seen on MRI_pre-RT. Patients without REP had a 38% median volume reduction of uninvolved brain if target volumes were planned with MRI_pre-RT.

Conclusion

Given the incidence of REP and its impact on treatment volumes, we recommend using MRI_pre-RT for radiation treatment planning to improve coverage of gross and subclinical disease, allow for early identification of REP, and decrease radiation treatment volumes in patients without REP.

SUBMITTER: Kraus RD

PROVIDER: S-EPMC9476988 | biostudies-literature | 2022 Oct

REPOSITORIES: biostudies-literature

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Publications

Incidence and extent of disease progression on MRI between surgery and initiation of radiotherapy in glioblastoma patients.

Kraus Ryan D RD Weil Christopher R CR Frances Su Fan-Chi FC Cannon Donald M DM Burt Lindsay M LM Mendez Joe S JS

Neuro-oncology practice 20220526 5

<h4>Background</h4>A post-operative MRI (MRI<sub>post-op</sub>) performed within 72 h is routinely used for radiation treatment planning in glioblastoma (GBM) patients, with radiotherapy starting about 4-6 weeks after surgery. Some patients undergo an additional pre-radiotherapy MRI (MRI<sub>pre-RT</sub>) about 2-6 weeks after surgery. We sought to analyze the incidence of rapid early progression (REP) between surgery and initiation of radiotherapy seen on MRI<sub>pre-RT</sub> and the impact on ...[more]

PMID: 36134015

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Project description:BACKGROUND:The aim of this retrospective study is to assess the incidence, localization, and potential predictors of rapid early progression (REP) prior to initiation of radiotherapy in newly diagnosed glioblastoma patients and to compare survival outcomes in cohorts with or without REP in relation to the treatment. METHODS:We assessed a consecutive cohort of 155 patients with histologically confirmed irradiated glioblastoma from 1/2014 to 12/2017. A total of 90 patients with preoperative, postoperative, and planning MRI were analyzed. RESULTS:Median age 59 years, 59% men, and 39 patients (43%) underwent gross total tumor resection. The Stupp regimen was indicated to 64 patients (71%); 26 patients (29%) underwent radiotherapy alone. REP on planning MRI performed shortly prior to radiotherapy was found in 46 (51%) patients, most often within the surgical cavity wall, and the main predictor for REP was non-radical surgery (p < 0.001). The presence of REP was confirmed as a strong negative prognostic factor; median overall survival (OS) in patients with REP was 10.7 vs. 18.7 months and 2-year survival was 15.6% vs. 37.7% (hazard ratio HR 0.53 for those without REP; p = 0.007). Interestingly, the REP occurrence effect on survival outcome was significantly different in younger patients (? 50 years) and older patients (> 50 years) for OS (p = 0.047) and non-significantly for PFS (p = 0.341). In younger patients, REP was a stronger negative prognostic factor, probably due to more aggressive behavior. Patients with REP who were indicated for the Stupp regimen had longer OS compared to radiotherapy alone (median OS 16.0 vs 7.5; HR = 0.5, p = 0.022; 2-year survival 22.3% vs. 5.6%). The interval between surgery and the initiation of radiotherapy were not prognostic in either the entire cohort or in patients with REP. CONCLUSION:Especially in the subgroup of patients without radical resection, one may recommend as early initiation of radiotherapy as possible. The phenomenon of REP should be recognized as an integral part of stratification factors in future prospective clinical trials enrolling patients before initiation of radiotherapy.

Dataset Information

Incidence and extent of disease progression on MRI between surgery and initiation of radiotherapy in glioblastoma patients.

Background

Methods

Results

Conclusion

Publications

Incidence and extent of disease progression on MRI between surgery and initiation of radiotherapy in glioblastoma patients.

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