Michael H Soike1, Emory R McTyre2, Nameeta Shah3, Ralph B Puchalski3, Jordan A Holmes4, Anna K Paulsson5, Lance D Miller6, Christina K Cramer2,7, Glenn J Lesser7,8, Roy E Strowd7,9, William H Hinson2, Ryan T Mott10, Annette J Johnson11, Hui-Wen Lo6,7, Adrian W Laxton7,12, Stephen B Tatter7,12, Waldemar Debinski6,7, Michael D Chan2,7. 1. Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC, 27157, USA. msoike@wakehealth.edu. 2. Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC, 27157, USA. 3. The Ben and Catherine Ivy Center for Advanced Brain Tumor Treatment, Swedish Neuroscience Institute, Seattle, WA, 98122, USA. 4. Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC, 27514, USA. 5. Department of Radiation Oncology, University of California San Francisco School of Medicine, San Francisco, CA, 94143, USA. 6. Department of Cancer Biology, Wake Forest Baptist Medical Center, Winston-Salem, NC, 27157, USA. 7. Brain Tumor Center of Excellence, Wake Forest Baptist Medical Center Comprehensive Cancer Center, Winston-Salem, NC, 27157, USA. 8. Department of Hematology & Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC, 27157, USA. 9. Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC, 27157, USA. 10. Department of Pathology, Wake Forest Baptist Medical Center, Winston-Salem, NC, 27157, USA. 11. Department of Radiology, Wake Forest Baptist Medical Center, Winston-Salem, NC, 27157, USA. 12. Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, NC, 27157, USA.
Abstract
PURPOSE: For glioblastoma (GBM), imaging response (IR) or pseudoprogression (PSP) is frequently observed after chemoradiation and may connote a favorable prognosis. With tumors categorized by the Cancer Genome Atlas Project (mesenchymal, classical, neural, and proneural) and by methylguanine-methyltransferase (MGMT) methylation status, we attempted to determine if certain genomic or molecular subtypes of GBM were specifically associated with IR or PSP. METHODS: Patients with GBM treated at two institutions were reviewed. Kaplan-Meier method was used to estimate overall survival (OS) and progression-free survival (PFS). Mantel-cox test determined effect of IR and PSP on OS and PFS. Fisher's exact test was utilized to correlate IR and PSP with genomic subtypes and MGMT status. RESULTS: Eighty-two patients with GBM were reviewed. The median OS and PFS were 17.9 months and 8.9 months. IR was observed in 28 (40%) and was associated with improved OS (median 29.4 vs 14.5 months p < 0.01) and PFS (median 17.7 vs 5.5 months, p < 0.01). PSP was observed in 14 (19.2%) and trended towards improved PFS (15.0 vs 7.7 months p = 0.08). Tumors with a proneural component had a higher rate of IR compared to those without a proneural component (IR 60% vs 28%; p = 0.03). MGMT methylation was associated with IR (58% vs 24%, p = 0.032), but not PSP (34%, p = 0.10). CONCLUSION: IR is associated with improved OS and PFS. The proneural subtype and MGMT methylated tumors had higher rates of IR.
PURPOSE: For glioblastoma (GBM), imaging response (IR) or pseudoprogression (PSP) is frequently observed after chemoradiation and may connote a favorable prognosis. With tumors categorized by the Cancer Genome Atlas Project (mesenchymal, classical, neural, and proneural) and by methylguanine-methyltransferase (MGMT) methylation status, we attempted to determine if certain genomic or molecular subtypes of GBM were specifically associated with IR or PSP. METHODS:Patients with GBM treated at two institutions were reviewed. Kaplan-Meier method was used to estimate overall survival (OS) and progression-free survival (PFS). Mantel-cox test determined effect of IR and PSP on OS and PFS. Fisher's exact test was utilized to correlate IR and PSP with genomic subtypes and MGMT status. RESULTS: Eighty-two patients with GBM were reviewed. The median OS and PFS were 17.9 months and 8.9 months. IR was observed in 28 (40%) and was associated with improved OS (median 29.4 vs 14.5 months p < 0.01) and PFS (median 17.7 vs 5.5 months, p < 0.01). PSP was observed in 14 (19.2%) and trended towards improved PFS (15.0 vs 7.7 months p = 0.08). Tumors with a proneural component had a higher rate of IR compared to those without a proneural component (IR 60% vs 28%; p = 0.03). MGMT methylation was associated with IR (58% vs 24%, p = 0.032), but not PSP (34%, p = 0.10). CONCLUSION: IR is associated with improved OS and PFS. The proneural subtype and MGMT methylated tumors had higher rates of IR.
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