Amaury De Barros1,2, Justine Attal3,4, Margaux Roques3,5, Julien Nicolau6,3, Jean-Christophe Sol6,3, Elizabeth Cohen-Jonathan-Moyal3,4,7, Franck-Emmanuel Roux6,3,8. 1. Department of Neurosurgery, Toulouse University Hospital, Toulouse, France. amaurydebarros@yahoo.fr. 2. Université Paul Sabatier, Toulouse III, 118 route de Narbonne, 31062, Toulouse, France. amaurydebarros@yahoo.fr. 3. Université Paul Sabatier, Toulouse III, 118 route de Narbonne, 31062, Toulouse, France. 4. Department of Radiation Oncology, Institut Universitaire du Cancer de Toulouse-Oncopôle, 1 Avenue Irène Joliot-Curie, 31059, Toulouse, France. 5. Neuroradiology Department, Toulouse University Hospital, Toulouse, France. 6. Department of Neurosurgery, Toulouse University Hospital, Toulouse, France. 7. INSERM U1037, Centre de Recherche contre le Cancer de Toulouse, 1 Avenue Irène Joliot-Curie, 31059, Toulouse, France. 8. CNRS UMR5549 Brain and Cognition (Cerco), Hôpital Purpan, Toulouse, France.
Abstract
PURPOSE: Systematic pre-radiotherapy MRI in patients with newly resected glioblastoma (OMS 2016) sometimes reveals tumor growth in the period between surgery and radiotherapy. We evaluated the relation between early tumor growth and overall survival (OS) with the aim of finding predictors of regrowth. METHODS: Seventy-five patients from 25 to 84 years old (Median age 62 years) with preoperative, immediate postoperative, and preradiotherapy MRI were included. Volumetric measurements were made on each of the three MRI scans and clinical and molecular parameters were collected for each case. RESULTS: Fifty-four patients (72%) had an early regrowth with a median contrast enhancement volume of 3.61 cm3-range 0.12-71.93 cm3. The median OS was 24 months in patients with no early tumor growth and 17.1 months in those with early tumor regrowth (p = 0.0024). In the population with initial complete resection (27 patients), the median OS was 25.3 months (19 patients) in those with no early tumor growth between surgery and radiotherapy compared to 16.3 months (8 patients) in those with tumor regrowth. In multivariate analysis, the initial extent of resection (p < 0.001) and the delay between postoperative MRI and preradiotherapy MRI (p < 0.001) were significant independent prognostic factors of regrowth and of poorer outcome. CONCLUSIONS: We demonstrated that, in addition to the well known issue of incomplete resection, longer delays between surgery and adjuvant treatment is an independent factors of tumor regrowth and a risk factor of poorer outcomes for the patients. To overcome the delay factor, we suggest shortening the usual time between surgery and radiotherapy.
PURPOSE: Systematic pre-radiotherapy MRI in patients with newly resected glioblastoma (OMS 2016) sometimes reveals tumor growth in the period between surgery and radiotherapy. We evaluated the relation between early tumor growth and overall survival (OS) with the aim of finding predictors of regrowth. METHODS: Seventy-five patients from 25 to 84 years old (Median age 62 years) with preoperative, immediate postoperative, and preradiotherapy MRI were included. Volumetric measurements were made on each of the three MRI scans and clinical and molecular parameters were collected for each case. RESULTS: Fifty-four patients (72%) had an early regrowth with a median contrast enhancement volume of 3.61 cm3-range 0.12-71.93 cm3. The median OS was 24 months in patients with no early tumor growth and 17.1 months in those with early tumor regrowth (p = 0.0024). In the population with initial complete resection (27 patients), the median OS was 25.3 months (19 patients) in those with no early tumor growth between surgery and radiotherapy compared to 16.3 months (8 patients) in those with tumor regrowth. In multivariate analysis, the initial extent of resection (p < 0.001) and the delay between postoperative MRI and preradiotherapy MRI (p < 0.001) were significant independent prognostic factors of regrowth and of poorer outcome. CONCLUSIONS: We demonstrated that, in addition to the well known issue of incomplete resection, longer delays between surgery and adjuvant treatment is an independent factors of tumor regrowth and a risk factor of poorer outcomes for the patients. To overcome the delay factor, we suggest shortening the usual time between surgery and radiotherapy.
Entities:
Keywords:
Extent of resection; Glioblastoma; Radiotherapy; Tumor regrowth
Authors: Ryan D Kraus; Christopher R Weil; Fan-Chi Frances Su; Donald M Cannon; Lindsay M Burt; Joe S Mendez Journal: Neurooncol Pract Date: 2022-05-26