Pre-Radiotherapy Progression after Surgery of Newly Diagnosed Glioblastoma: Corroboration of New Prognostic Variable.
chemotherapy
glioblastoma
overall survival
radiotherapy
rapid early progression
Journal
Diagnostics (Basel, Switzerland)
ISSN: 2075-4418
Titre abrégé: Diagnostics (Basel)
Pays: Switzerland
ID NLM: 101658402
Informations de publication
Date de publication:
05 Sep 2020
05 Sep 2020
Historique:
received:
31
07
2020
revised:
02
09
2020
accepted:
03
09
2020
entrez:
9
9
2020
pubmed:
10
9
2020
medline:
10
9
2020
Statut:
epublish
Résumé
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. 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. 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; 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.
Sections du résumé
BACKGROUND
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
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
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;
CONCLUSION
CONCLUSIONS
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.
Identifiants
pubmed: 32899528
pii: diagnostics10090676
doi: 10.3390/diagnostics10090676
pmc: PMC7555958
pii:
doi:
Types de publication
Journal Article
Langues
eng
Subventions
Organisme : Ministerstvo Zdravotnictví Ceské Republiky
ID : MMCI, 00209805 and FNBr, 65269705, NU20-03-00148 and NV19-05-00410
Références
Rep Pract Oncol Radiother. 2019 Jan-Feb;24(1):35-40
pubmed: 30337846
Neuro Oncol. 2010 Feb;12(2):190-8
pubmed: 20150386
Neurosurgery. 2015 Aug;62 Suppl 1:160-5
pubmed: 26181937
Clin Oncol (R Coll Radiol). 2006 Mar;18(2):93-103
pubmed: 16523808
Oncotarget. 2017 Oct 6;8(53):91779-91794
pubmed: 29207684
Lancet Oncol. 2009 May;10(5):459-66
pubmed: 19269895
J Neurooncol. 2017 Apr;132(2):249-254
pubmed: 28101701
Acta Neuropathol Commun. 2016 Aug 08;4(1):79
pubmed: 27503138
J Clin Oncol. 2017 Jan 20;35(3):361-369
pubmed: 27893327
Neuro Oncol. 2020 Aug 17;22(8):1073-1113
pubmed: 32328653
Contemp Oncol (Pozn). 2012;16(1):34-7
pubmed: 23788852
Int J Radiat Oncol Biol Phys. 2005 Sep 1;63(1):64-74
pubmed: 16111573
Lancet Oncol. 2017 Oct;18(10):1373-1385
pubmed: 28844499
Neuro Oncol. 2016 Sep;18(9):1199-208
pubmed: 27106405
J Neurooncol. 2007 Dec;85(3):339-43
pubmed: 17579810
Radiother Oncol. 2016 Jan;118(1):35-42
pubmed: 26777122
J Clin Oncol. 2009 Feb 10;27(5):733-9
pubmed: 19114694
Klin Onkol. 2017 Fall;30(5):361-371
pubmed: 29031038
Neuroimage Clin. 2016 Feb 26;11:316-321
pubmed: 27298760
J Neurooncol. 2017 Aug;134(1):213-219
pubmed: 28567589
Oncotarget. 2014 Mar 30;5(6):1515-25
pubmed: 24722048
J Neurooncol. 2012 Aug;109(1):167-75
pubmed: 22660920
Am J Clin Oncol. 2019 May;42(5):481-486
pubmed: 30973372
N Engl J Med. 2017 Mar 16;376(11):1027-1037
pubmed: 28296618
Lancet. 2019 Feb 16;393(10172):678-688
pubmed: 30782343
J Clin Oncol. 2009 Sep 1;27(25):4150-4
pubmed: 19636000
Radiother Oncol. 1999 Oct;53(1):49-52
pubmed: 10624853
JAMA. 2017 Dec 19;318(23):2306-2316
pubmed: 29260225
CNS Oncol. 2019 Mar 1;8(1):CNS28
pubmed: 30806082
J Clin Oncol. 2008 Sep 1;26(25):4189-99
pubmed: 18757334
Acta Neuropathol. 2016 Jun;131(6):803-20
pubmed: 27157931
Radiol Oncol. 2018 Jun 6;52(2):121-128
pubmed: 30018514
Strahlenther Onkol. 2001 Jun;177(6):283-90
pubmed: 11446316
ESMO Open. 2019 Jun 17;4(Suppl 2):e000520
pubmed: 31297242