Pattern of Recurrence of Glioblastoma Versus Grade 4 IDH-Mutant Astrocytoma Following Chemoradiation: A Retrospective Matched-Cohort Analysis

Abstract

Background and Purpose: To quantitatively compare the recurrence patterns of glioblastoma (isocitrate dehydrogenase-wild type) versus grade 4 isocitrate dehydrogenase-mutant astrocytoma (wild type isocitrate dehydrogenase and mutant isocitrate dehydrogenase, respectively) following primary chemoradiation. Materials and Methods: A retrospective matched cohort of 22 wild type isocitrate dehydrogenase and 22 mutant isocitrate dehydrogenase patients were matched by sex, extent of resection, and corpus callosum involvement. The recurrent gross tumor volume was compared to the original gross tumor volume and clinical target volume contours from radiotherapy planning. Failure patterns were quantified by the incidence and volume of the recurrent gross tumor volume outside the gross tumor volume and clinical target volume, and positional differences of the recurrent gross tumor volume centroid from the gross tumor volume and clinical target volume. Results: The gross tumor volume was smaller for wild type isocitrate dehydrogenase patients compared to the mutant isocitrate dehydrogenase cohort (mean ± SD: 46.5 ± 26.0 cm3 vs 72.2 ± 45.4 cm3, P = .026). The recurrent gross tumor volume was 10.7 ± 26.9 cm3 and 46.9 ± 55.0 cm3 smaller than the gross tumor volume for the same groups ( P = .018). The recurrent gross tumor volume extended outside the gross tumor volume in 22 (100%) and 15 (68%) ( P= .009) of wild type isocitrate dehydrogenase and mutant isocitrate dehydrogenase patients, respectively; however, the volume of recurrent gross tumor volume outside the gross tumor volume was not significantly different (12.4 ± 16.1 cm3 vs 8.4 ± 14.2 cm3, P = .443). The recurrent gross tumor volume centroid was within 5.7 mm of the closest gross tumor volume edge for 21 (95%) and 22 (100%) of wild type isocitrate dehydrogenase and mutant isocitrate dehydrogenase patients, respectively. Conclusion: The recurrent gross tumor volume extended beyond the gross tumor volume less often in mutant isocitrate dehydrogenase patients possibly implying a differential response to chemoradiotherapy and suggesting isocitrate dehydrogenase status might be used to personalize radiotherapy. The results require validation in prospective randomized trials.

Cystic glioblastoma mimicking toxoplasmosis in a young adult: A case report

“…In our case, the patient first was treated toxoplasmosis, based of the biopsy, however condition of the patient was worsening rapidly progressive the presentation of cystic lesion massively growing which is indicated to operate immediately, under subtotal accessible resection with biopsy and second pathological analysis which was last result was glioblastoma grade IV, in our case immediate referred to the radiotherapy and chemotherapy, but the patient developed cutaneous collection of the pus, which is made impossible to start his radio and chemotherapy [7].…”

Exploring the mechanism of 18F‐fluorodopa uptake in recurrent high‐grade gliomas: A comprehensive histomolecular‐positron emission tomography analysis

“…Recent literature showed that IDH‐mutant astrocytoma and IDH‐wildtype glioblastoma had different recurrence patterns following chemoradiation; therefore in vivo identification of IDH mutation among grade 4 glioma could be of great interest in the future [14]. Our work including 39 histologically confirmed recurrent HGGs showed that IDH‐mutant gliomas (astrocytoma grade 4 and oligodendroglioma grade 3) had higher 18F‐FDOPA uptake (TBRmax) than IDH‐wildtype HGGs.…”

Management of IDH-mutant astrocytoma based on WHO 2021 classification of central nervous system tumors: a single center retrospective study

“…A multi-center study shown that patients with primary IDH-mutant glioblastoma can have an overall survival bene t from TMZ and concurrent radiochemotherapy [12]. Followed the progression of WHO 4 glioblastoma/astrocytoma, the recurrent IDH-mutant astrocytoma was less likely to extend beyond gross tumor volume and indicated a modi ed plan of radiotherapy or radiochemotherapy [13].…”