Patterns and Timing of Recurrence After Temozolomide-Based Chemoradiation for Glioblastoma

Milano, Michael T.; Okunieff, Paul; Donatello, Rosemary S.; Mohile, Nimish; Sul, Joohee; Walter, Kevin A.; Korones, David N.

doi:10.1016/j.ijrobp.2009.09.018

Cited by 137 publications

(101 citation statements)

References 39 publications

(61 reference statements)

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“…In several studies analyzing patients treated with radiation and temozolomide, 72% to 92% of recurrence was revealed as local relapse, 25,26 the most frequent pattern of glioblastoma recurrence. 6 Local control is also important for recurrent lesions, but treatment with SRS led to local progression in 65% to 90%, 14,[27][28][29] which was in line with our result with conventional SRS targeting only the gadolinium-enhanced area.…”

Section: Discussionmentioning

confidence: 99%

“…The majority of patients treated with extended field SRS died of remote recurrences within the brain. Because the rates of new recurrences in patients treated with temozolomide and radiation are quite high to begin with, 25% at 1 year and 66% at 2 years, 26 the role of extended field SRS for the occurrence of remote recurrences is unclear. Obviously, radiation therapy, including SRS, and temozolomide are not sufficient to control the disease.…”

Section: Discussionmentioning

confidence: 99%

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Extended field stereotactic radiosurgery for recurrent glioblastoma

Koga

Maruyama

Tanaka

et al. 2011

Cancer

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BACKGROUND: Stereotactic radiosurgery (SRS) is among the few therapeutic options for glioblastoma that recurs after standard radiation and chemotherapy, but its efficacy has been limited. METHODS: Since November 2007, the authors have modified the clinical target volume by adding a 0.5-to 1-cm margin to the gadolinium-enhanced area (extended field SRS), in contrast to conventional SRS using no margin to set the clinical target volume. A total of 35 recurred glioblastoma lesions in 9 patients were treated with conventional SRS between December 1990 and January 2007, and 14 lesions in 9 patients were treated with extended field SRS. RESULTS: The median follow-up periods were 7 months (range, 3-29 months) and 8 months (range, 6-27 months), respectively. The local control rate was 47% for conventional SRS and 93% for extended field SRS (P ¼ .0035), and the numbers of radiation necrosis observed in SRS-treated lesions were 2 and 4, respectively. The median overall survival from the diagnosis was 24 months (range, 14-57 months) for conventional SRS and 21 months (range, 15-51 months) for extended field SRS (statistically not significant). Seven patients treated with conventional SRS died during follow-up, 6 from progression of the SRS-treated tumor, whereas 7 patients treated with extended field SRS died during follow-up, 6 from remote intracerebral dissemination. CONCLUSIONS: Extended field SRS was superior to conventional SRS in the local control of small recurrent lesions of glioblastoma, although a further device to suppress remote dissemination may be necessary to increase survival. KEYWORDS: glioblastoma, glioma, gamma knife, stereotactic radiosurgery, radiation therapy, recurrence. INTRODUCTIONGlioblastoma is a highly malignant and aggressive tumor of the central nervous system that corresponds to grade IV of the World Health Organization histological classification. 1 The current standard treatment for glioblastoma is a maximal resection with functional preservation, followed by radiation and chemotherapy. When temozolomide is used for chemotherapy, the median survival is 14.6 months after initial presentation, 2 and ranges from 5 to 13 months after recurrence. 3,4 Because of the aggressive and invasive nature of the tumor, recurrence is seen in >90% of patients. 5 The most common pattern of recurrence is local regrowth 6 ; therefore, successful local control should lead to prolongation of patients' survival. Various local treatment strategies have been attempted, including repeated operations, conformal radiotherapy, brachytherapy, and local chemotherapy. 7 Although stereotactic radiosurgery (SRS) is an option as salvage treatment for recurrent glioblastoma in clinical settings, the role of SRS is still limited for glioma. SRS is useful in controlling relatively well-demarcated glioma such as ependymoma, pilocytic astrocytoma, and pleomorphic xanthoastrocytoma. [8][9][10][11][12][13] However, the majority of glioma is infiltrative to brain parenchyma and is difficult to target with SRS. A randomized controlle...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Extended field stereotactic radiosurgery for recurrent glioblastoma

Koga

Maruyama

Tanaka

et al. 2011

Cancer

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“…4,20,33,37,48) The progression of glioblastoma after treatment in up to 97% of cases occurs either from the bulk of the mass or within 20 mm from the border of its enhanced part identifiable on T 1 -weighted magnetic resonance (MR) imaging, and the presence of such local recurrence may be associated with impaired prognosis. 2,3,12,13,23,25,32,34,35,43,44,54) Therefore, various methods for improvement of tumor control at the time of both initial and salvage treatment have been proposed, such as inclusion of the marginal brain tissue in the high dose area during FRT, 4,17,20,26,31-33, 35,49,50) additional dose boost with stereotactic radiosurgery, 14,18,41) brachytherapy, 10,36,43) implantation of Gliadel wafers (Guilford Pharmaceuticals Inc., Baltimore, Maryland, USA), 53) or various types of intralesional immunotherapy. 7,42) The majority of studies on progression of intracranial gliomas after initial treatment have included many cases with incomplete surgical tumor removal.…”

Section: Introductionmentioning

confidence: 99%

“…management was encountered in 67% to 97% of cases (Table 3), 2,3,12,23,25,31,32,34,35,43,54) but comparison of different studies is difficult due to differences in treatment strategy, proportion of patients with total surgical tumor removal, postoperative surveillance, length of follow-up, as well as definition and categorization of the tumor progression. Nevertheless, aggressive resection of the neoplasm may…”

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confidence: 99%

“…Previously, similar PFS was found in patients with local and distant recurrences of glioblastoma, 34) whereas some series demonstrated that time to regional tumor progression might be even shorter compared to distant failure. 25,31,36) At present, the standard management of glioblastoma includes chemotherapy with temozolomide concomitant and adjuvant to FRT. 46,47) This treatment is not complication-free, 15) which is enforcing the search for novel therapeutic options for malignant gliomas.…”

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Patterns of Intracranial Glioblastoma Recurrence After Aggressive Surgical Resection and Adjuvant Management: Retrospective Analysis of 43 Cases

Konishi

Muragakı

Iseki

et al. 2012

Neurol. Med. Chir.(Tokyo)

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The present retrospective study evaluated the recurrence patterns after aggressive surgical removal of intracranial glioblastomas in 43 consecutive adult patients. The resection rate of the enhanced lesion on magnetic resonance imaging was 100% and 95-99% in 22 and 21 cases, respectively. All patients received postoperative fractionated radiotherapy (60 Gy in 30 fractions) with additional chemotherapy (25 cases) or vaccine therapy (18 cases). During follow-up (median 17 months), tumor recurrence was identified in 33 patients, most frequently regional within the wall of the resection cavity (20 cases). No clinical factor differed significantly between the groups of patients with regional or marginal tumor progression (N ＝ 22) and patients with distant or multiple recurrences (N ＝ 8). Progression-free survival did not differ significantly between these two groups (p ＝ 0.27). However, overall survival was significantly longer (p ＝ 0.04) in patients with regional or marginal tumor progression, and constituted 90% and 54% at 1 and 2 years after surgery, respectively, compared to 75% and 0% in patients with distant or multiple recurrences. Aggressive surgical resection and adjuvant management of intracranial glioblastoma may change its recurrence pattern. Tumor progression appears in the wall of the resection cavity or within 2 cm from its margin in approximately half of patients.

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Interval brain imaging for adults with cerebral glioma

Thompson

Lawrie²,

Kernohan

et al. 2019

Cochrane Database of Systematic Reviews

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BackgroundClinical practice guidelines suggest that magnetic resonance imaging (MRI) of the brain should be performed at certain time points or intervals distant from diagnosis (interval or surveillance imaging) of cerebral glioma, to monitor or follow up the disease; it is not known, however, whether these imaging strategies lead to better outcomes among patients than triggered imaging in response to new or worsening symptoms. ObjectivesTo determine the e ect of di erent imaging strategies (in particular, pre-specified interval or surveillance imaging, and symptomatic or triggered imaging) on health and economic outcomes for adults with glioma (grades 2 to 4) in the brain. Search methodsThe Cochrane Gynaecological, Neuro-oncology and Orphan Cancers (CGNOC) Group Information Specialist searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and Embase up to 18 June 2019 and the NHS Economic Evaluation Database (EED) up to December 2014 (database closure). Selection criteriaWe included randomised controlled trials, non-randomised controlled trials, and controlled before-a er studies with concurrent comparison groups comparing the e ect of di erent imaging strategies on survival and other health outcomes in adults with cerebral glioma; and full economic evaluations (cost-e ectiveness analyses, cost-utility analyses and cost-benefit analyses) conducted alongside any study design, and any model-based economic evaluations on pre-and post-treatment imaging in adults with cerebral glioma. Data collection and analysisWe used standard Cochrane review methodology with two authors independently performing study selection and data collection, and resolving disagreements through discussion. We assessed the certainty of the evidence using the GRADE approach. Main resultsWe included one retrospective, single-institution study that compared post-operative imaging within 48 hours (early post-operative imaging) with no early post-operative imaging among 125 people who had surgery for glioblastoma (GBM: World Health Organization (WHO) grade 4 glioma). Most patients in the study underwent maximal surgical resection followed by combined radiotherapy and temozolomide treatment. Although patient characteristics in the study arms were comparable, the study was at high risk of bias overall.Interval brain imaging for adults with cerebral glioma (Review)

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Patterns and Timing of Recurrence After Temozolomide-Based Chemoradiation for Glioblastoma

Cited by 137 publications

References 39 publications

Extended field stereotactic radiosurgery for recurrent glioblastoma

Extended field stereotactic radiosurgery for recurrent glioblastoma

Patterns of Intracranial Glioblastoma Recurrence After Aggressive Surgical Resection and Adjuvant Management: Retrospective Analysis of 43 Cases

Interval brain imaging for adults with cerebral glioma

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