Patterns of recurrence according to the extent of resection in patients with IDH–wild-type glioblastoma: a retrospective study

Abstract

OBJECTIVE In glioblastoma (GBM) patients, controlling the microenvironment around the tumor using various treatment modalities, including surgical intervention, is essential in determining the outcome of treatment. This study was conducted to elucidate whether recurrence patterns differ according to the extent of resection (EOR) and whether this difference affects prognosis. METHODS This single-center study included 358 eligible patients with histologically confirmed isocitrate dehydrogenase (IDH)–wild-type GBM from November 1, 2005, to December 31, 2018. Patients were assigned to one of three separate groups according to EOR: supratotal resection (SupTR), gross-total resection (GTR), and subtotal resection (STR) groups. The patterns of recurrence were classified as local, marginal, and distant based on the range of radiation. The relationship between EOR and recurrence pattern was statistically analyzed. RESULTS Observed tumor recurrence rates for each group were as follows: SupTR group, 63.4%; GTR group, 75.3%; and STR group, 80.5% (p = 0.072). Statistically significant differences in patterns of recurrences among groups were observed with respect to local recurrence (SupTR, 57.7%; GTR, 76.0%; STR, 82.8%; p = 0.036) and distant recurrence (SupTR, 50.0%; GTR, 30.1%; STR, 23.2%; p = 0.028). Marginal recurrence showed no statistical difference between groups. Both overall survival and progression-free survival were significantly increased in the SupTR group compared with the STR and GTR groups (p < 0.0001). CONCLUSIONS In this study, the authors investigated the association between EOR and patterns of recurrence in patients with IDH–wild-type GBM. The findings not only show that recurrence patterns differ according to EOR but also provide clinical evidence supporting the hypothesized mechanism by which distant recurrence occurs.

Management of Recurrent Glioblastomas: What Can We Learn from the French Glioblastoma Biobank?

“…The prognosis remains poor, even with treatment, with a median survival of about 15 months and a 5-year survival rate of 4% [ 4 , 5 ]. Tumor relapse almost invariably occurs at or close to the initial site of disease [ 6 , 7 , 8 ].…”

Effects of Reoperation Timing on Survival among Recurrent Glioblastoma Patients: A Retrospective Multicentric Descriptive Study

“…In addition, radicality of resection also influences both the pattern of recurrent disease and repeated tumor resectability. Patients with supratotal resections or GTRs tend to have distant recurrences, while those with partial resections are more likely to suffer local recurrences [36].…”

“…The same appears to be true for efforts to apply tumor-treating-field (TTF) techniques in recurrent GBM [61]. Moreover, no positive effect on life expectancy has been observed for recurrent GBM in trials investigating off-label treatment with pharmaceutical agents and biotechnological interventions including immune checkpoint inhibitors (Nivolumab, Ipilimumab, Pembrolizumab), a PARP inhibitor (Niraparib), adaptive T-cell therapy (CAR-T B7-H3), a topoisomerase inhibitor (Irinotecan), autologous dendritic cells (ADCTA), a FASN inhibitor (ASC40), a PI3K/mTOR inhibitor (Paxalisib), a VEGFR2-TIE2 tyrosine kinase inhibitor (Regorafenib), a JAK1/3 inhibitor (Tofacitinib), oncolytic viruses, and peptide vaccines [36]. There is thus a clear lack of compelling alternatives to reoperation.…”

The Significance of Photodynamic Diagnosis Using 5-aminolevulinic Acid in The Resection of Glioblastoma

“…4.2 蛍光陽性病変の分布範囲 本検討および過去の報告 8) の結果から，画像上の蛍光 陽性病変残存例の 49～71%で造影病変の全摘出が得られ ている．また蛍光陽性病変を全摘出した 13 例の解析で は，術前の造影病変体積の 2 倍以上の体積が摘出されて いた 14) ．これらの報告からは，膠芽腫においては，蛍光 陽性病変は造影病変を越えて非造影病変にも存在すると 考えられる．造影病変と蛍光陽性病変の全摘出は独立し た予後良好因子であること 8) を踏まえると，5-ALA によ る蛍光診断は造影病変とは異なる視点から活動性の腫瘍 の拡がりを捉えている可能性が示唆された．ただし，非 造影病変では浸潤した腫瘍細胞の他に反応性グリアも蛍 光陽性を示す 15) ことが報告されており，特に eloquent 領 域では，術中増殖能診断などの新規技術 16) 等を用いた術 中鑑別方法の開発が必要と考えられた． 4.3 蛍光診断と再発形式・治療転帰 膠芽腫の再発の約 80%は局所再発である 17) ため，局所 制御のために従来の局所放射線治療に加え，カルムスチ ン脳内留置用剤 18) ，腫瘍電場療法 19) ，非造影病変の拡大 摘出 20) などの局所療法が開発されてきた．局所制御が改 善するに従い，遠隔再発が増加する 20 Progression-free survival (A) and overall survival (B) of patients without lesions exhibiting residual fluorescence (groups A and B) and those with lesions exhibiting residual fluorescence (group C) at the end of resection. No significant differences were present among the groups.…”