Preradiotherapy MR Imaging: A Prospective Pilot Study of the Usefulness of Performing an MR Examination Shortly before Radiation Therapy in Patients with Glioblastoma

Majós, Carles; Cos, Mònica; Castañer, Sara; Pons, Albert; Gil, Miguel; Fernández-Coello, Alejandro; Maciá, M.; Bruna, Jordi; Aguilera, Carles

doi:10.3174/ajnr.a4917

Cited by 18 publications

(12 citation statements)

References 24 publications

(30 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…After considering these points, we found that the overall incidence that we observed (48%) is similar to that reported in a few other studies with smaller sample sizes [12–14]. The clinical impact of this early tumor growth is reflected in the significantly shortened PFS and OS seen in patients who developed early tumor growth.…”

Section: Discussionsupporting

confidence: 88%

“…Radiotherapy treatment volumes are defined by a planning CT and comparison to immediate postoperative MRI. A few small studies of glioblastoma patients enrolled in clinical trials that included pre-radiotherapy MRI have investigated the phenomenon of early tumor growth, as evidenced by increased contrast-enhancement in the interval between surgery and the initiation of radiation [12–14]. Results of these studies show that a certain proportion of patients have new or increased enhancement suggesting progressive disease.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Early tumor growth between initial resection and radiotherapy of glioblastoma: incidence and impact on clinical outcomes

2017

View full text Add to dashboard Cite

Early tumor growth, or increased contrast-enhancing tumor not related to evolving post-surgical injury, in the interval between surgical resection and initiation of radiotherapy has implications for treatment planning and clinical outcomes. In this study we evaluated the incidence of early tumor growth, correlated tumor growth with survival outcome measures, and assessed predictors of early tumor growth in glioblastoma. We reviewed the records of patients with newly-diagnosed glioblastoma who underwent surgical resection and chemoradiotherapy at our institution. Patients with preoperative, immediate postoperative, and preradiotherapy MRI were included. Conventional MRI and DWI features were assessed. The correlation between early tumor growth and extent of resection with survival was assessed with Kaplan–Meier analysis. Logistic regression was carried out to evaluate predictors of early tumor growth. Of 140 included patients, sixty-seven cases (48%) had new or increased contrast enhancement attributed to early tumor growth. Median progression free survival (PFS) and overall survival (OS) were shorter in patients with early tumor growth compared to those without early tumor growth (p < 0.001 for both). Additionally, PFS and OS were longer in patients who underwent gross total resection of enhancing tumor (p = 0.016 and <0.001, respectively). Of the evaluated predictors of early growth, subtotal resection was most likely to result in early growth (p < 0.001). Imaging evidence of early tumor growth is often observed at preradiotherapy MRI and is associated with shorter survival. Gross total resection of contrast enhancing tumor decreases likelihood of early tumor growth.

show abstract

Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Early tumor growth between initial resection and radiotherapy of glioblastoma: incidence and impact on clinical outcomes

2017

View full text Add to dashboard Cite

show abstract

“…Approximately half of all glioblastoma patients develop macroscopically observed REP between surgery and postoperative radiotherapy, which is associated with a shorter survival (Table 1 and Fig. 1A) [5][6][7][8][9][10][11][12][13]. From a biological perspective, macroscopically observed REP is associated with extent of resection and volume of residual Fig.…”

Section: Rapid Early Progressionmentioning

confidence: 98%

“…In the time between surgery and radiotherapy, remnant tumour cells remain untreated causing rapid early progression (REP), which is associated with a shorter survival [5][6][7][8][9][10][11][12][13]. This highlights the limitations of the current glioblastoma treatment pathway and the desperate need for new strategies.…”

Section: Introductionmentioning

confidence: 99%

Early Therapeutic Interventions for Newly Diagnosed Glioblastoma: Rationale and Review of the Literature

et al. 2022

View full text Add to dashboard Cite

Purpose of Review Glioblastoma is the commonest primary brain cancer in adults whose outcomes are amongst the worst of any cancer. The current treatment pathway comprises surgery and postoperative chemoradiotherapy though unresectable diffusely infiltrative tumour cells remain untreated for several weeks post-diagnosis. Intratumoural heterogeneity combined with increased hypoxia in the postoperative tumour microenvironment potentially decreases the efficacy of adjuvant interventions and fails to prevent early postoperative regrowth, called rapid early progression (REP). In this review, we discuss the clinical implications and biological foundations of post-surgery REP. Subsequently, clinical interventions potentially targeting this phenomenon are reviewed systematically. Recent Findings Early interventions include early systemic chemotherapy, neoadjuvant immunotherapy, local therapies delivered during surgery (including Gliadel wafers, nanoparticles and stem cell therapy) and several radiotherapy techniques. We critically appraise and compare these strategies in terms of their efficacy, toxicity, challenges and potential to prolong survival. Finally, we discuss the most promising strategies that could benefit future glioblastoma patients. Summary There is biological rationale to suggest that early interventions could improve the outcome of glioblastoma patients and they should be investigated in future trials.

show abstract

“…There is evidence that PRMRI could provide a more accurate baseline for subsequent imaging studies compared to EPMRI, due to the detection of any interval changes occurring between EPMRI and the initiation of chemoradiotherapy [57]. These changes include tumour growth [57][58][59] and new reactive non-neoplastic enhancement [11,52,53], both of which can confound treatment response assessment on subsequent imaging studies. Pseudoprogression and radiation necrosis are two welldocumented forms of PTRE.…”

Section: Comparison With Other Studies and Study Relevancementioning

confidence: 99%

Glioblastoma post-operative imaging in neuro-oncology: current UK practice (GIN CUP study)

et al. 2020

View full text Add to dashboard Cite

Objectives MRI remains the preferred imaging investigation for glioblastoma. Appropriate and timely neuroimaging in the follow-up period is considered to be important in making management decisions. There is a paucity of evidence-based information in current UK, European and international guidelines regarding the optimal timing and type of neuroimaging following initial neurosurgical treatment. This study assessed the current imaging practices amongst UK neuro-oncology centres, thus providing baseline data and informing future practice. Methods The lead neuro-oncologist, neuroradiologist and neurosurgeon from every UK neuro-oncology centre were invited to complete an online survey. Participants were asked about current and ideal imaging practices following initial treatment. Results Ninety-two participants from all 31 neuro-oncology centres completed the survey (100% response rate). Most centres routinely performed an early post-operative MRI (87%, 27/31), whereas only a third performed a pre-radiotherapy MRI (32%, 10/31). The number and timing of scans routinely performed during adjuvant TMZ treatment varied widely between centres. At the end of the adjuvant period, most centres performed an MRI (71%, 22/31), followed by monitoring scans at 3 monthly intervals (81%, 25/31). Additional short-interval imaging was carried out in cases of possible pseudoprogression in most centres (71%, 22/31). Routine use of advanced imaging was infrequent; however, the addition of advanced sequences was the most popular suggestion for ideal imaging practice, followed by changes in the timing of EPMRI. Conclusion Variations in neuroimaging practices exist after initial glioblastoma treatment within the UK. Multicentre, longitudinal, prospective trials are needed to define the optimal imaging schedule for assessment. Key Points • Variations in imaging practices exist in the frequency, timing and type of interval neuroimaging after initial treatment of glioblastoma within the UK. • Large, multicentre, longitudinal, prospective trials are needed to define the optimal imaging schedule for assessment.

show abstract

Preradiotherapy MR Imaging: A Prospective Pilot Study of the Usefulness of Performing an MR Examination Shortly before Radiation Therapy in Patients with Glioblastoma

Cited by 18 publications

References 24 publications

Early tumor growth between initial resection and radiotherapy of glioblastoma: incidence and impact on clinical outcomes

Early tumor growth between initial resection and radiotherapy of glioblastoma: incidence and impact on clinical outcomes

Early Therapeutic Interventions for Newly Diagnosed Glioblastoma: Rationale and Review of the Literature

Glioblastoma post-operative imaging in neuro-oncology: current UK practice (GIN CUP study)

Contact Info

Product

Resources

About