Frequency and Prognostic Relevance of Volumetric MRI Changes in Contrast- and Non-Contrast-Enhancing Tumor Compartments between Surgery and Radiotherapy of IDHwt Glioblastoma.
Frequency and Prognostic Relevance of Volumetric MRI Changes in Contrast- and Non-Contrast-Enhancing Tumor Compartments between Surgery and Radiotherapy of IDHwt Glioblastoma.
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根据世界卫生组织2021分类诊断的胶质母细胞瘤患者，手术和术后辅助治疗之间早期肿瘤再生长对预后的影响尚不清楚。在一组患者的回顾性队列中，我们对肿瘤切除后早期和开始放(化)疗前(时间间隔：15.5±1.9d)获得的常规MRI进行了容量分析。大约三分之一的肿瘤在完全或不完全切除后出现了新的增强，这是由于肿瘤残留的进展或先前无强化的肿瘤的血脑屏障的破坏，但也与术后缺血和非特异性信号有关。提示肿瘤再生长的发现与不良结果无关。因此，术后即刻MRI应用于对切除范围的预后分层，而放疗开始前的额外成像可能有助于肿瘤体积和放射靶点的勾画。在新诊断的IDH-野生型胶质母细胞瘤中，切除和开始辅助放化疗之间肿瘤再生长的频率和预后相关性尚不清楚。在这项单中心的回顾性研究中，我们纳入了连续的病例，对于这些病例，磁共振成像既可用于术后立即切除范围的体积评估，也可用于在开始辅助放化疗前(时间间隔：15.5±1.9d)的体积靶点勾画。总体而言，21例患者中有21例出现了新的对比剂增强体积(33%，1.5±1.5cm3)，18例患者中有18例出现了新的非对比剂增强体积(28%，5.0±2.3cm3)。一项多学科的深入回顾显示，新的对比度增强要么是由于(1)6/21例患者出现了增强增强的肿瘤残留，要么是(2)5/21例患者出现了较远的对比度增强灶或血脑屏障的破坏，而10/21例患者是非特异性的或由于缺血。对于非对比剂增强的病变，18例中有3例有无对比剂增强的肿瘤残留进展，18例中有15例有非特异性变化或因缺血而发生的变化。与肿瘤再生长相一致的结果与不太有利的结果之间没有显著关联(总生存期：14个月对19个月；p=0.423)。这些发现支持这样的理论，即术后残留肿瘤体积的分析应在术后即刻(72小时)MRI上进行，因为非特异性改变是常见的。然而，根据WHO 2021分类诊断的IDH-野生型胶质母细胞瘤患者中，可能发生肿瘤再生长，包括远处的病灶。因此，应在放疗前获得MRI成像，以相应地调整放疗计划。
The prognostic impact of early tumor regrowth in glioblastoma patients diagnosed according to WHO 2021 classification between surgery and postoperative adjuvant therapy remains unclear. In a retrospective cohort of 64 patients, we performed volumetric analyses of routine MRI obtained early after tumor resection and directly before initiation of radio(chemo-)therapy (time interval: 15.5 ± 1.9 days). About one third developed new contrast-enhancement after complete or incomplete resection due to progression of tumor remnants or breakdown of the blood–brain barrier in previously non-enhancing tumor compartments, but also related to postoperative ischemia and unspecific signals. Findings suggestive for tumor regrowth were not associated with unfavorable outcomes. Immediate postoperative MRI should, therefore, be used for prognostic stratification of the extent of resection, while additional imaging before the start of radiotherapy may be helpful for tumor volume and radiation target delineation. In newly diagnosed IDH-wildtype glioblastoma, the frequency and prognostic relevance of tumor regrowth between resection and the initiation of adjuvant radiochemotherapy are unclear. In this retrospective single-center study we included 64 consecutive cases, for whom magnetic resonance imaging (MRI) was available for both the volumetric assessment of the extent of resection immediately after surgery as well as the volumetric target delineation before the initiation of adjuvant radiochemotherapy (time interval: 15.5 ± 1.9 days). Overall, a median new contrast-enhancement volume was seen in 21/64 individuals (33%, 1.5 ± 1.5 cm3), and new non-contrast lesion volume in 18/64 patients (28%, 5.0 ± 2.3 cm3). A multidisciplinary in-depth review revealed that new contrast-enhancement was either due to (I) the progression of contrast-enhancing tumor remnants in 6/21 patients or (II) distant contrast-enhancing foci or breakdown of the blood–brain barrier in previously non-contrast-enhancing tumor remnants in 5/21 patients, whereas it was unspecific or due to ischemia in 10/21 patients. For non-contrast-enhancing lesions, three of eighteen had progression of non-contrast-enhancing tumor remnants and fifteen of eighteen had unspecific changes or changes due to ischemia. There was no significant association between findings consistent with tumor regrowth and a less favorable outcome (overall survival: 14 vs. 19 months; p = 0.423). These findings support the rationale that analysis of the postsurgical remaining tumor-volume for prognostic stratification should be carried out on immediate postoperative MRI (<72 h), as unspecific changes are common. However, tumor regrowth including distant foci may occur in a subset of IDH-wildtype glioblastoma patients diagnosed per WHO 2021 classification. Thus, MRI imaging prior to radiotherapy should be obtained to adjust radiotherapy planning accordingly.
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影响因子：
158.5
作者：
Stupp, R;Mason, WP;Ryan, G
通讯作者：
Ryan, G
DOI：
10.1093/noajnl/vdac075
发表时间：
2022-01
期刊：
Neuro-oncology advances
影响因子：
--
作者：
通讯作者：
--
影响因子：
15.9
作者：
Kunz, Mathias;Albert, Nathalie Lisa;Thon, Niklas
通讯作者：
Thon, Niklas
影响因子：
4.7
作者：
Skardelly M;Kaltenstadler M;Behling F;Mäurer I;Schittenhelm J;Bender B;Paulsen F;Hedderich J;Renovanz M;Gempt J;Barz M;Meyer B;Tabatabai G;Tatagiba MS
通讯作者：
Tatagiba MS
DOI：
10.3390/diagnostics10090676
发表时间：
2020-09-05
期刊：
Diagnostics (Basel, Switzerland)
影响因子：
--
作者：
Lakomy R;Kazda T;Selingerova I;Poprach A;Pospisil P;Belanova R;Fadrus P;Smrcka M;Vybihal V;Jancalek R;Kiss I;Muckova K;Hendrych M;Knight A;Sana J;Slampa P;Slaby O
通讯作者：
Slaby O