Frequency and Prognostic Relevance of Volumetric MRI Changes in Contrast- and Non-Contrast-Enhancing Tumor Compartments between Surgery and Radiotherapy of IDHwt Glioblastoma
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)...
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MDPI AG
2023-03-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/15/6/1745 |
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| author | Nico Teske Nina C. Teske Maximilian Niyazi Claus Belka Niklas Thon Joerg-Christian Tonn Robert Forbrig Philipp Karschnia |
| author_facet | Nico Teske Nina C. Teske Maximilian Niyazi Claus Belka Niklas Thon Joerg-Christian Tonn Robert Forbrig Philipp Karschnia |
| author_sort | Nico Teske |
| collection | DOAJ |
| description | 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 cm<sup>3</sup>), and new non-contrast lesion volume in 18/64 patients (28%, 5.0 ± 2.3 cm<sup>3</sup>). 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; <i>p</i> = 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. |
| first_indexed | 2024-03-11T06:48:50Z |
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| language | English |
| last_indexed | 2024-03-11T06:48:50Z |
| publishDate | 2023-03-01 |
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| series | Cancers |
| spelling | doaj.art-a28d8d216fd54033aa286cab2ea67bea2023-11-17T10:06:38ZengMDPI AGCancers2072-66942023-03-01156174510.3390/cancers15061745Frequency and Prognostic Relevance of Volumetric MRI Changes in Contrast- and Non-Contrast-Enhancing Tumor Compartments between Surgery and Radiotherapy of IDHwt GlioblastomaNico Teske0Nina C. Teske1Maximilian Niyazi2Claus Belka3Niklas Thon4Joerg-Christian Tonn5Robert Forbrig6Philipp Karschnia7Department of Neurosurgery, Munich University Hospital, LMU Munich, 81377 Munich, GermanyDepartment of Neurosurgery, Munich University Hospital, LMU Munich, 81377 Munich, GermanyGerman Cancer Consortium (DKTK), Partner Site Munich, 80336 Munich, GermanyGerman Cancer Consortium (DKTK), Partner Site Munich, 80336 Munich, GermanyDepartment of Neurosurgery, Munich University Hospital, LMU Munich, 81377 Munich, GermanyDepartment of Neurosurgery, Munich University Hospital, LMU Munich, 81377 Munich, GermanyInstitute of Neuroradiology, Munich University Hospital, LMU Munich, 81377 Munich, GermanyDepartment of Neurosurgery, Munich University Hospital, LMU Munich, 81377 Munich, GermanyIn 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 cm<sup>3</sup>), and new non-contrast lesion volume in 18/64 patients (28%, 5.0 ± 2.3 cm<sup>3</sup>). 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; <i>p</i> = 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.https://www.mdpi.com/2072-6694/15/6/1745glioblastomaIDH-wildtypesurgeryradiotherapyextent of resectiontumor progression |
| spellingShingle | Nico Teske Nina C. Teske Maximilian Niyazi Claus Belka Niklas Thon Joerg-Christian Tonn Robert Forbrig Philipp Karschnia Frequency and Prognostic Relevance of Volumetric MRI Changes in Contrast- and Non-Contrast-Enhancing Tumor Compartments between Surgery and Radiotherapy of IDHwt Glioblastoma Cancers glioblastoma IDH-wildtype surgery radiotherapy extent of resection tumor progression |
| title | Frequency and Prognostic Relevance of Volumetric MRI Changes in Contrast- and Non-Contrast-Enhancing Tumor Compartments between Surgery and Radiotherapy of IDHwt Glioblastoma |
| title_full | Frequency and Prognostic Relevance of Volumetric MRI Changes in Contrast- and Non-Contrast-Enhancing Tumor Compartments between Surgery and Radiotherapy of IDHwt Glioblastoma |
| title_fullStr | Frequency and Prognostic Relevance of Volumetric MRI Changes in Contrast- and Non-Contrast-Enhancing Tumor Compartments between Surgery and Radiotherapy of IDHwt Glioblastoma |
| title_full_unstemmed | Frequency and Prognostic Relevance of Volumetric MRI Changes in Contrast- and Non-Contrast-Enhancing Tumor Compartments between Surgery and Radiotherapy of IDHwt Glioblastoma |
| title_short | Frequency and Prognostic Relevance of Volumetric MRI Changes in Contrast- and Non-Contrast-Enhancing Tumor Compartments between Surgery and Radiotherapy of IDHwt Glioblastoma |
| title_sort | frequency and prognostic relevance of volumetric mri changes in contrast and non contrast enhancing tumor compartments between surgery and radiotherapy of idhwt glioblastoma |
| topic | glioblastoma IDH-wildtype surgery radiotherapy extent of resection tumor progression |
| url | https://www.mdpi.com/2072-6694/15/6/1745 |
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