Abstract
PurposeTo analyze the enhancement patterns and apparent diffusion coefficient (ADC) values of non-measurable surgical cavity wall enhancement pattern, newly appearing after completion of standard concurrent chemoradiotherapy (CCRT) with temozolomide in glioblastoma patients for the prognosis prediction.Materials and MethodsFrom January 2010 to April 2014, among 190 patients with histopathologically confirmed glioblastoma, a total of 33 patients with non-measurable wall enhancement on post-CCRT MR imaging were enrolled and divided into two subgroups: non-progression (n = 18) and progression groups (n = 15). We analyzed the wall enhancement patterns, which were categorized into three patterns: thin, thick and nodular enhancement. ADC values were measured in the enhancing portions of the walls. The progression-free survival (PFS) related to the wall enhancement was analyzed by Kaplan-Meier analysis, and survival curves were compared using the log-rank test.ResultsStatistically significant differences in the surgical cavity wall enhancement patterns was shown between the progression and non-progression groups (P = 0.0032). Thin wall enhancement was more frequently observed in the non-progression group, and thick or nodular wall enhancement were observed in the progression group (P = 0.0016). There was no statistically significant difference in the mean ADC values between the progression and non-progression groups. The mean PFS was longer in patients with thin wall enhancement than in those with nodular or thick wall enhancement (35.5 months vs. 15.8 months, P = 0.008).ConclusionPattern analysis of non-measurable surgical cavity wall enhancement on post-CCRT MR imaging might be useful tool for predicting prognosis of GBM patient before clear progression of non-measurable disease.
Highlights
Glioblastoma multiforme (GBM) is characterized by aggressiveness and is represented by proliferation and invasion into brain tissue
Significant differences in the surgical cavity wall enhancement patterns was shown between the progression and non-progression groups (P = 0.0032)
Thin wall enhancement was more frequently observed in the non-progression group, and thick or nodular wall enhancement were observed in the progression group (P = 0.0016)
Summary
Glioblastoma multiforme (GBM) is characterized by aggressiveness and is represented by proliferation and invasion into brain tissue This aggressive feature of GBM makes new approaches to the treatment of the ‘cells left behind’ after resection important.[1] The current standard treatment for newly diagnosed GBM is based on concurrent chemoradiotherapy (CCRT) with temozolomide (TMZ) and six cycles of adjuvant TMZ after surgical resection to the extent feasible [2]. Macdonald et al [5] published criteria for response assessment in high-grade glioma in 1990. The Response Assessment in Neuro-Oncology (RANO) Working Group revised the response criteria for high-grade gliomas from the perception that the Macdonald criteria had a number of limitations. Despite effort to revise the response criteria, measurement of the tumor around cysts or the surgical cavity is challenging. In RANO response criteria [6], a thin cyst or surgical cavity wall enhancement is considered to indicate a non-measurable lesion, unless any nodular component corresponding to measurable criteria exists
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