Abstract
The treatment of recurrent high-grade gliomas remains a major challenge of daily neuro-oncology practice, and imaging findings of new therapies may be challenging. Regorafenib is a multi-kinase inhibitor that has recently been introduced into clinical practice to treat recurrent glioblastoma, bringing with it a novel panel of MRI imaging findings. On the basis of the few data in the literature and on our personal experience, we have identified the main MRI changes during regorafenib therapy, and then, we defined two different patterns, trying to create a simple summary line of the main changes of pathological tissue during therapy. We named these patterns, respectively, pattern A (less frequent, similar to classical progression disease) and pattern B (more frequent, with decreased diffusivity and decrease contrast-enhancement). We have also reported MR changes concerning signal intensity on T1-weighted and T2-weighted images, SWI, and perfusion imaging, derived from the literature (small series or case reports) and from our clinical experience. The clinical implication of these imaging modifications remains to be defined, taking into account that we are still at the dawn in the evaluation of such imaging modifications.
Highlights
AND BACKGROUNDGlioblastoma (GB), previously called glioblastoma multiforme, is the most common malignant primary brain tumor in adults
Microvascular proliferation and necrosis are two critical histologic features used for the differentiation between an anaplastic astrocytoma, WHO grade III, and a GB, Regorafenib in Glioblastoma: Treatment Changes
The response assessment in neuro-oncology (RANO) criteria standardizes the radiologic assessment of treatment response in patients with GB, but they focus primarily on measurements of contrast enhancement (CE), whereas the importance of nonenhancing components of tumors is frequently overlooked [16]
Summary
Glioblastoma (GB), previously called glioblastoma multiforme, is the most common malignant primary brain tumor in adults. Its therapeutic effect is blocking the process of angiogenesis, one of the main features of GB pathogenesis Most recently, another anti-angiogenic, namely, REG, that has shown efficacy in several cancers [10, 11], as well as preclinical glioma models [12], has been introduced in clinical practice. The response assessment in neuro-oncology (RANO) criteria standardizes the radiologic assessment of treatment response in patients with GB, but they focus primarily on measurements of contrast enhancement (CE), whereas the importance of nonenhancing components of tumors is frequently overlooked [16] Weaknesses in these criteria have emerged with the introduction in the clinical practice of anti-angiogenic drugs. Knowing the different ways of action of the two drugs, it is inductive to hypnotize that drug-induced MRI changes may be similar but not the same
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