Abstract
This study was designed to investigate the impact of interim progression of disease (PD) during the surgery-to-radiotherapy interval (SRI) and its predictors in glioblastoma based on MRIs. A total of 222 patients were planned for radiotherapy (RT) and 166 of them were evaluable for the presence of interim PD by 2 separate MRIs. The size criteria from the updated Response Assessment in Neuro-Oncology criteria was adopted to determine interim PD. 32 (19.3%) patients experienced interim PD, and their median survival (MS) was shorter than patients without PD in univariate (11.3 vs. 19.6 months, p < 0.001) and multivariate analysis (HR 2.237, 95% CI 1.367–3.660, p = 0.002). The volume of residual enhancing tumor (p = 0.003) and prolongation of the SRI (p = 0.004) were significant predictors of interim PD. Every 1-cc increase in residual enhancing tumor and every 1-day prolongation of the SRI significantly increased the risk of interim PD by 3.9% (p = 0.003) and 8.1% (p = 0.004), respectively. A significant portion of patients demonstrate interim PD during SRI and these patients have poor prognosis. The presence of interim PD should be concerned as a significant confounding factor for stratification in future clinical trials. A baseline pre-RT MRI is essential for accurate disease evaluation and RT-target delineation, especially in patients with larger residual disease after surgery and prolonged SRI due to the high risk of interim PD.
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Funding
This work was supported by the National R&D Program for Cancer Control by National Cancer Center Korea [Grant No. 1320220] and the National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIP) [Grant No. 2013M2A2A7043683] to Il Han Kim.
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This study was performed with the approval of the Health Institutional Review Board of Seoul National University Hospital, Seoul, Korea (IRB No. H-1507-138-690). For this type of study formal consent is not required. The current article also does not contain any studies with human participants or animals performed by any of the authors.
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Wee, C.W., Kim, E., Kim, T.M. et al. Impact of interim progression during the surgery-to-radiotherapy interval and its predictors in glioblastoma treated with temozolomide-based radiochemotherapy. J Neurooncol 134, 169–175 (2017). https://doi.org/10.1007/s11060-017-2505-x
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DOI: https://doi.org/10.1007/s11060-017-2505-x