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Initial and cumulative recurrence patterns of glioblastoma after temozolomide-based chemoradiotherapy and salvage treatment: a retrospective cohort study in a single institution.

Ogura K, Mizowaki T, Arakawa Y, Ogura M, Sakanaka K, Miyamoto S, Hiraoka M - Radiat Oncol (2013)

Bottom Line: Twenty-one patients with glioblastoma that recurred after concurrent temozolomide and localized radiotherapy were retrospectively analyzed (11 male, 10 female; median age, 57 years; range, 27-74).Disease progression was assessed by new response criteria proposed by the Response Assessment in Neuro-Oncology Working Group of the American Society of Clinical Oncology.The median follow-up of the recurrent patients was 501 (range, 217-1815) days after initial surgery.

View Article: PubMed Central - HTML - PubMed

Affiliation: Departments of Radiation Oncology and Image-applied Therapy, 54 Kawahara-cho, Shogoin Sakyo-ku, Kyoto 606-8507, Japan. mizo@kuhp.kyoto-u.ac.jp.

ABSTRACT

Purpose: To analyze initial recurrence patterns in patients with newly diagnosed glioblastoma after radiotherapy plus concurrent and adjuvant temozolomide, and to investigate cumulative recurrence patterns after salvage treatment, including surgery, stereotactic radiotherapy, and chemotherapy.

Methods: Twenty-one patients with glioblastoma that recurred after concurrent temozolomide and localized radiotherapy were retrospectively analyzed (11 male, 10 female; median age, 57 years; range, 27-74). Disease progression was assessed by new response criteria proposed by the Response Assessment in Neuro-Oncology Working Group of the American Society of Clinical Oncology. The pattern of recurrence was determined by relationships between locations of recurrent tumors and irradiated doses. Central, in-field, marginal, and out-field recurrences were defined relative to the prescribed isodose line. Distant recurrence was operationally defined as subependymal or disseminated disease. Initial and cumulative patterns of recurrence were evaluated in each patient.

Results: The median follow-up of the recurrent patients was 501 (range, 217-1815) days after initial surgery. Initial recurrences were central in 14 patients (66.7%), in-field in four patients (19.0%), marginal in no patient (0%), out-field in two patients (9.5%), and distant in four patients (19.0%). One patient had both central and in-field recurrences simultaneously, and two had both central and distant recurrences. In the analysis of cumulative recurrence patterns, five patients, who had no scans after initial recurrences, were excluded and the remaining 16 were included. Cumulative recurrences were central in 11 patients (68.8%), in-field in five patients (31.3%), marginal in three patients (18.8%), out-field in five patients (31.3%), and distant in 14 patients (87.5%). Regarding salvage treatments, 11 (52.4%), 11 (52.4%) and 17 (81.0%) patients underwent surgery, stereotactic radiotherapy and chemotherapy, respectively. Eighteen (85.7%) patients had died at the time of analysis, and 16 of them (88.9%) had suffered distant recurrences, which could have been the immediate causes of death.

Conclusions: Recurrence patterns of glioblastoma after radiotherapy plus concomitant and adjuvant temozolomide were mainly central at first, and distant recurrences were often detected during the clinical course. Much better local control and prevention of distant recurrence, including effective salvage treatment, seem to be important.

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Examples of recurrence patterns. Examples of recurrence patterns on T1-weighted magnetic resonance imaging with contrast: central (a), in-field (b), marginal (c), out-field (d), and distant recurrences (e). Red contours indicate recurrent tumors. Green and yellow lines indicate 95% isodose lines of 60 Gy and 50 Gy, respectively.
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Figure 4: Examples of recurrence patterns. Examples of recurrence patterns on T1-weighted magnetic resonance imaging with contrast: central (a), in-field (b), marginal (c), out-field (d), and distant recurrences (e). Red contours indicate recurrent tumors. Green and yellow lines indicate 95% isodose lines of 60 Gy and 50 Gy, respectively.

Mentions: The results of recurrence patterns and typical cases are shown in Figures 3 and 4, respectively. Details of recurrence patterns and salvage treatments are summarized in Table 2. All of the initial recurrences were diagnosed as new or enlarged contrast-enhancing lesions on MRI scans. Central recurrence was most often observed as the initial recurrence. One patient had both central and in-field recurrences simultaneously, and two had both central and distant recurrences. The median times from initial surgery to initial failure were 191 (range, 90-1430) days for central/in-field recurrences and 161.5 (range, 111–425) days for other recurrences. Regarding tumor locations, 14 of 21 recurrent patients had primary tumors adjacent to the ventricles and four of them (28.6%) had distant recurrences as initial patterns; two had central and distant recurrences simultaneously, and the other two had only distant recurrences. On the other hand, none of the remaining seven patients with primary tumors not adjacent to the ventricles had distant recurrences as initial patterns. Regarding cumulative recurrences, 16 patients had successive follow-up MRI scans after initial recurrence and were included in the analysis. The remaining five patients underwent no follow-up imaging after initial recurrence because of poor performance status due to progressive disease in four patients (all had distant recurrences) and changing hospital in the other patient. Central and distant recurrences were the most often detected (Figure 3, Table 2). Distant recurrence was observed in almost all the patients who died (16 of 18 patients); 14 of these 16 patients had an uncontrollable local lesion(s) before distant recurrence occurred. The median survival time after the diagnosis of distant recurrence was 149 (range, 63–394) days.


Initial and cumulative recurrence patterns of glioblastoma after temozolomide-based chemoradiotherapy and salvage treatment: a retrospective cohort study in a single institution.

Ogura K, Mizowaki T, Arakawa Y, Ogura M, Sakanaka K, Miyamoto S, Hiraoka M - Radiat Oncol (2013)

Examples of recurrence patterns. Examples of recurrence patterns on T1-weighted magnetic resonance imaging with contrast: central (a), in-field (b), marginal (c), out-field (d), and distant recurrences (e). Red contours indicate recurrent tumors. Green and yellow lines indicate 95% isodose lines of 60 Gy and 50 Gy, respectively.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3643853&req=5

Figure 4: Examples of recurrence patterns. Examples of recurrence patterns on T1-weighted magnetic resonance imaging with contrast: central (a), in-field (b), marginal (c), out-field (d), and distant recurrences (e). Red contours indicate recurrent tumors. Green and yellow lines indicate 95% isodose lines of 60 Gy and 50 Gy, respectively.
Mentions: The results of recurrence patterns and typical cases are shown in Figures 3 and 4, respectively. Details of recurrence patterns and salvage treatments are summarized in Table 2. All of the initial recurrences were diagnosed as new or enlarged contrast-enhancing lesions on MRI scans. Central recurrence was most often observed as the initial recurrence. One patient had both central and in-field recurrences simultaneously, and two had both central and distant recurrences. The median times from initial surgery to initial failure were 191 (range, 90-1430) days for central/in-field recurrences and 161.5 (range, 111–425) days for other recurrences. Regarding tumor locations, 14 of 21 recurrent patients had primary tumors adjacent to the ventricles and four of them (28.6%) had distant recurrences as initial patterns; two had central and distant recurrences simultaneously, and the other two had only distant recurrences. On the other hand, none of the remaining seven patients with primary tumors not adjacent to the ventricles had distant recurrences as initial patterns. Regarding cumulative recurrences, 16 patients had successive follow-up MRI scans after initial recurrence and were included in the analysis. The remaining five patients underwent no follow-up imaging after initial recurrence because of poor performance status due to progressive disease in four patients (all had distant recurrences) and changing hospital in the other patient. Central and distant recurrences were the most often detected (Figure 3, Table 2). Distant recurrence was observed in almost all the patients who died (16 of 18 patients); 14 of these 16 patients had an uncontrollable local lesion(s) before distant recurrence occurred. The median survival time after the diagnosis of distant recurrence was 149 (range, 63–394) days.

Bottom Line: Twenty-one patients with glioblastoma that recurred after concurrent temozolomide and localized radiotherapy were retrospectively analyzed (11 male, 10 female; median age, 57 years; range, 27-74).Disease progression was assessed by new response criteria proposed by the Response Assessment in Neuro-Oncology Working Group of the American Society of Clinical Oncology.The median follow-up of the recurrent patients was 501 (range, 217-1815) days after initial surgery.

View Article: PubMed Central - HTML - PubMed

Affiliation: Departments of Radiation Oncology and Image-applied Therapy, 54 Kawahara-cho, Shogoin Sakyo-ku, Kyoto 606-8507, Japan. mizo@kuhp.kyoto-u.ac.jp.

ABSTRACT

Purpose: To analyze initial recurrence patterns in patients with newly diagnosed glioblastoma after radiotherapy plus concurrent and adjuvant temozolomide, and to investigate cumulative recurrence patterns after salvage treatment, including surgery, stereotactic radiotherapy, and chemotherapy.

Methods: Twenty-one patients with glioblastoma that recurred after concurrent temozolomide and localized radiotherapy were retrospectively analyzed (11 male, 10 female; median age, 57 years; range, 27-74). Disease progression was assessed by new response criteria proposed by the Response Assessment in Neuro-Oncology Working Group of the American Society of Clinical Oncology. The pattern of recurrence was determined by relationships between locations of recurrent tumors and irradiated doses. Central, in-field, marginal, and out-field recurrences were defined relative to the prescribed isodose line. Distant recurrence was operationally defined as subependymal or disseminated disease. Initial and cumulative patterns of recurrence were evaluated in each patient.

Results: The median follow-up of the recurrent patients was 501 (range, 217-1815) days after initial surgery. Initial recurrences were central in 14 patients (66.7%), in-field in four patients (19.0%), marginal in no patient (0%), out-field in two patients (9.5%), and distant in four patients (19.0%). One patient had both central and in-field recurrences simultaneously, and two had both central and distant recurrences. In the analysis of cumulative recurrence patterns, five patients, who had no scans after initial recurrences, were excluded and the remaining 16 were included. Cumulative recurrences were central in 11 patients (68.8%), in-field in five patients (31.3%), marginal in three patients (18.8%), out-field in five patients (31.3%), and distant in 14 patients (87.5%). Regarding salvage treatments, 11 (52.4%), 11 (52.4%) and 17 (81.0%) patients underwent surgery, stereotactic radiotherapy and chemotherapy, respectively. Eighteen (85.7%) patients had died at the time of analysis, and 16 of them (88.9%) had suffered distant recurrences, which could have been the immediate causes of death.

Conclusions: Recurrence patterns of glioblastoma after radiotherapy plus concomitant and adjuvant temozolomide were mainly central at first, and distant recurrences were often detected during the clinical course. Much better local control and prevention of distant recurrence, including effective salvage treatment, seem to be important.

Show MeSH
Related in: MedlinePlus