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

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%), outfield 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.

Glioblastoma recurrence and the role of MGMT promoter methylation

“…To demonstrate the model dynamics, we first provide a single sample path simulation of the model in Figure 4a, showing the type-1 (methylated) and total population sizes during the standard treatment regimen. Figure 4b shows the distribution of recurrence times from a computational experiment with 100 Monte Carlo simulations; the median recurrence time is 213.8 days, roughly consistent with clinical data in [29], reporting a median recurrence time of 191 days.…”

Can advanced new radiation therapy technologies improve outcome of high grade glioma (HGG) patients? analysis of 3D-conformal radiotherapy (3DCRT) versus volumetric-modulated arc therapy (VMAT) in patients treated with surgery, concomitant and adjuvant chemo-radiotherapy

“…Clinical outcome was evaluated by neurological examination and brain MRI performed 1 month after radiation therapy and then every 3 months. Recurrence was defined as follows: “in-field recurrence” (IFR) if it was overlapped with isodose of 95 %, “marginal recurrence” (MR) if it was overlapped with isodose of 90 %, “outfield recurrence” (OR) if it was outside of treatment volume and “distant recurrence” (DR) if it occurred in other brain lobe [ 17 ]. MRI images acquired during follow up were co-registered with pre-radiation therapy MRI to precisely define the site of relapse.…”

Effects of nuclear factor I phosphorylation on calpastatin (CAST) gene variant expression and subcellular distribution in malignant glioma cells

“…Post-mortem examination often reveals the dissemination of tumor cells into normal brain parenchyma, frequently found distal from the original tumor mass and at early stages of the disease (6). Early infiltration of tumor cells, together with the inherent resistance of MG cells to cytotoxic drugs and radiation therapy, severely limits the efficacy of conventional focal and systemic treatments (7)(8)(9). Whereas targeting infiltrative MG cells would likely be of clinical benefit, molecular mechanisms underlying MG cell migration and infiltration remain poorly characterized.…”