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Pre-Radiotherapy Progression after Surgery of Newly Diagnosed Glioblastoma: Corroboration of New Prognostic Variable

Background: The aim of this retrospective study is to assess the incidence, localization, and potential predictors of rapid early progression (REP) prior to initiation of radiotherapy in newly diagnosed glioblastoma patients and to compare survival outcomes in cohorts with or without REP in relation...

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Autores principales: Lakomy, Radek, Kazda, Tomas, Selingerova, Iveta, Poprach, Alexandr, Pospisil, Petr, Belanova, Renata, Fadrus, Pavel, Smrcka, Martin, Vybihal, Vaclav, Jancalek, Radim, Kiss, Igor, Muckova, Katarina, Hendrych, Michal, Knight, Andrea, Sana, Jiri, Slampa, Pavel, Slaby, Ondrej
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7555958/
https://www.ncbi.nlm.nih.gov/pubmed/32899528
http://dx.doi.org/10.3390/diagnostics10090676
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author Lakomy, Radek
Kazda, Tomas
Selingerova, Iveta
Poprach, Alexandr
Pospisil, Petr
Belanova, Renata
Fadrus, Pavel
Smrcka, Martin
Vybihal, Vaclav
Jancalek, Radim
Kiss, Igor
Muckova, Katarina
Hendrych, Michal
Knight, Andrea
Sana, Jiri
Slampa, Pavel
Slaby, Ondrej
author_facet Lakomy, Radek
Kazda, Tomas
Selingerova, Iveta
Poprach, Alexandr
Pospisil, Petr
Belanova, Renata
Fadrus, Pavel
Smrcka, Martin
Vybihal, Vaclav
Jancalek, Radim
Kiss, Igor
Muckova, Katarina
Hendrych, Michal
Knight, Andrea
Sana, Jiri
Slampa, Pavel
Slaby, Ondrej
author_sort Lakomy, Radek
collection PubMed
description Background: The aim of this retrospective study is to assess the incidence, localization, and potential predictors of rapid early progression (REP) prior to initiation of radiotherapy in newly diagnosed glioblastoma patients and to compare survival outcomes in cohorts with or without REP in relation to the treatment. Methods: We assessed a consecutive cohort of 155 patients with histologically confirmed irradiated glioblastoma from 1/2014 to 12/2017. A total of 90 patients with preoperative, postoperative, and planning MRI were analyzed. Results: Median age 59 years, 59% men, and 39 patients (43%) underwent gross total tumor resection. The Stupp regimen was indicated to 64 patients (71%); 26 patients (29%) underwent radiotherapy alone. REP on planning MRI performed shortly prior to radiotherapy was found in 46 (51%) patients, most often within the surgical cavity wall, and the main predictor for REP was non-radical surgery (p < 0.001). The presence of REP was confirmed as a strong negative prognostic factor; median overall survival (OS) in patients with REP was 10.7 vs. 18.7 months and 2-year survival was 15.6% vs. 37.7% (hazard ratio HR 0.53 for those without REP; p = 0.007). Interestingly, the REP occurrence effect on survival outcome was significantly different in younger patients (≤ 50 years) and older patients (> 50 years) for OS (p = 0.047) and non-significantly for PFS (p = 0.341). In younger patients, REP was a stronger negative prognostic factor, probably due to more aggressive behavior. Patients with REP who were indicated for the Stupp regimen had longer OS compared to radiotherapy alone (median OS 16.0 vs 7.5; HR = 0.5, p = 0.022; 2-year survival 22.3% vs. 5.6%). The interval between surgery and the initiation of radiotherapy were not prognostic in either the entire cohort or in patients with REP. Conclusion: Especially in the subgroup of patients without radical resection, one may recommend as early initiation of radiotherapy as possible. The phenomenon of REP should be recognized as an integral part of stratification factors in future prospective clinical trials enrolling patients before initiation of radiotherapy.
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spelling pubmed-75559582020-10-19 Pre-Radiotherapy Progression after Surgery of Newly Diagnosed Glioblastoma: Corroboration of New Prognostic Variable Lakomy, Radek Kazda, Tomas Selingerova, Iveta Poprach, Alexandr Pospisil, Petr Belanova, Renata Fadrus, Pavel Smrcka, Martin Vybihal, Vaclav Jancalek, Radim Kiss, Igor Muckova, Katarina Hendrych, Michal Knight, Andrea Sana, Jiri Slampa, Pavel Slaby, Ondrej Diagnostics (Basel) Article Background: The aim of this retrospective study is to assess the incidence, localization, and potential predictors of rapid early progression (REP) prior to initiation of radiotherapy in newly diagnosed glioblastoma patients and to compare survival outcomes in cohorts with or without REP in relation to the treatment. Methods: We assessed a consecutive cohort of 155 patients with histologically confirmed irradiated glioblastoma from 1/2014 to 12/2017. A total of 90 patients with preoperative, postoperative, and planning MRI were analyzed. Results: Median age 59 years, 59% men, and 39 patients (43%) underwent gross total tumor resection. The Stupp regimen was indicated to 64 patients (71%); 26 patients (29%) underwent radiotherapy alone. REP on planning MRI performed shortly prior to radiotherapy was found in 46 (51%) patients, most often within the surgical cavity wall, and the main predictor for REP was non-radical surgery (p < 0.001). The presence of REP was confirmed as a strong negative prognostic factor; median overall survival (OS) in patients with REP was 10.7 vs. 18.7 months and 2-year survival was 15.6% vs. 37.7% (hazard ratio HR 0.53 for those without REP; p = 0.007). Interestingly, the REP occurrence effect on survival outcome was significantly different in younger patients (≤ 50 years) and older patients (> 50 years) for OS (p = 0.047) and non-significantly for PFS (p = 0.341). In younger patients, REP was a stronger negative prognostic factor, probably due to more aggressive behavior. Patients with REP who were indicated for the Stupp regimen had longer OS compared to radiotherapy alone (median OS 16.0 vs 7.5; HR = 0.5, p = 0.022; 2-year survival 22.3% vs. 5.6%). The interval between surgery and the initiation of radiotherapy were not prognostic in either the entire cohort or in patients with REP. Conclusion: Especially in the subgroup of patients without radical resection, one may recommend as early initiation of radiotherapy as possible. The phenomenon of REP should be recognized as an integral part of stratification factors in future prospective clinical trials enrolling patients before initiation of radiotherapy. MDPI 2020-09-05 /pmc/articles/PMC7555958/ /pubmed/32899528 http://dx.doi.org/10.3390/diagnostics10090676 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Lakomy, Radek
Kazda, Tomas
Selingerova, Iveta
Poprach, Alexandr
Pospisil, Petr
Belanova, Renata
Fadrus, Pavel
Smrcka, Martin
Vybihal, Vaclav
Jancalek, Radim
Kiss, Igor
Muckova, Katarina
Hendrych, Michal
Knight, Andrea
Sana, Jiri
Slampa, Pavel
Slaby, Ondrej
Pre-Radiotherapy Progression after Surgery of Newly Diagnosed Glioblastoma: Corroboration of New Prognostic Variable
title Pre-Radiotherapy Progression after Surgery of Newly Diagnosed Glioblastoma: Corroboration of New Prognostic Variable
title_full Pre-Radiotherapy Progression after Surgery of Newly Diagnosed Glioblastoma: Corroboration of New Prognostic Variable
title_fullStr Pre-Radiotherapy Progression after Surgery of Newly Diagnosed Glioblastoma: Corroboration of New Prognostic Variable
title_full_unstemmed Pre-Radiotherapy Progression after Surgery of Newly Diagnosed Glioblastoma: Corroboration of New Prognostic Variable
title_short Pre-Radiotherapy Progression after Surgery of Newly Diagnosed Glioblastoma: Corroboration of New Prognostic Variable
title_sort pre-radiotherapy progression after surgery of newly diagnosed glioblastoma: corroboration of new prognostic variable
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7555958/
https://www.ncbi.nlm.nih.gov/pubmed/32899528
http://dx.doi.org/10.3390/diagnostics10090676
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