Top

Published in:

01-07-2016 | Original Article

MRI during radiotherapy of glioblastoma

Does MRI allow for prognostic stratification?

Authors: Dr. C. Leitzen, T. Wilhelm-Buchstab, L. C. Schmeel, S. Garbe, S. Greschus, T. Müdder, S. Oberste-Beulmann, B. Simon, H. H. Schild, H. Schüller

Published in: Strahlentherapie und Onkologie | Issue 7/2016

Abstract

Aim

To evaluate the role of magnetic resonance imaging (MRI) as a predictor for the clinical course in patients with glioblastoma.

Patients and methods

In 64 patients with glioblastoma undergoing (chemo)radiotherapy MRI studies were obtained before radiation, after 30 gray (Gy), after 60 Gy and during follow-up. MRI findings were assigned to categories: definite progression, questionable progression, no change. Patients were followed clinically.

Results

At 30 Gy, 23 of 64 patients (36 %) demonstrated definite (dp; n = 15) or questionable (qp; n = 8) progression; in 41/64 (64 %) no change was found compared with preradiation MRI. After radiotherapy at 60 Gy, 26 of 64 (41 %) patients showed dp (n = 18) or qp (n = 8). In 2 cases with qp at the 30 Gy MRI, progress was unquestionable in the 60 Gy MRI study. In the 64 patients, 5 of the 60 Gy MRIs showed dp/qp after being classified as no change at the 30 Gy MRI, 2 of the 30 Gy MRIs showed qp, while the 60 Gy MRI showed tumour regression and 3 fulfilled the criteria for pseudoprogression during ongoing radiotherapy. The 30 Gy study allowed for prognostic stratification: dp/qp compared to stable patients showed median survival of 10.5 versus 20 months.

Conclusion

MR follow-up after 30 Gy in patients undergoing (chemo)radiotherapy for glioblastoma allows prognostic appraisal. Pseudoprogression has to be taken into account, though rare in our setting. Based on these findings, early discussion of treatment modification is possible.

Ahmed R, Oborski MJ, Hwang M et al (2014) Malignant gliomas: current perspectives in diagnosis, treatment, and early response assessment using advanced quantitative imaging methods. Cancer Manag Res 6:149–170PubMedPubMedCentral

Brandes A, Tosoni A, Spagnolli F et al (2008) Disease progression or pseudoprogression after concomitant radiochemotherapy treatment: pitfalls in neurooncology. Neuro Oncol 10:361–367CrossRefPubMedPubMedCentral

Barajas R, Chang J, Segal M et al (2009) Differentiation of recurrent glioblastoma multiforme from radiation necrosis after external beam radiation therapy with dynamic susceptibility-weighted contrast-enhanced perfusion MR Imaging. Radiology 253:486–496CrossRefPubMedPubMedCentral

Brandes A, Franceschi E, Tosoni A et al (2008) MGMT promoter methylation status can predict the incidence and outcome of pseudoprogression after concomitant radiochemotherapy in newly diagnosed glioblastoma patients. J Clin Oncol 26:2192–2197CrossRefPubMed

Peca C, Pacelli R, Elefante A et al (2009) Early clinical and neuroradiological worsening after radiotherapy and concomitant temozolomide in patients with glioblastoma: Tumour progression or radionecrosis? Clin Neurol Neurosurg 111:331–334CrossRefPubMed

Ryken TC, Aygun N, Morris J et al (2014) The role of imaging in the management of progressive glioblastoma: A systematic review and evidence-based clinical practice guideline. J Neurooncol 118:435–460CrossRefPubMed

Träber F, Block W, Flacke S et al (2002) 1H-MR spectroscopy of brain tumors in the course of radiation therapy: Use of fast spectroscopic imaging and single-voxel spectroscopy for diagnosing recurrence. Rofo 174:33–42CrossRefPubMed

Stupp R, Dietrich P‑Y, Ostermann S et al (2002) Promising survival for patients with newly diagnosed glioblastoma multiforme treated with concomitant radiation plus temozolomide followed by adjuvant temozlomide. J Clin Oncol 20:1375–1382CrossRefPubMed

Stupp R, Mason W, Bent M van den et al (2005) Radiotherapy plus concomitant and adjuvant temozolomid for glioblastoma. N Engl J Med 452:987–996CrossRef

10.

Fabrini M, Perrone F, De Franco L et al (2009) Perioperative high-dose-rate brachytherapy in the treatment of recurrent malignant gliomas. Strahlenther Onkol 185:524–529CrossRefPubMed

11.

Tselis N, Kolotas C, Birn G et al (2007) CT-guided interstitial HDR brachytherapy for recurrent glioblastoma multiforme. Long-term results. Strahlenther Onkol 183:563–570CrossRefPubMed

12.

Robles P de, Cairncross G (2008) Glioblastoma in the elderly: an age-old problem. Ann Neurol 64:597–599CrossRefPubMed

13.

Iwamoto F, Reiner A, Panageas K et al (2008) Patterns of care in elderly glioblastoma patients. Ann Neurol 64:628–634CrossRefPubMed

14.

Pichlmeier U, Bink A, Schackert G, Stummer W, ALA Glioma Study Group (2008) Resection and survival in glioblastoma multiforme: an RTOG recursive partitioning analysis of ALA study patients. Neuro Oncol 10:1025–1034CrossRefPubMedPubMedCentral

15.

Brandes A, Tosoni A, Franceschi E et al (2009) Recurrence pattern after temozolomide concomitant with and adjuvant to radiotherapy in newly diagnosed patients with glioblastoma: Correlation with MGMT promoter methylation status. J Clin Oncol 27:1275–1279CrossRefPubMed

16.

Brell M, Tortosa A, Verger E et al (2005) Prognostic significance of O6-methylguanine-DNA methyltransferase determined by promoter hypermethylation and immunohistochemical expression in anaplastic gliomas. Clin Cancer Res 11:5167–5174CrossRefPubMed

17.

Chamberlain M (2008) Pseudoprogression in glioblastoma. J Clin Oncol 26:4359CrossRefPubMed

18.

Kloosterhof NK, Bralten LB, Dubbink HJ et al (2011) Isocitrate dehydrogenase-1 mutations: a fundamentally new understanding of diffuse glioma? Lancet Oncol 12:83–91CrossRefPubMed

19.

Wen PY, Macdonald DR, Reardon DA (2010) Updated response assessment criteria for high-grade gliomas: response assessment in neuro-oncology working group. J Clin Oncol 10;28(11):1963–1972CrossRef

20.

Choi J, Lee M, Kim I et al (2008) The outcomes of concomitant chemoradiotherapy followed by adjuvant chemotherapy with temozolomide for newly diagnosed high grade gliomas: the preliminary results of single center prospective study. J Korean Neurosurg Soc 44:222–227CrossRefPubMedPubMedCentral

21.

Kocher M, Frommolt P, Borberg SK et al (2008) Randomized study of postoperative radiotherapy and simultaneous temozolomide without adjuvant chemotherapy for glioblastoma. Strahlenther Onkol 184:572–579CrossRefPubMed

22.

Nishikawa R (2010) Standard therapy for glioblastoma – a review of where we are. Neurol Med Chir (Tokyo) 50:713–719CrossRef

23.

Muth C, Rubner Y, Semrau S et al (2016) Primary glioblastoma multiforme tumors and recurrence: Comparative analysis of the danger signals HMGB1, HSP70, and calreticulin. Strahlenther Onkol 192(3):146–155CrossRefPubMed

24.

Berberat J, McNamara J, Remonda L et al (2014) Diffusion tensor imaging for target volume definition in glioblastoma multiforme. Strahlenther Onkol 190(10):939–943CrossRefPubMed

25.

Fokas E, Wacker U, Gross MW et al (2009) Hypofractionated stereotactic reirradiation of recurrent glioblastomas: a beneficial treatment option after high-dose radiotherapy? Strahlenther Onkol 185:235–240CrossRefPubMed

26.

Henke G, Paulsen F, Steinbach JP et al (2009) Hypofractionated reirradiation for recurrent malignant glioma. Strahlenther Onkol 185:113–119CrossRefPubMed

27.

Idbaih A, Taillibert S, Simon J‑M et al (2008) Short course of radiation therapy in elderly patients with glioblastoma multiforme. Cancer Radiother 12:788–792CrossRefPubMed

28.

McDonald MW, Shu HK, Curran WJ Jr et al (2011) Pattern of failure after limited margin radiotherapy and temozolomide for glioblastoma. Int J Radiat Oncol Biol Phys 79:130–136CrossRefPubMed

29.

Pedicini P, Fiorentino A, Simeon V et al (2014) Clinical radiobiology of glioblastoma multiforme: estimation of tumor control probability from various radiotherapy fractionation schemes. Strahlenther Onkol 190(10):925–932CrossRefPubMed

30.

Pierga JY, Hoang-Xuan K, Feuvret L et al (1999) Treatment of malignant gliomas in the elderly. J Neurooncol 43:187–193CrossRefPubMed

31.

Piroth MD, Gagel B, Pinkawa M et al (2007) Postoperative radiotherapy of glioblastoma multiforme: analysis and critical assessment of different treatment strategies and predictive factors. Strahlenther Onkol 183:695–702CrossRefPubMed

32.

Leitzen C, Schild HH, Bungart B et al (2010) Prediction of clinical course of glioblastomas by MRI during radiotherapy. Strahlenther Onkol 186:681–686CrossRefPubMed

33.

Stupp R, Taillibert S (2015) Kanner AA maintenance therapy with tumor-treating fields plus temozolomide vs temozolomide alone for glioblastoma: A randomized clinical trial. JAMA 314(23):2535–2543CrossRefPubMed

34.

Brandsma D, Stalpers L, Taal W (2008) Clinical features, mechanisms, and management of pseudoprogression in malignant gliomas. Lancet Oncol 9(5):453–461CrossRefPubMed

35.

Radbruch A, Fladt J, Kickingereder P, Wiestler B, Nowosielski M, Bäumer P et al (2011) Pseudoprogression in patients with glioblastoma: clinical relevance despite low incidence. Clin Neuroradiol 21(4):199–205CrossRefPubMed

36.

Taal W, Brandsma D, Bruin HG de et al (2008) Incidence of early pseudo-progression in a cohort of malignant glioma patients treated with chemoirradiation with temozolomide. Cancer 113(2):405–410CrossRefPubMed

Title: MRI during radiotherapy of glioblastoma
Does MRI allow for prognostic stratification?
Authors: Dr. C. Leitzen
T. Wilhelm-Buchstab
L. C. Schmeel
S. Garbe
S. Greschus
T. Müdder
S. Oberste-Beulmann
B. Simon
H. H. Schild
H. Schüller
Publication date: 01-07-2016
Publisher: Springer Berlin Heidelberg
Published in: Strahlentherapie und Onkologie / Issue 7/2016
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-016-0983-y

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

MRI during radiotherapy of glioblastoma

Does MRI allow for prognostic stratification?

Abstract

Aim

Patients and methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Aim

Patients and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 7/2016

Capacitabine und Oxaliplatin (XelOx) im Vergleich zu Fluorouracil/Folinsäure als adjuvante Therapie bei Kolonkarzinomen im Stadium III: Ergebnisse der kontrollierten randomisierten Phase III-Studie NO16968

68Ga-PSMA ligand PET/CT-based radiotherapy in locally recurrent and recurrent oligometastatic prostate cancer

Überlebensvorteil durch konsolidierende Strahlentherapie bei Patienten mit diffusem großzelligen B‑Zell-Lymphom in den Frühstadien

Protonentherapie bei Kindern mit Medulloblastom bei akzeptablen Nebenwirkungen ähnlich erfolgreich wie Photonentherapie

Inclined head position improves dose distribution during hippocampal-sparing whole brain radiotherapy using VMAT

High dose-rate endoluminal brachytherapy for primary and recurrent esophageal cancer