Kim Hakyoung, Lim Do Hoon, Kim Tae Gyu, Lee Jung-Il, Nam Do-Hyun, Seol Ho Jun, Kong Doo-Sik, Choi Jung Won, Suh Yeon-Lim, Kim Sung Tae
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Radiation Oncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
Asia Pac J Clin Oncol. 2018 Oct;14(5):e366-e373. doi: 10.1111/ajco.12861. Epub 2018 Feb 23.
Leptomeningeal enhancement (LME) on preoperative brain magnetic resonance imaging (MRI) does not always indicate leptomeningeal seeding (LMS). With Stupp's regimen, authors have treated glioblastoma patients with LME on preoperative brain MRI but here we tried to find the clinical impact of LME.
From 2005 to 2015, 290 patients with glioblastoma have been treated with Stupp's regimen at Samsung Medical Center. Among these, 33 patients showed LME on preoperative brain MRI. We compared the clinical outcomes between the patients with or without LME on preoperative brain MRI and analyzed the clinical results according to changes of LME at following MRI.
The median survival was 23 months, and 2-year overall survival (OS) and disease-free survival (DFS) rate was 46.3% and 19.6%, respectively. Prognostic factors for OS and DFS were Karnofsky performance status, extent of resection and adjuvant chemotherapy. MGMT promoter methylation status was a significant prognostic factor for DFS. However, LME was not a significant prognostic factor for OS (P = 0.156) or DFS (P = 0.193). Among the 33 patients with LME on preoperative MRI, 21 (63.6%) showed persistent LME at the next MRI. A statistically significant difference in 2-year survival was evident between patients with and without persistent LME (OS, 17.3% and 70.1%, respectively, P = 0.044; DFS, 5.3% and 54.0%, respectively, P = 0.006). The most common pattern of failure was local recurrence. However, patients with persistent LME displayed a higher incidence of LMS than patients without LME.
LME on preoperative brain MRI did not affect the clinical results in glioblastoma patients treated with the Stupp's regimen. However, persistence of LME was associated with poor survival and high possibility of LMS. For these patients, the postoperative adjuvant treatment should focus on palliative aim or more aggressive treatment scheme should be followed to overcome the disastrous results.
术前脑磁共振成像（MRI）上的软脑膜强化（LME）并不总是提示软脑膜播散（LMS）。采用Stupp方案，作者对术前脑MRI有LME的胶质母细胞瘤患者进行了治疗，但在此我们试图找出LME的临床影响。
2005年至2015年，三星医疗中心有290例胶质母细胞瘤患者接受了Stupp方案治疗。其中，33例患者术前脑MRI显示有LME。我们比较了术前脑MRI有或无LME患者的临床结局，并根据后续MRI上LME的变化分析了临床结果。
中位生存期为23个月，2年总生存期（OS）和无病生存期（DFS）率分别为46.3%和19.6%。OS和DFS的预后因素为卡诺夫斯基功能状态、切除范围和辅助化疗。MGMT启动子甲基化状态是DFS的重要预后因素。然而，LME不是OS（P = 0.156）或DFS（P = 0.193）的重要预后因素。在术前MRI有LME的33例患者中，21例（63.6%）在下一次MRI时显示LME持续存在。有和无持续LME的患者2年生存率有统计学显著差异（OS分别为17.3%和70.1%，P = 0.044；DFS分别为5.3%和54.0%，P = 0.006）。最常见的失败模式是局部复发。然而，有持续LME的患者比无LME的患者LMS发生率更高。
术前脑MRI上的LME对接受Stupp方案治疗的胶质母细胞瘤患者的临床结果没有影响。然而，LME的持续存在与生存率低和LMS可能性高相关。对于这些患者，术后辅助治疗应侧重于姑息目的，或应采用更积极的治疗方案以克服灾难性结果。
