Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Bonn, Germany.
West German Cancer Center (WTZ), University Hospital Essen and German Cancer Consortium, Partner Site University Hospital Essen, University Duisburg-Essen, Essen, Germany.
J Cancer Res Clin Oncol. 2018 Aug;144(8):1581-1589. doi: 10.1007/s00432-018-2671-z. Epub 2018 May 28.
We evaluated patterns of tumor growth in patients with newly diagnosed MGMT-non-methylated glioblastoma who were assigned to undergo radiotherapy in conjunction with bevacizumab/irinotecan (BEV/IRI) or standard temozolomide (TMZ) within the randomized phase II GLARIUS trial.
In 142 patients (94 BEV/IRI, 48 TMZ), we reviewed magnetic resonance imaging scans at baseline and first tumor recurrence. Based on contrast-enhanced T1-weighted and fluid-attenuated inversion recovery images, we assessed tumor growth patterns and tumor invasiveness. Tumor growth patterns were classified as either multifocal or local at baseline and recurrence; at first recurrence, we additionally assessed whether distant lesions appeared. Invasiveness was determined as either diffuse or non-diffuse. Associations with treatment arms were calculated using Fisher's exact test.
At baseline, 115 of 142 evaluable patients (81%) had a locally confined tumor. Between treatment arms, there was no significant difference in the fraction of tumors that changed from an initially local tumor growth pattern to a multifocal pattern (12 and 13%, p = 0.55). Distant lesions appeared in 17% (BEV/IRI) and 13% (TMZ) of patients (p = 0.69). 15% of patients in the BEV/IRI arm and 8% in the TMZ arm developed a diffuse growth pattern from an initially non-diffuse pattern (p = 0.42).
The tumor growth and invasiveness patterns do not differ between BEV/IRI and TMZ-treated MGMT-non-methylated glioblastoma patients in the GLARIUS trial. BEV/IRI was not associated with an increased rate of multifocal, distant, or highly invasive tumors at the time of recurrence.
我们评估了新诊断的 MGMT 非甲基化胶质母细胞瘤患者的肿瘤生长模式，这些患者在 GLARIUS 试验的随机 2 期试验中被分配接受贝伐单抗/伊立替康（BEV/IRI）或标准替莫唑胺（TMZ）联合放疗。
在 142 名患者（94 名 BEV/IRI，48 名 TMZ）中，我们回顾了基线和首次肿瘤复发时的磁共振成像扫描。根据对比增强 T1 加权和液体衰减反转恢复图像，我们评估了肿瘤生长模式和肿瘤侵袭性。基线和复发时，肿瘤生长模式分为多灶性或局限性；首次复发时，我们还评估了是否出现远处病变。侵袭性分为弥漫性或非弥漫性。使用 Fisher 精确检验计算与治疗臂的关联。
在基线时，142 名可评估患者中有 115 名（81%）具有局部受限的肿瘤。在治疗臂之间，从最初的局部肿瘤生长模式转变为多灶性模式的肿瘤比例没有显著差异（12%和 13%，p=0.55）。17%（BEV/IRI）和 13%（TMZ）的患者出现远处病变（p=0.69）。BEV/IRI 臂的 15%患者和 TMZ 臂的 8%患者从最初的非弥漫性模式发展为弥漫性生长模式（p=0.42）。
在 GLARIUS 试验中，BEV/IRI 和 TMZ 治疗的 MGMT 非甲基化胶质母细胞瘤患者的肿瘤生长和侵袭模式没有差异。在复发时，BEV/IRI 与多灶性、远处或高度侵袭性肿瘤的发生率增加无关。
