Sollmann Nico, Laub Tobias, Kelm Anna, Albers Lucia, Kirschke Jan S, Combs Stephanie E, Meyer Bernhard, Krieg Sandro M
Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Germany.
TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Germany.
Neurooncol Pract. 2018 May;5(2):82-95. doi: 10.1093/nop/npx021. Epub 2017 Sep 6.
Due to frequent recurrences, high-grade gliomas still confer a poor prognosis. Several regrowth prediction models have been developed, but most of these models are based on cellular models or dynamic mathematical calculations, thus limiting direct clinical use. The present study aims to evaluate whether navigated transcranial magnetic stimulation (nTMS) or functional magnetic resonance imaging (fMRI) may be used to predict the direction of tumor regrowth.
Sixty consecutive patients with high-grade gliomas were enrolled prospectively and analyzed in a case-control design after tumor recurrence. All patients underwent serial MRI after surgery and suffered from recurrent tumors during a mean follow-up of 13.2 ± 14.9 months. Tumor regrowth speed and direction were measured in relation to motor areas defined by nTMS, nTMS-based tractography, and fMRI. Depending on initial resection, patients were separated into three groups (group 1: without residual tumor, group 2: residual tumor away from motor areas, and group 3: residual tumor facing motor areas).
Sixty-nine percent of patients in group 1, 64.3% in group 2, and 66.7% in group 3 showed tumor recurrence towards motor eloquence on contrast-enhanced T1-weighted sequences ( = .9527). Average growth towards motor areas on contrast-enhanced T1-weighted sequences was 0.6 ± 1.5 (group 1), 0.6 ± 2.4 (group 2), and 2.3 ± 5.5 (group 3) mm/month ( = .0492).
This study suggests a new strategy to predict tumor regrowth patterns in high-grade glioma patients. Our approach could be directly applied in the clinical setting, thus having clinical impact on both surgical treatment and radiotherapy planning.
2793/10.
由于高级别胶质瘤频繁复发，其预后仍然很差。已经开发了几种复发预测模型，但这些模型大多基于细胞模型或动态数学计算，因此限制了其直接临床应用。本研究旨在评估导航经颅磁刺激（nTMS）或功能磁共振成像（fMRI）是否可用于预测肿瘤复发方向。
前瞻性纳入60例连续的高级别胶质瘤患者，在肿瘤复发后采用病例对照设计进行分析。所有患者术后均接受系列MRI检查，在平均13.2±14.9个月的随访期间出现肿瘤复发。根据nTMS、基于nTMS的纤维束成像和fMRI定义的运动区域测量肿瘤复发速度和方向。根据初始切除情况，将患者分为三组（第1组：无残留肿瘤，第2组：残留肿瘤远离运动区域，第3组：残留肿瘤朝向运动区域）。
第1组69%的患者、第2组64.3%的患者和第3组66.7%的患者在对比增强T1加权序列上显示肿瘤向运动功能区复发（P = 0.9527）。对比增强T1加权序列上向运动区域的平均生长速度分别为0.6±1.5（第1组）、0.6±2.4（第2组）和2.3±5.5（第3组）mm/月（P = 0.0492）。
本研究提出了一种预测高级别胶质瘤患者肿瘤复发模式的新策略。我们的方法可直接应用于临床环境，因此对手术治疗和放疗计划均具有临床意义。
2793/10。
