Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
Can J Neurol Sci. 2020 Jul;47(4):525-530. doi: 10.1017/cjn.2020.36. Epub 2020 Feb 20.
Patients diagnosed with glioblastoma (GBM) are treated with surgery followed by fractionated radiotherapy with concurrent and adjuvant temozolomide. Patients are monitored with serial magnetic resonance imaging (MRI). However, treatment-related changes frequently mimic disease progression. We reviewed a series of patients undergoing surgery for presumed first-recurrence GBM, where pathology reports were available for tissue diagnosis, in order to better understand factors associated with a diagnosis of treatment-related changes on final pathology.
Patient records at a single institution between 2005 and 2015 were retrospectively reviewed. Pathology reports were reviewed to determine diagnosis of recurrent GBM or treatment effect. Survival analysis was performed interrogating overall survival (OS) and progression-free survival (PFS). Correlation with radiation treatment plans was also examined.
One-hundred-twenty-three patients were identified. One-hundred-sixteen patients (94%) underwent resection and seven underwent biopsy. Treatment-related changes were reported in 20 cases (16%). These patients had longer median OS and PFS from the time of recurrence than patients with true disease progression. However, there was no significant difference in OS from the time of initial diagnosis. Treatment effect was associated with surgery within 90 days of completing radiation. In patients receiving radiation at our institution (n = 53), larger radiation target volume and a higher maximum dose were associated with treatment effect.
Treatment effect was associated with surgery nearer to completion of radiation, a larger radiation target volume, and a higher maximum point dose. Treatment effect was associated with longer PFS and OS from the time of recurrence, but not from the time of initial diagnosis.
诊断为胶质母细胞瘤（GBM）的患者接受手术治疗，随后进行分割放射治疗，同时联合和辅助替莫唑胺治疗。患者通过连续磁共振成像（MRI）进行监测。然而，治疗相关的变化经常模仿疾病进展。我们回顾了一系列接受手术治疗疑似首次复发性 GBM 的患者的病例，这些患者的组织诊断均有病理报告，以便更好地了解与最终病理诊断为治疗相关变化相关的因素。
回顾了 2005 年至 2015 年期间一家机构的患者记录。对病理报告进行了审查，以确定是否为复发性 GBM 或治疗效果的诊断。进行了生存分析，以检查总生存期（OS）和无进展生存期（PFS）。还检查了与放射治疗计划的相关性。
共确定了 123 例患者。116 例患者（94%）接受了切除术，7 例患者接受了活检。20 例（16%）报告了治疗相关变化。与真正的疾病进展相比，这些患者的复发性中位 OS 和 PFS 更长。然而，从初始诊断开始，OS 没有显著差异。治疗效果与放射治疗完成后 90 天内的手术有关。在我们机构接受放射治疗的患者（n=53）中，较大的放射靶体积和较高的最大剂量与治疗效果相关。
治疗效果与接近完成放射治疗的手术、较大的放射靶体积和较高的最大点剂量有关。治疗效果与复发后 PFS 和 OS 延长有关，但与初始诊断时无关。
