Title: Recurrence Patterns of Glioblastoma in the Era of Temozolomide
Abstract: To analyze recurrence patterns of glioblastoma (GBM) after radiation therapy (RT) plus concurrent and adjuvant temozolomide (TMZ). From March 2006 through February 2011, 39 consecutive patients with newly diagnosed GBM were treated with concurrent TMZ and localized RT at our hospital. Four of them were excluded from the analysis by reason of insufficient imaging follow-up. Twenty of the remaining 35 patients were suffered from recurrent GBM and retrospectively analyzed (10 men and 10 women, median age, 56 years; range, 27-74). Disease progression was assessed by new response criteria proposed by the Response Assessment in Neuro-Oncology Working Group of the American Society of Clinical Oncology. Magnetic resonance imaging scans showing recurrent tumors were fused with initial planning computed tomography. The pattern of recurrence was determined by the relationships between the location of recurrent tumors and irradiated doses. Central, in-field, marginal, and out-field recurrences were defined relative to the prescribed isodose line. Distant recurrence was operationally defined as subependymal recurrence or disseminated disease. Initial and cumulative patterns of recurrence were evaluated in each patient. In addition, overall survival (OS) and progression-free survival (PFS) of the recurrent patients were measured from the date of initial surgery using the Kaplan-Meier method. A median follow-up of the recurrent patients was 497 days (range, 217-1779 days) after initial surgery. Extent of initial surgery was total resection in eight patients, subtotal resection in three patients, partial resection in seven patients, and biopsy in two patients. Initial recurrences were central in 11 patients, in-field in three patients, marginal in no patients, out-field in two patients, and distant in two patients. Additionally, one patient had both central and in-field recurrences, and another had both central and distant recurrences. Cumulative recurrences were central in 14 patients, in-field in eight patients, marginal in three patients, out-field in five patients, and distant in 15 patients. As to salvage treatments, 10, 11, and 16 patients underwent surgery, RT, and chemotherapy, respectively. The 1-year and 2-year OS was 90.0% and 36.9%, respectively. The 6-month and 12-month PFS was 65.0% and 20.0%, respectively. Fourteen patients had died at the time of analysis, and 12 of them had suffered from distant recurrences, which could be the immediate cause of death. Recurrence patterns of GBM after RT plus concomitant and adjuvant TMZ were mainly central at first, and distant recurrences were often detected during the clinical course. Much better local control and prevention of distant recurrence, including effective salvage treatment, seem to be important.
Publication Year: 2012
Publication Date: 2012-10-25
Language: en
Type: article
Indexed In: ['crossref']
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