Cancer Res Treat.  2020 Apr;52(2):524-529. 10.4143/crt.2019.520.

Interim Tumor Progression and Volumetric Changes of Surgical Cavitiesduring the Surgery-to-Radiotherapy Interval in Anaplastic Gliomas:Implications for Additional Pre-radiotherapy Magnetic Resonance Imaging

Affiliations
  • 1Department of Radiation Oncology, SMG-SNU Boramae Medical Center, Seoul, Korea
  • 2Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
  • 3Department of Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
  • 4Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea

Abstract

Purpose
This study was designed to investigate the incidence of interim disease progression (IPD) and volumetric changes of the surgical cavity (SC) during the surgery-to-radiotherapy interval (SRI), and eventually assess the value of magnetic resonance imaging (MRI) at the time of radiotherapy (RT) planning in newly diagnosed anaplastic gliomas.
Materials and Methods
Among 195 anaplastic glioma patients who underwent RT, 121 were evaluable with two separate MRIs during SRI. The presence of IPD was determined using the updated Response Assessment in Neuro-Oncology size criteria. In 84 patients who underwent surgical resection, each SC was contoured by a radiation oncologist and the volumetric changes of the SCs were calculated between the two separate MRIs. Daily rate of change in the SC volume was calculated assuming an exponential and linear change.
Results
Five of 121 patients (4.13%) demonstrated IPD during SRI, and the incidence was significantly higher in patients undergoing biopsy (vs. surgical resection, 12.9% vs. 1.1%, p=0.015) and in patients with remnant contrast-enhancing tumor after surgery (15.8 vs. 2.0%, p=0.027). The mean daily rate of absolute change in SC was 1.06% (95% confidence interval [CI], 0.89 to 1.23) and 0.89% (95% CI, 0.77 to 1.02) according to the exponential and linear model, respectively. The expected mean volumetric change at 2 weeks were 16.64% (95% CI, 13.77 to 19.52) and 12.51% (95% CI, 10.77 to 14.26), respectively.
Conclusion
IPD during the SRI is rare in surgically resected anaplastic gliomas. However, pre-RT MRI is essential for accurate RT-target delineation and disease evaluation for patients initiating RT beyond postoperative 2 weeks and undergoing biopsy, respectively.

Keyword

Anaplastic glioma; Radiotherapy; Interim progression; Surgical cavity; Magnetic resonance imaging

Figure

  • Fig. 1. A 23-year-old female with anaplastic oligodendroglioma in the right fronto-temporal lobe who underwent gross total resection of the tumor. Volumes of the contoured surgical cavities on postoperative (A) and pre-radiotherapy (B) magnetic resonance imaging are displayed.

  • Fig. 2. Expected mean changes in the volume of postoperative surgical cavities in anaplastic glioma patients according to the exponential (blue line) and linear (red line) model (n=84). Error bar, 95% confidence interval.


Reference

References

1. Ostrom QT, Gittleman H, Truitt G, Boscia A, Kruchko C, Barnholtz-Sloan JS. CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2011-2015. Neuro Oncol. 2018; 20:iv1–86.
Article
2. Louis DN, Perry A, Reifenberger G, von Deimling A, Figarella-Branger D, Cavenee WK, et al. The 2016 World Health Organization classification of tumors of the central nervous system: a summary. Acta Neuropathol. 2016; 131:803–20.
Article
3. National Comprehensive Cancer Network. Central nervous system cancers (version 1.2019) [Internet]. Plymouth Meeting, PA: National Comprehensive Cancer Network;2019. [cited 2019 Sep 9]. Available from: https://www.nccn.org/professionals/physician_gls/pdf/cns.pdf.
4. Weller M, van den Bent M, Tonn JC, Stupp R, Preusser M, Cohen-Jonathan-Moyal E, et al. European Association for Neuro-Oncology (EANO) guideline on the diagnosis and treatment of adult astrocytic and oligodendroglial gliomas. Lancet Oncol. 2017; 18:e315–29.
Article
5. Cairncross G, Wang M, Shaw E, Jenkins R, Brachman D, Buckner J, et al. Phase III trial of chemoradiotherapy for anaplastic oligodendroglioma: long-term results of RTOG 9402. J Clin Oncol. 2013; 31:337–43.
Article
6. van den Bent MJ, Brandes AA, Taphoorn MJ, Kros JM, Kouwenhoven MC, Delattre JY, et al. Adjuvant procarbazine, lomustine, and vincristine chemotherapy in newly diagnosed anaplastic oligodendroglioma: long-term follow-up of EORTC brain tumor group study 26951. J Clin Oncol. 2013; 31:344–50.
7. van den Bent MJ, Baumert B, Erridge SC, Vogelbaum MA, Nowak AK, Sanson M, et al. Interim results from the CATNON trial (EORTC study 26053-22054) of treatment with concurrent and adjuvant temozolomide for 1p/19q non-co-deleted anaplastic glioma: a phase 3, randomised, open-label intergroup study. Lancet. 2017; 390:1645–53.
Article
8. Navarria P, Ascolese AM, Tomatis S, Reggiori G, Clerici E, Villa E, et al. Hypofractionated stereotactic radiation therapy in recurrent high-grade glioma: a new challenge. Cancer Res Treat. 2016; 48:37–44.
Article
9. Wee CW, Kim E, Kim TM, Park CK, Kim JW, Choi SH, et al. Impact of interim progression during the surgery-to-radiotherapy interval and its predictors in glioblastoma treated with temozolomide-based radiochemotherapy. J Neurooncol. 2017; 134:169–75.
Article
10. Pennington C, Kilbride L, Grant R, Wardlaw JM. A pilot study of brain tumour growth between radiotherapy planning and delivery. Clin Oncol (R Coll Radiol). 2006; 18:104–8.
Article
11. Pirzkall A, McGue C, Saraswathy S, Cha S, Liu R, Vandenberg S, et al. Tumor regrowth between surgery and initiation of adjuvant therapy in patients with newly diagnosed glioblastoma. Neuro Oncol. 2009; 11:842–52.
Article
12. Villanueva-Meyer JE, Han SJ, Cha S, Butowski NA. Early tumor growth between initial resection and radiotherapy of glioblastoma: incidence and impact on clinical outcomes. J Neurooncol. 2017; 134:213–9.
Article
13. Stensjoen AL, Solheim O, Kvistad KA, Haberg AK, Salvesen O, Berntsen EM. Growth dynamics of untreated glioblastomas in vivo. Neuro Oncol. 2015; 17:1402–11.
Article
14. Ellingson BM, Nguyen HN, Lai A, Nechifor RE, Zaw O, Pope WB, et al. Contrast-enhancing tumor growth dynamics of preoperative, treatment-naive human glioblastoma. Cancer. 2016; 122:1718–27.
Article
15. Wen PY, Macdonald DR, Reardon DA, Cloughesy TF, Sorensen AG, Galanis E, et al. Updated response assessment criteria for high-grade gliomas: response assessment in neuro-oncology working group. J Clin Oncol. 2010; 28:1963–72.
Article
16. Leung D, Han X, Mikkelsen T, Nabors LB. Role of MRI in primary brain tumor evaluation. J Natl Compr Canc Netw. 2014; 12:1561–8.
Article
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