title: Small increases in enhancement on MRI may predict survival post radiotherapy in patients with glioblastoma.
abstract: To assess impact of volumetric changes in tumour volume post chemoradiotherapy in glioblastoma. Patients managed with chemoradiotherapy between 2008 and 2011 were included. Patients with incomplete MRI sets were excluded. Analyses were performed on post-operative MRI, and MRIs at 1 month (M+1), 3 months (M+3), 5 months (M+5), 7 months (M+7), and 12 months (M+12) post completion of RT. RANO definitions of response were used for all techniques. Modified RANO criteria and two volumetric analysis techniques were used. The two volumetric analysis techniques involved utility of the Eclipse treatment planning software to calculate the volume of delineated tissue: surgical cavity plus all surrounding enhancement (Volumetric) versus surrounding enhancement only (Rim). Retrospective analysis of 49 patients with median survival of 18.4 months. Using Volumetric analysis the difference in MS for patients who had a <5 % increase versus ≥5 % at M+3 was 23.1 versus 15.1 months (p = 0.006), and M+5 was 26.3 versus 15.1 months (p = 0.006). For patients who were classified as progressive disease using modified RANO criteria at M+1 and M+3 there was a difference in MS compared with those who were not (M+1: 13.1 vs. 19.4 months, p = 0.017, M+3: 13.2 vs. 20.1 months, p = 0.096). An increase in the volume of cavity and enhancement of ≥5 % at M+3 and M+5 post RT was associated with reduced survival, suggesting that increases in radiological abnormality of <25 % may predict survival.
authors.affiliation: Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, 2065, Australia. cgzell@gmail.com.|Northern Sydney Clinical School, Sydney University Medical School, Sydney, NSW, 2065, Australia. cgzell@gmail.com.|Genesis Cancer Care, Level A, 438 Victoria Street, Darlinghurst, Sydney, NSW, 2010, Australia. cgzell@gmail.com.
authors.forename: Cecelia Elizabeth
authors.initials: CE
authors.lastname: Gzell
authors.affiliation: Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, 2065, Australia.|Northern Sydney Clinical School, Sydney University Medical School, Sydney, NSW, 2065, Australia.
authors.forename: Helen R
authors.initials: HR
authors.lastname: Wheeler
authors.affiliation: Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, 2065, Australia.
authors.forename: Philip
authors.initials: P
authors.lastname: McCloud
authors.affiliation: Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, 2065, Australia.
authors.forename: Marina
authors.initials: M
authors.lastname: Kastelan
authors.affiliation: Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, 2065, Australia.|Northern Sydney Clinical School, Sydney University Medical School, Sydney, NSW, 2065, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Back
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging / Q000187:drug effects / Q000528:radiation effects / Q000601:surgery; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy*; D059248:Chemoradiotherapy; D005260:Female; D005909:Glioblastoma / Q000000981:diagnostic imaging* / Q000628:therapy*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult
keywords: GBM; Glioblastoma; Pseudoprogression; RANO