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Patterns of failure in glioblastoma multiforme following Standard (60 Gy) or Short course (40 Gy) radiation and concurrent temozolomide

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Abstract

Purpose

The purpose of this study was to analyze the patterns of failure in patients with glioblastoma multiforme (GBM) treated using chemoradiotherapy in the Standard radiotherapy (60 Gy/30 fractions; Standard) or Short course (40 Gy/15 fractions: Short).

Materials and methods

Ninety-three consecutive patients with newly diagnosed glioblastoma treated at our hospital between April 2007 and December 2016, and 68 patients who could be followed up were included. All patients underwent surgical resection followed by radiotherapy with concurrent temozolomide. We retrospectively analyzed treatment outcomes and recurrence patterns.

Results

The median follow-up period of the surviving patients was 82.8 months (range: 46.0–158.9 months). Of the 68 patients, 58 patients (85%) had recurrences, 34 underwent the Standard and 24 Short course. The Standard course was seen in younger age groups and had a better Karnofsky performance status (KPS) than the Short course. The median survival time (MST) was 25.8 months for the Standard and 15.4 months with the Short in all cases. Standard course had significantly longer MST than the Short (p = 0.001) course. For recurrent cases only, there was no significant difference between Standard and Short courses in OS (p = 0.06). The recurrences occurred at the radiation fields alone (Standard/Short: 85%/83%), only at distant sites (Standard/Short: 12%/13%), and at both the radiation fields and distant sites (Standard/Short: 3%/4%). There was no significant difference in recurrence pattern and frequency between the two protocols (p = 0.11).

Conclusions

Standard course tended to be significant in younger age groups and have a better KPS than the Short course; therefore, the Standard course has a longer OS, but the recurrence pattern of the Short course is similar to that of the Standard treatment.

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References

  1. Ostrom QT, Gittleman H, Xu J, Kromer C, Wolinsky Y, Kruchko C, et al. CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2009–2013. Neuro Oncol. 2016;18(suppl_5):v1–75.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005;352:987–96.

    Article  CAS  PubMed  Google Scholar 

  3. Stupp R, Hegi ME, Mason WP, van den Bent MJ, Taphoorn MJ, Janzer RC, et al. Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol. 2009;10:459–66.

    Article  CAS  PubMed  Google Scholar 

  4. Lamborn KR, Chang SM, Prados MD. Prognostic factors for survival of patients with glioblastoma: recursive partitioning analysis. Neuro Oncol. 2004;6:227–35.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Roa W, Brasher PMA, Bauman G, Anthes M, Bruera E, Chan A, et al. Abbreviated course of radiation therapy in older patients with glioblastoma multiforme: a prospective randomized clinical trial. J Clin Oncol. 2004;22:1583–8.

    Article  CAS  PubMed  Google Scholar 

  6. Minniti G, Scaringi C, Lanzetta G, Terrenato I, Esposito V, Arcella A, et al. Standard (60 Gy) or short-course (40 Gy) irradiation plus concomitant and adjuvant temozolomide for elderly patients with glioblastoma: a propensity-matched analysis. Int J Radiat Oncol Biol Phys. 2015;91:109–15.

    Article  CAS  PubMed  Google Scholar 

  7. Minniti G, Scaringi C, Baldoni A, Lanzetta G, De Sanctis V, Esposito V, et al. Health-related quality of life in elderly patients with newly diagnosed glioblastoma treated with short-course radiation therapy plus concomitant and adjuvant temozolomide. Int J Radiat Oncol Biol Phys. 2013;86:285–91.

    Article  PubMed  Google Scholar 

  8. Perry JR, Laperriere N, O’Callaghan CJ, Brandes AA, Menten J, Phillips C, et al. Short-course radiation plus temozolomide in elderly patients with glioblastoma. N Engl J Med. 2017;376:1027–37.

    Article  CAS  PubMed  Google Scholar 

  9. Konishi Y, Muragaki Y, Iseki H, Mitsuhashi N, Okada Y. Patterns of intracranial glioblastoma recurrence after aggressive surgical resection and adjuvant management: retrospective analysis of 43 cases. Neurol Med Chir (Tokyo). 2012;52:577–86.

    Article  PubMed  Google Scholar 

  10. Petrecca K, Guiot MC, Panet-Raymond V, Souhami L. Failure pattern following complete resection plus radiotherapy and temozolomide is at the resection margin in patients with glioblastoma. J Neurooncol. 2013;111:19–23.

    Article  PubMed  Google Scholar 

  11. McDonald MW, Shu HKG, Curran WJ Jr, Crocker IR. Pattern of failure after limited margin radiotherapy and temozolomide for glioblastoma. Int J Radiol Oncol Biol Phys. 2011;79:130–6.

    Article  CAS  Google Scholar 

  12. Lundemann M, Costa JC, Law I, Engellholm SA, Muhic A, Poulsen HS, et al. Patterns of failure for patients with glioblastoma following O-(2-[18F]fluoroethyl)-L-tyrosine PET- and MRI-guided radiotherapy. Radiother Oncol. 2017;122:380–6.

    Article  PubMed  Google Scholar 

  13. Gebhardt BJ, Dobelbower MC, Ennis WH, Bag AK, Markert JM, Fiveash JB. Patterns of failure for glioblastoma multiforme following limited-margin radiation and concurrent temozolomide. Radiat Oncol. 2014;9:130.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Murakami R, Hirai T, Nakamura H, Furusawa M, Nakaguchi Y, Uetani H, et al. Recurrence patterns of glioblastoma treated with postoperative radiation therapy: relationship between extent of resection and progression-free interval. Jpn J Radiol. 2012;30:193–7.

    Article  CAS  PubMed  Google Scholar 

  15. Kruser TJ, Bosch WR, Badiyan SN, Bovi JA, Ghia AJ, Kim MM, et al. NRG brain tumor specialists consensus guidelines for glioblastoma contouring. J Neurooncol. 2019;143:157–66.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Vogelbaum MA, Jost S, Aghi MK, Heimberger AB, Sampson JH, Wen PY, et al. Application of novel response/progression measures for surgically delivered therapies for gliomas: response assessment in neuro-oncology (RANO) working group. Neurosurgery. 2012;70:234–43.

    Article  PubMed  Google Scholar 

  17. Keime-Guibert F, Chinot O, Taillandier L, Cartalat-Carel S, Frenay M, Kantor G, et al. Radiotherapy for glioblastoma in the elderly. N Engl J Med. 2007;356:1527–35.

    Article  CAS  PubMed  Google Scholar 

  18. Malmström A, Grønberg BH, Marosi C, Stupp R, Frappaz D, Schultz H, et al. Temozolomide versus standard 6-week radiotherapy versus hypofractionated radiotherapy in patients older than 60 years with glioblastoma: the Nordic randomised, phase 3 trial. Lancet Oncol. 2012;13:916–26.

    Article  PubMed  Google Scholar 

  19. Chang-Halpenny CN, Yeh J, Lien WW. Elderly patients with glioblastoma multiforme treated with concurrent temozolomide and standard-versus abbreviated-course radiotherapy. Perm J. 2015;19:15–20.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Lombardi G, Pace A, Pasqualetti F, Rizzato S, Faedi M, Anghileri E, et al. Predictors of survival and effect of short (40 Gy) or standard-course (60 Gy) irradiation plus concomitant temozolomide in elderly patients with glioblastoma: a multicenter retrospective study of AINO (Italian Association of Neuro-Oncology). J Neurooncol. 2015;125:359–67.

    Article  CAS  PubMed  Google Scholar 

  21. Wang TJC, Wu CC, Jani A, Estrada J, Ung T, Chow DS, et al. Hypofractionated radiation therapy versus standard fractionated radiation therapy with concurrent temozolomide in elderly patients with newly diagnosed glioblastoma. Pract Radiat Oncol. 2016;6:306–14.

    Article  PubMed  Google Scholar 

  22. Adeberg S, König L, Bostel T, Harrabi S, Welzel T, Debus J, et al. Glioblastoma recurrence patterns after radiation therapy with regard to the subventricular zone. Int J Radiat Oncol Biol Phys. 2014;90:886–993.

    Article  PubMed  Google Scholar 

  23. Bette S, Barz M, Huber T, Straube C, Schmidt-Graf F, Combs SE, et al. Retrospective analysis of radiological recurrence patterns in glioblastoma, their prognostic value and association to postoperative infarct volume. Sci Rep. 2018;8:4561.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Mallick S, Benson R, Hakim A, Rath GK. Management of glioblastoma after recurrence: a changing paradigm. J Egypt Natl Canc Inst. 2016;28:199–210.

    Article  PubMed  Google Scholar 

  25. Kawabata S, Suzuki M, Hirose K, Tanaka H, Kato T, Goto H, et al. Accelerator-based BNCT for patients with recurrent glioblastoma: a multicenter phase II study. Neurooncol Adv. 2021;3:vdab067.

    PubMed  PubMed Central  Google Scholar 

  26. Terakawa Y, Tsuyuguchi N, Iwai Y, Yamanaka K, Higashiyama S, Takami T, et al. Diagnostic accuracy of 11C-methionine PET for differentiation of recurrent brain tumors from radiation necrosis after radiotherapy. J Nucl Med. 2008;49:694–9.

    Article  PubMed  Google Scholar 

  27. Chen W, Silverman DH, Delaloye S, Czernin J, Kamdar N, Pope W, et al. 18F-FDOPA PET imaging of brain tumors: comparison study with 18F-FDG PET and evaluation of diagnostic accuracy. J Nucl Med. 2006;47:904–11.

    CAS  PubMed  Google Scholar 

  28. Albert NL, Weller M, Suchorska B, Galldiks N, Soffietti R, Kim MM, et al. Response assessment in neuro-oncology working group and european association for neuro-oncology recommendations for the clinical use of PET imaging in gliomas. Neuro Oncol. 2016;18:119–208.

    Article  Google Scholar 

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Acknowledgements

The authors thank all the staff in the radiotherapy section, all the neurosurgeons in our institution and all of the patients who participated in the study, for their understanding and support. We would like to thank Editage (www.editage.com) for English language editing. This paper was presented at the 102nd Annual Meeting of The Radiological Society of North America on November 27–December 2, 2016.

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Authors and Affiliations

  1. Department of Radiology, Graduate School of Medicine, Kanazawa University, 13-1 Takaramachi, Kanazawa City, Ishikawa, 920-8641, Japan

    Miu Mizuhata, Shigeyuki Takamatsu, Satoshi Shibata, Takayuki Sakurai, Risako Minamikawa, Masahiro Yamazaki & Toshifumi Gabata

  2. Department of Neurosurgery, Graduate School of Medicine, Kanazawa University, Kanazawa, Ishikawa, 920-8641, Japan

    Masashi Kinoshita & Mitsutoshi Nakada

  3. Department of Neurosurgery, Fukui Prefectural Hospital, Fukui, Fukui, 910-8526, Japan

    Katsuyoshi Miyashita

  4. Department of Radiology, Graduate School of Medicine, Gifu University, Gifu, Gifu, 501-1194, Japan

    Tomoyasu Kumano

Authors
  1. Miu Mizuhata
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  2. Shigeyuki Takamatsu
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  11. Toshifumi Gabata
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by MM, ST and TS. The first draft of the manuscript was written by MM, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Miu Mizuhata.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures were performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent for this study was waived because of its retrospective nature.

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Mizuhata, M., Takamatsu, S., Shibata, S. et al. Patterns of failure in glioblastoma multiforme following Standard (60 Gy) or Short course (40 Gy) radiation and concurrent temozolomide. Jpn J Radiol 41, 660–668 (2023). https://doi.org/10.1007/s11604-023-01386-2

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  • DOI: https://doi.org/10.1007/s11604-023-01386-2

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