Sage Journals: Discover world-class research

Abstract

Background

Residual tumor volume (RTV) and extent of resection (EOR) have previously been shown to affect survival in glioblastoma (GB) patients. Quantitative radiological assessment (QRA) of these factors could potentially affect clinical decision-making in the postoperative period.

Purpose

The first aim was to evaluate the reproducibility of different volume estimation methods of RTV and EOR by comparing QRA with subjective visual estimation and with objective volume estimations. The second aim was to clarify whether QRA of RTV and EOR would provide accuracy in predicting progression-free survival (PFS) and overall survival (OS) in GB patients.

Material and Methods

Seventy GB patients were studied retrospectively. Reproducibility of QRA was compared to conventional visual analysis. Intra-rater agreement between two repeated measurements of 25 patients was calculated. QRA for RTV and EOR was made for the entire study population. Survival analysis was performed by multivariate cox-regression analysis.

Results

QRA of RTV and EOR gave superior intra-rater agreement compared to subjective evaluation. Multivariate survival analysis showed prognostic significance on 18 months PFS (hazard ratio [HR] = 0.44, P = 0.003) and OS (HR = 0.42, P = 0.012) at RTV < 1.6 mL and with EOR > 96% on PFS (HR = 2.152, P = 0.005) but not on OS (HR = 1.92, P = 0.053).

Conclusion

QRA of tumor volumes is more robust compared to standard evaluation methods. Since EOR and RTV are correlated to the prognosis in GB, quantitative analysis of tumor volumes could aid decision-making and patient management postoperatively.

Keywords

Magnetic resonance imaging (MRI)brain/brainstem adults 3D computer applications primary neoplasms surgery

Get full access to this article

View all access options for this article.

References

Wen

Kesari

. Malignant gliomas in adults. N Engl J Med 2008; 359: 492–507.

Stupp

Hegi

Mason

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: 459–466.

Stupp

Brada

van den Bent

et al.

High-grade glioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2014; 25(Suppl. 3): iii93–101.

Watts

Price

Santarius

. Current concepts in the surgical management of glioma patients. Clin Oncol (R Coll Radiol) 2014; 26: 385–394.

Chaudhry

Shah

Ferraro

et al.

Predictors of long-term survival in patients with glioblastoma multiforme: advancements from the last quarter century. Cancer Invest 2013; 31: 287–308.

Bloch

Han

Cha

et al.

Impact of extent of resection for recurrent glioblastoma on overall survival: clinical article. J Neurosurg 2012; 117: 1032–1038.

Chaichana

Jusue-Torres

Navarro-Ramirez

et al.

Establishing percent resection and residual volume thresholds affecting survival and recurrence for patients with newly diagnosed intracranial glioblastoma. Neuro Oncol 2014; 16: 113–122.

Dea

Fournier-Gosselin

Mathieu

et al.

Does extent of resection impact survival in patients bearing glioblastoma?

Can J Neurol Sci 2012; 39: 632–637.

Grabowski

Recinos

Nowacki

et al.

Residual tumor volume versus extent of resection: predictors of survival after surgery for glioblastoma. J Neurosurg 2014; 121: 1115–1123.

10.

Lacroix

Abi-Said

Fourney

et al.

A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J Neurosurg 2001; 95: 190–198.

11.

McGirt

Chaichana

Gathinji

et al.

Independent association of extent of resection with survival in patients with malignant brain astrocytoma. J Neurosurg 2009; 110: 156–162.

12.

Orringer

Lau

Khatri

et al.

Extent of resection in patients with glioblastoma: limiting factors, perception of resectability, and effect on survival. J Neurosurg 2012; 117: 851–859.

13.

Sanai

Polley

McDermott

et al.

An extent of resection threshold for newly diagnosed glioblastomas. J Neurosurg 2011; 115: 3–8.

14.

Chaichana

Jusue-Torres

Lemos

et al.

The butterfly effect on glioblastoma: is volumetric extent of resection more effective than biopsy for these tumors?

J Neurooncol 2014; 120: 625–634.

15.

D’Amico

Englander

Canoll

et al.

Extent of resection in glioma - a review of the cutting edge. World Neurosurg 2017; 103: 538–549.

16.

Albert

Forsting

Sartor

et al.

Early postoperative magnetic resonance imaging after resection of malignant glioma: objective evaluation of residual tumor and its influence on regrowth and prognosis. Neurosurg 1994; 34: 45–60. discussion 60–61.

17.

Meier

Knecht

Loosli

et al.

Clinical evaluation of a fully-automatic segmentation method for longitudinal brain tumor volumetry. Sci Rep 2016; 6: 23376–23376.

18.

Porz

Habegger

Meier

et al.

Fully automated enhanced tumor compartmentalization: man vs. machine reloaded. PLoS One 2016; 11: e0165302–e0165302.

19.

Meier

Porz

Knecht

et al.

Automatic estimation of extent of resection and residual tumor volume of patients with glioblastoma. J Neurosurg 2017; 127: 798–806.

20.

Kanaly

Ding

Mehta

et al.

A novel method for volumetric MRI response assessment of enhancing brain tumors. PLoS One 2011; 6: e16031–e16031.

21.

Louis

Ohgaki

Wiestler

et al.

The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol (Berl) 2007; 114: 97–109.

22.

Louis

Perry

Reifenberger

et al.

The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol (Berl) 2016; 131: 803–820.

23.

Walker

Green

Byar

et al.

Randomized comparisons of radiotherapy and nitrosoureas for the treatment of malignant glioma after surgery. N Engl J Med 1980; 303: 1323–1329.

24.

Laperriere

Zuraw

Cairncross

. Radiotherapy for newly diagnosed malignant glioma in adults: a systematic review. Radiother Oncol 2002; 64: 259–273.

25.

Sawaya

Hammoud

Schoppa

et al.

Neurosurgical outcomes in a modern series of 400 craniotomies for treatment of parenchymal tumors. Neurosurg 1998; 42: 1044–1056.

26.

Karnofsky

Abelmann

Craver

. The use of the nitrogen mustards in the palliative treatment of carcinoma. With particular reference to broncogenic carcinoma. Cancer 1948; 1: 634–656.

27.

Upadhyay

Waldman

. Conventional MRI evaluation of gliomas. Br J Radiol 2011; 84: 107–111.

28.

Suchorska

Weller

Tabatabai

et al.

Complete resection of contrast-enhancing tumor volume is associated with improved survival in recurrent glioblastoma-results from the DIRECTOR trial. Neuro Oncol 2016; 18: 549–556.

29.

McHugh

. Interrater reliability: the kappa statistic. Biochem Med 2012; 22: 276–282.

30.

Bland

Altman

. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1: 307–310.

31.

Weller

van den Bent

Hopkins

et al.

EANO guideline for the diagnosis and treatment of anaplastic gliomas and glioblastoma. Lancet Oncol 2014; 15: e395–403.

Evaluation of reproducibility in MRI quantitative volumetric assessment and its role in the prediction of overall survival and progression-free survival in glioblastoma

Abstract

Background

Purpose

Material and Methods

Results

Conclusion

Keywords

Get full access to this article

References