Copyright 2008 by the Society for Neuro-Oncology
A novel tool to analyze MRI recurrence patterns in glioblastoma
Department of General Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany (W.W., A.-C.B., A.W., M.P., M.W.); Department of Neurooncology, University of Heidelberg, Heidelberg, Germany (W.W., M.P.); University of Lausanne Hospitals, Multidisciplinary Oncology Center, Lausanne, Switzerland (R.S.); Neuro-Oncology Unit, Daniel den Hoed Oncology Center, Rotterdam, The Netherlands (J.B.); Department of Neuroradiology, University of Tübingen, Tübingen, Germany (U.E.); Department of Internal Medicine I, Clinical Division of Oncology, Medical University Vienna, Vienna, Austria (C.M.); Princess Margaret Hospital, Toronto, ON, Canada (W.P.M.); Department of Neuro-Oncology, Erasmus MC, Rotterdam, The Netherlands (M.v.d.B.); Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA (C.R.); Section Neuropsychology, Department of Cognitive Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany (H.-O.K.)
Address correspondence to Wolfgang Wick, Department of Neurooncology, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany (wolfgang.wick{at}med.uni-heidelberg.de).
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Abstract |
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At least 10% of glioblastoma relapses occur at distant and even contralateral locations. This disseminated growth limits surgical intervention and contributes to neurological morbidity. Preclinical data pointed toward a role for temozolomide (TMZ) in reducing radiotherapy-induced glioma cell invasiveness. Our objective was to develop and validate a new analysis tool of MRI data to examine the clinical recurrence pattern of glioblastomas. MRIcro software was used to map the location and extent of initial preoperative and recurrent tumors on MRI of 63 patients in the European Organisation for Research and Treatment of Cancer (EORTC) 26981/22981/National Cancer Institute of Canada (NCIC) CE.3 study into the same stereotaxic space. This allowed us to examine changes of site and distance between the initial and the recurrent tumor on the group level. Thirty of the 63 patients were treated using radiotherapy, while the other patients completed a radiotherapy-plus-TMZ treatment. Baseline characteristics (median age, KPS) and outcome data (progression-free survival, overall survival) of the patients included in this analysis resemble those of the general study cohort. The patient groups did not differ in the promoter methylation status of methyl guanine methyltransferase (MGMT). Overall frequency of distant recurrences was 20%. Analysis of recurrence patterns revealed no difference between the groups in the size of the recurrent tumor or in the differential effect on the distance of the recurrences from the preoperative tumor location. The data show the feasibility of groupwise recurrence pattern analysis. An effect of TMZ treatment on the recurrence pattern in the EORTC 26981/22981/NCIC CE.3 study could not be demonstrated.
Keywords: brain tumor, invasiveness, MRIcro, relapse pattern, temozolomide
Received February 27, 2008; Accepted July 11, 2008