Purpose or Objective Standard up-front therapy of high grade glioma (HGG) is focused on the so called Stupp protocol, that includes surgical resection followed by radiotherapy (RT) combined with concomitant and adjuvant chemotherapy with temozolomide (TMZ). As supported by several international guidelines, disease assessment is performed using magnetic resonance (MR) one month since the end of RT and then every 3 months: in case of tumour progression the administration of temozolomide (the most active agent against glioma) is interrupted and salvage therapy or best supportive care are recommended. The aim of this study is to investigate in a retrospective manner the real value of first MR following RT and its relevance in clinical decision making about up-front therapy. Material and Methods Between April 2005 and July 2017, data of 78 patients (pts) with a proven diagnosis of HGG and treated with Stupp protocol at the University Hospital of Pisa were collected. Tumor progression was defined according to Mac-Donald’s Criteria. Considering the potential presence of pseudoprogression (PSP) and the evolutionary pattern of the suspected recurrences, lesions suggestive for tumor progression inside the radiotherapy field were investigate with a new MR after 6-8 weeks. Otherwise, the presence of new lesions outside the radiotherapy field was interpreted as disease progression (PD) and patient’s therapy was changed. Presence or absence of symptoms, extent of surgery and MGMT methylation status were recorded. Results The first MR after RT-CT evidenced infield progression (interpreted as PSP) in 16 pts (20,5%) and outfield progression in 8 (10.2%).Three out of 8 patients with outfield progression were symptomatic for the tumor growth. The second MRI confirmed the presence of PSP in 10 pts out of 16 pts whereas in 6 patients a true progression (PD) was present since the first MR. Conclusion In absence of symptoms, the first MR after radiochemotherapy influenced clinical decision making (sending the patients to further salvage therapy or BSC) only in 5 out of 78 patients (6.4%). In 72 patients, even in presence of radiological signs suggestive for disease progression inside the RT field, clinical decision making did not change. Further studies involving a higher number of patients are required in order to confirm our findings.

EP-1227 The impact of first MR in clinical decision making of patients with HGG treated with RTCT

Gonnelli, A.;Paiar, F.
2019-01-01

Abstract

Purpose or Objective Standard up-front therapy of high grade glioma (HGG) is focused on the so called Stupp protocol, that includes surgical resection followed by radiotherapy (RT) combined with concomitant and adjuvant chemotherapy with temozolomide (TMZ). As supported by several international guidelines, disease assessment is performed using magnetic resonance (MR) one month since the end of RT and then every 3 months: in case of tumour progression the administration of temozolomide (the most active agent against glioma) is interrupted and salvage therapy or best supportive care are recommended. The aim of this study is to investigate in a retrospective manner the real value of first MR following RT and its relevance in clinical decision making about up-front therapy. Material and Methods Between April 2005 and July 2017, data of 78 patients (pts) with a proven diagnosis of HGG and treated with Stupp protocol at the University Hospital of Pisa were collected. Tumor progression was defined according to Mac-Donald’s Criteria. Considering the potential presence of pseudoprogression (PSP) and the evolutionary pattern of the suspected recurrences, lesions suggestive for tumor progression inside the radiotherapy field were investigate with a new MR after 6-8 weeks. Otherwise, the presence of new lesions outside the radiotherapy field was interpreted as disease progression (PD) and patient’s therapy was changed. Presence or absence of symptoms, extent of surgery and MGMT methylation status were recorded. Results The first MR after RT-CT evidenced infield progression (interpreted as PSP) in 16 pts (20,5%) and outfield progression in 8 (10.2%).Three out of 8 patients with outfield progression were symptomatic for the tumor growth. The second MRI confirmed the presence of PSP in 10 pts out of 16 pts whereas in 6 patients a true progression (PD) was present since the first MR. Conclusion In absence of symptoms, the first MR after radiochemotherapy influenced clinical decision making (sending the patients to further salvage therapy or BSC) only in 5 out of 78 patients (6.4%). In 72 patients, even in presence of radiological signs suggestive for disease progression inside the RT field, clinical decision making did not change. Further studies involving a higher number of patients are required in order to confirm our findings.
2019
https://www.thegreenjournal.com/article/S0167-8140(19)31647-0/fulltext
File in questo prodotto:
File Dimensione Formato  
1-s2.0-S0167814019316470-main.pdf

accesso aperto

Tipologia: Versione finale editoriale
Licenza: Creative commons
Dimensione 207.6 kB
Formato Adobe PDF
207.6 kB Adobe PDF Visualizza/Apri

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11568/1071389
Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus ND
  • ???jsp.display-item.citation.isi??? 0
social impact