Main Article Content
Abstract
BACKGROUND
Glioblastoma multiforme is the commonest primary brain tumor in adults, responsible for 45.2% of primary brain tumors. It is considered a highly aggressive brain tumor with a grave prognosis. Standard treatment for GBM (Glioblastoma Multiforme) consists of maximal safe resection, adjuvant RT (Radiation Therapy), and temozolomide chemotherapy. Despite all the treatments, survival for GBM remains 15-18 months post-diagnosis. Several studies have demonstrated the prognostic significance of different factors, including age, performance status, extent of surgery, and status of molecular markers such as tumor MGMT promoter methylation and IDH mutation. Among the various factors, studies have shown that delaying the start of radiation therapy decreases survival in these patients.
METHODS
This retrospective study was conducted from January 2020 to June 2024 on 47 patients diagnosed with GBM. All these patients underwent surgical resection followed by adjuvant chemoradiation therapy and 6 cycles of maintenance temozolomide. Patient demographics, tumor, and treatment-related details were extracted from retrospectively collected, prospectively curated data. The patients who had been previously treated for a primary brain tumor or for whom pre-RT and follow-up scans were not available were excluded.
RESULTS
The median age at presentation was 45 years. The extent of surgical resection was subtotal in 91.5% of patients. Following surgery, tumor size greater than 4 cm was noted in 63.8% of the patients. The course of adjuvant and maintenance chemoradiation therapy could be completed by 86% of the patients. Among the factors influencing the tumor volume reduction during adjuvant RT, a delay in initiating RT beyond 3 weeks and a residual tumor greater than 4 cm were significantly associated with reduced mean percentage volume change.
CONCLUSIONS
This study provides an important insight into the various prognostic factors affecting the tumor volume reduction rate in GBM patients. We found that greater residual tumor volume following surgery and prolonged interval to RT significantly negatively influenced the rate of tumor volume reduction in GBM patients. Our study strengthens the fact that adjuvant RT should be started as early as possible after surgery. Future studies are warranted to elucidate the impact of the extent of surgical resection and the interval before initiating RT on patient survival.
Keywords
Article Details
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References
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- Dasgupta A, Gupta T, Jalali R. Indian data on central nervous tumors: a summary of published work. South Asian J Cancer 2016;5(3):147-53.
- Louis DN, Perry A, Wesseling P, et al. The 2021 WO classification of tumors of the central nervous system: a summary. Neuro Oncol 2021;23(8):1231-51.
- Zaki A, Soomar SM, Niazi MNK, et al. Outcome of high-grade glioma patients: a single institution experience. Ann Oncol 2022;33(Suppl 9):1609-10.
- Scheider T, Mawrin C, Scherlach C, et al. Gliomas in adults. Dtsch Arztebl Int 2010;107(45):799-808.
- Awad AW, Karsy M, Sanai N, et al. Impact of removed tumor volume and location on patient outcome in glioblastoma. J Neurooncol 2017;135(1):161-71.
- Magrowski L, Nowicka E, Masri O, et al. The survival impact of significant delays between surgery and radiochemotherapy in glioblastoma patients: a retrospective analysis from a large tertiary center. J Clin Neuro Sci 2021;90:39-47.
- Niyazi M, Brada M, Chalmers AJ, et al. ESTRO-ACROP Guidelines “Target delineation of glioblastomas”. Radiother Oncol 2016;118(1):35-42.
- Stupp R, Mason WP, Bent MJ, et al. Radiotherapy plus concomitant and adjuvant Temozolomide for glioblastoma. N Engl J Med 2005;352(10):987-96.
- Thakkar JP, Dolecek TA, Horbinski C, et al. Epidemiologic and molecular prognostic review of glioblastoma. Cancer Epidemiol Biomarkers Prev 2014;23(10):1985-96.
- Mrowczynski OD, Yang AL, Liao J, et al. The potential of glioblastoma patient symptoms to diagnose and predict survival. Cureus 2021;13(7):e16675.
- Cini NT, Pennisi M, Genc S, et al. Glioma lateralization: focus on the anatomical localization and the distribution of molecular alterations (Review). Oncol Rep 2024;52(4):139.
- Fyllingen EH, Bo LE, Reinertsen I, et al. Survival of glioblastoma in relation to tumor location: a statistical tumor atlas of a population-based cohort. Acta Neurochir 2021;163(7):1875-905.
- Dono A, Wang E, Lopez-Rivera V, et al. Molecular characteristics and clinical features of multifocal glioblastoma. J Neuro Oncol 2020;148(2):389-97.
- Li Y, Zhang ZX, Huang GH, et al. A systematic review of multifocal and multicentric glioblastoma. J Clin Neuro Sci 2021;83:71-6.
- Lasocki A, Gaillard F, Tacey M, et al. Multifocal and multicentric glioblastoma: Improved characterization with FLAIR imaging and prognostic implications. J Clin Neuro Sci 2016;31:92-8.
- Johnstad C, Reinertsen I, Thurin E, et al. The prognostic importance of glioblastoma size and shape. Acta Neurochir 2024;166(1):450.
- Ellingson BM, Abrey LE, Nelson SJ, et al. Validation of postoperative residual contrast-enhancing tumor volume as an independent prognostic factor for overall survival in newly diagnosed glioblastoma. Neuro Oncol 2018;20(9):1240-50.
- Zhang M, Xu F, Ni W, et al. Survival impact of delaying postoperative chemoradiotherapy in newly diagnosed glioblastoma patients. Transl Cancer Res 2020;9(9):5450-8.
- Potharaju M, Mathavan A, Mangaleswaran B, et al. Delay in adjuvant chemoradiation impacts survival outcome in glioblastoma multiforme patients. Acta Oncol 2020;59(3):320-3.
- Blumenthal DT, Won M, Mehta MP, et al. Short delay in initiation of radiotherapy may not affect the outcome of patients with glioblastoma: a secondary analysis from the Radiation Therapy Oncology Group database. J Clin Oncol 2008;27(5):733-9.
References
Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer J Clinicians 2021;71(3):191-280.
Clinicopathological profile of cancers in India: a report of the Hospital Based Cancer Registries. Indian Council of Medical Research, Hospital-Based Cancer Registry 2021.
Dasgupta A, Gupta T, Jalali R. Indian data on central nervous tumors: a summary of published work. South Asian J Cancer 2016;5(3):147-53.
Louis DN, Perry A, Wesseling P, et al. The 2021 WO classification of tumors of the central nervous system: a summary. Neuro Oncol 2021;23(8):1231-51.
Zaki A, Soomar SM, Niazi MNK, et al. Outcome of high-grade glioma patients: a single institution experience. Ann Oncol 2022;33(Suppl 9):1609-10.
Scheider T, Mawrin C, Scherlach C, et al. Gliomas in adults. Dtsch Arztebl Int 2010;107(45):799-808.
Awad AW, Karsy M, Sanai N, et al. Impact of removed tumor volume and location on patient outcome in glioblastoma. J Neurooncol 2017;135(1):161-71.
Magrowski L, Nowicka E, Masri O, et al. The survival impact of significant delays between surgery and radiochemotherapy in glioblastoma patients: a retrospective analysis from a large tertiary center. J Clin Neuro Sci 2021;90:39-47.
Niyazi M, Brada M, Chalmers AJ, et al. ESTRO-ACROP Guidelines “Target delineation of glioblastomas”. Radiother Oncol 2016;118(1):35-42.
Stupp R, Mason WP, Bent MJ, et al. Radiotherapy plus concomitant and adjuvant Temozolomide for glioblastoma. N Engl J Med 2005;352(10):987-96.
Thakkar JP, Dolecek TA, Horbinski C, et al. Epidemiologic and molecular prognostic review of glioblastoma. Cancer Epidemiol Biomarkers Prev 2014;23(10):1985-96.
Mrowczynski OD, Yang AL, Liao J, et al. The potential of glioblastoma patient symptoms to diagnose and predict survival. Cureus 2021;13(7):e16675.
Cini NT, Pennisi M, Genc S, et al. Glioma lateralization: focus on the anatomical localization and the distribution of molecular alterations (Review). Oncol Rep 2024;52(4):139.
Fyllingen EH, Bo LE, Reinertsen I, et al. Survival of glioblastoma in relation to tumor location: a statistical tumor atlas of a population-based cohort. Acta Neurochir 2021;163(7):1875-905.
Dono A, Wang E, Lopez-Rivera V, et al. Molecular characteristics and clinical features of multifocal glioblastoma. J Neuro Oncol 2020;148(2):389-97.
Li Y, Zhang ZX, Huang GH, et al. A systematic review of multifocal and multicentric glioblastoma. J Clin Neuro Sci 2021;83:71-6.
Lasocki A, Gaillard F, Tacey M, et al. Multifocal and multicentric glioblastoma: Improved characterization with FLAIR imaging and prognostic implications. J Clin Neuro Sci 2016;31:92-8.
Johnstad C, Reinertsen I, Thurin E, et al. The prognostic importance of glioblastoma size and shape. Acta Neurochir 2024;166(1):450.
Ellingson BM, Abrey LE, Nelson SJ, et al. Validation of postoperative residual contrast-enhancing tumor volume as an independent prognostic factor for overall survival in newly diagnosed glioblastoma. Neuro Oncol 2018;20(9):1240-50.
Zhang M, Xu F, Ni W, et al. Survival impact of delaying postoperative chemoradiotherapy in newly diagnosed glioblastoma patients. Transl Cancer Res 2020;9(9):5450-8.
Potharaju M, Mathavan A, Mangaleswaran B, et al. Delay in adjuvant chemoradiation impacts survival outcome in glioblastoma multiforme patients. Acta Oncol 2020;59(3):320-3.
Blumenthal DT, Won M, Mehta MP, et al. Short delay in initiation of radiotherapy may not affect the outcome of patients with glioblastoma: a secondary analysis from the Radiation Therapy Oncology Group database. J Clin Oncol 2008;27(5):733-9.