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Article: Determining a cut-off residual tumor volume threshold for patients with newly diagnosed glioblastoma treated with temozolomide chemoradiotherapy: A multicenter cohort study

TitleDetermining a cut-off residual tumor volume threshold for patients with newly diagnosed glioblastoma treated with temozolomide chemoradiotherapy: A multicenter cohort study
Authors
KeywordsExtent of resection
Glioblastoma
Overall survival
Residual tumor volume
Temozolomide chemo-radiotherapy
Volumetric analysis
Issue Date2019
Citation
Journal of Clinical Neuroscience, 2019, v. 63, p. 134-141 How to Cite?
AbstractStandard-of-care treatment of glioblastomas involves maximal safe resection and adjuvant temozolomide chemo-radiotherapy. Although extent of resection (EOR) is a well-known surgical predictor for overall survival most lesions cannot be completely resected. We hypothesize that in the event of incomplete resection, residual tumor volume (RTV) may be a more significant predictor than EOR. This was a multicenter retrospective review of 147 adult glioblastoma patients (mean age 53 years) that underwent standard treatment. Semiautomatic magnetic resonance imaging segmentation was performed for pre- and postoperative scans for volumetric analysis. Cox proportional hazards regression and Kaplan-Meier survival analyses were performed for prognostic factors including: age, Karnofsky performance score (KPS), O(6)-methylguanine methyltransferase (MGMT) promoter methylation status, EOR and RTV. EOR and RTV cut-off values for improved OS were determined and internally validated by receiver operator characteristic (ROC) analysis for 12-month overall survival. Half of the tumors had MGMT promoter methylation (77, 52%). The median tumor volume, EOR and RTV were 43.20 cc, 93.5%, and 3.80 cc respectively. Gross total resection was achieved in 52 patients (35%). Cox proportional hazards regression, ROC and maximum Youden index analyses for RTV and EOR showed that a cut-off value of <3.50 cc (HR 0.69; 95% CI 0.48–0.98) and ≥84% (HR 0.64; 95% CI 0.43–0.96) respectively conferred an overall survival advantage. Independent overall survival predictors were MGMT promoter methylation (adjusted HR 0.35; 95% CI 0.23–0.55) and a RTV of <3.50 cc (adjusted HR 0.53; 95% CI 0.29–0.95), but not EOR for incompletely resected glioblastomas.
Persistent Identifierhttp://hdl.handle.net/10722/325427
ISSN
2023 Impact Factor: 1.9
2023 SCImago Journal Rankings: 0.609
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorWoo, Peter Y.M.-
dc.contributor.authorHo, Jason M.K.-
dc.contributor.authorTse, Teresa P.K.-
dc.contributor.authorLam, Sandy W.-
dc.contributor.authorMak, Calvin H.K.-
dc.contributor.authorChan, Danny T.M.-
dc.contributor.authorLee, Michael W.Y.-
dc.contributor.authorWong, Sui To-
dc.contributor.authorChan, Kwong Yau-
dc.contributor.authorPoon, Wai Sang-
dc.date.accessioned2023-02-27T07:33:12Z-
dc.date.available2023-02-27T07:33:12Z-
dc.date.issued2019-
dc.identifier.citationJournal of Clinical Neuroscience, 2019, v. 63, p. 134-141-
dc.identifier.issn0967-5868-
dc.identifier.urihttp://hdl.handle.net/10722/325427-
dc.description.abstractStandard-of-care treatment of glioblastomas involves maximal safe resection and adjuvant temozolomide chemo-radiotherapy. Although extent of resection (EOR) is a well-known surgical predictor for overall survival most lesions cannot be completely resected. We hypothesize that in the event of incomplete resection, residual tumor volume (RTV) may be a more significant predictor than EOR. This was a multicenter retrospective review of 147 adult glioblastoma patients (mean age 53 years) that underwent standard treatment. Semiautomatic magnetic resonance imaging segmentation was performed for pre- and postoperative scans for volumetric analysis. Cox proportional hazards regression and Kaplan-Meier survival analyses were performed for prognostic factors including: age, Karnofsky performance score (KPS), O(6)-methylguanine methyltransferase (MGMT) promoter methylation status, EOR and RTV. EOR and RTV cut-off values for improved OS were determined and internally validated by receiver operator characteristic (ROC) analysis for 12-month overall survival. Half of the tumors had MGMT promoter methylation (77, 52%). The median tumor volume, EOR and RTV were 43.20 cc, 93.5%, and 3.80 cc respectively. Gross total resection was achieved in 52 patients (35%). Cox proportional hazards regression, ROC and maximum Youden index analyses for RTV and EOR showed that a cut-off value of <3.50 cc (HR 0.69; 95% CI 0.48–0.98) and ≥84% (HR 0.64; 95% CI 0.43–0.96) respectively conferred an overall survival advantage. Independent overall survival predictors were MGMT promoter methylation (adjusted HR 0.35; 95% CI 0.23–0.55) and a RTV of <3.50 cc (adjusted HR 0.53; 95% CI 0.29–0.95), but not EOR for incompletely resected glioblastomas.-
dc.languageeng-
dc.relation.ispartofJournal of Clinical Neuroscience-
dc.subjectExtent of resection-
dc.subjectGlioblastoma-
dc.subjectOverall survival-
dc.subjectResidual tumor volume-
dc.subjectTemozolomide chemo-radiotherapy-
dc.subjectVolumetric analysis-
dc.titleDetermining a cut-off residual tumor volume threshold for patients with newly diagnosed glioblastoma treated with temozolomide chemoradiotherapy: A multicenter cohort study-
dc.typeArticle-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/j.jocn.2019.01.022-
dc.identifier.pmid30712777-
dc.identifier.scopuseid_2-s2.0-85060769126-
dc.identifier.volume63-
dc.identifier.spage134-
dc.identifier.epage141-
dc.identifier.eissn1532-2653-
dc.identifier.isiWOS:000466249000025-

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