The extent of edema and tumor synchronous invasion into the subventricular zone and corpus callosum classify outcomes and radiotherapy strategies of glioblastomas

Hsiang-Kuang Tony Liang; Wan-Yu Chen; Shih-Fan Lai; Mao-Yuan Su; San-Lin You; Liang-Hsin Chen; Ham-Min Tseng; Chung-Ming Chen; Sung-Hsin Kuo; Wen-Yih Isaac Tseng

doi:10.1016/j.radonc.2017.09.024

The extent of edema and tumor synchronous invasion into the subventricular zone and corpus callosum classify outcomes and radiotherapy strategies of glioblastomas

Radiother Oncol. 2017 Nov;125(2):248-257. doi: 10.1016/j.radonc.2017.09.024. Epub 2017 Oct 19.

Authors

Affiliations

¹ Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan; Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Radiation Science and Proton Therapy Center, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Neurology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
² Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Radiation Science and Proton Therapy Center, National Taiwan University College of Medicine, Taipei, Taiwan.
³ Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan; Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Radiation Science and Proton Therapy Center, National Taiwan University College of Medicine, Taipei, Taiwan.
⁴ Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
⁵ School of Medicine, College of Medicine, and Big Data Research Center, Fu-Jen Catholic University, New Taipei City, Taiwan.
⁶ Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
⁷ Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.
⁸ Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Radiation Science and Proton Therapy Center, National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei, Taiwan.
⁹ Institute of Medical Device and Imaging, National Taiwan University College of Medicine, Taipei, Taiwan. Electronic address: wytseng@ntu.edu.tw.

PMID: 29056290
DOI: 10.1016/j.radonc.2017.09.024

Abstract

Background and purpose: Irradiating glioblastoma preoperative edema (PE) remains controversial. We investigated the associations between tumors' PE extent with invasion into synchronous subventricular zone and corpus callosum (sSVZCC) and treatment outcomes to provide the clinical evidence for radiotherapy decision-making.

Material and methods: Extensive PE (EPE) was defined as PE extending ≥2 cm from the tumor edge and extensive progressive disease (EPD) as tumors spreading ≥2 cm from the preoperative tumor edge along PE. The survival and progression patterns were analyzed according to EPE and sSVZCC invasion.

Results: In total, 136 patients were followed for a median of 74.9 (range, 47.6-102.1) months. The median overall survival and progression-free survival were 19.7 versus 28.6 months (p = 0.005) and 11.0 versus 17.4 months (p = 0.011) in patients with EPE+ versus EPE-, and were 18.7 versus 25.4 months (p = 0.021) and 10.7 versus 14.6 months (p = 0.020) in those with sSVZCC+ versus sSVZCC-. The EPD rates for tumors with EPE-/sSVZCC-, EPE-/sSVZCC+, EPE+/sSVZCC-, and EPE+/sSVZCC+ were 2.8%, 7.1%, 37.0%, and 71.9%, respectively. In EPE+/sSVZCC+, tumor migration was associated with the PE extending along the corpus callosum (77.8%) and subventricular zone (50.0%).

Conclusions: Our results support the need for developing individualized irradiation strategies for glioblastomas according to EPE and sSVZCC.

Keywords: EORTC and RTOG treatment volume guidelines; Glioblastoma; Personalized treatment strategies; Preoperative edema; Radiotherapy decision-making; Subventricular zone and corpus callosum.

MeSH terms

Adult
Brain Neoplasms / diagnostic imaging
Brain Neoplasms / pathology
Brain Neoplasms / radiotherapy*
Corpus Callosum / diagnostic imaging
Corpus Callosum / pathology*
Disease Progression
Disease-Free Survival
Edema / pathology*
Female
Glioblastoma / diagnostic imaging
Glioblastoma / pathology
Glioblastoma / radiotherapy*
Humans
Lateral Ventricles / diagnostic imaging
Lateral Ventricles / pathology*
Male
Middle Aged
Neoplasm Invasiveness
Neoplasms, Multiple Primary
Treatment Outcome