Artikel
MRI changes after proton therapy for glioblastoma with and without tumor treating fields therapy
MRT-Veränderungen nach Protonentherapie in Kombination mit Tumor Treating Fields bei Glioblastompatienten
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Autoren
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Hanna Goett
- Justus-Liebig Universität Gießen, Klinik für Neurochirurgie, Gießen, Deutschland
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Alexandra Jensen
- Justus-Liebig Universität Gießen, Klinik für Strahlentherapie, Gießen, Deutschland
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Tobias Struffert
- Justus-Liebig Universität Gießen, Institut für Neuroradiologie, Gießen, Deutschland
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Eberhard Uhl
- Justus-Liebig Universität Gießen, Klinik für Neurochirurgie, Gießen, Deutschland
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Marco Stein
- Justus-Liebig Universität Gießen, Klinik für Neurochirurgie, Gießen, Deutschland
| Veröffentlicht: | 4. Juni 2021 |
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Gliederung
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Objective: Tumor treating fields (TTFields) are an approved treatment modality for glioblastoma (GBM) with significant improvement of progression free survival and overall survival. Growing evidence suggest, that proton therapy increase early magnetic resonance imaging (MRI) changes. The aim of this study was to evaluate the morphologic changes in serial MRI after combination treatment of TTFields and proton therapy.
Methods: Twenty-four patients with GBM were included in this prospective analysis. All patients received initial tumor resection followed by combined chemo- and radiation therapy and temozolomide maintenance. Radiation therapy was performed with 50.0 Gy photons and a proton boost with 10 Gy equivalent (Gy(RBE)). In 12 patients additionally a therapy with with TTFields during temozolomide maintenance was performed.
Results: An increase of contrast enhancement and a progress in the T2 FLAIR hyperintensity were found in 50.0% (N=12) at 3 months and in 29.2% (N=7) at 6 months. No differences were observed between patients with and without TTFields therapy at 3 months [58.3% (N=7) vs. 41.6% (N=5); P=0.414] and at 6 months 57.1 (N=4) vs. 42.9% (N=3); P=0.673).
By the RANO criteria, a progressive disease (PD) was observed in seven patients (29.2%) at 3 months and in eight patients (33.3%) at 6 months. Pseudoprogression (PP) was observed in in 33.3% (N=8) at 3 months and in 25.0% (N=6) at 6 months. Neither for PD at 3 months [57.1% (N=4 ) vs. 42.9% (N=3); P=0.653] or at 6 months [62,5% (N=5) vs. 37.5% (N=3); P=0.386), nor for PP at 3 months [62.5% (N=5) vs. 37.5% (N=3); P=0.386] or at 6 months [33.3% (N=2) vs. 66.6% (N=4); P=0.346] differences for patients with and without TTFields therapy were found.
Conclusion: An increase of contrast enhancement and/or T2 FLAIR MRI hyperintensity after proton boost therapy is common. The rates of new contrast enhancement, PD, and PP after photon therapy are in range with the results of patients with additional TTFields therapy.
