gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Radiologic patterns of first tumor recurrence of glioblastoma: Prognostic value and association to postoperative infarct volume

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  • Stefanie Bette - Klinikum rechts der Isar, Technische Universität München, Abteilung für Diagnostische und Interventionelle Neuroradiologie, München, Deutschland
  • Melanie Barz - Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
  • Thomas Huber - Klinikum rechts der Isar, Technische Universität München, Abteilung für Diagnostische und Interventionelle Neuroradiologie, München, Deutschland
  • Julia Gerhardt - Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
  • Christoph Straube - Technische Universität München, Klinikum Rechts der Isar, Department of Radiation Oncology, München, Deutschland
  • Friedericke Schmidt-Graf - Technische Universität München, Klinikum Rechts der Isar, Neurologische Klinik, München, Deutschland
  • Claus Zimmer - Klinikum rechts der Isar, Technische Universität München, Abteilung für Diagnostische und Interventionelle Neuroradiologie, München, Deutschland
  • Bernhard Meyer - Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
  • Jan Kirschke - Abteilung für Neuroradiologie, Abteilung für Diagnostische und Interventionelle Neuroradiologie, München, Deutschland
  • Tobias Boeck-Behrens - Klinikum rechts der Isar, Technische Universität München, Abteilung für Diagnostische und Interventionelle Neuroradiologie, München, Deutschland
  • Benedikt Wiestler - Klinikum rechts der Isar, Technische Universität München, Abteilung für Diagnostische und Interventionelle Neuroradiologie, München, Deutschland
  • Jens Gempt - Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocDI.03.05

doi: 10.3205/17dgnc195, urn:nbn:de:0183-17dgnc1955

Published: June 9, 2017

© 2017 Bette et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Postoperative infarct volume is a prognostic factor for glioblastoma (GB) patients, postoperative hypoxia is suggested as potential mediatior for invasive tumor growth, resulting in diffuse/multifocal recurrence patterns. Aim of this study was to analyze distinct recurrence patterns and its association to overall survival (OS)/post-progression survival (PPS) and postoperative infarct volume.

Methods: 526 consecutive GB patients were retrospectively analyzed, 129 patients met the inclusion criteria: surgery for initial tumor diagnosis, postoperative diffusion-weighted imaging and tumor recurrence during follow-up. The following imaging patterns were recorded: multifocal recurrence, contact to dura and/or ventricle, ependymal spread, circular/garland like or extensive/solid enhancement, homogenous/inhomogenous enhancement, invasive/displacing growth, with/without sharp demarcation and the local or distant recurrence. Binary logistic regression analysis as well as multivariate (Cox regression) survival analyses were performed.

Results: Patients with larger postoperative infarct volume significantly more often developed multifocal recurrence (Odds Ratio (OR) 1.10 per cm³ infarct volume, P=0.040), recurrence with contact to ventricle (OR 1.14, P=0.012) and contact to dura (OR 1.07, P=0.029). Multivariate survival analysis showed that patients with multifocal recurrence (Hazard Ratio (HR) 1.99 [1.18-3.35], P=0.009) and recurrence with contact to ventricle (HR 1.71 [1.03-2.85], P=0.038) had significantly shorter OS including other known prognostic factors like age, Karnofsky Performance Score (KPS), therapy and extent of resection. Also PPS was significantly reduced in patients with tumor recurrence with contact to ventricle (HR 1.80 [1.11-2.93], P=0.017), distant recurrence (HR 1.74 [1.09-2.77], P=0.020) and ependymal spread (HR 3.03 [1.48-6.23] P=0.003) in multivariate analysis.

Conclusion: Multifocal tumor recurrence and recurrence with contact to ventricle are associated with postoperative infarct volume and were shown as independent predictors for OS and PPS. Hypoxia-mediated aggressive tumor growth might be the trigger formultifocal and diffuse recurrence patterns.