215 The Impact of Intraoperative MRI and Other Factors on Survival for Patients With Newly Diagnosed Glioblastoma. A Multicenter Assessment of Over 800 Patients

AbstractThe influence of perioperative red blood cell (RBC) transfusion on prognosis of glioblastoma patients continues to be inconclusive. The aim of the present study was to evaluate the association between perioperative blood transfusion (PBT) and overall survival (OS) in patients with newly diagnosed glioblastoma. Between 2013 and 2018, 240 patients with newly diagnosed glioblastoma underwent surgical resection of intracerebral mass lesion at the authors’ institution. PBT was defined as the transfusion of RBC within 5 days from the day of surgery. The impact of PBT on overall survival was assessed using Kaplan–Meier analysis and multivariate regression analysis. Seventeen out of 240 patients (7%) with newly diagnosed glioblastoma received PBT. The overall median number of blood units transfused was 2 (95% CI 1–6). Patients who received PBT achieved a poorer median OS compared to patients without PBT (7 versus 18 months; p < 0.0001). Multivariate analysis identified “age > 65 years” (p < 0.0001, OR 6.4, 95% CI 3.3–12.3), “STR” (p = 0.001, OR 3.2, 95% CI 1.6–6.1), “unmethylated MGMT status” (p < 0.001, OR 3.3, 95% CI 1.7–6.4), and “perioperative RBC transfusion” (p = 0.01, OR 6.0, 95% CI 1.5–23.4) as significantly and independently associated with 1-year mortality. Perioperative RBC transfusion compromises survival in patients with glioblastoma indicating the need to minimize the use of transfusions at the time of surgery. Obeying evidence-based transfusion guidelines provides an opportunity to reduce transfusion rates in this population with a potentially positive effect on survival.

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The impact of the time to start radiotherapy (TRT) on overall survival in newly diagnosed glioblastoma.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.15_suppl.2040 ◽

2015 ◽

Vol 33 (15_suppl) ◽

pp. 2040-2040

Author(s):

Vanessa Montes Santos ◽

Marcella Coelho Mesquita ◽

Maria Del Pilar Estevez-Diz ◽

Gustavo N Marta ◽

Olavo Feher

Keyword(s):

Overall Survival ◽

Newly Diagnosed ◽

Newly Diagnosed Glioblastoma ◽

The Impact

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Intraoperative MRI for newly diagnosed supratentorial glioblastoma: a multicenter-registry comparative study to conventional surgery

Journal of Neurosurgery ◽

10.3171/2020.6.jns19287 ◽

2020 ◽

pp. 1-10 ◽

Cited By ~ 1

Author(s):

Amar S. Shah ◽

Peter T. Sylvester ◽

Alexander T. Yahanda ◽

Ananth K. Vellimana ◽

Gavin P. Dunn ◽

...

Keyword(s):

Dna Methyltransferase ◽

Cox Regression ◽

Volumetric Analysis ◽

Intraoperative Mri ◽

Neurological Deficits ◽

Subtotal Resection ◽

Supporting Evidence ◽

Newly Diagnosed ◽

Mri Features ◽

The Impact

OBJECTIVEIntraoperative MRI (iMRI) is used in the surgical treatment of glioblastoma, with uncertain effects on outcomes. The authors evaluated the impact of iMRI on extent of resection (EOR) and overall survival (OS) while controlling for other known and suspected predictors.METHODSA multicenter retrospective cohort of 640 adult patients with newly diagnosed supratentorial glioblastoma who underwent resection was evaluated. iMRI was performed in 332/640 cases (51.9%). Reviews of MRI features and tumor volumetric analysis were performed on a subsample of cases (n = 286; 110 non-iMRI, 176 iMRI) from a single institution.RESULTSThe median age was 60.0 years (mean 58.5 years, range 20.5–86.3 years). The median OS was 17.0 months (95% CI 15.6–18.4 months). Gross-total resection (GTR) was achieved in 403/640 cases (63.0%). Kaplan-Meier analysis of 286 cases with volumetric analysis for EOR (grouped into 100%, 95%–99%, 80%–94%, and 50%–79%) showed longer OS for 100% EOR compared to all other groups (p < 0.01). Additional resection after iMRI was performed in 104/122 cases (85.2%) with initial subtotal resection (STR), leading to a 6.3% mean increase in EOR and a 2.2-cm3 mean decrease in tumor volume. For iMRI cases with volumetric analysis, the GTR rate increased from 54/176 (30.7%) on iMRI to 126/176 (71.5%) postoperatively. The EOR was significantly higher in the iMRI group for intended GTR and STR groups (p = 0.02 and p < 0.01, respectively). Predictors of GTR on multivariate logistic regression included iMRI use and intended GTR. Predictors of shorter OS on multivariate Cox regression included older age, STR, isocitrate dehydrogenase 1 (IDH1) wild type, no O6-methylguanine DNA methyltransferase (MGMT) methylation, and no Stupp therapy. iMRI was a significant predictor of OS on univariate (HR 0.82, 95% CI 0.69–0.98; p = 0.03) but not multivariate analyses. Use of iMRI was not associated with an increased rate of new permanent neurological deficits.CONCLUSIONSGTR increased OS for patients with newly diagnosed glioblastoma after adjusting for other prognostic factors. iMRI increased EOR and GTR rate and was a significant predictor of GTR on multivariate analysis; however, iMRI was not an independent predictor of OS. Additional supporting evidence is needed to determine the clinical benefit of iMRI in the management of glioblastoma.

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Effects of cediranib (VEGF signaling inhibitor) on edema in newly diagnosed glioblastoma patients during initial chemoradiation.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.2012 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 2012-2012 ◽

Cited By ~ 3

Author(s):

Pavlina Polaskova ◽

Marco C Pinho ◽

Jayashree Kalpathy-Cramer ◽

Alexander R Guimaraes ◽

Patrick Y. Wen ◽

...

Keyword(s):

Antiangiogenic Therapy ◽

Control Group ◽

Newly Diagnosed ◽

Post Contrast ◽

Diffusion Weighted Images ◽

Apparent Diffusion ◽

Adc Values ◽

Newly Diagnosed Glioblastoma ◽

The Right ◽

The Impact

2012 Background: A significant benefit of antiangiogenic therapy is control of brain edema. We evaluated the impact of adding cediranib to standard chemoradiation (CRT) on peritumoral edema in patients with newly diagnosed glioblastoma(GBM) during the initial 6 weeks of CRT. Methods: Two cohorts of patients were enrolled in two clinical trials. The control group (N=13) received radiation for 6 weeks plus temozolomide. The cediranib (CED) group received standard CRT plus daily cediranib (N=34). MRIs were performed at baseline and weekly during CRT. Volumes of interest (VOIs) were drawn outlining the enhancing tumor on T1-weighted post contrast images and the abnormal FLAIR hyperintensity. ADC (apparent diffusion coefficient) maps were calculated from diffusion-weighted images and histograms of the distribution of ADC values created for each visit using the baseline FLAIR VOI to characterize the peritumoraledema. Patients were on stable or decreasing doses of steroids. Results: In the CED group, T1 and FLAIR VOI decreased during CRT vs controls where T1 VOI did not change and FLAIR VOI increased. By the end of CRT, the mode of the ADC histogram in the CED group shifted to the left while the mode of the controls shifted to the right. The skewness, a measure of asymmetry of the distribution, increased in the CED group and decreased in controls. Conclusions: In patients with newly diagnosed GBM treated with CRT and cediranib, tumor volume decreased on T1 and FLAIR images whereas the FLAIR volume significantly increased in the control group suggesting increased edema. The shift of mode to the right and decreasing skewness in controls (indicating an increase in the proportion of very high ADC values) suggests that adding cediranibprevented the development of edema and contributed to the resolution of existing edema. Preventing the edema by adding anti-VEGF treatment may improve the tolerability of CRT for GBM patients. [Table: see text]

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The impact of the time to start radiation therapy on overall survival in newly diagnosed glioblastoma

Journal of Neuro-Oncology ◽

10.1007/s11060-019-03137-8 ◽

2019 ◽

Vol 143 (1) ◽

pp. 95-100 ◽

Cited By ~ 1

Author(s):

Vanessa Montes Santos ◽

Gustavo Nader Marta ◽

Marcella Coelho Mesquita ◽

Rossana Veronica Mendoza Lopez ◽

Edla Renata Cavalcante ◽

...

Keyword(s):

Overall Survival ◽

Radiation Therapy ◽

Newly Diagnosed ◽

Newly Diagnosed Glioblastoma ◽

The Impact

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PATH-13. SEX-LINKED TUMORAL MGMT STATUS AND OUTCOMES IN NEWLY DIAGNOSED GLIOBLASTOMA

Neuro-Oncology ◽

10.1093/neuonc/noz175.609 ◽

2019 ◽

Vol 21 (Supplement_6) ◽

pp. vi145-vi145

Author(s):

Addison Barnett ◽

Anas Saeed Bamashmos ◽

Assad Ali ◽

Hong Li ◽

David Bosler ◽

...

Keyword(s):

Tertiary Care ◽

Progression Free Survival ◽

Primary Objective ◽

Newly Diagnosed ◽

Cox Proportional Hazard ◽

Kaplan Meier ◽

Newly Diagnosed Glioblastoma ◽

Cox Proportional Hazard Models ◽

Tertiary Care Institution ◽

The Impact

Abstract INTRO/OBJECTIVE Glioblastoma (GBM) and MGMT have been reported to have sexual dimorphism. The primary objective of this study was to analyze the impact and association between sex and MGMT status on progression-free survival (PFS) and overall survival (OS) in patients with newly diagnosed GBM. METHODS 582 patients with newly diagnosed GBM who underwent first surgical intervention at a single tertiary care institution between 2012 and 2018 were reviewed. Adults with documented methylated (≥ 12) and un-methylated (≤ 7) MGMT status were included. A Kaplan-Meier and Cox proportional hazard models were used to analyze the association between sex and MGMT status on PFS and OS. RESULTS 464 adult patients (median age 63.4, 36.6% female) had documented MGMT status. Overall rate of MGMT methylated patients was 42.5%, while females were more often methylated than males (52.1% vs 37.4%, p=0.004). MGMT methylated compared to un-methylated females (median: 12.8 vs 7.4 months; 1-yr: 53% vs 27%) had a greater PFS benefit than males (median: 9.6 vs 6.8 months; 1-yr: 44% vs 23%). OS was significantly improved in MGMT methylated compared to un-methylated patients among females (p=0.001) but not among males (p=0.22). Among MGMT methylated patients, females had significantly better OS compared to males (median: 18.7 vs 12.4 months; 2-yr OS: 36.8% vs 24.3%, p=0.03). Although statistically not significant, a similar pattern was observed on PFS (median: 12.8 vs 9.6 months; 1-yr PFS: 52.6% vs 44.4%). Compared to MGMT methylated females, MGMT methylated males had a PFS HR=1.22 (95% CI=0.80 – 1.85, p=0.36), and an OS HR=1.45 (95% CI=1.03 – 2.04, p=0.032). CONCLUSION MGMT methylation is more common in females and methylation had a larger impact on both PFS and OS in females compared to males. These analyses highlight the need to further investigate sex differences that can inform clinical management of GBM.

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Impact of Body Mass Index on Survival Outcome in Patients with Newly Diagnosed Glioblastoma: A Retrospective Single-Center Study

Integrative Cancer Therapies ◽

10.1177/1534735421991233 ◽

2021 ◽

Vol 20 ◽

pp. 153473542199123

Author(s):

Jun-Yong Cha ◽

Jae-Sung Park ◽

Yong-Kil Hong ◽

Sin-Soo Jeun ◽

Stephen Ahn

Keyword(s):

Cox Regression ◽

Survival Outcomes ◽

Newly Diagnosed ◽

Eligibility Criteria ◽

Cox Regression Analysis ◽

Asian Populations ◽

Kaplan Meier ◽

Single Center Study ◽

Newly Diagnosed Glioblastoma ◽

The Impact

Introduction: The impact of obesity on survival outcomes in patients with glioblastoma (GBM) has not been well reported and the results for patients are currently unclear. We investigated the effect of obesity on survival outcomes in patients with newly diagnosed GBM. Methods: Using electronic medical records, all GBM patients that visited the Seoul St. Mary’s Hospital between 2008 and 2018 were reviewed. A total of 177 patients met our eligibility criteria. The cut-off point for BMI was 23.0 kg/m2 based on previous studies which focused on Asian populations. Results: A total of 177 patients met our eligibility criteria. The overall median BMI of patients was 24.5 kg/m2 (range 15.82-39.26). About 62 patients who had a BMI less than the cut-off value were assigned to the “lower BMI” group, while 115 patients who had a BMI greater than the cut-off value were assigned to the “higher BMI” group. In Kaplan-Meier survival analysis, the median OS of the higher BMI group was longer than that of the lower BMI group (21.3 months vs 15.3 months, P = .002). In multivariate Cox regression analysis for OS, lower BMI was associated with inferior OS (HR 1.48 CI 1.06-2.08, P = .002). Conclusion: Our findings suggest that elevated BMI may be associated with better survival in patients with newly diagnosed GBM. Additional larger prospective studies could help validate our findings to confirm the effect of body composition and survival outcomes in GBM patients.

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