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Tumor regrowth between surgery and initiation of adjuvant therapy in patients with newly diagnosed glioblastoma.

Posted on: 03/08/2009

Neuro Oncol. 2009 Feb 19. [Epub ahead of print] Related Articles

Tumor regrowth between surgery and initiation of adjuvant therapy in patients with newly diagnosed glioblastoma.

Pirzkall A, McGue C, Saraswathy S, Cha S, Liu R, Vandenberg S, Lamborn KR, Berger MS, Chang SM, Nelson SJ.

Department of Radiology and Margaret Hart Surbeck Laboratory of Advanced Imaging, Department of Neurological Surgery and Radiation Oncology, University of California, San Francisco; Dept. of Radiology, University of San Francisco, 1700 4th St., Byers Hall, Room 301, San Francisco, CA 94158, USA.

Purpose: To assess incidence and degree of regrowth in glioblastoma between surgery and radiation therapy (RT) and to correlate regrowth with pre-surgical imaging and survival. Materials & Methods: Thirty-two patients with newly diagnosed glioblastoma underwent MRI, spectroscopy (MRSI), perfusion (PWI) and diffusion (DWI) imaging prior to surgery, post-surgery, and prior to RT/Temozolomide. Contrast enhancement (CE) in the pre-RT MRI was compared with postsurgical DWI to differentiate tumor growth from postsurgical infarct. MRSI and PWI parameters were analyzed prior to surgery and pre-RT. Results: The postsurgical MRI indicated that 18 patients had gross-total and 14 sub-total resections. Twenty-one patients showed reduced diffusion and 25 patients showed new or increased CE. In 8 patients (25%) the new CE was confined to areas of postsurgical reduced diffusion. In the other 17 patients (53%) new CE was assumed to be indicative of tumor growth or a combination of tumor growth and surgical injury. Higher perfusion and creatine within non-enhancing tumor in the pre-surgery MR were associated with subsequent tumor growth. High levels of choline and reduced diffusion in pre-RT CE suggested active metabolism and tumor cell proliferation. Median survival was 14.6 months in patients with interim tumor growth and 24 months in patients with no growth. Conclusions: Increased volume or new onset of CE between surgery and RT was attributed to tumor growth in 53% of patients and was associated with shorter survival. This suggests that reducing the time between surgery and adjuvant therapy may be important. The acquisition of metabolic and physiologic imaging data prior to adjuvant therapy may also be valuable in assessing regions of new CE and non-enhancing tumor.

PMID: 19229057 [PubMed - as supplied by publisher]

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