Prognostic Value of Initial Magnetic Resonance Imaging Growth Rates for World Health Organization Grade II Glioma
Reviewer: Eric Shinohara MD, PhD
Abramson Cancer Center of the University of Pennsylvania
Ultima Vez Modificado: 10 de diciembre del 2006
Author: Pallud J. et al 2006;60:380-383
Source: Ann Neurol Objective
To determine if MRI-based measurement of growth rate prior to treatment has prognostic value in grade II gliomas.
143 consecutive patients diagnosed between 1992-2004
Older than 17 years of age
Absence of contrast enhancement
Astrocytoma, oligodendroglioma, or mixed glioma
At least 2 MRI studies pre-treatment, at least 3 months apart
Median age 34
Symptoms at dx: 7 patients asymptomatic, 124 patients with seizures, 12 patients with headache, 7 patients with neurologic deficits
Median tumor volume 74.5 cm 3: 54 patients had histologic diagnosis via biopsy, 34 patients had partial resections, 40 had subtotal resections, and 15 had total resections
92 oligodendrogliomas, 24 astrocytomas, 27 mixed histology
Median Ki-97 proliferation index 5% (72% of cases were assessable)
Median of 3 tumor measurements prior to treatment
Median duration of repeat measurements was 21.7 months
Median Individual Radiological Growth Rate (IGR) 4.4 mm/year
Two Groups: 121 <8mm/year à low risk (LR) and 22 >8mm/year à high risk (HR)
No significant difference between the 2 groups regarding various demographics and treatment factors except that more biopsies done in LR group
Median clinical follow-up after radiologic diagnosis was 6.5 years
18.1% of LR patients died during this time versus 45.5% in HR group; median time to death was 6.7 years in LR group and 4.9 years in HR group
Median survival was 5.16 years in HR group versus 15 years in LR group
Univariate Analysis: inverse correlation between IGR and survival (p<0.001); histology, tumor volume, age, neurologic deficits, and Ki-67 proliferation score not significant predictors of survival
Multivariate Analysis: IGR (p<0.0001) and tumor volume (p=0.034) were independent prognostic factors for survival
IGR measurements prior to treatment in supratentorial grade II gliomas are predictive of prognosis
Previous studies have shown age >40, astrocytoma histology, tumor diameter >6 cm, neurologic defects, and lesions crossing midline have worse prognosis.
Lack of significance for several other prognostic factors may be due to small sample size.
Limitations of histologic diagnosis
Limited because it is "static"
Limited to part of the tumor, particularly in biopsies or partial resections
Conversely, tumor growth rate a macroscopic, dynamic parameter
In tumors growing >8 mm/year, worse prognosis despite absence of anaplastic transformation à seem to behave more like anaplastic gliomas with median survival of 5.16 years
Study may be limited as 2 MRIs may not accurately determine growth velocity
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