Volumetric extent of resection and residual contrast enhancement on initial surgery as predictors of outcome in adult patients with hemispheric anaplastic astrocytoma

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Object

To investigate the prognostic significance of the volumetrically assessed extent of resection on time to tumor progression (TTP), overall survival (OS), and tumor recurrence patterns, the authors retrospectively analyzed preoperative and postoperative tumor volumes in 102 adult patients from the time of the initial resection of a hemispheric anaplastic astrocytoma (AA).

Methods

The quantification of tumor volumes was based on a previously described method involving computerized analysis of magnetic resonance (MR) images. Analysis of contrast-enhancing tumor volumes on T1-weighted MR images was conducted for 67 patients who had contrast-enhancing tumors. Measurements of T2 hyperintensity were obtained for all 102 patients in the study.

The presence or absence of preresection enhancement, actual volume of this enhancement, and the percentage of preoperative enhancement as it relates to the total T2 tumor volume did not have a statistically significant relationship to TTP or OS. In addition to age, the volume of residual disease measured on T2-weighted MR images was the most significant predictor of TTP (p < 0.001), and residual contrast-enhancing tumor volume was the most significant predictor of OS (p = 0.003) on multivariate analysis. In contrast to low-grade gliomas, there was no statistically significant relationship between the extent of resection and histological characteristics at the time of recurrence, that is, tumor Grade III compared with Grade IV.

Conclusions

Data from this retrospective analysis of a histologically uniform group of hemispheric AAs treated in the MR imaging era suggest that residual tumor volumes, as documented on postoperative imaging studies, may be a prognostic factor for TTP and OS for this patient population.

Abbreviations used in this paper:AA = anaplastic astrocytoma; CI = confidence interval; GBM = glioblastoma multiforme; HR = hazard ratio; KPS = Karnofsky Performance Scale; MR = magnetic resonance; OS = overall survival; POR = percent of resection; RTOG = Radiation Therapy Oncology Group; TTP = time to tumor progression; VRD = volume of residual disease.

Article Information

Address reprint requests to: G. Evren Keles, M.D., Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M-787, San Francisco, California 94143-0112. email: kelese@neurosurg.ucsf.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Kaplan–Meier curve showing the TTP as it relates to the three subgroups of residual tumor volumes (< 10 cm3, 10–20 cm3, and > 20 cm3) defined as hyperintensity on postoperative T2-weighted MR images. p < 0.001.

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    Kaplan–Meier curve depicting the TTP as it relates to the three subgroups of contrast-enhancing residual tumor volumes (<5 cm3, 5–10 cm3, and > 10 cm3) as depicted on postoperative T1-weighted MR images. CE = contrast enhancement.

  • View in gallery

    Kaplan–Meier curve indicating survival from the time of initial surgery as it relates to the three subgroups of residual tumor volumes (< 10 cm3, 10–20 cm3, and > 20 cm3) defined as hyperintensity on postoperative T2-weighted MR images.

  • View in gallery

    Kaplan–Meier curve demonstrating survival from the time of initial surgery as it relates to the three subgroups of contrast-enhancing residual tumor volumes (< 5 cm3, 5–10 cm3, and > 10 cm3) as depicted on postoperative T1-weighted MR images. p = 0.003.

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