Histopathological correlates with survival in reoperated glioblastomas

Graeme F. Woodworth, Tomas Garzon-Muvdi, Xiaobu Ye, Jaishri O. Blakeley, Jon D. Weingart, Peter C. Burger

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

The addition of concomitant and adjuvant chemotherapy to radiation therapy after surgical resection has increased significantly the survival of patients with glioblastoma (GB). In conjunction, there has been an increasing fraction of patients who present with new enlarged areas of contrast enhancement and edema on post-treatment imaging that improve without further treatment. It remains to be established how this phenomenon, commonly termed pseudoprogression, can be distinguished from true tumor recurrence defined as the histological presence of active high-grade tumor, as well as its prognostic significance. Data for over 500 patients undergoing surgery for recurrent GB were reviewed. Pathological specimens were categorized as those that contained active high-grade glioma in any amount, and those that did not. Patient survival was compared between these two groups, and independent associations were assessed using Cox proportionate hazards regression analysis. 59 patients met the study criteria including complete pathological and follow-up data. Mean age was 53 ± 11 years. Median survival from suspected recurrence and initial diagnosis were 8 [5-14] and 20 [12-30] months. Seventeen patients (29 %) had no evidence of active high-grade tumor and 42 (71 %) had at least focal active high-grade glioma. Pathologic pseudoprogression at re-operation (p = 0.03) and gross total resection (p = 0.01) were independently associated with survival. The histopathological features defined here and used to assess the tumor at reoperation were independently associated with survival. These findings may be important in designing treatment strategies and clinical trial endpoints for patients with GB.

Original languageEnglish (US)
Pages (from-to)485-493
Number of pages9
JournalJournal of Neuro-Oncology
Volume113
Issue number3
DOIs
StatePublished - Jul 2013
Externally publishedYes

Fingerprint

Glioblastoma
Survival
Glioma
Neoplasms
Recurrence
Adjuvant Chemotherapy
Reoperation
Edema
Radiotherapy
Therapeutics
Regression Analysis
Clinical Trials

Keywords

  • Glioblastoma
  • Pathology
  • Pseudoprogression
  • Recurrence
  • Treatment effect

ASJC Scopus subject areas

  • Oncology
  • Neurology
  • Clinical Neurology
  • Cancer Research

Cite this

Woodworth, G. F., Garzon-Muvdi, T., Ye, X., Blakeley, J. O., Weingart, J. D., & Burger, P. C. (2013). Histopathological correlates with survival in reoperated glioblastomas. Journal of Neuro-Oncology, 113(3), 485-493. https://doi.org/10.1007/s11060-013-1141-3

Histopathological correlates with survival in reoperated glioblastomas. / Woodworth, Graeme F.; Garzon-Muvdi, Tomas; Ye, Xiaobu; Blakeley, Jaishri O.; Weingart, Jon D.; Burger, Peter C.

In: Journal of Neuro-Oncology, Vol. 113, No. 3, 07.2013, p. 485-493.

Research output: Contribution to journalArticle

Woodworth, GF, Garzon-Muvdi, T, Ye, X, Blakeley, JO, Weingart, JD & Burger, PC 2013, 'Histopathological correlates with survival in reoperated glioblastomas', Journal of Neuro-Oncology, vol. 113, no. 3, pp. 485-493. https://doi.org/10.1007/s11060-013-1141-3
Woodworth, Graeme F. ; Garzon-Muvdi, Tomas ; Ye, Xiaobu ; Blakeley, Jaishri O. ; Weingart, Jon D. ; Burger, Peter C. / Histopathological correlates with survival in reoperated glioblastomas. In: Journal of Neuro-Oncology. 2013 ; Vol. 113, No. 3. pp. 485-493.
@article{50e06a6fd1c14978a8b9765dfd7027d9,
title = "Histopathological correlates with survival in reoperated glioblastomas",
abstract = "The addition of concomitant and adjuvant chemotherapy to radiation therapy after surgical resection has increased significantly the survival of patients with glioblastoma (GB). In conjunction, there has been an increasing fraction of patients who present with new enlarged areas of contrast enhancement and edema on post-treatment imaging that improve without further treatment. It remains to be established how this phenomenon, commonly termed pseudoprogression, can be distinguished from true tumor recurrence defined as the histological presence of active high-grade tumor, as well as its prognostic significance. Data for over 500 patients undergoing surgery for recurrent GB were reviewed. Pathological specimens were categorized as those that contained active high-grade glioma in any amount, and those that did not. Patient survival was compared between these two groups, and independent associations were assessed using Cox proportionate hazards regression analysis. 59 patients met the study criteria including complete pathological and follow-up data. Mean age was 53 ± 11 years. Median survival from suspected recurrence and initial diagnosis were 8 [5-14] and 20 [12-30] months. Seventeen patients (29 {\%}) had no evidence of active high-grade tumor and 42 (71 {\%}) had at least focal active high-grade glioma. Pathologic pseudoprogression at re-operation (p = 0.03) and gross total resection (p = 0.01) were independently associated with survival. The histopathological features defined here and used to assess the tumor at reoperation were independently associated with survival. These findings may be important in designing treatment strategies and clinical trial endpoints for patients with GB.",
keywords = "Glioblastoma, Pathology, Pseudoprogression, Recurrence, Treatment effect",
author = "Woodworth, {Graeme F.} and Tomas Garzon-Muvdi and Xiaobu Ye and Blakeley, {Jaishri O.} and Weingart, {Jon D.} and Burger, {Peter C.}",
year = "2013",
month = "7",
doi = "10.1007/s11060-013-1141-3",
language = "English (US)",
volume = "113",
pages = "485--493",
journal = "Journal of Neuro-Oncology",
issn = "0167-594X",
publisher = "Kluwer Academic Publishers",
number = "3",

}

TY - JOUR

T1 - Histopathological correlates with survival in reoperated glioblastomas

AU - Woodworth, Graeme F.

AU - Garzon-Muvdi, Tomas

AU - Ye, Xiaobu

AU - Blakeley, Jaishri O.

AU - Weingart, Jon D.

AU - Burger, Peter C.

PY - 2013/7

Y1 - 2013/7

N2 - The addition of concomitant and adjuvant chemotherapy to radiation therapy after surgical resection has increased significantly the survival of patients with glioblastoma (GB). In conjunction, there has been an increasing fraction of patients who present with new enlarged areas of contrast enhancement and edema on post-treatment imaging that improve without further treatment. It remains to be established how this phenomenon, commonly termed pseudoprogression, can be distinguished from true tumor recurrence defined as the histological presence of active high-grade tumor, as well as its prognostic significance. Data for over 500 patients undergoing surgery for recurrent GB were reviewed. Pathological specimens were categorized as those that contained active high-grade glioma in any amount, and those that did not. Patient survival was compared between these two groups, and independent associations were assessed using Cox proportionate hazards regression analysis. 59 patients met the study criteria including complete pathological and follow-up data. Mean age was 53 ± 11 years. Median survival from suspected recurrence and initial diagnosis were 8 [5-14] and 20 [12-30] months. Seventeen patients (29 %) had no evidence of active high-grade tumor and 42 (71 %) had at least focal active high-grade glioma. Pathologic pseudoprogression at re-operation (p = 0.03) and gross total resection (p = 0.01) were independently associated with survival. The histopathological features defined here and used to assess the tumor at reoperation were independently associated with survival. These findings may be important in designing treatment strategies and clinical trial endpoints for patients with GB.

AB - The addition of concomitant and adjuvant chemotherapy to radiation therapy after surgical resection has increased significantly the survival of patients with glioblastoma (GB). In conjunction, there has been an increasing fraction of patients who present with new enlarged areas of contrast enhancement and edema on post-treatment imaging that improve without further treatment. It remains to be established how this phenomenon, commonly termed pseudoprogression, can be distinguished from true tumor recurrence defined as the histological presence of active high-grade tumor, as well as its prognostic significance. Data for over 500 patients undergoing surgery for recurrent GB were reviewed. Pathological specimens were categorized as those that contained active high-grade glioma in any amount, and those that did not. Patient survival was compared between these two groups, and independent associations were assessed using Cox proportionate hazards regression analysis. 59 patients met the study criteria including complete pathological and follow-up data. Mean age was 53 ± 11 years. Median survival from suspected recurrence and initial diagnosis were 8 [5-14] and 20 [12-30] months. Seventeen patients (29 %) had no evidence of active high-grade tumor and 42 (71 %) had at least focal active high-grade glioma. Pathologic pseudoprogression at re-operation (p = 0.03) and gross total resection (p = 0.01) were independently associated with survival. The histopathological features defined here and used to assess the tumor at reoperation were independently associated with survival. These findings may be important in designing treatment strategies and clinical trial endpoints for patients with GB.

KW - Glioblastoma

KW - Pathology

KW - Pseudoprogression

KW - Recurrence

KW - Treatment effect

UR - http://www.scopus.com/inward/record.url?scp=84879327111&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84879327111&partnerID=8YFLogxK

U2 - 10.1007/s11060-013-1141-3

DO - 10.1007/s11060-013-1141-3

M3 - Article

C2 - 23666202

AN - SCOPUS:84879327111

VL - 113

SP - 485

EP - 493

JO - Journal of Neuro-Oncology

JF - Journal of Neuro-Oncology

SN - 0167-594X

IS - 3

ER -