Annals of Surgical Oncology

, Volume 24, Issue 3, pp 794–800

Dynamics of FLAIR Volume Changes in Glioblastoma and Prediction of Survival

  • Rachel Grossman
  • Nir Shimony
  • Dror Shir
  • Tal Gonen
  • Razi Sitt
  • Tali Jonas Kimchi
  • Carmit Ben Harosh
  • Zvi Ram
Neuro-Oncology

DOI: 10.1245/s10434-016-5635-z

Cite this article as:
Grossman, R., Shimony, N., Shir, D. et al. Ann Surg Oncol (2017) 24: 794. doi:10.1245/s10434-016-5635-z
  • 124 Downloads

Abstract

Background

The extent of tumor resection (EOTR) calculated by enhanced T1 changes in glioblastomas has been previously reported to predict survival. However, fluid-attenuated inversion recovery (FLAIR) volume may better represent tumor burden. In this study, we report the first assessment of the dynamics of FLAIR volume changes over time as a predictive variable for post-resection overall survival (OS).

Methods

Contemporary data from 103 consecutive patients with complete imaging and clinical data who underwent resection of newly diagnosed glioblastoma followed by the Stupp protocol between 2010 and 2013 were analyzed. Clinical, radiographic, and outcome parameters were retrieved for each patient, including magnetic resonance imaging (MRI)-based volumetric tumor analysis before, immediately after, and 3 months post-surgery.

Results

OS rate was 17.6 months. A significant incremental OS advantage was noted, with as little as 85 % T1-weighted gadolinium-enhanced (T1Gd)-EOTR measured on contrast-enhanced MRI. Pre- and immediate postoperative FLAIR-based EOTR was not predictive of OS; however, abnormal FLAIR volume measured 3 months post-surgery correlated significantly with outcome when FLAIR residual tumor volume (RTV) was <19.3 cm3 and <46 % of baseline volume (p < 0.0001 for both). Age and isocitrate dehydrogenase (IDH)-1 mutation were predictive of OS (p < 0.0001, Cox proportional hazards).

Conclusions

OS correlated with the immediate postoperative T1Gd-EOTR measured by enhanced T1 MRI, but not by FLAIR volume. Diminished abnormal FLAIR volume at 3 months post-surgery was associated with OS benefit when FLAIR-RTV was <19.3 cm3 or <46 % of baseline. These threshold values provide a new radiological variable that can be used for prediction of OS in patients with glioblastoma immediately after completion of standard chemoradiation.

Supplementary material

10434_2016_5635_MOESM1_ESM.docx (16 kb)
Supplementary material 1 (DOCX 15 kb)

Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Rachel Grossman
    • 1
  • Nir Shimony
    • 1
  • Dror Shir
    • 1
  • Tal Gonen
    • 2
  • Razi Sitt
    • 1
  • Tali Jonas Kimchi
    • 3
  • Carmit Ben Harosh
    • 1
  • Zvi Ram
    • 1
  1. 1.Department of Neurosurgery, Tel Aviv Medical Center, Affiliated to the Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
  2. 2.Functional Brain Center, Tel Aviv Medical Center, Affiliated to the Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
  3. 3.Diagnostic Neuroradiology Unit, Tel Aviv Medical Center, Affiliated to the Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael