| Chapter1. The relationship between peritumoral brain edema innewly diagnosis and recurrence patterns after total resection incerebral hemisphere gliomaObjective: This study aimed to explore the relationship between peritumoral edema(PTE) and the tendency of recurrent location and morphological character after totalresection.Materials and methods: magnetic resonance image(MRI)datas were collected from43patients with recurrent gliomas after total resection from four clinical centers,andthe relationship among the different degrees, types of newly diagnosed PTE thatwere showed on the T2-weighted images,the location tendency and themorphological character of recurrent glioma were retrospectively analyzed.Results: Patterns of glioma recurrence could be different and related to thecharacteristic of PTE on preoperative MRI. Different gliomas have differentrecurrence patterns, the morphology（P=0.002）and tendency of recurrent gliomas（P=0.001）were significantly different among various PTE degrees. In the groupwith minor PTE, the morphological character of recurrent glioma tended to be focalshape (6/8), and the location tendency tended to be local located(5/8). In the groupwith major PTE, the morphological character of recurrent glioma tended to be spreadshape（30/35）,and the location tendency tended to be marginal located(7/35) anddiffuse(25/35). The morphology（P<0.001）and tendency of recurrent gliomas（P<0.001）were significantly different among various PTE types. In the group withedema appeared to be ring, recurrent glioma was more likely focal shape (7/9) andlocal located(6/9), followed by marginal located (2/9)and diffuse(1/9). If edema was irregular, most of recurrent glioma tended to be diffuse(25/34), followed by marginallocated (7/34)，and less likely to be local located(2/34).Conclusion: The degrees and types of brain glioma PTE could significantly related tothe location tendency and morphological character of recurrent glioma after totalresection. These findings can provide us the guidance of individualized treatmentstrategies for brain glioma to improve clinical effects of brain glioma throughcharacteristic of newly diagnosed PTE on the MRI, such as the resection extent offirst surgery and radiotherapy treatment volumes after surgery. Chapter2. MRI characteristics of recurrent or regrowthcerebral hemisphere gliomasObjective: analyze MRI characteristics of cerebral hemisphere gliomas recurrent orregrowth, to see if it can be used to predict tumor migration directionsMaterials and methods: Retrospectively analyzed MRI datas from70patients withrecurrent gliomas after surgical treatment from four different Clinical Centers,identified the recurrent tendency after total resection and regrowth locations aftersubtotal resection as main tumor migration directions, then analyzed correlationbetween the characteristics of MRI datas in newly diagnosis and the main tumormigration directions.Results: Dispersion directions of brain gliomas peritumoral edema (PTE) in newlydiagnosis were correlated with main tumor migration directions（P<0.0001）.In the23cases of local-marginal migration,18cases of PTE presented no specific dispersiondirections, yet24PTEs in the30cases of specific expansional invasion displayed thespecific and the same dispersion directions; however, in the17cases of multipleexpansional migration,10PTEs showed multiple dispersion directions. Preoperativetumor locations also correlated with gliomas migration directions（P<0.0001）,whentumors located near or in the brain cortex, their migration directions showedlocal-marginal migration (16/31);when tumors located near or on the white matter fiber tracts pathways, a large proportion of gliomas migration directions exhibitedspecific expansional migration (15/19); when tumors located near or on theventricular wall, then their migration directions emerged multiple expansionalmigration (10/20).Conclusion: MRI characteristics of cerebral hemisphere gliomas such as dispersiondirections of PTE and tumor locations in newly diagnosis could predict tumormigration directions, which can provide us the guidance for the individualizedformulation of the resection extent of first surgery and radiotherapy treatmentvolumes after surgery. Chapter3. Factors affecting progression-free survival of patientswith cerebral hemisphere malignant gliomas after total resectionObjective:The purpose of this study was to assess the imaging features of newlydiagnosed maligant glioma, postoperative radiotherapy and chemotherapy,andanalysed the effect of these factors on patients’ progression-free survival(PFS) time.Materials and methods:A total of54patients with recurrent malignant gliomaconfirmed by pathology or progressive malignant glioma proved by clinical follow-upwere included in this retrospective study from4clinical centers.Several factorsselected from clinical, radiological, pathological,and treatment variables were MRimage features at initial diagnosis(including maximum diameter of tumor,peritumoraledema,degree of enhancement,degree of necrosis,whether there was cystic or satellite)and postoperative radiotherapy and chemotherapy. Kaplan-Meier method and Cox’sproportion-hazards model were used to analyse the factors influencing patients′progression free survival (PFS) time.Results: The overall median PFS was12months (95%CI,8.799to15.201).Age(P=0.009),degree of peritumoral edema(P=0.001),degree of necrosis(P<0.0001),degree of enhancement(P<0.0001),postoperative radiotherapy(P=0.008) andchemotherapy(P=0.035)were statistically significant factors for PFS in the univariate Kaplan-Meier analysis. Median PFS of patients with age<50years and age≧50yearswere16Ms(95%CI:11.199-20.801)and9Ms(95%CI:6.322-11.678)respectively;MedianPFS of patients with minor PTE and major PTE were24Ms (95%CI:14.200-33.800)and10Ms (95%CI:7.411-12.589)respectively;Median PFS of patients with necrosis(Minor,mode rate and major)were26Ms(95%CI:15.879-36.121),16Ms(95%CI:11.684-20.3161) and9Ms (95%CI:7.410-10.590) respectively; Median PFSof patients with no enhancement and enhancement of tumor were33Ms(95%CI:26.559-39.441) and11Ms (95%CI:6.885-15.115);Median PFS of patientswith none,irregular,regular chemotherapy were7Ms(95%CI:4.886-9.114),12Ms(95%CI:8.173-15.827)and17Ms(95%CI:10.277-23.723) respectively；Median PFSof patients with postoperative radiotherapy and none radiotherapy were7Ms(95%CI:5.614-8.268) and14Ms(95%CI:11.387-16.613) respectively.Furthermore,Cox multivariate analysis also showed that the degree of PTE(P=0.019),degree ofnecrosis (P<0.0001),postoperative radiotherapy(P=0.035) and chemotherapy(P=0.049)were all significantly correlated with PFS.Conclusion: Degree of PTE, degree of necrosis,postoperative radiotherapy andchemotherapy are independent predictive factors for PFS. The degree of PTE andnecrosis on preoperative MR images can be used to evaluate the PFS of glioma afertotal resection; for Supratentorial malignant gliomas even with total resectionconfirmed by MRI, adjuvant normative chemotherapy and radiotherapy shoud berecommend. Chapter4. The effect of peritumoral edema on radiation andchemotherapy in newly diagnosis high grade cerebralhemisphere glioma after operation Objective: The primary objective of this study was to explore the influence of PTEin high-grade glioma(HGG) on postoperative radio-chemotherapy effect and patients’overall survival.Methods and materials: MR imaging features，clinical datas and postoperativeradio-chemotherapy information were analyzed retrospectively in102patients withhistologically proven high-grade gliomas from the First Affiliated Hospital of FujianMedical University between January2007and December2012were enrolled..Thepreoperative PTE in HGGs was measured on first diagnostic MRI,defined as minoredema and major edema. Associations between different degree of PTE andcategorical variables were analyzed by2-test, The influence of different degree ofPTE on patients’ overall survival receiving radio-chemotharapy after surgery wasassessed using the Kaplan–Meier method and the Cox proportional hazard model.Results: The univariate analysis revealed age,gender,preoperative KPS,receivingchemotherapy or not,with or without regular chemotherapy,receiving radiotherapy ornot,degree of PTE and pathological grade were significantly correlated withpatients’ overall survival.The median survival of all patients was10months (95%CI5.834-14.166).The median survival of patients with pathological grade Ⅲ andⅣwere35months(95%CI,5.667-64.333) and13months(95%CI,5.834-14.166).Themedian survival of patients with no chemotherapy,irregular chemotherapy and regularchemotherapy were10months (95%CI,5.834-14.166),21months(95%CI,11.185--30.815) and28months (95%CI,4.628-51.372)， respectively.For all patientsreceiving chemotherapy,the differences of clinical data(incluing age,preoperativeKPS,pathological trade,with or without radiochemotherapy, with regular or irregularchemotherapy) showed no statistical significance.In addition, multivariate analysisindicated PTE was the independent impactor influencing the overall survival ofpatients with chemotherapy(RR2.245,95%CI1.071-4.710,p=0.032).For patientsreceicing chemotherapy,the median survival of minor edema group and major edemagroup were41months (95%CI7.411-12.589) and16months (95%CI11.357-20.643),respectively(Log-rank test, P=0.037).For patients receivingradiotherapy, multivariate analysis indicated PTE was the independent impactor influencing the overall survival, the median survival of minor edema group and majoredema group were44months (95%CI,19.386-68.514) and16months (95%CI，13.709-24.291),respectively(Log-rank test, P=0.043).Conclusion：The degrees of PTE influenced the effect of postoperative radio-chemotherapy and patients’ overall survival. The effect of radio-chemotherapy forpatients with minor PTE was much better than those with major PTE, this result couldprovide the reference information for tailoring individual radio-chemotherapy topatients with high-grade glioma. |
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