| (Ⅰ)Pattern of failure for high-grade glioma patients after treatment.Purpose:Explore the pattern of failure for high-grade glioma patients after treatment under the guidance of Magnetic Resonance Imaging(MRI).Method:A retrospective analysis of 36 patients with high-grade glioma who underwent postoperative radiotherapy combined with temozolomide during 2014.01.01-2019.12.31 and had sufficient evidence to demonstrate recurrence during follow-up was done.The TI enhanced(T1/c+)sequence images for the first diagnosed of recurrence were fused with the computerized tomography(CT)images used for positioning in the initial radiotherapy plan,and then the delineation to the recurrence area on the basis of the original target area was drew.The relative volume of 95%of the prescribed dose in the recurrence area was obtained from the Dose-Volume-Histogram(DVH)plot.The values were greater than 95%,80%-95%,20-80%,and less than 20%were defined as central,in-field,marginal and distant failure,respectively.For those who had central and in-field failure,the overlapped area volume and the ratio of the recurrence area to the operative cavity and peritumoral edema area were calculated and compared.In addition,ADC images of 8 patients were fused with localized CT images in the initial radiotherapy plan to delineate the abnormal signal area and to analyze and compare the correlation with the volume of edema area(T2 high-signal area)Result:Of the 36 high-grade glioma patients,27 developed central failure,accounting for 75%;5 in-field failure,accounting for 13.9%;3 had marginal failure,accounting for 8.3%.1 had distant failure,accounting for 2.8%,and in patients with central and in-field failure,the percentage of tumor recurrence in the peritumoral edema area and central surgical cavity area was not significantly different(paired t test,p=0.121).In addition,the volume of ADC abnormal signal area is highly positively correlated with the volume of edema area(Pearson correlation coefficient R=0.88,p=0.004),and the ADC abnormal signal area is significantly smaller than the edema area(paired t test,p=0.012.Conclusion:The patterns of failure for patients with high-grade glioma after treatment are mainly central and in-field.Postoperative tumor cavity and peritumoral edema area are high-risk recurrence areas,which recommended to receive high-dose irradiation.In addition,the functional images of ADC images may be helpful to guide the target area delineation of tumor invasion sites.(Ⅱ)The prognostic factors of survivals of high-grade glioma patients after standard treatment.Purpose:Analyzed the survival data of high-grade glioma patients after treatment and probe the prognostic factors.Method:Medical records including gender,onset time,immunopathology,recurrence time,recurrence volume,post-relapse treatment,and time of death of 36 high-grade glioma patients who underwent postoperative radiotherapy combined with temozolomide during 2014.01.01-2019.12.31 and had enough evidence of recurrence were collected.For patients who have no clear medical document to prove death,we call to follow up the survival situation as of 2019.12.31 and used Kaplan-Meier(K-M)analysis for univariate survival analysis(log-rank test),drew survival curves,and analyzed meaningful results by COX regression.Result:The median survival time(OS)of 36 patients with high-grade glioma recurrence,was 22.82 months(ranged:9.23-N).The median total follow-up time was 20.27 months(ranged 9.23-56.97).The one-year survival rate was 94.44%,the two-year survival rate was 34.38%,and the three-year survival rate was 20.00%.The median progression-free-survival(PFS)was 9.44 months(ranged:4.13-34.13),the median survival time after relapse was 13.23 months(ranged 1.97-N),and the follow-up time after median relapse was 9.68 Month(range:1.37-35.23),the six-month survival rate after relapse was 79.41%,the one-year survival rate after relapse was 45.16%,and the two-year survival rate after relapse was 17.24%.Univariate K-M survival analysis showed that recurrence pattern,post-relapse treatment,and relapse volume had an effect on OS and survival time after relapse.The patients who developed central or in-field pattern of failure with smaller recurrence volume developed longer OS and survial time after recurrence.It was found that the secondary surgery and TMZ chemotherapy had comparable efficacy,witch were all better than those who only received support treatment.COX regression analysis showed recurrence pattern and and relapse volume are independent influencing factors.Conclusion:After treatment,most patients with high-grade glioma were developed central and in-field pattern of recurrence,whose their survival time may be longer than those with marginal and distant recurrence.Meanwhile,recurrence volume is also one of the factors to evaluate the prognosis.Anti-tumor intervention should be carried out as soon as possible for patients with the central or in-field pattern of failure... |
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