| Objectives: The changes in tumour location,maximum tumour/residual cavity diameter and volume at different time periods before and after surgery were observed by image fusion of MRI of patients with intracranial tumours,and retrospective analysis of clinical data of patients with high-grade glioma treated with radiotherapy after surgical resection was conducted to investigate the influence of the timing of postoperative radiotherapy on the target area and clinical prognosis of patients with high-grade glioma,and to analyse the factors affecting their prognosis,with a view to providing theoretical guidance for the clinical treatment of patients.Methods: 1.205 patients with intracranial tumours admitted to the Third Affiliated Hospital of Kunming Medical University from January 1,2015 to March 21,2021 who had MR images 1 week before and 8 weeks after the complete surgery were included.The patients were divided into two groups according to the time of post-operative MRI examination: the 2-6 week group,i.e.those with MRI T1WI-enhanced images before surgery and within 2-6 weeks(14-42 days)after surgery,in a total of 121 cases;and the 6-8 week group,i.e.those with MRI T1WI-enhanced images before surgery and within 6-8 weeks(43-56 days)after surgery,in a total of 84 cases.MIM Maestrover 7.7.8 was used to fuse the preoperative and postoperative MR images to compare the differences in location,maximum diameter and volume of the postoperative tumour bed area(GTVtb)compared to the preoperative tumour area(GTV)at different time periods after surgery.2.Information was collected on 178 patients with high-grade glioma who underwent radiotherapy after surgical resection at the Third Affiliated Hospital of Kunming Medical University from January 1,2013 to January 1,2021.Patients were divided into three groups according to the timing of postoperative radiation treatment: 2-6 weeks group(14-42 days),6-8 weeks group(43-56 days),and >8 weeks group(more than 56 days).Baseline characteristics counted included gender,age,KPS score,ECOG score,pathological grading,receipt of chemotherapy and targeted therapy,number and location of tumours,maximum tumour diameter,seizure symptoms,presence or absence of midline deviation,MGMT,and radiotherapy dose.The Log-rank test was used to compare the differences in intracranial progression-free survival(iPFS)and overall survival time(OS)between the three groups of patients.Log-rank test was also used to conduct one-way analysis of prognostic factors affecting OS and iPFS,and variables with P < 0.1 in the one-way analysis were included in the multifactor analysis,which used Cox proportional risk regression model to investigate independent prognostic factors affecting OS and iPFS.Results: 1.After image fusion of cranial images from 205 groups of patients with intracranial tumours,it was found that there was no statistical difference between the postoperative GTVtb compared to the preoperative GTV in terms of maximum tumour diameter,volume,distance between geometric centroids and change in centroid location between the 2-6 and 6-8 week postoperative groups,but the location,maximum diameter and volume of the GTVtb were closer to the GTV in the 6-8 week postoperative group.2.An image fusion subgroup analysis of 50 patients with high-grade glioma among 205 patients with intracranial tumours revealed that the differences in the changes in GTVtb compared to GTV in terms of centroid location,centroid distance,maximum tumour diameter and volume were not statistically significant between the 2-6 weeks postoperative group(30 patients)and the 6-8 weeks group(20 patients),but the GTVtb at 6-8 weeks postoperative was closer to the preoperative GTV The location was closer,and the GTVtb at 2-6 weeks postoperatively was closer to the maximum diameter and volume of the preoperative CTV.3.A retrospective analysis of 178 patients with high-grade glioma treated with postoperative radiotherapy was performed.Patients were divided into three groups according to the timing of receiving postoperative radiotherapy: 2-6 weeks group(50 patients),6-8 weeks group(30 patients)and >8 weeks group(98 patients).After a median follow-up of 23.3 months,the median OS of 178 patients was found to be 30.7 months,with OS rates of 95.5%,84.8%,59.1% and 43.1% at six months,one year,two years and three years respectively.The median OS for patients in the 2-6 week group was 32.2 months,and the OS rates at six months,one year,two years and three years were 91.0%,82.0%,63.3% and 42.7%,respectively;the median OS for patients in the 6-8 week group was 25.9 months,and the OS rates at six months,one year,two years and three years were 95.5%,85.0%,48.1% and 36.3%,respectively;the median OS for patients in the >8 The median OS for patients in the 6-8 week group was 31.0 months,with OS rates of 96.0%,84.7%,60.6% and 45.3% at six months,one year,two years and three years respectively;there was no statistical difference in OS between the three groups.4.The median iPFS for 178 patients was 16.6 months,with six-month,one-year and two-year iPFS rates of 82.5%,63.7% and 32.5%,respectively.The median iPFS was 16.6 months for patients in the 2-6 week group,13.9 months for patients in the 6-8 week group and 16.6 months for patients in the greater than 8 week group.The 2-year iPFS rate was higher in the greater than 8 weeks group than in the 2-6 weeks group(34.2% vs 31.5%)and the 6-8 weeks group(34.2% vs 32.3 %),but the difference was not statistically significant(P=0.880).5.The results of the multifactorial analysis showed that independent adverse prognostic factors affecting OS included tumour pathological grade IV(P<0.001),number of tumours >1(P=0.007)and negative MGMT(P=0.002).Male(P=0.015),tumour pathological grade IV(P<0.001),number of tumours >1(P=0.005),having received targeted therapy(P=0.032)and MGMT negative(P=0.004)were independent unfavourable prognostic factors affecting iPFS.Conclusions: 1.There was no significant difference in the location and volume of the postoperative tumour bed area in patients with intracranial tumours between 2-6 weeks and 6-8 weeks postoperatively compared to the preoperative tumour area,and radiotherapy in patients with intracranial tumours at 8 weeks postoperatively did not significantly affect the target area outline.2.There was no significant effect on OS and iPFS in patients with high-grade glioma who received radiation therapy at different times postoperatively.3.Tumour pathological grade,tumour number,and MGMT were independent prognostic factors affecting OS in patients with high-grade glioma treated with postoperative radiotherapy;tumour pathological grade,tumour number,MGMT,gender,and targeted therapy were independent prognostic factors affecting patients’ iPFS. |
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