Background
A study published in the prestigious JAMA Oncology (The Journal of the American Medical Association) confirmed an association between maximal resection of contrast-enhanced tumor and survival in patients with Glioblastoma across all subgroups.
Additionally, the researchers found that maximal resection of non-contrast-enhanced tumor was associated with longer survival in younger patients. Plus, it was found regardless of IDH status AND regardless of the methylation status of the MGMT.
About Glioblastoma
Glioblastoma Multiforme, or GBM, is a type of cancer which originates in the brain and made of brain cells known as “gliomas.”
Gliomas are neuron supporting cells, constituting a part of the nervous system.
Glioblastoma tends to develop into a star shaped formation.
They are particularly aggressive tumors with the potential to grow fast and spread to other parts of the brain relatively quickly.
Glioblastoma creates its own independent blood supply which feeds it, promoting its growth and even enabling it to invade additional areas of the brain and establish more foci, hence the name “multiforme.”
GBM is a stage 4 cancer and constitutes about 50% of all brain tumors among patients aged 18 and older. Glioblastoma does not metastasize outside the brain.
The existing therapies used for glioblastoma are not curative, and this is a source of the need for innovative and effective treatment strategies in order to fight the disease.
What are the differences between enhancing and non-enhancing lesions in MRI?
In general, the terms ‘enhancing’ or ‘non-enhancing’ lesion refer to the uptake of Gadolinium-based contrast agent in the lesion.
The difference between enhancing an non-enhancing is very pronounced in brain tissue, where the Blood-Brain Barrier, BBB, effectively hinders Gd-based contrast agent from accumulating in the tissue in normal circumstances.
When the BBB is leaking, e.g. due to an inflammatory process in a lesion or due to cancerous angiogenesis, Gd can extravasate and accumulate in the tissue.
About the Study
In this study, researchers looked at the outcomes of 761 newly diagnosed patients. The patients were divided into 4 groups based on age, treatment protocols, and extent of resections of both contrast- and non-contrast-enhanced tumor.
After surgery nearly all patient were treated for their disease.
Conclusion
Neurosurgeons may need to change how they approach tumor removal and, when safe, include non-contrast-enhancing tumor during resection to achieve maximal resection.
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