Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Influence of MRI Follow-Up on Treatment Decisions during Standard Concomitant and Adjuvant Chemotherapy in Patients with Glioblastoma: Less Is More?

Bart R.J. Van Dijken
* ORCID logo ,
Annerieke R. Doff
,
Roelien H. Enting
,
Peter Jan Van Laar
,
Hanne-Rinck Jeltema
,
Rudi A. Dierckx
,
Anouk Van der Hoorn
ORCID logo
Version 1 : Received: 18 September 2023 / Approved: 19 September 2023 / Online: 20 September 2023 (10:47:56 CEST)

A peer-reviewed article of this Preprint also exists.

van Dijken, B.R.J.; Doff, A.R.; Enting, R.H.; van Laar, P.J.; Jeltema, H.-R.; Dierckx, R.A.J.O.; van der Hoorn, A. Influence of MRI Follow-Up on Treatment Decisions during Standard Concomitant and Adjuvant Chemotherapy in Patients with Glioblastoma: Is Less More? Cancers 2023, 15, 4973. van Dijken, B.R.J.; Doff, A.R.; Enting, R.H.; van Laar, P.J.; Jeltema, H.-R.; Dierckx, R.A.J.O.; van der Hoorn, A. Influence of MRI Follow-Up on Treatment Decisions during Standard Concomitant and Adjuvant Chemotherapy in Patients with Glioblastoma: Is Less More? Cancers 2023, 15, 4973.

Abstract

MRI is the gold standard for treatment response assessment in glioblastoma. However, there is no consensus regarding the optimal interval for MRI follow-up during standard treatment. Moreover, reliable assessment of treatment response is hindered by the occurrence of pseudoprogression. It is unknown if a radiological follow-up strategy with 2-3 months intervals actually benefits patients and how it influences clinical decision making about continuation or discontinuation of treatment. This study assessed the consequences of scheduled follow-up scans (post-chemoradiotherapy [post-CCRT], after 3 cycles of adjuvant chemotherapy [TMZ3/6], after completion of treatment [TMZ6/6]) and unscheduled scans on treatment decisions during standard concomitant and adjuvant treatment in glioblastoma patients. Additionally, we evaluated how often follow-up scans resulted in diagnostic uncertainty (tumor progression versus pseudoprogression), and whether perfusion MRI improved clinical decision making. Scheduled follow-up scans during standard treatment in glioblastoma patients rarely resulted in early termination of treatment (2.3% post-CCRT, 3.2% TMZ3/6, and 7.8% TMZ6/6), but introduced diagnostic uncertainty in 27.7% of cases. Unscheduled scans resulted in more major treatment consequences (30%; p<0.001). Perfusion MRI caused less diagnostic uncertainty (p=0.021) but did not influence treatment consequences (p=0.871). This study does not support the current pragmatic follow-up strategy and suggests a more tailored follow-up approach.

Keywords

Glioblastoma; Magnetic Resonance Imaging; Treatment response assessment; Treatment follow-up; Pseudoprogression; Perfusion Imaging

Subject

Medicine and Pharmacology, Oncology and Oncogenics

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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