文章：

磁共振成像随访对胶质母细胞瘤患者标准同步与辅助化疗期间治疗决策的影响：少即是多？

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

原文发布日期：13 October 2023

DOI: 10.3390/cancers15204973

类型: Article

开放获取: 是

英文摘要：

MRI is the gold standard for treatment response assessments for glioblastoma. However, there is no consensus regarding the optimal interval for MRI follow-up during standard treatment. Moreover, a reliable assessment of treatment response is hindered by the occurrence of pseudoprogression. It is unknown if a radiological follow-up strategy at 2–3 month intervals actually benefits patients and how it influences clinical decision making about the continuation or discontinuation of treatment. This study assessed the consequences of scheduled follow-up scans post-chemoradiotherapy (post-CCRT), after three cycles of adjuvant chemotherapy [TMZ3/6], and after the completion of treatment [TMZ6/6]), and of 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 an 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.

摘要翻译： 

MRI是胶质母细胞瘤治疗反应评估的金标准。然而，在标准治疗期间进行MRI随访的最佳时间间隔尚未达成共识。此外，假性进展的出现阻碍了对治疗反应的可靠评估。目前尚不清楚每2-3个月进行一次影像学随访的策略是否真正使患者受益，以及它如何影响关于继续或停止治疗的临床决策。本研究评估了在胶质母细胞瘤患者标准同步放化疗及辅助治疗期间，按计划进行的随访扫描（放化疗后、辅助化疗三个周期后[TMZ3/6]以及治疗完成后[TMZ6/6]）以及非计划扫描对治疗决策的影响。此外，我们评估了随访扫描导致诊断不确定性（肿瘤进展与假性进展）的频率，以及灌注MRI是否改善了临床决策。在胶质母细胞瘤患者标准治疗期间，按计划进行的随访扫描很少导致早期终止治疗（放化疗后为2.3%，TMZ3/6为3.2%，TMZ6/6为7.8%），但在27.7%的病例中引入了诊断不确定性。非计划扫描导致更多重大治疗后果（30%；p<0.001）。灌注MRI减少了诊断不确定性（p=0.021），但未影响治疗后果（p=0.871）。本研究不支持当前实用的随访策略，并建议采用更具个体化的随访方法。

原文链接：

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