Scripties UMCG - Rijksuniversiteit Groningen
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Impact van MRI Follow-up bij glioblastomen tijdens de eerstelijnsbehandeling

(2019) Doff, A.R.

Glioblastoma is the most common malignant brain tumour in adults and has a poor prognosis. Tumour progression is inevitable despite the extensive treatment. It’s difficult to predict when progression will start, that’s why the tumour is monitored by MRI follow-up. At the University Medical Center Groningen (UMCG), 4 MRI scans are scheduled for every glioblastoma patient during the first line treatment; after surgery (post-surgery), after chemoradiotherapy (post-CRT), after 3/6 cycles of adjuvant temozolomide (TMZ3/6) and after 6/6 cycles of adjuvant temozolomide (TMZ6/6). MRI scans don’t always have clear answers about the effect of the treatment, CRT can induce abnormalities which are similar to the abnormalities seen in tumour progression, this is called pseudoprogression. The impact of MRI follow-up is unknown, this results into the following research question: ‘What is the impact of MRI follow-up during the first line treatment of glioblastoma?’
Material and methods
A retrospective study in the UMCG where patient files were analysed of patients who got the diagnosis glioblastoma after October 2004. For all scans that were made during the first line treatment the assessment was made whether and to which extend treatment consequences followed after the scan and whether the scan resulted in uncertainty about the effect of the treatment caused by not being able to differentiate between tumour progression and pseudoprogression.
Both the post-CRT scan and the TMZ3/6 scan caused uncertainty about the effect of the treatment in about one third of the patients, besides that only in respectively 2.3% and 3.2% of the patients there were treatment consequences caused only by the MRI scan. Significantly more treatment consequences caused only by MRI were seen after the TMZ6/6 scan compared to the post-CRT scan, also there was significantly less uncertainty about the treatment consequences compared to both the post-CRT scan and the TMZ3/6 scan. The post-OK scan rarely caused treatment consequences and never caused uncertainty.
The post-OK scan had the least impact on the treatment, but this scan is important to compare later scans with and to determine the quality of the resection and because of that can’t be left out of the protocol. Both the post-CRT scan and the TMZ3/6 scan have low impact on the treatment and often cause uncertainly about the effect to the treatment, that’s why it’s seems recommendable to at least leave out one of these scans.

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