The study was released on November 8th , as a preprint on researchsquare.com. It has not yet been peer reviewed.
Key Takeaways
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A retrospective study found better survival associated with incidental-discovered glioblastomas (iGBMs) that were treated early compared to other GBMs.
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These findings suggest that GBMs are detectable early, which can improve survival rates.
Why this is important
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With increased imaging and improved imaging technology, incidental detection of intracranial neoplastic lesions is becoming more common.
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The incidence of lower-grade Gliomas is estimated to represent 3.8% to 17.2% of lower grade gliomas. This is defined as having a steady growth rate of less than 3.5mm in diameter or 3.9cm in volume per annum.
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High-grade gliomas and high-grade iGBMs are not well-defined.
Study Design
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Single-center retrospective analysis of 234 adult GBM/iGBM patients treated between August 2005 & October 2019. All patients had at least six months of follow-up.
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iGBMs are a GBM that does not have a focal sign that was identified from radiologic images that were not connected.
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The study excluded patients who had headaches initially that were accompanied by signs of intracranial pressure.
Key Results
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Four patients (1.7%) were diagnosed with IGBM (one female, three males). Three cases were identified in a health checkup and one during headache screening. All of the tumors were right-sided. Three patients had a lesion that was enhanced. The patient with normal lesions was examined with MRI and underwent surgery to improve the lesion.
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The median time between confirmation of lesion (and surgery) was 13.5 days (range 4-19).
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Two lesions were located in the temporal lobe; one in the parietal lobe and one in the frontal lobe. The mean volume was 16.8 cm 3 (range, 2.2 – 23.6).
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Two iGBM patients received total resection, while the other two had subtotal resection. When they were discharged from the hospital, all four patients had scores of Karnofsky Performance of 90.
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The results of molecular studies revealed that there were no H3F3A or IDH1/2 mutations. Two iGBMs were affected by the TERT promoter mutation and one was affected by the BRAF mutation. MGMT promoter methylation status was low in all four instances.
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After resection After resection, three patients received treatment with temozolomide (75mg/m 2 7/7 days/week with radiotherapy and then 150-200 mg/m 2 over six cycles of adjuvant therapies). One patient underwent nimustine hydrochloride (100 mg/body) treatment. All received local brain radiotherapy (60 Gy in 30 fractions). None of the patients had any severe side effects from chemotherapy.
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The study result revealed that all four patients had disease progression and three of them died. The median progression-free survival was 11.5 months, while the median overall survival was 20.0 months. They were higher than previous reports of 6.3 – 7.1 months and 10.1 – 15.2 months, respectively.
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The tendency for asymptomatic iGBMs to be right-enhanced can be caused by the fact that the left hemisphere is predominant in 95% of right-handed individuals and 70% of left-handed individuals.
Limitations
Study Disclosures
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The study was not funded. Two of the authors have received grants from Chugai Pharmaceutical, Eisai, Daiichi Sankyo, MSD, Toshiba, SBI Pharma, Glaxo, Abbvie, Ono, Stella-Pharma, Ohtuka, and Meiji-Seika.
This is a summary of preprint research, “The Clinic Characteristics and Results of Globlastoma that was discovered by accident,” conducted by Yoshitaka N. Narita, MD, PhD of the National Cancer Center Hospital, Tokyo. The study was published on researchsquare.com in advance of peer-review and made available to you by Medscape.
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