Contrast-enhancing tumor growth dynamics of preoperative, treatment-naive human glioblastoma

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Abstract

BACKGROUND:

Little is known about the natural growth characteristics of untreated glioblastoma before surgical or therapeutic intervention, because patients are rapidly treated after preliminary radiographic diagnosis. Understanding the growth characteristics of uninhibited human glioblastoma may be useful for characterizing changes in response to therapy. Thus, the objective of the current study was to explore tumor growth dynamics in a cohort of patients with untreated glioblastoma before surgical or therapeutic intervention.

METHODS:

Ninety-five patients with glioblastoma who had measurable enhancing disease on >2 magnetic resonance imaging scans before surgery were identified. Tumor growth rates were quantified in 4 different ways (the percentage change per day, the absolute rate of change per day, the estimated volumetric doubling time, and the radial expansion rate) using 3 different approaches (bidirectional product, enhancing disease, and total lesion volume).

RESULTS:

The median volumetric doubling time was 21.1 days, the percentage change in tumor volume was 2.1% per day, and the rate of change in total lesion volume was 0.18 cc per day. The length of follow-up between magnetic resonance imaging examinations should be >28 days to detect progressive disease with high specificity. Small initial tumor sizes (<3 cm in greatest dimension) are biased toward a large percentage change at follow-up.

CONCLUSIONS:

Presurgical, treatment-naive glioblastoma growth dynamics can be estimated in a variety of ways with similar results. The percentage changes in tumor size and volume depend on baseline tumor size and the time interval between scans. Cancer2016;122:1718-27. © 2016 American Cancer Society.

The growth dynamics of contrast-enhancing tumors are explored in 95 patients with glioblastoma who had measurable disease at>2 or more time points before undergoing initial surgical resection. The results suggest that follow-up between magnetic resonance imaging examinations in glioblastoma should be >28 days to reliably detect tumor growth and progressive disease and that small initial tumor sizes are inherently biased toward large percentage changes in tumor volume at follow-up.

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