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Interstitial Photodynamic Therapy of Glioblastomas: A Long-Term Follow-up Analysis of Survival and Volumetric MRI
Marco Foglar1, Maximilian Aumiller1,2, Katja Bochmann3,4
1Laser-Forschungslabor, LIFE Center, University Hospital, LMU Munich, 81377 Munich, Germany.
Background:
The treatment of glioblastomas, the most common primary malignant brain tumors, with a devastating survival perspective, remains a major challenge in medicine. Among the recently explored therapeutic approaches, 5-aminolevulinic acid (5-ALA)-mediated interstitial photodynamic therapy (iPDT) has shown promising results.
Methods:
A total of 16 patients suffering from de novo glioblastomas and undergoing iPDT as their primary treatment were retrospectively analyzed regarding survival and the characteristic tissue regions discernible in the MRI data before treatment and during follow-up. These regions were segmented at different stages and were analyzed, especially regarding their relation to survival.
Results:
In comparison to the reference cohorts treated with other therapies, the iPDT cohort showed a significantly prolonged progression-free survival (PFS) and overall survival (OS). A total of 10 of 16 patients experienced prolonged OS (≥ 24 months). The dominant prognosis-affecting factor was the MGMT promoter methylation status (methylated: median PFS of 35.7 months and median OS of 43.9 months) (unmethylated: median PFS of 8.3 months and median OS of 15.0 months) (combined: median PFS of 16.4 months and median OS of 28.0 months). Several parameters with a known prognostic relevance to survival after standard treatment were not found to be relevant to this iPDT cohort, such as the necrosis-tumor ratio, tumor volume, and posttreatment contrast enhancement. After iPDT, a characteristic structure (iPDT remnant) appeared in the MRI data in the former tumor area.
Conclusions:
In this study, iPDT showed its potential as a treatment option for glioblastomas, with a large fraction of patients having prolonged OS. Parameters of prognostic relevance could be derived from the patient characteristics and MRI data, but they may partially need to be interpreted differently compared to the standard of care.
Insights
5-aminolevulinic acid (5-ALA)-mediated interstitial photodynamic therapy (iPDT) offers a promising new treatment for glioblastomas, significantly extending patient survival. MGMT promoter methylation status is a key factor influencing outcomes in patients undergoing iPDT.
Area of Science:
- Oncology
- Neurosurgery
- Medical Imaging
Background:
- Glioblastomas are aggressive brain tumors with poor prognoses, necessitating novel therapeutic strategies.
- 5-aminolevulinic acid (5-ALA)-mediated interstitial photodynamic therapy (iPDT) is an emerging treatment with potential for glioblastoma management.
Purpose of the Study:
- To retrospectively analyze the survival outcomes of glioblastoma patients treated with iPDT.
- To identify prognostic factors, including MRI characteristics, relevant to survival after iPDT.
Main Methods:
- Retrospective analysis of 16 de novo glioblastoma patients treated with iPDT as primary therapy.
- Assessment of survival data (progression-free survival and overall survival).
- Segmentation and analysis of MRI data to identify prognostic tissue regions and characteristic post-treatment structures.
Main Results:
- The iPDT cohort demonstrated significantly prolonged progression-free survival (PFS) and overall survival (OS) compared to reference cohorts.
- 10 out of 16 patients achieved prolonged OS (≥ 24 months).
- MGMT promoter methylation status was the dominant prognostic factor; other standard prognostic markers (necrosis-tumor ratio, tumor volume, posttreatment enhancement) were less relevant for this iPDT cohort. A characteristic 'iPDT remnant' structure was observed on MRI post-treatment.
Conclusions:
- iPDT shows significant potential as a glioblastoma treatment, with a substantial proportion of patients experiencing extended survival.
- Prognostic factors can be derived from patient characteristics and MRI data, but require different interpretation compared to standard treatments.
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