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Volumetric response and pattern of failure of histone altered high grade glioma in adults following management with radiation therapy

Publisher:
Springer Nature
Publication Type:
Journal Article
Citation:
Journal of Neuro-Oncology, 2023, 163, (1), pp. 281-288
Issue Date:
2023-05
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Abstract:
PurposeH3K27M and H3G34R mutant gliomas are recently classified subgroups of high grade gliomas HGGs affecting younger adults This study aimed to describe patterns of infiltration and failure and the volumetric response of these tumours to radiotherapy MethodsPatients with histone mutant gliomas aged 16 50 years managed from 2009 to 2021 were identified and clinical radiological and histopathological characteristics collected Tumour volume was assessed on MRI at diagnosis pre radiotherapy month 1 3 and 5 post radiation and at relapse ResultsOf 538 IDH1 2 wild type HGGs 18 15 had a histone alteration Eleven were H3K27M and 7 H3G34R mutant respectively Median age at diagnosis was 20 years range17 48 years Median overall survival was 20 months 95 CI 14 29 months Both H3K27M and H3G34R mutant tumours exhibited extensive T2F infiltration involving a median of 4 neuroanatomical subsites at diagnosis Median volume of disease pre radiotherapy on T1gd and T2F respectively was 0 5cm3 IQR 0 1 7cm3 and 11 9 cm3 IQR 7 5 29 6cm3 for H3K27M and 0 9cm3 IQR 0 8 4cm3 and 43 8cm3 IQR 25 2 86 6 cm3 for H3G34R tumours T2F volume reduction 50 was observed 3 months post IMRT in 7 64 patients with H3K27M and 1 14 with H3G34R tumours Fourteen patients had relapsed Relapse was local only distant only and both in 4 44 3 33 and 2 22 H3K27M mutant and 1 20 2 40 and 2 40 H3G34R mutant tumours On last scan before death leptomeningeal spread was present in 4 8 50 and 1 5 20 and subependymal spread in 4 8 50 and 0 5 H3K27M and G34R mutant cases respectively ConclusionH3K27M mutant gliomas are highly responsive to radiotherapy but exhibit high propensity for subsequent leptomeningeal and subependymal spread H3G34R mutant tumours exhibit lesser early volumetric response to radiotherapy and propensity for distant in brain failure
Please use this identifier to cite or link to this item:
http://hdl.handle.net/10453/177197

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