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Abstract
Background: An optimal radiological surveillance plan is crucial for high-grade glioma (HGG) patients, which is determined arbitrarily in daily clinical practice. We propose the radiological assessment schedule using a parametric model of standardized progression-free survival (PFS) curves.

Methods: A total of 277 HGG patients (178 glioblastoma [GBM] and 99 anaplastic astrocytoma [AA]) from a single institute who completed the standard treatment protocol were enrolled in this cohort study and retrospectively analyzed. The patients were stratified into each layered risk group by genetic signatures and residual mass or through recursive partitioning analysis. PFS curves were estimated using the piecewise exponential survival model. The criterion of a 10% progression rate among the remaining patients at each observation period was used to determine the optimal radiological assessment time point.

Results: The optimal follow-up intervals for MRI evaluations of isocitrate dehydrogenase (IDH) wild-type GBM was every 7.4 weeks until 120 weeks after the end of standard treatment, followed by a 22-week inflection period and every 27.6 weeks thereafter. For the IDH mutated GBM, scans every 13.2 weeks until 151 weeks are recommended. The optimal follow-up intervals were every 22.8 weeks for IDH wild-type AA, and 41.2 weeks for IDH mutated AA until 241 weeks. Tailored radiological assessment schedules were suggested for each layered risk group of the GBM and the AA patients.

Conclusions: The optimal schedule of radiological assessments for each layered risk group of patients with HGG could be determined from the parametric model of PFS.

Affiliations

So Young Ji  1 , Jongjin Lee  2 , Joo Ho Lee  3 , Soon-Tae Lee  4 , Jae Kyung Won  5 , Jin Wook Kim  1 , Yong Hwy Kim  1 , Tae Min Kim  6 , Seung Hong Choi  7 , Sung-Hye Park  5 , Yongdai Kim  2 , Chul-Kee Park  1
1 Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine.
2 Department of Statistics, Seoul National University.
3 Department of Radiation Oncology, Seoul National University Hospital.
4 Department of Neurology, Seoul National University Hospital.
5 Department of Pathology, Seoul National University Hospital.
6 Department of Internal Medicine, Seoul National University Hospital.
7 Department of Radiology, Seoul National University Hospital.