Identification and relevance of ultra-early progression after resection of glioblastoma

OBJECTIVE The aim of this study was to analyze the relevance of tumor progression in the interval between surgery and radiation therapy (RT) in patients with glioblastoma and its interaction with the extent of resection. METHODS In a retrospective cohort study, all patients who underwent resection for glioblastoma, IDH wildtype, at a single institution from January 2011 to February 2023 with early postoperative and additional pre-RT MRI available for analysis were included. Early postoperative MR images were graded according to whether they showed no enhancing or nonenhancing residual tumor (group 1a), no contrast-enhancing but residual nonenhancing tumor (group 1b), or residual contrast-enhancing tumor (group 2). The primary outcome was overall survival. Risk factors for ultra-early progression were assessed using a binary logistic regression analysis. RESULTS A total of 133 patients (median age 66.0 years) were included, and 64 patients (48.1%) had ultra-early progression. Overall survival was significantly worse among patients with ultra-early progression (p < 0.001). The only risk factor identified for ultra-early progression was the resection category (p < 0.001). While ultra-early progression was seen in 10.3% of patients in group 1a, it occurred in 43.8% and 85.2% of patients in groups 1b and 2, respectively (p < 0.001). Patients with ultra-early progression showed no difference in survival whether or not they had undergone complete resection of enhancing tumor (p = 0.850). CONCLUSIONS Ultra-early progression after resection of a glioblastoma is a frequent finding with a profound prognostic impact. Complete resection of enhancing and nonenhancing tumors reduced the frequency of ultra-early progression. Nevertheless, new strategies for management of ultra-early progression are urgently needed to improve prognosis.