Imaging timing after surgery for glioblastoma: an evaluation of practice in Great Britain and Ireland (INTERVAL-GB)- a multi-centre, cohort study
Authors:   INTERVAL-GB Collaborative, Gillespie Conor S , Bligh Emily R , Poon Michael TC , Islim Abdurrahman I , Solomou Georgios , Gough Melissa , Millward Christopher P , Rominiyi Ola , Zakaria Rasheed , Price Stephen J. , Watts Colin , Camp Sophie , Booth Thomas C , Thompson Gerard , Mills Samantha J , Waldman Adam , Brennan Paul M. , Jenkinson Michael D , Abdullmalek Hidayatul , Abualsaud Suhaib , Adegboyega Gideon , Afulukwe Chinelo , Ahmed Najma , Amoo Michael , Al-Sousi Abdelsalam Nedal , Al-Tamimi Yahia , Anand Ajitesh , Barua Neil , Bhatt Harsh , Boiangiu Ion , Boyle Abbey , Bredell Christiaan , Chaudri Talhah , Cheong Jeremy , Cios Ana , Coope David , Coulter Ian , Critchley Giles , Davis Harriet , De Luna Paolo Jose , Dey Nayan , Duric Bea , Egiz Abdullah , Ekert Justyna O. , Egu Chinedu Brian , Ekanayake Jinendra , Elso Anna , Ferreira Tomas , Flannery Tom , Fung Kwan Wai , Ganguly Rahul , Goyal Sanay , Hardman Emily , Harris Lauren , Hirst Theodore , Hoah Kelvin Sunn , Hodgson Sam , Hossain-Ibrahim Kismet , Houlihan Lena Mary , Houssaini Sami Squali , Hoque Sadid , Hutton Dana , Javed Mahnoor , Kalra Neeraj , Kannan Siddarth , Kapasouri Efthymia Maria , Keenlyside Andrew , Kehoe Kristy , Kewlani Bharti , Khanna Prerna , de Koning Rosaline , Kumar Kunalika Sathish , Kuri Ashvin , Lammy Simon , Lee Eunkyung , Magouirk Robert , Martin Andrew J , Masina Riccardo , Mathew Ryan , Mazzoleni Adele , McAleavey Patrick , McKenna Gráinne , McSweeney Daniel , Moughal Saad , Mustafa Mohammad Arish , Mthunzi Engelbert , Nazari Armin , Ngoc Trinh Ton Nu , Nischal Shiva , O’Sullivan Michael , Park Jay J. , Pandit Anand S. , Smith Jonathan Pesic , Peterson Peter , Phang Isaac , Plaha Puneet , Pujara Shyam , Richardson George E. , Saad Marwa , Sangal Shinjan , Shanbhag Avani , Shetty Veekshith , Simon Natalie , Spencer Robert , Sun Rosa , Syed Irtiza , Sunny Jesvin Tom , Vasilica Anca-Mihaela , O’Flaherty Daniel , Raja Arslan , Ramsay Daniele , Reddi Renitha , Roman Elena , Rominiyi Ola , Roy Dorina , Salim Omar , Samkutty Jeremiah , Selvakumar Jashan , Santarius Thomas , Smith Stuart , Sofela Agbolahan , St. George Edward Jerome , Subramanian Preethi , Sundaresan Vaibhav , Sweeney Kieron , Tan Boon Hoe , Turnbull Nicole , Tao Yuewei , Thorne Lewis , Tweedie Rebecca , Tzatzidou Anastasia , Vaqas Babar , Venturini Sara , Whitehouse Kathrin , Whitfield Peter , Wildman Jack , Williams Isabelle , Williams Karl , Wykes Victoria , Ye Tiffany Tze Shan , Yap Kelvin Sunn , Yousuff Mahir , Zulfiqar Asaad ,   Neurology and Neurosurgery Interest Group (NANSIG), Bandyopadhyay Soham , Ooi Setthasorn Z. Y. , Clynch Abigail , Burton Oliver , Steinruecke Moritz , Bolton William , Touzet Alvaro Yanez , Redpath Hannah , Lee Seong Hoon , Erhabor Joshua , Mantle Orla , Gillespie Conor S , Bligh Emily S ,   British Neurosurgical Trainee Research Collaborative (BNTRC), Kolias Angelos , Woodfield Julie , Chari Aswin , Borchert Robin , Piper Rory , Fountain Daniel M. , Poon Michael TC , Islim Abdurrahman I 
Published: August 2024

Abstract

Purpose
Post-operative MRI is used to assess extent of resection, monitor treatment response and detect progression in high-grade glioma. However, compliance with accepted guidelines for follow-up MRI, and impact on management/outcomes is unclear.

Methods
Multi-center, retrospective observational cohort study of patients with confirmed WHO grade 4 glioma (August 2018-February 2019) receiving oncological treatment. Primary objective: investigate follow-up MRI surveillance practice and compliance with recommendations from NICE (Post-operative scan < 72h, MRI every 3–6 months) and EANO (Post-operative scan < 48h, MRI every 3 months).

Results
There were 754 patients from 26 neuro-oncology centers with a median age of 63 years (IQR 54–70), yielding 10,100 (median, 12.5/person, IQR 5.2–19.4) person-months of follow-up. Of patients receiving debulking surgery, most patients had post-operative MRI within 72 h of surgery (78.0%, N = 407/522), and within 48 h of surgery (64.2%, N = 335/522). The median number of subsequent follow-up MRI scans was 1 (IQR 0–4). Compliance with NICE and EANO recommendations for follow-up MRI was 52.8% (N = 398/754) and 24.9% (N = 188/754), respectively. On multivariable Cox regression analysis, increased time spent in recommended follow-up according to NICE guidelines was associated with longer OS (HR 0.56, 95% CI 0.46–0.66, P < 0.001), but not PFS (HR 0.93, 95% CI 0.79–1.10, P = 0.349). Increased time spent in recommended follow-up according to EANO guidelines was associated with longer OS (HR 0.54, 95% CI 0.45–0.63, P < 0.001) but not PFS (HR 0.99, 95% CI 0.84–1.16, P = 0.874).

Conclusion
Regular surveillance follow-up for glioblastoma is associated with longer OS. Prospective trials are needed to determine whether regular or symptom-directed MRI influences outcomes.

Graphical Abstract