Spatial invasion patterns of temporal lobe glioblastoma after complete resection of contrast-enhancing tumor.

Abstract

Purpose: This study investigated invasion patterns of temporal lobe glioblastoma following complete resection of contrast-enhancing tumor and evaluated whether non-enhancing tumor presence in the anterior temporal tip predicts the site of progression.

Methods: We retrospectively analyzed patients from a single-institution database who were diagnosed with IDH-wildtype temporal lobe glioblastoma and underwent complete resection of the contrast-enhancing region. Eligible patients had preoperative, immediate postoperative, and progression MRIs to assess tumor progression patterns. FLAIR imaging was examined for its predictive value in identifying progression sites. Surgical outcomes, progression-free survival (PFS), and overall survival were analyzed.

Results: A total of 48 patients were identified, of whom 14 (29%) underwent anterior temporal lobectomy and were excluded from further analysis. Among the remaining 34 patients, 21 (62%) exhibited anterior progression. Expert assessment suggested that in 12 of these 21 patients (57%), an anterior temporal lobectomy might have encompassed the region of tumor progression. Superior, inferior, and lateral progression patterns were associated with longer median PFS (~ 11 months), whereas medial progression correlated with the shortest PFS (5.9 months). FLAIR signal at the temporal tip had moderate sensitivity (71.43%) but low specificity (18.52%) for predicting anterior progression, resulting in a high false-positive rate.

Conclusions: Temporal lobe glioblastomas often progress anteriorly, suggesting that anterior temporal lobectomy may help reduce progression in select cases. FLAIR imaging had limited predictive value for anterior progression, emphasizing the need for advanced imaging techniques. Future research should identify reliable biomarkers and evaluate the role of anterior temporal lobectomy through well-designed prospective studies.