Fractional tumor burden refines prognostic stratification beyond MGMT status in glioblastoma after chemoradiotherapy

Fractional tumor burden measured within 6 weeks after chemoradiotherapy is linked to overall survival in glioblastoma, refining prognosis beyond O6-methylguanine DNA methyltransferase promoter methylation.

• Why it matters: Early posttreatment T1 enhancement can reflect either treatment effect or tumor progression, and MGMT status alone leaves heterogeneous outcomes.
• What they did: In a retrospective cohort of 43 newly diagnosed glioblastoma patients receiving standard chemoradiotherapy, diffusion/perfusion MRI metrics were assessed within 6 weeks, including fractional tumor burden (FTB) and O6-methylguanine DNA methyltransferase methylation.
• The result: O6-methylguanine DNA methyltransferase-methylated tumors had longer median overall survival than unmethylated tumors (19.7 vs 10.6 months; P = .01), and among unmethylated tumors, FTB <5 mL predicted longer survival (14.5 vs 8.4 months; P = .006) while FTB did not differentiate survival in methylated tumors (P = .50).

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