Temporal muscle thickness as a glioblastoma prognostic marker

• Temporal Muscle Thickness as a Prognostic Marker in a Real-Life Cohort of Newly Diagnosed MGMT Promoter Methylated Glioblastoma: A Multicentric Imaging Analysis
• Comprehensive Evaluation of Frailty and Sarcopenia Markers to Predict Survival in Glioblastoma Patients
• Correlation of reduced temporal muscle thickness and systemic muscle loss in newly diagnosed glioblastoma patients
• Temporal muscle thickness as an independent prognostic marker in glioblastoma patients-a systematic review and meta-analysis
• Temporal muscle thickness as an independent prognostic imaging marker in newly diagnosed glioblastoma patients: A validation study
• Newly Diagnosed IDH-Wildtype Glioblastoma and Temporal Muscle Thickness: A Multicenter Analysis
• Temporal Muscle Thickness as a Prognostic Marker in Patients with Newly Diagnosed Glioblastoma: Translational Imaging Analysis of the CENTRIC EORTC 26071-22072 and CORE Trials
• A novel radiographic marker of sarcopenia with prognostic value in glioblastoma

Temporal muscle thickness (TMT) is emerging as a non-invasive imaging biomarker that may have significance in glioblastoma prognosis.

GBM patients frequently suffer from systemic catabolic states due to:

Tumor burden

Treatment side effects (e.g., corticosteroids, chemotherapy)

Reduced physical activity

Low TMT has been associated with:

Shorter overall survival (OS)

Poorer performance status

Increased treatment-related toxicity

Measured bilaterally at the level of the orbital roof on axial MR or CT.

Usually averaged between sides to reduce interobserver variability.

Prognostic stratification: TMT may help identify high-risk patients early.

Treatment tailoring: Patients with low TMT might benefit from nutritional or physical interventions.

Clinical trials: TMT can serve as a stratifying factor or exploratory endpoint.

Lazaridis et al. performed a multicentric analysis in a retrospective observational cohort study aiming to validate recently proposed sex-specific cutoff values using a homogeneous cohort of newly diagnosed MGMT promoter methylated glioblastoma patients; they included a balanced control cohort for comparison.

TMT was measured at baseline using the initial preoperative/postoperative magnetic resonance images (MRIs) and in disease course using the first MRI after radiotherapy. Patients were divided by sex and TMT into “at risk of sarcopenia” or “normal muscle status.” Kaplan-Meier and multivariable Cox regression analysis were used for survival correlation.

In total, n = 126 patients were included (n = 66 treated with CCNU/temozolomide, n = 60 with single-drug temozolomide). Patients with normal muscle mass at baseline had significantly prolonged survival (median overall survival: 44.2 months versus 16.7 months with CCNU/temozolomide, and 29.5 months versus 17.4 months with single-drug temozolomide) compared to those at risk of sarcopenia. In a multivariable Cox regression analysis, normal muscle mass and an initial age at diagnosis of < 50 years emerged as significant prognostic markers. Longitudinally, survival was longest in patients with a lack of TMT decline over the disease course.

This analysis confirms TMT as an important prognostic marker in glioblastoma in two real-life cohorts. However, to establish TMT assessment as a routine marker for patient selection and therapeutic measures, further validation in prospective controlled trials is necessary ¹⁾.

This is a well-conceived and clinically relevant study that adds to the growing body of evidence supporting sarcopenia (via TMT) as a prognostic factor in neuro-oncology. While methodologically limited by its retrospective nature, it opens promising avenues for both risk stratification and future biomarker development. However, implementation into routine practice remains premature until prospective validation and standardization are achieved.