Artikel
What has changed for patients with newly diagnosed GBM over the last decade? An institutional review of treatment modalities and outcome in 339 patients
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Autoren
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Hans Christoph Bock
- Department of Neurosurgery, Georg-August University of Göttingen, Germany
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Jose Maria Hinz
- Department of Anaesthesiology, Emergency and Intensive Care Medicine, Georg-August-University of Göttingen, Germany
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Angelika Gutenberg
- Department of Neurosurgery, Georg-August University of Göttingen, Germany
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Timo Behm
- Department of Neurosurgery, Georg-August University of Göttingen, Germany
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Veit Rohde
- Department of Neurosurgery, Georg-August University of Göttingen, Germany
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Alf Giese
- Department of Neurosurgery, Georg-August University of Göttingen, Germany
| Veröffentlicht: | 16. September 2010 |
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Gliederung
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Objective: Up-to-date treatment options for patients with newly diagnosed glioblastoma (GBM) have always been established by randomized clinical trials in which the treated patient population is highly selected and homogeneous. Postoperative concomitant radiochemotherapy followed by temozolomide monotherapy has proven significant survival benefit and has become the current treatment standard for GBM. Of course the assumption is, that level-I-recommended treatment protocols fulfil the expectations in unselected patient collectives, which are encountered in daily clinical practice.
Methods: Using our institutional glioma database, complete clinical courses of 339 patients treated between 1998 and 2008 for newly diagnosed GBM have been analyzed for epidemiological factors, KPS, extend of tumor resection and radiotherapy as well as first- and second-line chemotherapy and experimental protocols.
Results: Of 339 newly diagnosed GBM patients (median age=62, median KPS=70), 17% underwent biopsy, 29% subtotal and 54% gross total tumor resection. 20% received no adjuvant treatment because of low KPS. In 18% only radiotherapy was performed, in 27% radiotherapy was performed before and in 33% concomitant to chemotherapy. In 5% of all patients local chemotherapy with BCNU and radiochemotherapy was accomplished. 26% of all patients underwent re-operation for recurrent tumor. Median overall- and progression-free survival (OAS, PFS) for all 339 patients was 10.5 months and 4.9 months respectively. The median OAS and PFS showed a continuous improvement from 7.3 and 3.9 months in 1998 to 15.1 and 10.4 months in 2008 most likely due to modern protocols and strict and intensified institutional adjuvant outpatient treatment.
Conclusions: Our institutional review of an unselected GBM patient collective clearly demonstrates a steady improvement concerning the OAS over the last decade. Gross total tumor resection followed by radiation and subsequent temozolomide chemotherapy as first line treatments based on a strict follow up schedule suggests most effective strategy. We found no significant median OAS benefit for first-line concomitant temozolomide treatment (OAS 15.0 months) over radiation followed by temozolomide treatment (OAS 16.9 months) in our patient collective.
