gms | German Medical Science

Objective: Fluorescence guided surgery (FGS) and concomitant radiochemotherapy according to the Stupp protocol have impressively improved outcome in glioblastoma (GBM) patients over the past years. Multicentre trials have demonstrated the efficacy of these options. We investigated the impact of these treatment strategies on the overall survival (OAS) using a single centre database.

Methods: 253 patients treated for newly diagnosed, primary GBM between 1990 and 2009 were reviewed for this survey. Patients were divided into three treatment groups: A(FGS-/Stupp-), B(FGS-/Stupp+) and C (FGS+/Stupp+). Kaplan-Meyer and Cox regression analysis were performed to determine coherence between treatment group, age, gender, Karnofsky performance score, MGMT methylation status and OAS.

Results: Epidemiological and medical data were completely available in 253 patients (A = 163, B = 22, C = 68) Median OAS in months differed significantly between the groups (A = 8.8 month, B = 13.6 month, C = 20.1 month, p < 0.01). Known epidemiological factors influencing outcome did not significantly differ between treatment groups. Degree of resection (p < 0.01, beta = 0.54, CI 0.34–0.85), MGMT-methylation status (p < 0.01, beta = 0.516, CI 0.336–0.793) and age at surgery (p = 0.05, beta = 1.022, CI 1.002–1.042) did significantly influence OAS. KPS prior to surgery and gender did not significantly influence OAS.

Conclusions: FGS and the Stupp protocol induce an impressive improvement in OAS in glioblastoma patients. This effect is not limited to multicentre trials but is reproducible in routine treatment in a neurosurgical centre.