Artikel
Distance to the neurooncological centre: a new prognostic parameter in GBM patients?
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Autoren
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J. Kerschbaumer
- Klinik für Neurochirurgie, Medizinische Universität Innsbruck, Innsbruck, Österreich
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C.F. Freyschlag
- Klinik für Neurochirurgie, Medizinische Universität Innsbruck, Innsbruck, Österreich
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R. Bauer
- Abteilung Neurochirurgie, Landeskrankenhaus Feldkirch, Feldkirch, Österreich
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A.A. Obwegeser
- Klinik für Neurochirurgie, Medizinische Universität Innsbruck, Innsbruck, Österreich
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C. Thomé
- Klinik für Neurochirurgie, Medizinische Universität Innsbruck, Innsbruck, Österreich
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M. Seiz
- Klinik für Neurochirurgie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| Veröffentlicht: | 4. Juni 2012 |
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Gliederung
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Objective: Regardless of current multimodal treatment strategies patients harbouring glioblastoma multiforme (GBM) still have a dismal prognosis. The introduction of concomitant and adjuvant temozolomide that shows a lower toxicity profile compared to previous nitrosourea based chemotherapy in 2005 allowed treatment on an outpatient basis. This should translate into a benefit for GBM patients in urban as well as in rural areas. In this study the influence of the distance to the neurooncological centre with regard to overall survival and administration of adjuvant chemotherapy cycles was evaluated over a two decade period.
Methods: 208 GBM patients (m/f=1.4/1), operated between 1990 and 2009 were included retrospectively in this analysis. Distance from patients' home to the neurooncological centre was determined and a cox regression analysis was performed to assess the influence on overall survival and administration of adjuvant treatment (radiotherapy alone, nitrosourea based chemotherapy and adjuvant temozolomide).
Results: 86 patients of the cohort (41.3%) underwent a subtotal surgical resection, whereas a gross total resection was accomplished in 119 patients (57.2 %). The median distance to the neurooncological centre was 75 km (range 1–870). Postoperatively, 68 patients received concomitant and adjuvant radiochemotherapy with temozolomide, 31 where treated with nitrosourea other than PCV, 34 with PCV and 71 patients had no treatment in addition to radiation. Interestingly there was no significant difference in overall survival between the different treatment groups. The distance to the neurooncological centre had a significant influence on overall survival (p=0.027). Patients with increased distance to the centre were significantly less often treated with chemotherapy (p=0.05).
Conclusions: The distance to the neurooncological centre directly influenced prognosis in GBM patients. The proportion of patients without adjuvant chemotherapy is significantly higher with increasing distance to the centre. Therefore beside classical prognostic parameters the influence of the patients' distance to their neurooncological centre has to be kept in mind when treating GBM patients.
