gms | German Medical Science

Purpose: We analyzed our patient collective, which was treated with continuous application of TMZ after (chemo-) radiotherapy, for long-term survivors.

Material and methods: Since 6/2000 62 patients with histologically proven glioblastoma (+/- surgery) were treated with continuous application of oral TMZ after (chemo-)radiotherapy. Preirradiated patients with recurrent tumors (Group A; n=18) received a re-irradiation with 30 Gy. Chemotherapy was carried out over five days with 200 mg/m2/d. Chemotherapy were repeated in 4-week intervals until clinical progression. Radiotherapy was interposed between the first two chemotherapy courses.

21 Patients (Group B) treated with primary or postoperative radiotherapy received TMZ (75 mg/m2/day) concurrent with 60 Gy of conventional radiotherapy. The patients continued TMZ therapy (5 days; 200 mg/m2/d) every 28 days until progression. 23 patients (Group C) received postoperative radiotherapy (60 Gy) alone, followed by TMZ therapy until progression. Long-term survivor were defined as patients surviving more than 36 months after the beginning of treatment. A historical control collective of patients (Group D; n=100) was treated with radiotherapy alone.

Results: In group A the median actuarial overall survival (OS) was 7.2 months. In group B OS was 19.2 months. In group C OS was 16.8 months. In group D OS was 12.2 months.

Overall there were 10 long-term (> 36 months) surviving patients (16.1%). Group A: 0; group B: 6 (28.6%); group C: 4 (19%); and group D: 1 (0.9%) (p = 0.01, chi2-test).

Conclusions: Our results suggest, that TMS may be able to improve long-term survival rates compared to conventional radiotherapy with acceptable toxicity. A larger trial is warranted to verify these results.