gms | German Medical Science

Objective: In 2005 a standard treatment for primary glioblastoma patients was defined and within the setting of the study, concomitant radiochemotherapy was well tolerated. However, side effects such as fatigue, neutropenia and thrombopenia were reported in 7% of the patients. In the literature prolonged thrombopenia in up to 80% during radiation therapy and hematologic toxicity with adjuvant TMZ in 20% is discussed. As yet, little is known about the feasibility of this treatment protocol outside the study setting in an unselected patient collective. We were therefore interested in the practicability of the protocol in daily practice, in particular given that the intermittent part of the protocol and further follow-up is performed under the responsibility of a neurosurgical out-patient clinic.

Method: We analysed primary glioblastoma patients diagnosed between 2005 to 2012, who were treated according to the STUPP protocol. The parameters associated with treatment performance (interruption of radiotherapy, concomitant chemotherapy and intermittent chemotherapy, total number of cycles and side effects) were analysed in retrospect and compared to the data from the original publication by Stupp.

Results: In this retrospective setting, we identified 170 patients (106 men, 64 women, mean age 62), who where treated according to the Stupp protocol. 162 patients underwent open surgery, 8 patients had stereotactic biopsy only (EORTC study: 239 patients and 48 patients, retrospectively). Median postoperative KPS in our patient cohort was 100. Radiotherapy had to be interrupted in 9 patients (5%) (EORTC study: 15 patients (5%)), concomitant chemotherapy in 12 patients (7%) (EORTC study: 37 patients (13%). 89 patients (61%) completed 6 TMZ cycles (EORTC study: 105 patients (47%)), dose escalation to 200mg/qm in the third cycle was performed in 85 patients (58%) (vs. 149 patients (67%)). Intermittent TMZ therapy was discontinued in 58 patients (39%) (vs. 118 patients (53%)). Median OAS was 20 months (vs. 14.6 months), median TTP 9 months (vs. 6.9 months). Median KPS after therapy completion was 90.

Conclusions: The comparison between the feasibility of the Stupp protocol in the settings of a prospective randomized trial and within the daily routine in a dedicated neurooncological-neurosurgical department demonstrates that the protocol is suitable for daily practice within our settings.