gms | German Medical Science

Objective: Despite improved treatment regimes for Glioblastoma patients, the median overall survival (OS) remains poor at 12–15 months. Over the last decade molecular and therapeutic prognostic factors have been described. The clinical implication of these factors is subject of ongoing trials. To depict the impact in a single center patient cohort this retrospective analysis was conducted.

Method: Records of 250 Glioblastoma patients in a single institution were reviewed. The OS of thirty patients exceeded 15 months and these were further reviewed for age, gender, adjuvant therapy, preoperative Karnofsky Performance Status (KPS) and Charlson comorbidity score (CS), MGMT promoter methylation and IDH1 R132H mutational status. Using the Osirix analysis software, MRI scans were analyzed for tumor location taking the ventricular vicinity into account. Preoperative and postoperative MRI scans were measured for the extent of resection (EOR), gross total resection (GTR) being defined as an EOR > 95%. Factors were described as means and survival was analyzed using the Kaplan-Meier method.

Results: The age of the 30 patients ranged from 27–74 years (median 52.7 years), with 53% being male. The mean OS was 34.7 months (median 35.4 ± 2.7 months), with 20 censored patients alive at the end of follow-up. The 95% CI for the median survival was 29.5 and 40.0 months. The mean CS was 2.10 indicating low comorbidity. All the patients had a preoperative KPS of > 70 %. The MGMT promoter was methylated in two thirds of the population (67%). Only 13% showed a positive IDH1 R132H mutation. Temporal and frontal tumor locations were most frequent. Non eloquent tumor location was found in 90% of the cases. 16 out of the 30 tumors (53,33%) had a near ventricular location. GTR was achieved in more than 90% of cases. Another 90% of the patients had had the standard EORTC 26981 therapy with concomitant radiation and Temozolomide (TMZ) followed by complete six cycles of adjuvant TMZ.

Conclusions: The descriptive review of our long-term surviving glioblastoma patients showed that majority of the patients were in good clinical condition depicted by the low CS and high KPS. Non-eloquent tumor location was predominant, the vicinity to the ventricular zone was evenly distributed. The current most adequate therapy with GTR and standard adjuvant therapy was implemented in most of the patients. The molecular factors MGMT promoter methylation and IDH1 R132H mutation status did not show a weighted distribution.