gms | German Medical Science

Backround: The prognosis of Glioblastoma is bad despite multimodality therapy.The aim of our evaluation was to estimate the value of different predictive factors in context with radiotherapy in a retrospective analysis of the patients irradiated in Aachen 1999 to 2004.

Patients and method: An intention to treat analysis was performed on 110 patients Median age was 61.4 years.A complete resection/partial resection/biopsy was done in 69/22/19 pat. 56 pat. received conventional fractionated radiotherapy (RT) (median dose 60 Gy, 2 Gy daily). 54 patients received RT hyperfractionated-accelerated (median dose 54 Gy, 2x 1.6-1.8 Gy daily). 20 pat. received temozolomid (TMZ, 50-75 mg/m² daily) and 20 pat. topotecan (0.5 mg/m² cvi over 21 days) simultaneous. After relapse 37 pat. received TMZ, 57 did not receive salvage therapy.

Results: Median OS and DFS was 8.67 and 4.8 months. Median OS was 8.5 month with radiotherapy alone and 13.8 or 8.2 month with simultaneous TMZ or topotecan. TMZ resulted in a significant benefit in OS. Topotecan leads to increased, in particular hematological toxicity. After complete resection/partial resection/biopsy median OS was 9,5/8,5/5,5 month. Median OS was 9.7 month for conventional fractionation and 8.1 month for hyperfractionated acceleration (p=0,003; log-rank test), median DFS was 5,1 and 3,9 months (p=0,048, log-rank test). Median OS in patients with RPA-Score III/IV/V/VI was 14.1/9.97/9.5/5.8 months. Patients treated with TMZ as salvage after relapse had a median OS of 10.6 month. Without salvage median OS was 7.7 months (p=0,0001, log-rank test). In a multivariate cox regression analysis concomitant chemo (p=0.02), fractionation (p=0.01), resection (p=0.007) and salvage temozolomide (p=0.002) had a statistically significant influence on OS. In OS hazard ratio (HR) was 0.54 for complete resection (p=0,03).

Conclusion: Survival data are unsatisfactory, according to the literature. Simultaneous topotekan or hyperfractionation cannot improve the results partly explained by increasing toxicity using topotecan. Regarding to the EORTC study of Stupp et al. TMZ must be integrated in therapy. This is shown in the own data too, with a small patient number. Until now it is not clear whether temozolomid should be given immediately after radiochemotherapy or only as salvage therapy. In our opinion this question should be tested in a randomised trial.