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65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

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Recurrent glioblastoma multiforme: the role of combined salvage therapies and introduction of a new treatment algorithm

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  • Eleftherios Archavlis - Neurochirurgische Klinik und Ambulanz, Sana Klinikum Offenbach, Akademisches Lehrkrankenhaus der Universität Frankfurt, Offenbach, Deutschland
  • Nikolaos Tselis - Strahlenklinik, Sana Klinikum Offenbach, Akademisches Lehrkrankenhaus der Universität Frankfurt, Offenbach, Deutschland
  • Gerhard Birn - Neurochirurgische Klinik, Klinikum Darmstadt, Akademisches Lehrkrankenhaus der Universität Frankfurt, Darmstadt, Deutschland
  • Peter Ulrich - Neurochirurgische Klinik und Ambulanz, Sana Klinikum Offenbach, Akademisches Lehrkrankenhaus der Universität Frankfurt, Offenbach, Deutschland; Neurochirurgische Klinik, Klinikum Darmstadt, Akademisches Lehrkrankenhaus der Universität Frankfurt, Darmstadt, Deutschland
  • Nikolaos Zamboglou - Strahlenklinik, Sana Klinikum Offenbach, Akademisches Lehrkrankenhaus der Universität Frankfurt, Offenbach, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocMI.17.06

doi: 10.3205/14dgnc374, urn:nbn:de:0183-14dgnc3744

Published: May 13, 2014

© 2014 Archavlis et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Glioblastoma multiforme patients presenting a recurrence following multimodality therapy have limited palliative treatment options when these major modalities of therapy have been exhausted. The authors introduce a clinical and radiological indication-solving algorithm and provide outcome rates of a glioblastoma recurrence cohort after multimodal salvage treatment.

Method: In the period from 2008-2010, 33 consecutive adult patients with recurrent glioblastoma underwent a combined scheme of salvage treatments including reoperation, high dose rate (HDR) brachytherapy and chemotherapy. All patients were previously treated with surgery of the primary pathology, concomitant and adjuvant radiochemotherapy with temozolomide. During HDR-brachytherapy, a median dose of 40 Gy was prescribed. Radiation Therapy Oncology Group (RTOG) criteria were used to assess toxicities associated with these treatments.

Results: Median follow-up was 32 months (range 28-36 months). Median survival was 9 months for the entire cohort after salvage treatment and can be translated into a 3-month improvement in survival compared to the control group of patients with glioblastoma recurrence treated with temozolomide alone (P=0.043). Reoperation and HDR-brachytherapy combined with chemotherapy renders acceptable complication rates and seem to be a reasonable salvage option for patients with recurrent glioblastoma.

Conclusions: Our experience suggests that a combined salvage treatment plan appears to be either feasible or effective and can be considered in selected patients affected by recurrent high-grade gliomas. The authors’ clinical and radiological indication-solving algorithm may assist in providing the best possible salvage treatment for this difficult population.