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Survival improvements with adjuvant therapy in patients with glioblastoma
Author(s) -
Jayamanne Dasantha,
Wheeler Helen,
Cook Raymond,
Teo Charles,
Brazier David,
Schembri Geoff,
Kastelan Marina,
Guo Linxin,
Back Michael F.
Publication year - 2018
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.14153
Subject(s) - medicine , temozolomide , bevacizumab , univariate analysis , recursive partitioning , radiation therapy , clinical endpoint , surgery , cancer , oncology , clinical trial , chemotherapy , multivariate analysis
Background Evaluate survival of patients diagnosed with glioblastoma multiforme ( GBM ) managed with adjuvant intensity modulated radiation therapy and temozolomide since the introduction of the European Organisation for Research and Treatment of Cancer and National Cancer Institute of Canada Clinical Trials Group (EORTC‐NCIC) protocol. Methods All patients with GBM managed between May 2007 and December 2014 with EORTC‐NCIC protocol were entered into a prospective database. The primary endpoint was the median survival. Univariate predictors of survival were evaluated with respect to tumour resection, age and Eastern Cooperative Oncology Group ( ECOG ) performance status using log‐rank comparisons. Results Two hundred and thirty‐three patients were managed under the protocol and analysed for outcome. The median age was 57 years; the rate of gross total resection, subtotal resection and biopsy were 47.2%, 35.2% and 17.6%, respectively. At progression, 49 patients had re‐resection, and in addition to second‐line chemotherapy, 86 patients had Bevacizumab including 26 with re‐irradiation. Median survival was 17.0 months (95% CI : 15.4–18.6). On univariate evaluation, extent of resection ( P = 0.001), age, ECOG performance status and recursive partitioning analysis class III were shown to significantly improve survival ( P < 0.0001). The median survival for gross total resection, age <50 years, ECOG 0–1 and recursive partitioning analysis class III were 21, 27, 20 and 47 months, respectively. Conclusion This study confirms the significant improvement in median survival in GBM that has occurred in recent years since introduction of the EORTC‐NCIC protocol. Further improvements have occurred presumably related to subspecialized care, improved resection rates, sophisticated radiotherapy targeting and early systemic salvage therapies. However, the burden of the disease within the community remains high and the median survival improvements over time have plateaued.