Clinical outcome of concomitant chemoradiotherapy followed by adjuvant temozolomide therapy for glioblastaomas: Single-center experience
Introduction
Glioblastoma (GBM) is the most common and aggressive neoplasm of the brain in adults. These tumors account for 45–50% of all gliomas [6]. The median survival is generally less than 1 year from the time of diagnosis, and most patients die within 2 years, even under the most favorable circumstances. Despite the use of macroscopic debulking and effective adjuvant radiation therapy (RT), the median survival (MS) of patients who present with GBM is generally only 9–12 months, with less than 15% of patients alive at 2 years post-diagnosis [7], [8]. Temozolomide (TMZ) is an oral alkylating agent with considerable antitumor activity in brain tumors [14]. Concomitant TMZ along with radiotherapy (RT) followed by 6 cycles of adjuvant TMZ has become the standard treatment for such patients in accordance with the randomized European and Canadian trial, which demonstrated a significant improvement in the median and 2-year survival of patients receiving or not receiving TMZ [1], [4], [5]. However, it is important to assess whether the same results can be replicated in clinical practice and in patients from different populations. We hereby report the analysis of the first 79 patients with GBM treated uniformly in accordance with the protocol of Stupp et al. [1], [15] with a focus on the safety, tolerability and survival benefits of this protocol in a Korean population. We believe that this study is the first to investigate the efficacy of radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma in a Korean population, and we believe that this study included more cases than any other such study in an Asian population.
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Materials and methods
Between May 2004 and December 2007, we experienced a total of 79 patients with newly diagnosed glioblastomas in our institute. All patients were histopathologically confirmed with glioblastomas according to the WHO classification (ref. 2007 WHO).
Patient characteristics
The age range of the patient population was from 15 to 76 years, with a median of 52 years. Only one patient, aged 15 years, was below 18 years of age. Seventy-four percent of the patients underwent gross total resection of the tumor prior to radiotherapy, while 18% underwent subtotal or partial resection, and the rest (8%) underwent open or stereotactic biopsy. All patients had pathology categorized as WHO grade IV or GBM. The patient details are outlined in Table 1. Prior to surgery, 35% of
Discussion
The results of this local cohort of patients managed with adjuvant TMZ demonstrated a MS of 18.3 months and a 2-year survival rate of 37.1%. Outcome results of high-grade gliomas are quite dependent upon pre-treatment factors such as age, performance status, histology and extent of surgical resection [12]. It is therefore important to critically analyze the impact of these factors on the outcome results in order to evaluate and compare the results of any therapy. The median age of our patient
Conclusion
The median and 2-year survival outcomes of this study population of Asian patients with GBM are comparable to the results of the large European Multicentre Study and justify the continued use of TMZ in routine clinical practice. Although TMZ therapy has now become the standard of care for patients with newly diagnosed GBM, numerous unanswered questions remain, and larger randomized trials should be conducted to guide clinical decision making in the management of patients with glioblastoma.
Acknowledgements
This work was supported by the Sungkyunkwan University School of Medicine and the Samsung Medical Center.
References (16)
- et al.
Interpretation of early imaging after concurrent radiotherapy and temozolomide for glioblastoma
Clin Oncol (R Coll Radiol)
(2007) - et al.
Health-related quality of life in patients with glioblastoma: a randomised controlled trial
Lancet Oncol
(2005) - et al.
Influence of location and extent of surgical resection on survival of patients of glioblastoma multiforme: results of three consecutive Radiation Therapy Oncology Group (RTOG) clinical trials
Int J Radiat Oncol Biol Phys
(1993) Factors influencing survival in high-grade gliomas
Semin Oncol
(2003)- et al.
Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma
N Engl J Med
(2005) - et al.
Physiologic and metabolic magnetic resonance imaging in gliomas
J Clin Oncol
(2006) - et al.
MGMT gene silencing and benefit from temozolomide in glioblastoma
N Engl J Med
(2005) - et al.
Management of glioma in Victoria (1998–2000): retrospective cohort study
Med J Aust
(2006)