Background:Over the last decade, the approach to the management of brain tumours and the understanding of glioblastoma tumour biology has advanced and a number of therapeutic interventions have evolved, some of which have shown statistically significant effects on overall survival (OS) and progression-free survival in glioblastoma. The aim of this study is to compare survival in glioblastoma patients over a 10-year period (1999–2000 and 2009–2010).Methods:A retrospective cohort study was performed. Identification of all histologically confirmed glioblastoma in a single centre in years 1999, 2000, 2009 and 2010, and production of survival analysis comparing 1999–2000 and 2009–2010 were achieved.Results:A total of 317 patients were included in the analysis (133 in year 1999–2000, and 184 in year 2009–2010). Cox regression analysis showed that the survival was significantly longer in patients in years 2009–2010 than those in 1999–2000 at P<0.001 with HR=0.56, confidence interval (CI) (0.45–0.71). The 1- and 3-year survival rates were 20.7% and 4.4%, respectively, for patients in 1999–2000, improving to 40.0% and 10.3%, respectively, for patients in 2009–2010. The comparisons between the two groups in survival at 1, 2 and 3 years are all statistically significant at P<0.001, respectively. The median OS was 0.36 and 0.74 in 1999–2000 and 2009–2010 groups, respectively.Conclusions:Over this period, OS from glioblastoma has increased significantly in our unit. We believe this is due to the institution of evidence-based surgical and oncological strategies practised in a multidisciplinary setting.
Dendritic cell (DC) immunotherapy is developing as a promising treatment modality for patients with glioblastoma multiforme (GBM). The aim of this article is to review the data from clinical trials and prospective studies evaluating the safety and efficacy of DC vaccines for newly diagnosed (ND)- and recurrent (Rec)-GBM and for other high-grade gliomas (HGGs). By searching all major databases we identified and reviewed twenty-two (n=22) such studies, twenty (n=20) of which were phase I and II trials, one was a pilot study towards a phase I/II trial and one was a prospective study. GBM patients were exclusively recruited in 12/22 studies, while 10/22 studies enrolled patients with any diagnosis of a HGG. In 7/22 studies GBM was newly diagnosed. In the vast majority of studies the vaccine was injected subcutaneously or intradermally and consisted of mature DCs pulsed with tumour lysate or peptides. Median overall survival ranged between 16.0 and 38.4 months for ND-GBM and between 9.6 and 35.9 months for Rec-GBM. Vaccine-related side effects were in general mild (grade I and II), with serious adverse events (grade III, IV and V) reported only rarely. DC immunotherapy therefore appears to have the potential to increase the overall survival in patients with HGG, with an acceptable side effect profile. The findings will require confirmation by the ongoing and future phase III trials.
PROMs that currently feature in the neurosurgical literature may not address the specific outcomes relevant to neurosurgical practice. There is an emergent need for generic and disease-specific PROMs to be validated in neurosurgical patients and neurosurgery-specific PROMs developed to address unmet needs of patients undergoing neurosurgical procedures.
Contents lists available at ScienceDirectClinical Oncology j o ur n a l h o m e p a ge : w w w . c l i n i c a l on c o l o gy o n l i ne . n e t
To the Editor:We read with renewed enthusiasm the paper published by Weyer-Jamora et al. 1 In this paper, the authors provide a comprehensive review of the impact of cognitive rehabilitation in patients with brain tumor after surgery. They suggest a patientcentered framework supported in the Tripe A model-acquisition, application, and adaptation-to address the different needs in the cognitive, emotional, psychosocial, and physical domains.We agree with the commitment to cognitive rehabilitation for the patient with brain tumor in the acute, postsurgical, inpatient setting and the outpatient, postacute setting. This is particularly important, given the improved overall survival rates for patients with primary and metastatic brain tumors. We share in our center the same challenges with identifying the optimal timing for cognitive rehabilitation postsurgery, particularly given the pressure to start adjuvant treatments.We believe that prehabilitation can further enhance postoperative cognitive rehabilitation in patients with brain tumor. Therefore, our center holds a clinic and program dedicated to preoperative and postoperative rehabilitation for this group of patients. The core clinicians include a neurosurgeon who subspecializes in neuro-oncology, a neuro-oncology nurse consultant, and a neuropsychologist with a specialist interest. Extended members who attend as required include a speech and language therapist, a neurophysiotherapist, and an occupational therapist. The clinic runs every 2 weeks ensuring that there is minimal waiting time from referral. Patients are selected from our weekly neuro-oncology multidisciplinary team meeting. This clinic and program are designed to reduce the level of anxiety and depression in this population, which the evidence recognizes to be particularly high, 2 and enhance their cognitive rehabilitation.The program is delivered through a variable number of sessions adjusted to patients' needs. We use a combination of techniques to prepare them for surgery, diagnosis, and adjuvant treatment as well as coming to accept the diagnosis of a brain tumor and be able to live well with it. The tools we use include the BRIAN app, 3 developed by The Brain Tumour Charity, the PEAK brain training app, 4 and the EORTC quality of life questionnaire. 5 Throughout the sessions, these tools are used to monitor patient progress and see how interventions and treatments are affecting their physical and psychological health. The team responsible for this clinic has access to these reports and can act upon significant variations as required.This paper is welcomed and supported by our group because we agree this is one of the avenues neuro-oncology has to pursue.Cognitive, emotional, psychosocial, and physical domains should be part of the treatment plan from the first moment the patient meets the neuro-oncology team. We believe integrated transhabilitation-prehabilitation and rehabilitation during and after treatment-will establish a new paradigm between the patient and the treating team. It will increas...
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