Concurrent Chemoradiotherapy with Temozolomide Followed by Adjuvant Temozolomide for Newly Diagnosed Glioblastoma Patients: A Retrospective Multicenter Observation Study in Korea

Abstract

PurposeThe purpose of this study was to investigate the feasibility and survival benefits of combined treatment with radiotherapy and adjuvant temozolomide (TMZ) in a Korean sample.Materials and MethodsA total of 750 Korean patients with histologically confirmed glioblastoma multiforme, who received concurrent chemoradiotherapy with TMZ (CCRT) and adjuvant TMZ from January 2006 until June 2011, were analyzed retrospectively.ResultsAfter the first operation, a gross total resection (GTR), subtotal resection (STR), partial resection (PR), biopsy alone were achieved in 388 (51.7%), 159 (21.2%), 96 (12.8%), and 107 (14.3%) patients, respectively. The methylation status of O6-methylguanine-DNA methyltransferase (MGMT) was reviewed retrospectively in 217 patients. The median follow-up period was 16.3 months and the median overall survival (OS) was 17.5 months. The actuarial survival rates at the 1-, 3-, and 5-year OS were 72.1%, 21.0%, and 9.0%, respectively. The median progression-free survival (PFS) was 10.1 months, and the actuarial PFS at 1-, 3-, and 5-year PFS were 42.2%, 13.0%, and 7.8%, respectively. The patients who received GTR showed a significantly longer OS and PFS than those who received STR, PR, or biopsy alone, regardless of the methylation status of the MGMT promoter. Patients with a methylated MGMT promoter also showed a significantly longer OS and PFS than those with an unmethylated MGMT promoter. Patients who received more than six cycles of adjuvant TMZ had a longer OS and PFS than those who received six or fewer cycles. Hematologic toxicity of grade 3 or 4 was observed in 8.4% of patients during the CCRT period and in 10.2% during the adjuvant TMZ period.ConclusionPatients treated with CCRT followed by adjuvant TMZ had more favorable survival rates and tolerable toxicity than those who did not undergo this treatment.

Impact of epidemiological characteristics of supratentorial gliomas in adults brought about by the 2016 world health organization classification of tumors of the central nervous system

“…We noted that patients with IDH-wildtype anaplastic astrocytoma (AA) exhibited worse prognosis than IDH-mutated GBM, which was in accordance with the results reported by Hartmann et al [9]. Our data showed the median OS of IDH-wildtype AA was 19.0 months, which was close to the survival of newly diagnosed “classic” GBM [10–12]. With this regard, it seemed to be more rational to group IDH-wildtype AA into WHO grade IV which implied more aggressive treatments were needed in routine clinical course.…”

Notch1ablation radiosensitizes glioblastoma cells

“…Glioblastoma multiforme (GBM) is an aggressive brain tumor with a dismal outcome despite the current best therapeutic regimen. The median overall survival (OS) is merely 14.6 months with the majority of patients surviving less than two years, even with the current standard of care with maximal surgical debulking followed by adjuvant radiotherapy and oral temozolomide [ 1 , 2 ]. The infiltrative and invasive growth pattern of the tumor and highly angiogenic characteristics that define GBM result in a high recurrence rate.…”

Risk Factors for Cognitive Impairment in High-Grade Glioma Patients Treated with Postoperative Radiochemotherapy

“…In recent years, CCRT followed by adjuvant TMZ is the standard treatment for postoperative HGG patients. The regimen had more favorable survival rates than those who did not undergo this treatment and tolerable toxicity [17,18]. The application of molecular biology for precision medicine can accurately reflect the molecular biological characteristics and clinical treatment effects and prognosis of glioma [19,20].…”