Long-term outcomes of concomitant chemoradiotherapy with temozolomide for newly diagnosed glioblastoma patients

Abstract

The present study analyzed outcomes of surgery followed by concomitant chemoradiotherapy (CCRT) with temozolomide (TMZ) in patients with newly diagnosed glioblastoma (GBM) at a single institution. Outcomes were retrospectively reviewed in 252 consecutive patients with newly diagnosed GBM who underwent surgery followed by CCRT with TMZ at the authors’ institution between 2005 and 2013. At initial operation, 126 (50.0%), 55 (21.8%), 45 (17.9%), and 26 (10.3%) patients underwent gross total resection (GTR), subtotal resection, partial resection (PR), and biopsy, respectively. Their median overall survival (OS) was 20.8 months (95% confidence interval [CI] 17.7–23.9 months) and their median progression-free survival was 12.7 months (95% CI 11.2–14.2 months). The O6-methylguanine-DNA methyltransferase (MGMT) promoter was methylated in 78 (34.1%) of the 229 patients assayed, and an isocitrate dehydrogenase 1 mutation was detected in 7 (6.6%) of the 106 patients analyzed. Univariate analyses showed that patient age, involvement of eloquent areas, involvement of the subventricular zone, presence of leptomeningeal seeding, Karnofsky Performance Status, extent of resection (EOR), MGMT promoter methylation, and presence of an oligodendroglioma component were prognostic of OS. Multivariate analysis showed that age, involvement of eloquent areas, presence of leptomeningeal seeding, EOR, and MGMT promoter methylation were significantly predictive of survival. OS in patients with GBM who undergo surgery followed by CCRT with TMZ is enhanced by complete resection. Other factors significantly prognostic of OS include that age, involvement of eloquent areas, presence of leptomeningeal seeding, and MGMT promoter methylation.

Effect of combined anti-PD-1 and temozolomide therapy in glioblastoma

“…1 Despite multimodal interventions, GBM is associated with a dismal prognosis and a high recurrence rate, which necessitate the development of novel therapeutic approaches. 2,3 However, recent studies targeting angiogenic pathways 4 and cell-matrix interactions 5 have failed to improve patient outcomes.…”

Glioblastoma Cellular Origin and the Firework Pattern of Cancer Genesis from the Subventricular Zone

“…An epiphany came from the experience of 5-aminolevulinic acid (5-ALA) fluorescence without any tumor cells in the tumor specimen by pathologic examinations 45) . During surgery to remove GBM, high fluorescence of 5-ALA was found in the walls of ventricles 45) , which are non-coincidentally exposed after supra-total resection (or a so-called planned lobectomy) 52,53) . Moon et al 45) described interesting patterns of 5-ALA fluorescence in the ventricular wall of brain tumor patients.…”

“…Isocitrate dehydrogenase (IDH)-wildtype glioblastoma (GBM) is a disease with a dismal prognosis, a distinction that has led to GBM being dubbed the "emperor of all cancers". The disease progression is rapid, and even with standard therapy 53) and supra-total resection 52) , the median survival of patients from diagnosis is approximately 14-20 months 53,63) .…”

Tumor treating fields and maintenance temozolomide for newly-diagnosed glioblastoma: a cost-effectiveness study

“…Of the 541 publications screened, 23 publications were reviewed in full text based on their relevance, as indicated by title and abstract, and seven publications were selected for a detailed review based on the time horizon and suitability of reported results. All seven publications indicated that the probability of surviving GBM increased the longer patients survived since diagnosis, and that the first 2 years after diagnosis were the period of the highest mortality hazard rates 6,7,[20][21][22][23][24] . We excluded four publications based on single institution reports in favor of larger epidemiological populations 6,[22][23][24] .…”