Outcome of salvage treatment for recurrent glioblastoma

Kim, Hong Rye; Kim, Kyung Hwan; Kong, Doo‐Sik; Seol, Ho Jun; Nam, Do‐Hyun; Lim, Do Hoon; Lee, Jung-Il

doi:10.1016/j.jocn.2014.09.018

Cited by 39 publications

(33 citation statements)

References 20 publications

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“…For example, it has already been shown that younger patients with a good KPS score and long treatment-free intervals are more likely to receive further treatment. 8,11,21 A comparison of data published before and after the implementation of the Stupp protocol is also problematic due to the positive effect of temozolomide at primary treatment. 6,14 Since some patients were treated in both centers contrary to the usual local treatment strategy, the observed difference in OS is probably an underestimation of the true benefit of second-line treatment compared to supportive care alone.…”

Section: Discussionmentioning

confidence: 99%

Survival effects of a strategy favoring second-line multimodal treatment compared to supportive care in glioblastoma patients at first progression

Stavrinou

Kalyvas

Grau

et al. 2019

Journal of Neurosurgery

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OBJECTIVEData on the survival effects of supportive care compared to second-line multimodal treatment for glioblastoma progression are scarce. Thus, the authors assessed survival in two population-based, similar cohorts from two European university hospitals with different treatment strategies at first progression.METHODSThe authors retrospectively identified patients with newly diagnosed glioblastoma treated at two neurooncological centers. After diagnosis, patients from both centers received identical treatments, but at tumor progression each center used a different approach. In the majority of cases, at center A (Greece), supportive care or a single therapeutic modality was offered at progression, whereas center B (Germany) provided multimodal second-line therapy. The main outcome measure was survival after progression (SaP). The influence of the treatment strategy on SaP was assessed by multivariate analysis.RESULTSOne hundred three patients from center A and 156 from center B were included. Tumor progression was observed in 86 patients (center A) and 136 patients (center B). At center A, 53 patients (72.6%) received supportive care alone, while at center B, 91 patients (80.5%) received second-line treatment. Progression-free survival at both centers was similar (9.4 months [center A] vs 9.0 months [center B]; p = 0.97), but SaP was significantly improved in the patients treated with multimodal second-line therapy at center B (7 months, 95% CI 5.3–8.7 months) compared to those treated with supportive care or a single therapeutic modality at center A (4.5 months, 95% CI 3.5–5.5 months; p = 0.003). In the multivariate analysis, the treatment center was an independent prognostic factor for overall survival (HR 1.59, 95% CI 0.17–2.15; p = 0.002).CONCLUSIONSTreatment strategy favoring multimodal second-line treatment over minimal treatment or supportive care at glioblastoma progression is associated with significantly better overall survival.

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Section: Discussionmentioning

confidence: 99%

Survival effects of a strategy favoring second-line multimodal treatment compared to supportive care in glioblastoma patients at first progression

Stavrinou

Kalyvas

Grau

et al. 2019

Journal of Neurosurgery

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“…Younger age, smaller tumor volume, higher KPS, and unifocal tumors were significant prognostic factors associated with patients' overall survival times. Several studies reported the impact of a combination of Gamma Knife SRS and adjuvant chemoagents on overall survival times [17,37,47,55,59]. In 2002, Larson et al reported a prospective phase II study on patients who received a combination of Gamma Knife SRS, and marimastat had a median overall survival of 8.7 months, whereas the median survival time in patients who received only Gamma Knife SRS alone was 10.1 months.…”

Section: The Effect Of Gamma Knife Radiosurgery In Patients With Recumentioning

confidence: 99%

“…Marimastat did not offer an advantage for patients with recurrent GBMs. However, in a retrospective study of 57 patients with recurrent GBMs, Kim et al showed that the combination of adjuvant temozolomide and Gamma Knife SRS significantly improved the medium overall survival time from 9.2 to 15.5 months [47]. In the bevacizumab era, two studies reported that the median survival time was approximately 13 months after the combined treatment of Gamma Knife SRS and adjuvant bevacizumab [55,59].…”

Section: The Effect Of Gamma Knife Radiosurgery In Patients With Recumentioning

confidence: 99%

“…Due to the blood-brain barrier, temozolomide rechallenge is considered to be a reasonable option in patients with recurrent GBMs. In this review, the combination of SRS and temozolomide was employed in three studies [34,42,47]. Cyberknife SRS was performed in two studies, and the other study used the Gamma Knife SRS.…”

Section: The Impact Of Srs and Adjuvant Temozolomide For Recurrent Gbmsmentioning

confidence: 99%

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Stereotactic Radiosurgery for Recurrent Glioblastoma Multiforme

Hsieh¹,

Ju²

2020

Tumor Progression and Metastasis

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Glioblastoma multiforme (GBM) is the most aggressive intracranial tumor that primarily affects adults. Since the introduction of temozolomide in 2005, maximal resection surgery with concurrent chemoradiation has become the standard treatment method for patients with newly diagnosed GBM. Although newly discovered chemoagents have been demonstrated to improve the median survival time, GBM still recurs in most patients. Recurrent GBM is still a therapeutic challenge for clinical physicians. Surgical intervention and other conventional chemoagents have been applied to manage recurrent GBM. Stereotactic radiosurgery (SRS) provides a highly precise radiation dose to the tumor lesion and reduces the dose to the adjacent normal brain tissue. After standard treatment for newly diagnosed GBM is completed, conventional re-irradiation therapy is not suitable for patients with recurrent GBMs. Therefore, SRS may become an alternative option in the treatment of recurrent GBMs. In this review, we discuss the relevant literature regarding SRS for recurrent GBMs and provide treatment advice for clinical physicians.

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“…We hypothesized that such PET abnormalities could predict the location and timing of subsequent tumor progression as defined by serial contrast-enhanced MRI. Reliable detection of such areas at high risk for tumor progression may be useful for clinical decisions regarding targeted second-line treatments, such as reoperation, radiosurgery, or application of tumor treating alternating electric fields [23–25]. …”

Section: Introductionmentioning

confidence: 99%

Tryptophan PET predicts spatial and temporal patterns of post-treatment glioblastoma progression detected by contrast-enhanced MRI

et al. 2015

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Background Amino acid PET is increasingly utilized for the detection of recurrent gliomas. Increased amino acid uptake is often observed outside the contrast-enhancing brain tumor mass. In this study, we evaluated if non-enhancing PET+ regions could predict spatial and temporal patterns of subsequent MRI progression in previously treated glioblastomas. Methods Twelve patients with a contrast-enhancing area suspicious for glioblastoma recurrence on MRI underwent PET scanning with the amino acid radiotracer alpha-[11C]-methyl-L-tryptophan (AMT). Brain regions showing increased AMT uptake in and outside the contrast-enhancing volume were objectively delineated to include high uptake consistent with glioma (as defined by previous studies). Volume and tracer uptake of such non-enhancing PET+ regions were compared to spatial patterns and timing of subsequent progression of the contrast-enhancing lesion, as defined by serial surveillance MRI. Results Non-enhancing PET+ volumes varied widely across patients and extended up to 24 mm from the edge of MRI contrast enhancement. In 10 patients with clear progression of the contrast-enhancing lesion, the non-enhancing PET+ volumes predicted the location of new enhancement, which extended beyond the PET+ brain tissue in 6. In two patients, with no PET+ area beyond the initial contrast enhancement, MRI remained stable. There was a negative correlation between AMT uptake in non-enhancing brain and time to subsequent progression (r=−0.77, p=0.003). Conclusions Amino acid PET imaging could complement MRI not only for detecting glioma recurrence but also predicting the location and timing of subsequent tumor progression. This could support decisions for surgical intervention or other targeted therapies for recurrent gliomas.

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Outcome of salvage treatment for recurrent glioblastoma

Cited by 39 publications

References 20 publications

Survival effects of a strategy favoring second-line multimodal treatment compared to supportive care in glioblastoma patients at first progression

Survival effects of a strategy favoring second-line multimodal treatment compared to supportive care in glioblastoma patients at first progression

Stereotactic Radiosurgery for Recurrent Glioblastoma Multiforme

Tryptophan PET predicts spatial and temporal patterns of post-treatment glioblastoma progression detected by contrast-enhanced MRI

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