Survival improvement in patients with glioblastoma multiforme during the last 20 years in a single tertiary-care center.
METHODS
The survival of 357 consecutive patients with newly diagnosed glioblastoma multiforme (GBM) in three treatment groups reflecting different time-periods of diagnosis (A: 1982-1984; B: 1994/1995; C: 1996-1998) was analysed to assess the impact and the potential improvement of changing treatment strategies in our tertiary-care center.


METHODS
Group A (n = 100) included all consecutive patients diagnosed from 1982 to 1984 and served as the historical control. Group B (n = 93) included all consecutive patients diagnosed in 1994/1995 and group C (n = 164) those diagnosed from 1996 to 1998. Survival in the three treatment groups (A vs. B vs. C) was analysed according to treatment given after neurosurgical intervention (i.e. no specific therapy versus radiotherapy versus combined radio-/chemotherapy), and according to first-line chemotherapy, age (< 40, 40-60, > 60), sex, and tumor location (hemispheric versus bilateral or multifocal tumors, and tumors involving eloquent brain areas). Survival was analysed using Kaplan-Meier's non-parametric method. A p-value < 0.05 was considered statistically significant.


RESULTS
Patients in groups A and B received radio- and/or chemotherapy to a varying extent (radiotherapy: group A: 22%, group B: 62%; chemotherapy: group A: 6%, group B: 33%). Chemotherapy was administered after termination of radiotherapy in both groups. In group C, 96% of patients received combined radio-/chemotherapy which was administered concomitantly and started within three weeks after surgery. Median survival was 5.2 months in group A, 5.1 months in group B and 14.5 months in C (p < 0.0001). Nine patients in group A (9%), 9 in group B (10%) and 40 in group C (25%) survived more than 18 months (p < 0.05).


CONCLUSIONS
Survival improvement in group C might be attributable to the early start of combined radio-/chemotherapy. Therapy was administered on a complete outpatient basis, enabled by a dedicated interdisciplinary neuro-oncologic team caring for group C. Toxicity was mild and patients' acceptance excellent.
Fazeny-Dörner
Barbara
B
Clinical Division of Oncology & Ludwig Boltzmann Intitute for Clinical Experimental Oncology, Department of Medicine I, University of Vienna, Vienna, Austria.
Gyries
Anwar
A
Rössler
Karl
K
Ungersböck
Karl
K
Czech
Thomas
T
Budinsky
Alexandra
A
Killer
Monika
M
Dieckmann
Karin
K
Piribauer
Maria
M
Baumgartner
Gerhart
G
Prayer
Daniela
D
Veitl
Mario
M
Muhm
Manfred
M
Marosi
Christine
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery; D002986:Clinical Trials as Topic; D003037:Cobalt Radioisotopes / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003606:Dacarbazine / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005909:Glioblastoma / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery; D006801:Humans; D008130:Lomustine / Q000008:administration & dosage / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009607:Nitrosourea Compounds / Q000008:administration & dosage / Q000627:therapeutic use; D009943:Organophosphorus Compounds / Q000008:administration & dosage / Q000627:therapeutic use; D011879:Radiotherapy Dosage; D016019:Survival Analysis; D013997:Time Factors; D014057:Tomography, X-Ray Computed
D000970:Antineoplastic Agents; D018906:Antineoplastic Agents, Alkylating; D003037:Cobalt Radioisotopes; D009607:Nitrosourea Compounds; D009943:Organophosphorus Compounds; D008130:Lomustine; D003606:Dacarbazine; C054368:fotemustine