Salvage therapy in patients with glioblastoma: is there any benefit?
BACKGROUND
Survival after first-line therapy is poor for patients with glioblastoma. The role of second-line treatment for recurrent disease is controversial. The authors studied the outcome in a subset of patients with glioblastoma who were selected for an aggressive reintervention strategy at the time of progression. Their objectives were to improve patients' overall survival with sustained quality of life and to make comparisons with overall survival in unselected patients.


METHODS
Overall, 168 patients were eligible for retrospective analysis. Ninety patients received specific therapy for disease recurrence (reintervention group) by specific criteria.


RESULTS
In the reintervention group, promising median overall survival (mOS) results after diagnosis (61.5 weeks) and progression (33 weeks) were obtained. The progression-free survival (PFS) rate at 12 months and the overall survival rate were superior in the reintervention group (71% at 12 months and 32% at 24 months) compared with the total cohort (45% and 20%, respectively) and the standard group (15% and 5%, respectively). A matched-pair analysis (n = 46 in each group), with an mOS period of 65.5 versus 28.5 weeks, confirmed these data. Quality of life was stable or slightly improved during reinterventions in a subset of patients treated within clinical studies.


CONCLUSIONS
The majority of patients in the current series were treated with a reintervention strategy, which had an impact on PFS and mOS. A second resection, focal radiotherapy (in selected cases), and additional chemotherapeutic regimens should be considered for patients with recurrent glioblastoma.
Hau
Peter
P
Klinik und Poliklinik für Neurologie der Universität Regensburg im Bezirksklinikum, Regensburg, Germany.
Baumgart
Ulrike
U
Pfeifer
Katharina
K
Bock
Anne
A
Jauch
Tanya
T
Dietrich
Jörg
J
Fabel
Klaus
K
Grauer
Oliver
O
Wismeth
Caecilia
C
Klinkhammer-Schalke
Monika
M
Allgäuer
Michael
M
Schuierer
Gerhard
G
Koch
Horst
H
Schlaier
Juergen
J
Ulrich
Winfried
W
Brawanski
Alexander
A
Bogdahn
Ulrich
U
Steinbrecher
Andreas
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000401:mortality; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D005909:Glioblastoma / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy*; D009367:Neoplasm Staging; D011788:Quality of Life; D011879:Radiotherapy Dosage; D012086:Reoperation; D012189:Retrospective Studies; D016879:Salvage Therapy; D015996:Survival Rate
D000970:Antineoplastic Agents