title: Combined modality treatment of newly diagnosed glioblastoma multiforme in a regional neurosurgical centre.
abstract: The "local experience" of the Stupp protocol was examined in the treatment of patients with newly diagnosed glioblastoma multiforme (GBM) with particular emphasis given to the extent of surgical resection and its effect on survival. Thirty-one patients with newly diagnosed GBM who underwent combined modality treatment according to the Stupp protocol were assessed retrospectively. Variables assessed were the extent of surgery, size and site of the tumour, age and performance status. Primary end points were overall survival (OS) and progression-free survival (PFS). Median OS was 33 months for macroscopic tumour resection (9 patients; 29%), 15 months for debulking (15; 48%) and 9 months for biopsy (7; 22%). Macroscopic tumour resection resulted in significantly improved OS and PFS compared to the two less radical surgical options (p<0.001). Patients with GBM undergoing maximal resection of the tumour followed by adjuvant radiotherapy and chemotherapy have an improved survival compared to patients undergoing either subtotal resection or biopsy alone. This statistically significant survival benefit was achieved in a regional neurosurgical centre with minimal additional toxicity.
authors.affiliation: Department of Neurosurgery, Royal Hobart Hospital, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia. andrew.gauden@gmail.com
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Gauden
authors.forename: Andrew
authors.initials: A
authors.lastname: Hunn
authors.forename: Albert
authors.initials: A
authors.lastname: Erasmus
authors.forename: Pauline
authors.initials: P
authors.lastname: Waites
authors.forename: Arvind
authors.initials: A
authors.lastname: Dubey
authors.forename: Stanislaw J
authors.initials: SJ
authors.lastname: Gauden
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D018906:Antineoplastic Agents, Alkylating / Q000009:adverse effects / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000401:mortality* / Q000601:surgery* / Q000628:therapy; D003131:Combined Modality Therapy / Q000009:adverse effects; D003606:Dacarbazine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D005909:Glioblastoma / Q000401:mortality* / Q000601:surgery* / Q000628:therapy; D006764:Hospitals, Community; D006801:Humans; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects; D012189:Retrospective Studies; D013534:Survival; D000077204:Temozolomide
chemical_list: D000305:Adrenal Cortex Hormones; D000927:Anticonvulsants; D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide