title: The challenges of managing glioblastoma multiforme in developing countries: a trade-off between cost and quality of care.
abstract: OBJECTIVE
  The management of glioblastoma multiforme (GBM) in developing countries is hindered by the paucity of clear protocols due in part to growing economic constraints and the lack of availability of expensive chemotherapeutic agents. We evaluated the deliverable treatment protocols and achievable outcomes for patients with GBM in a low-income country prior and subsequent to the worldwide adoption of temozolomide.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Charts of consecutive patients with a pathologic diagnosis of high-grade glioma diagnosed between January 2003 and December 2008 were retrospectively reviewed.
  
  
  RESULTS
  We identified 146 adult patients, including 105 males and 41 females between 19 and 81 years of age (median age, 51 years), with histologically confirmed high-grade glioma. All patients underwent craniotomy. Eighty-two patients were treated with radiotherapy and temozolomide, of whom 42 patients received temozolomide concurrent with radiation followed by adjuvant temozolomide; 40 patients received irradiation followed sequentially by 6 cycles of temozolomide. In 40 patients irradiation was utilized as a single modality treatment adjuvant to surgery. The follow-up ranged from 1 to 56 months (median, 9.4 months). The median survival for the whole cohort was 10.2 months. The median survival for the radiotherapy-alone group was 5.3 months and for combined radiotherapy/temozolomide was 14.8 months. Survival was similar in both concurrent and sequential groups. Temozolomide conferred a statistically significant survival benefit of 9 months compared with standard therapeutic modalities.
  
  
  CONCLUSIONS
  The results compare favorably to those reported in developed nations. Current management of GBM in developing countries should include maximal surgical resection followed by radiotherapy/temozolomide whenever medically and/or financially feasible. Outcomes comparable to those obtained within the context of randomized trials can be expected in low-income settings if healthcare delivery is carefully planned. Our results indicate that concurrent and sequential regimens are equally effective in these patients.
authors: Department of Radiation Oncology, King Hussein Cancer Center, HM Queen Rania Hospital, Amman, Jordan.
authors: Ahmed
authors: A
authors: Salem
authors: Sameh A
authors: SA
authors: Hashem
authors: Abdulla
authors: A
authors: Al-Rashdan
authors: Najeeb
authors: N
authors: Ezam
authors: Ala'a
authors: A
authors: Nour
authors: Amer
authors: A
authors: Alsharbaji
authors: Maher
authors: M
authors: Sughayer
authors: Issa
authors: I
authors: Mohamad
authors: Maher
authors: M
authors: Elyan
authors: Ala'a
authors: A
authors: Addas
authors: Maysa
authors: M
authors: Al-Hussaini
authors: Abdelatif
authors: A
authors: Almousa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D003606:Dacarbazine / Q000031:analogs & derivatives / Q000627:therapeutic use; D003906:Developing Countries / Q000191:economics*; D005260:Female; D005909:Glioblastoma / Q000188:drug therapy / Q000191:economics* / Q000532:radiotherapy / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care / Q000191:economics* / Q000592:standards*; D018714:Radiotherapy, Adjuvant; D000077204:Temozolomide; D055815:Young Adult
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide