title: The impact of improved treatment strategies on overall survival in glioblastoma patients.
abstract: BACKGROUND
  The introduction of ALA-Fluorescence-guided surgery (FGS) followed by concomitant radiochemotherapy according to the Stupp-protocol is representative of the major changes in glioblastoma therapy in the past years. We were interested in the impact of this new first-line treatment on the overall survival of patients suffering from newly diagnosed primary glioblastoma in a retrospective single-centre study.
  
  
  METHODS
  For this retrospective analysis, data was derived from a prospective single-centre database. Patients were divided into three treatment groups: A (FGS-/radiochemotherapy-), B (FGS-/radiochemotherapy+) and C (FGS+/radiochemotherapy+). Further stratification was applied regarding MGMT-methylation status and degree of resection. Statistical analysis was performed to determine factors (treatment regime, age, gender, performance status, MGMT promoter methylation status) significantly influencing overall survival (OAS).
  
  
  RESULTS
  Two hundred and fifty-three patients suffering from primary glioblastoma treated by cytoreductive surgery between 2002 and 2009 were included in this survey. Median OAS differed significantly between the treatment groups (A = 8.8, B = 16.6, C = 20.1, p < 0.01). Resection data was available in all 253 patients. The usage of FGS highly significantly correlated with a complete resection (p < 0.01). Complete resection was positively correlated with an increase in OAS (complete 20.3 months vs. incomplete 9.3 months, p < 0.01).
  
  
  CONCLUSIONS
  FGS and radiochemotherapy according to the Stupp protocol have induced an impressive improvement in overall survival in glioblastoma patients. This effect is not limited to clinical trials, but is reproducible in daily routine.
authors.affiliation: Neurochirurgische Klinik, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany. slotty@med.uni-duesseldorf.de
authors.forename: P J
authors.initials: PJ
authors.lastname: Slotty
authors.forename: B
authors.initials: B
authors.lastname: Siantidis
authors.forename: T
authors.initials: T
authors.lastname: Beez
authors.forename: H J
authors.initials: HJ
authors.lastname: Steiger
authors.forename: M
authors.initials: M
authors.lastname: Sabel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality / Q000628:therapy*; D059248:Chemoradiotherapy / Q000379:methods; D018572:Disease-Free Survival; D005909:Glioblastoma / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult