title: Factors associated with a higher rate of distant failure after primary treatment for glioblastoma.
abstract: Our purpose was to analyze the pattern of failure in glioblastoma (GBM) patients at first recurrence after radiotherapy and temozolomide and its relationship with different factors. From 77 consecutive GBM patients treated at our institution with fluorescence guided surgery and standard radiochemotherapy, 58 first recurrences were identified and included in a retrospective review. Clinical data including age, Karnofsky performance score, preoperative tumor volume and location, extend of resection, MGMT promoter methylation status, time to progression (PFS), overall survival (OS) and adjuvant therapies were reviewed for every patient. Recurrent tumor location respect the original lesion was the end point of the study. The recurrence pattern was local only in 65.5% of patients and non-local in 34.5%. The univariate and multivariate analysis showed that greater preoperative tumor volume in T1 gadolinium enhanced sequences, was the only variable with statistical signification (p < 0.001) for increased rate of non-local recurrences, although patients with MGMT methylation and complete resection of enhancing tumor presented non-local recurrences more frequently. PFS was longer in patients with non-local recurrences (13.8 vs. 6.4 months; p = 0.019, log-rank). However, OS was not significantly different in both groups (24.0 non-local vs. 19.3 local; p = 0.9). Rate of non-local recurrences in our series of patients treated with fluorescence guided surgery and standard radiochemotherapy was higher than previously published in GBM, especially in patients with longer PFS. Greater preoperative enhancing tumor volume was associated with increased rate of non-local recurrences.
authors.affiliation: Department of Neurosurgery, Clínica Universidad de Navarra, C/Pio XII, 36, 31008, Pamplona, Spain, stejadasolis@yahoo.es.
authors.forename: Sonia
authors.initials: S
authors.lastname: Tejada
authors.forename: Guillermo
authors.initials: G
authors.lastname: Aldave
authors.forename: Miguel
authors.initials: M
authors.lastname: Marigil
authors.forename: Jaime
authors.initials: J
authors.lastname: Gállego Pérez-Larraya
authors.forename: Jaime
authors.initials: J
authors.lastname: de Gallego
authors.forename: Pablo Daniel
authors.initials: PD
authors.lastname: Domínguez
authors.forename: Ricardo
authors.initials: R
authors.lastname: Díez-Valle
mesh_terms: D018906:Antineoplastic Agents, Alkylating / Q000009:adverse effects; D001932:Brain Neoplasms / Q000235:genetics / Q000628:therapy*; D015254:DNA Modification Methylases / Q000235:genetics; D045643:DNA Repair Enzymes / Q000235:genetics; D003606:Dacarbazine / Q000009:adverse effects / Q000031:analogs & derivatives; D018450:Disease Progression; D005260:Female; D005909:Glioblastoma / Q000235:genetics / Q000628:therapy*; D006801:Humans; D017567:Karnofsky Performance Status; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000209:etiology* / Q000235:genetics; D011401:Promoter Regions, Genetic / Q000235:genetics; D011878:Radiotherapy / Q000009:adverse effects; D000077204:Temozolomide; D025521:Tumor Suppressor Proteins / Q000235:genetics
chemical_list: D018906:Antineoplastic Agents, Alkylating; D025521:Tumor Suppressor Proteins; D003606:Dacarbazine; D015254:DNA Modification Methylases; C515491:MGMT protein, human; D045643:DNA Repair Enzymes; D000077204:Temozolomide