title: Evaluation of outcome and prognostic factors in patients of glioblastoma multiforme: A single institution experience.
abstract: OBJECTIVE
  We present retrospective analysis of patients of glioblastoma multiforme (GBM) and discuss clinical characteristics, various treatment protocols, survival outcomes, and prognostic factors influencing survival.
  
  
  METHODS
  From January 2002 to June 2009, 439 patients of GBM were registered in our department. The median age of patients was 50 years, 66.1% were males, and 75% underwent complete or near-total excision. We evaluated those 360 patients who received radiotherapy (RT). Radiotherapy schedule was selected depending upon pre-RT Karnofsky Performance Status (KPS). Patients with KPS < 70 (Group I, n = 48) were planned for RT dose of 30-35 Gy in 10-15 fractions, and patients with KPS ≥ 70 (Group II, n = 312) were planned for 60 Gy in 30 fractions. In group I, six patients and in group II, 89 patients received some form of chemotherapy (lomustine or temozolomide).
  
  
  METHODS
  Statistical analysis was done using Statistical Package for Social Sciences, version 12.0. Overall survival (OS) was calculated using Kaplan-Meier method, and prognostic factors were determined by log rank test. The Cox proportional hazards model was used for multivariate analysis.
  
  
  RESULTS
  The median follow-up was 7.53 months. The median and 2-year survival rates were 6.33 months and 2.24% for group I and 7.97 months and 8.21% for group II patients, respectively (P = 0.001). In multivariate analysis, site of tumor (central vs. others; P = 0.006), location of tumor (parietal lobe vs. others; P = 0.003), RT dose (<60 Gy vs. 60 Gy; P = 0.0001), and use of some form of chemotherapy (P = 0.0001) were independent prognostic factors for survival.
  
  
  CONCLUSIONS
  In patients with GBM, OS and prognosis remains dismal. Whenever possible, we should use concurrent and/or adjuvant chemotherapy to maximize the benefits of post-operative radiotherapy. Patients with poor performance status may be considered for hypofractionated RT schedules, which have similar median survival rates as conventional RT.
authors.affiliation: Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Sector - 12, Chandigarh, India.
authors.forename: Narendra
authors.initials: N
authors.lastname: Kumar
authors.forename: Pankaj
authors.initials: P
authors.lastname: Kumar
authors.forename: Shabab Lalit
authors.initials: SL
authors.lastname: Angurana
authors.forename: Divya
authors.initials: D
authors.lastname: Khosla
authors.forename: Kanchan Kumar
authors.initials: KK
authors.lastname: Mukherjee
authors.forename: Rupali
authors.initials: R
authors.lastname: Aggarwal
authors.forename: Ritesh
authors.initials: R
authors.lastname: Kumar
authors.forename: Anjan
authors.initials: A
authors.lastname: Bera
authors.forename: Suresh Chander
authors.initials: SC
authors.lastname: Sharma
keywords: Glioblastoma multiforme; prognostic factors; radiotherapy; survival; temozolomide