title: Combined salvage therapies for recurrent glioblastoma multiforme: evaluation of an interdisciplinary treatment algorithm.
abstract: Glioblastoma multiforme patients presenting with recurrence following multimodality therapy have limited palliative treatment options when the major modalities of therapy including surgery, radiochemotherapy and adjuvant chemotherapy have been exhausted. The authors introduce a clinical and radiological indication-solving algorithm and provide outcome rates of a glioblastoma recurrence cohort. Sixty six consecutive adult patients with recurrent glioblastoma who underwent a combined scheme of salvage treatments consisting of reoperation, high dose rate (HDR) brachytherapy and chemotherapy were included in this prospective study and were compared to a historical control group of 24 recurrent glioblastoma patients who have been treated with intensive temozolomide chemotherapy as the only treatment modality. Median follow-up was 32 months (range 28-36 months). Median survival was 9 months for the entire cohort after salvage treatment and can be translated into a 3-month improvement in survival compared to the control group of patients with glioblastoma recurrence treated with temozolomide alone (P = 0.043). Toxicity and adverse events of reoperation, HDR brachytherapy combined with chemotherapy were quite favourable compared to intensive temomozolomide chemotherapy as the only treatment. Our experience suggests that a combined salvage treatment plan appears to be both feasible and effective and can be considered in selected patients affected by recurrent high grade gliomas. The authors' clinical and radiological indication-solving algorithm may assist in providing the best possible salvage treatment for this difficult population.
authors.affiliation: Department of Neurosurgery, Sana Klinikum Offenbach, Akademisches Lehrkrankenhaus der Universität Frankfurt, Starkenburgring 66, 63069, Offenbach, Germany, neurosurgery@t-online.de.
authors.forename: Eleftherios
authors.initials: E
authors.lastname: Archavlis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Tselis
authors.forename: Gerhard
authors.initials: G
authors.lastname: Birn
authors.forename: Peter
authors.initials: P
authors.lastname: Ulrich
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Zamboglou
mesh_terms: D000465:Algorithms; D001932:Brain Neoplasms / Q000628:therapy*; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005909:Glioblastoma / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D011446:Prospective Studies; D016879:Salvage Therapy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome