title: Improvement in treatment results of glioblastoma over the last three decades and beneficial factors.
abstract: BACKGROUND
  The purpose of this study is to elucidate the trend of glioblastoma outcome and scrutinize the factors contributing to better outcome over three decades.
  
  
  METHODS
  Survival time and the influencing factors were retrospectively analyzed in 223 newly diagnosed primary glioblastoma patients during 1980-2010. Appraised factors included age, sex, tumor site, year of surgery, extent of resections, use of surgery supporting system, Karnofsky Performance Status (KPS), chemotherapy, conventional external beam radiotherapy (EBRT), and CyberKnife stereotactic radiotherapy (CK-SRT) use.
  
  
  RESULTS
  The median survival time (MST) in all patients was 13.6 months. The MSTs for 4 periods were 9.8 (1980-1990), 13.7 (1991-2000), 12.9 (2001-2005), and 15.8 months (2006-2010), respectively (p=0.0047). Total resection, subtotal resection, partial resection, and biopsy had MSTs of 31.8, 13.9, 11.4, and 7.0 months, respectively (p<0.0001). Regarding chemotherapy, MSTs of the temozolomide base group and nimustine hydrochloride (ACNU) base group were 16.9 and 14.6 months, respectively, whereas the MST of patients without chemotherapy was only 9.8 months (p<0.0001). The MSTs for 40-Gy EBRT plus CK-SRT and 60-Gy EBRT were 19.1 and 10.7 months, respectively (p<0.0001). But in sub-selected patients, treated during 2001-2010, whose resection rate was total resection or subtotal resection, EBRT was completed and postoperative KPS was greater than or equal to 70, the MST with and without CK-SRT was 26.6 and 18.3 months, respectively (p=0.1529). According to the Cox proportional hazards model, degree of resection, KPS, ACNU use, temozolomide use, bevacizumab use, EBRT dose, and CK-SRT use were good prognostic factors. Use of neuronavigation and use of intraoperative magnetic resonance imaging were related to higher resection rate, but not determined as prognostic factors.
  
  
  CONCLUSIONS
  We observed a gradual improvement in glioblastoma outcome, presumably because of improvements in therapeutic modalities for surgery, anticancer agents, and radiation, but the efficacy of CK-SRT remains unclear.
authors.affiliation: Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima City, Kagoshima , Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Kawano
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Hirano
authors.forename: Hajime
authors.initials: H
authors.lastname: Yonezawa
authors.forename: Shunji
authors.initials: S
authors.lastname: Yunoue
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Yatsushiro
authors.forename: Mikio
authors.initials: M
authors.lastname: Ogita
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Hiraki
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Uchida
authors.forename: Mika
authors.initials: M
authors.lastname: Habu
authors.forename: Shingo
authors.initials: S
authors.lastname: Fujio
authors.forename: Tatsuki
authors.initials: T
authors.lastname: Oyoshi
authors.forename: Yuriz
authors.initials: Y
authors.lastname: Bakhtiar
authors.forename: Sei
authors.initials: S
authors.lastname: Sugata
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yamahata
authors.forename: Ryousuke
authors.initials: R
authors.lastname: Hanaya
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tokimura
authors.forename: Kazunori
authors.initials: K
authors.lastname: Arita
mesh_terms: D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000628:therapy*; D017024:Chemotherapy, Adjuvant / Q000379:methods; D003606:Dacarbazine / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D005909:Glioblastoma / Q000628:therapy*; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D000077204:Temozolomide
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide
keywords: CyberKnife; chemotherapy; extent of resection; glioblastoma; outcome