title: Post-surgical therapeutic approaches to glioblastoma patients submitted to biopsy (BA) or "partial" resection (PR): the possibilities to treat also them without renunciations. Study from the Brescia Neuro-Oncology Group.
abstract: The extent of surgery predicts overall survival (OS) in patients treated for glioblastoma (GBM). The therapeutic approach after partial resection (PR) or biopsy alone (BA) is not clearly defined. This retrospective analysis was therefore planned to analyse clinical features, treatment and survival of patients undergoing PR or BA. We analysed the clinical/therapeutic features and the outcome of 232 patients submitted to BA/PR and treated with radiotherapy (RT) with/without chemotherapy. Two subgroups (pre- and post-Temozolomide-era) were identified. The BA/PR ratio did not change with the accrual periods. In the TMZ-era, 50 % of the patients had chemotherapy; "small" volume, hypo-fractionated and "low" dose RT (<54 Gy) were delivered to 93, 38 and 44 % of the patients; corresponding values for the previous period were 4, 28, 11 and 2 % (P < 0.001). Better two-year OS was evident in the TMZ-era (18 vs 7 %); PR and chemotherapy affected OS in patients treated with hypo-fractionated, low doses RT (P = 0.02, 0.04). Limited volume, more often MRI-based, and "short" RT treatments were given mostly to unfavourably selected patients, without compromising the results of the whole group. This strategy, combined with an increased use of chemotherapy, resulted in reduced treatment burden, in an improved 2-year OS rate and prospectively in better quality of life, even in this prognostically worse subset of glioma patients.
authors.affiliation: Department of Radiation Oncology, University of Brescia, P.le Spedali Civili, 1, 25123, Brescia, BS, Italy. michela.buglione@unibs.it.
authors.forename: Michela
authors.initials: M
authors.lastname: Buglione
authors.affiliation: Department of Radiation Oncology, University of Brescia, P.le Spedali Civili, 1, 25123, Brescia, BS, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Borghetti
authors.affiliation: Department of Radiation Oncology, University of Brescia, P.le Spedali Civili, 1, 25123, Brescia, BS, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Pedretti
authors.affiliation: Department of Radiation Oncology, University of Brescia, P.le Spedali Civili, 1, 25123, Brescia, BS, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Triggiani
authors.affiliation: Department of Neurosurgery, University of Brescia, Brescia, Italy.
authors.forename: Marco Maria
authors.initials: MM
authors.lastname: Fontanella
authors.affiliation: Department of Neurosurgery, University of Brescia, Brescia, Italy.
authors.forename: Giannantonio
authors.initials: G
authors.lastname: Spena
authors.affiliation: Department of Medical Oncology, Spedali Civili Brescia, Brescia, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Grisanti
authors.affiliation: Department of Neuroradiology, University of Brescia, Brescia, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Liserre
authors.affiliation: Department of Pathology, University of Brescia, Brescia, Italy.
authors.forename: Luigi Pietro
authors.initials: LP
authors.lastname: Poliani
authors.affiliation: Department of Neurology, University of Brescia, Brescia, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Gipponi
authors.affiliation: Department of Medical Physics, Spedali Civili Brescia, Brescia, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Spiazzi
authors.affiliation: Department of Radiation Oncology, University of Brescia, P.le Spedali Civili, 1, 25123, Brescia, BS, Italy.
authors.forename: Stefano Maria
authors.initials: SM
authors.lastname: Magrini
mesh_terms: D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D001706:Biopsy; D001932:Brain Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D003606:Dacarbazine / Q000031:analogs & derivatives / Q000627:therapeutic use; D005909:Glioblastoma; D006801:Humans; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D012189:Retrospective Studies; D000077204:Temozolomide
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide
keywords: Biopsy; Glioblastoma; Partial surgery; Radiotherapy; Temozolomide