title: Multimodality therapy approaches, local and systemic treatment, compared with chemotherapy alone in recurrent glioblastoma.
abstract: BACKGROUND
  Long-term local control in Glioblastoma is rarely achieved and nearly all patients relapse. In this study we evaluated the clinical effect of different treatment approaches in recurrent patients.
  
  
  METHODS
  Forty-three patients, with median age of 51 years were evaluated for salvage treatment: re-resection and/or re-irradiation plus chemotherapy or chemotherapy alone. Response was recorded using the Response Assessment in Neuro-Oncology criteria. Hematologic and non-hematologic toxicities were graded according to Common Terminology Criteria for Adverse Events 4.0. Twenty-one patients underwent chemotherapy combined with local treatment, surgery and/or radiation therapy, and 22 underwent chemotherapy only.
  
  
  RESULTS
  The median follow up was 7 months (range 3-28 months). The 1 and 2-years Progression Free Survival was 65 and 10 % for combined treatment and 22 and 0 % for chemotherapy alone (p < 0.01). The 1 and 2-years overall survival was 69 and 29 % for combined and 26 and 0 % for chemotherapy alone (p < 0.01). No toxicity greater than grade 2 was recorded.
  
  
  CONCLUSIONS
  These data showed that in glioblastoma recurrence the combination of several approaches in a limited group of patients is more effective than a single treatment alone. This stress the importance of multimodality treatment whenever clinically feasible.
authors.affiliation: Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Humanitas Cancer Center, Istituto Clinico Humanitas, Via Manzoni 56, 20089, Rozzano, Milano, Italy. marta.scorsetti@humanitas.it.
authors.forename: Marta
authors.initials: M
authors.lastname: Scorsetti
authors.affiliation: Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Humanitas Cancer Center, Istituto Clinico Humanitas, Via Manzoni 56, 20089, Rozzano, Milano, Italy. piera.navarria@humanitas.it.
authors.forename: Pierina
authors.initials: P
authors.lastname: Navarria
authors.affiliation: Neuro-oncological Surgery Department, Humanitas Cancer Center and Università degli Studi di Milano, Milan, Italy. federico.pessina@humanitas.it.
authors.forename: Federico
authors.initials: F
authors.lastname: Pessina
authors.affiliation: Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Humanitas Cancer Center, Istituto Clinico Humanitas, Via Manzoni 56, 20089, Rozzano, Milano, Italy. annamaria.ascolese@humanitas.it.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Ascolese
authors.affiliation: Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Humanitas Cancer Center, Istituto Clinico Humanitas, Via Manzoni 56, 20089, Rozzano, Milano, Italy. giuseppe.dagostino@humanitas.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: D'Agostino
authors.affiliation: Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Humanitas Cancer Center, Istituto Clinico Humanitas, Via Manzoni 56, 20089, Rozzano, Milano, Italy. stefano.tomatis@humanitas.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Tomatis
authors.affiliation: Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Humanitas Cancer Center, Istituto Clinico Humanitas, Via Manzoni 56, 20089, Rozzano, Milano, Italy. fiorenza.derose@humanitas.it.
authors.forename: Fiorenza
authors.initials: F
authors.lastname: De Rose
authors.affiliation: Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Humanitas Cancer Center, Istituto Clinico Humanitas, Via Manzoni 56, 20089, Rozzano, Milano, Italy. elisa.villa@humanitas.it.
authors.forename: Elisa
authors.initials: E
authors.lastname: Villa
authors.affiliation: Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Humanitas Cancer Center, Istituto Clinico Humanitas, Via Manzoni 56, 20089, Rozzano, Milano, Italy. giulia.maggi@humanitas.it.
authors.forename: Giulia
authors.initials: G
authors.lastname: Maggi
authors.affiliation: Oncology and Hematology Department, Humanitas Cancer Center, Milan, Italy. matteo.simonelli@humanitas.it.
authors.forename: Matteo
authors.initials: M
authors.lastname: Simonelli
authors.affiliation: Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Humanitas Cancer Center, Istituto Clinico Humanitas, Via Manzoni 56, 20089, Rozzano, Milano, Italy. elena.clerici@humanitas.it.
authors.forename: Elena
authors.initials: E
authors.lastname: Clerici
authors.affiliation: Neuroncology Department Le Molinette, Turin, Italy. riccardo.soffietti@humanitas.it.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Soffietti
authors.affiliation: Oncology and Hematology Department, Humanitas Cancer Center, Milan, Italy. armando.santoro@humanitas.it.
authors.forename: Armando
authors.initials: A
authors.lastname: Santoro
authors.affiliation: Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Humanitas Cancer Center, Istituto Clinico Humanitas, Via Manzoni 56, 20089, Rozzano, Milano, Italy. luca.cozzi@humanitas.it.
authors.forename: Luca
authors.initials: L
authors.lastname: Cozzi
authors.affiliation: Neuro-oncological Surgery Department, Humanitas Cancer Center and Università degli Studi di Milano, Milan, Italy. lorenzo.bello@humanitas.it.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Bello
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000235:genetics / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D003131:Combined Modality Therapy; D019175:DNA Methylation; D005260:Female; D005909:Glioblastoma / Q000235:genetics / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009154:Mutation; D009364:Neoplasm Recurrence, Local; D011401:Promoter Regions, Genetic; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome