title: Patterns of care in recurrent glioblastoma in Switzerland: a multicentre national approach based on diagnostic nodes.
abstract: Despite moderate improvements in outcome of glioblastoma after first-line treatment with chemoradiation recent clinical trials failed to improve the prognosis of recurrent glioblastoma. In the absence of a standard of care we aimed to investigate institutional treatment strategies to identify similarities and differences in the pattern of care for recurrent glioblastoma. We investigated re-treatment criteria and therapeutic pathways for recurrent glioblastoma of eight neuro-oncology centres in Switzerland having an established multidisciplinary tumour-board conference. Decision algorithms, differences and consensus were analysed using the objective consensus methodology. A total of 16 different treatment recommendations were identified based on combinations of eight different decision criteria. The set of criteria implemented as well as the set of treatments offered was different in each centre. For specific situations, up to 6 different treatment recommendations were provided by the eight centres. The only wide-range consensus identified was to offer best supportive care to unfit patients. A majority recommendation was identified for non-operable large early recurrence with unmethylated MGMT promoter status in the fit patients: here bevacizumab was offered. In fit patients with late recurrent non-operable MGMT promoter methylated glioblastoma temozolomide was recommended by most. No other majority recommendations were present. In the absence of strong evidence we identified few consensus recommendations in the treatment of recurrent glioblastoma. This contrasts the limited availability of single drugs and treatment modalities. Clinical situations of greatest heterogeneity may be suitable to be addressed in clinical trials and second opinion referrals are likely to yield diverging recommendations.
authors.affiliation: Department of Neurology and Department of Haematology/Oncology, Cantonal Hospital St. Gallen, Rorschacherstr. 95, 9007, St. Gallen, Switzerland. thomas.hundsberger@kssg.ch.
authors.forename: T
authors.initials: T
authors.lastname: Hundsberger
authors.affiliation: Department of Clinical Neurosciences & Oncology, University Hospital, Lausanne, Switzerland.
authors.forename: A F
authors.initials: AF
authors.lastname: Hottinger
authors.affiliation: Department of Neurology and Brain Tumour Centre, Cantonal Hospital Aarau, Aarau, Switzerland.
authors.forename: U
authors.initials: U
authors.lastname: Roelcke
authors.affiliation: Department of Neurology, and Brain Tumor Centre, University Hospital, Zurich, Switzerland.
authors.forename: P
authors.initials: P
authors.lastname: Roth
authors.affiliation: Department of Oncology, University Hospital Geneva, Geneva, Switzerland.
authors.forename: D
authors.initials: D
authors.lastname: Migliorini
authors.affiliation: Department of Oncology, University Hospital Geneva, Geneva, Switzerland.
authors.forename: P Y
authors.initials: PY
authors.lastname: Dietrich
authors.affiliation: Department of Oncology, University Hospital Basel, Basel, Switzerland.
authors.forename: K
authors.initials: K
authors.lastname: Conen
authors.affiliation: Department of Radiation Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
authors.forename: G
authors.initials: G
authors.lastname: Pesce
authors.affiliation: Department of Radiation Oncology, University Hospital Bern, Bern, Switzerland.
authors.forename: E
authors.initials: E
authors.lastname: Hermann
authors.affiliation: Department of Radiation Oncology, University Hospital Bern, Bern, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Pica
authors.affiliation: Department of Radiation Oncology, University Hospital Basel, Basel, Switzerland.
authors.forename: M W
authors.initials: MW
authors.lastname: Gross
authors.affiliation: Department of Radiation Oncology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
authors.forename: D
authors.initials: D
authors.lastname: Brügge
authors.affiliation: Department of Radiation Oncology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
authors.forename: L
authors.initials: L
authors.lastname: Plasswilm
authors.affiliation: Department of Neurology, and Brain Tumor Centre, University Hospital, Zurich, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Weller
authors.affiliation: Department of Radiation Oncology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
authors.forename: P M
authors.initials: PM
authors.lastname: Putora
mesh_terms: D000328:Adult; D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005909:Glioblastoma / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D011379:Prognosis; D013557:Switzerland; D016896:Treatment Outcome
chemical_list: D018906:Antineoplastic Agents, Alkylating
keywords: Decision making; Diagnostic nodes; Objective consensus; Re-treatment criteria; Recurrent glioblastoma