title: Concurrent Chemoradiotherapy with Temozolomide Followed by Adjuvant Temozolomide for Newly Diagnosed Glioblastoma Patients: A Retrospective Multicenter Observation Study in Korea.
abstract: OBJECTIVE
  The purpose of this study was to investigate the feasibility and survival benefits of combined treatment with radiotherapy and adjuvant temozolomide (TMZ) in a Korean sample.
  
  
  METHODS
  A total of 750 Korean patients with histologically confirmed glioblastoma multiforme, who received concurrent chemoradiotherapy with TMZ (CCRT) and adjuvant TMZ from January 2006 until June 2011, were analyzed retrospectively.
  
  
  RESULTS
  After the first operation, a gross total resection (GTR), subtotal resection (STR), partial resection (PR), biopsy alone were achieved in 388 (51.7%), 159 (21.2%), 96 (12.8%), and 107 (14.3%) patients, respectively. The methylation status of O6-methylguanine-DNA methyltransferase (MGMT) was reviewed retrospectively in 217 patients. The median follow-up period was 16.3 months and the median overall survival (OS) was 17.5 months. The actuarial survival rates at the 1-, 3-, and 5-year OS were 72.1%, 21.0%, and 9.0%, respectively. The median progression-free survival (PFS) was 10.1 months, and the actuarial PFS at 1-, 3-, and 5-year PFS were 42.2%, 13.0%, and 7.8%, respectively. The patients who received GTR showed a significantly longer OS and PFS than those who received STR, PR, or biopsy alone, regardless of the methylation status of the MGMT promoter. Patients with a methylated MGMT promoter also showed a significantly longer OS and PFS than those with an unmethylated MGMT promoter. Patients who received more than six cycles of adjuvant TMZ had a longer OS and PFS than those who received six or fewer cycles. Hematologic toxicity of grade 3 or 4 was observed in 8.4% of patients during the CCRT period and in 10.2% during the adjuvant TMZ period.
  
  
  CONCLUSIONS
  Patients treated with CCRT followed by adjuvant TMZ had more favorable survival rates and tolerable toxicity than those who did not undergo this treatment.
authors.affiliation: Department of Neurosurgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea.
authors.forename: Byung Sup
authors.initials: BS
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Ho Jun
authors.initials: HJ
authors.lastname: Seol
authors.affiliation: Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Do-Hyun
authors.initials: DH
authors.lastname: Nam
authors.affiliation: Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Chul-Kee
authors.initials: CK
authors.lastname: Park
authors.affiliation: Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Il Han
authors.initials: IH
authors.lastname: Kim
authors.affiliation: Division of Hematology/Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Tae Min
authors.initials: TM
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jeong Hoon
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Young Hyun
authors.initials: YH
authors.lastname: Cho
authors.affiliation: Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Sang Min
authors.initials: SM
authors.lastname: Yoon
authors.affiliation: Department of Neurosurgery, Brain Tumor Center, Yonsei University Health System, Seoul, Korea.
authors.forename: Jong Hee
authors.initials: JH
authors.lastname: Chang
authors.affiliation: Department of Neurosurgery, Brain Tumor Center, Yonsei University Health System, Seoul, Korea.
authors.forename: Seok-Gu
authors.initials: SG
authors.lastname: Kang
authors.affiliation: Department of Neurosurgery, Brain Tumor Center, Yonsei University Health System, Seoul, Korea.
authors.forename: Eui Hyun
authors.initials: EH
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Brain Tumor Center, Yonsei University Health System, Seoul, Korea.
authors.forename: Chang-Ok
authors.initials: CO
authors.lastname: Suh
authors.affiliation: Department of Neurosurgery, Chonnam National University Hwasun Hospital, Hwasun, Korea.
authors.forename: Tae-Young
authors.initials: TY
authors.lastname: Jung
authors.affiliation: Department of Pathology, Chonnam National University Hwasun Hospital, Hwasun, Korea.
authors.forename: Kyung-Hwa
authors.initials: KH
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
authors.forename: Chae-Yong
authors.initials: CY
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
authors.forename: In Ah
authors.initials: IA
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Health Science, Seoul, Korea.
authors.forename: Chang-Ki
authors.initials: CK
authors.lastname: Hong
authors.affiliation: Department of Neuro-Oncology Clinic, Center for Specific Organs Cancer, National Cancer Center Hospital, National Cancer Center, Goyang, Korea.
authors.forename: Heon
authors.initials: H
authors.lastname: Yoo
authors.affiliation: Department of Radiation Oncology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
authors.forename: Jin Hee
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
authors.forename: Shin-Hyuk
authors.initials: SH
authors.lastname: Kang
authors.affiliation: Department of Radiation Oncology, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea.
authors.forename: Min Kyu
authors.initials: MK
authors.lastname: Kang
authors.affiliation: Department of Neurosurgery, Inha University Hospital, Inha University School of Medicine, Incheon, Korea.
authors.forename: Eun-Young
authors.initials: EY
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea.
authors.forename: Sun-Hwan
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea.
authors.forename: Dong-Sup
authors.initials: DS
authors.lastname: Chung
authors.affiliation: Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
authors.forename: Sun-Chul
authors.initials: SC
authors.lastname: Hwang
authors.affiliation: Department of Neurosurgery, Hallym University Sacred Heart Hospital, Anyang, Korea.
authors.forename: Joon-Ho
authors.initials: JH
authors.lastname: Song
authors.affiliation: Department of Neurosurgery, Soonchunhyang University Hospital, Seoul, Korea.
authors.forename: Sung Jin
authors.initials: SJ
authors.lastname: Cho
authors.affiliation: Department of Neurosurgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
authors.forename: Sun-Il
authors.initials: SI
authors.lastname: Lee
authors.affiliation: Department of Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Youn-Soo
authors.initials: YS
authors.lastname: Lee
authors.affiliation: Department of Radiation, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Kook-Jin
authors.initials: KJ
authors.lastname: Ahn
authors.affiliation: Department of Pathology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Se Hoon
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Do Hun
authors.initials: DH
authors.lastname: Lim
authors.affiliation: Department of Systemic Cancer Science, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.
authors.forename: Ho-Shin
authors.initials: HS
authors.lastname: Gwak
authors.affiliation: Division of Hematotology/Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Se-Hoon
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Yong-Kil
authors.initials: YK
authors.lastname: Hong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D001706:Biopsy; D001932:Brain Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods; D003131:Combined Modality Therapy; D003606:Dacarbazine / Q000031:analogs & derivatives / Q000627:therapeutic use; D018450:Disease Progression; D005260:Female; D005909:Glioblastoma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D000077204:Temozolomide; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide
keywords: Chemoradiotherapy; Glioblastoma; MGMT; Temozolomide