title: The survival significance of a measurable enhancing lesion after completing standard treatment for newly diagnosed glioblastoma.
abstract: The goal of this study was to analyze the survival outcome according to the treatment response after completing standard treatment protocol for newly diagnosed glioblastoma (GBM) and to suggest a patient who should be considered for further treatment. After approving by our Institutional Review Board, 57 patients (38 male, 19 female; median age, 52years; age range, 16-81years) with newly diagnosed GBM who completed standard treatment protocol were examined retrospectively. According to the treatment response using the RANO criteria, there were 20 patients with complete response (CR), five patients with partial response (PR), 13 patients with stable disease (SD) and 19 patients with progressive disease (PD) after the completion of standard treatment. Patients (PR+SD+PD) with a measurable enhancing lesion were categorized the MEL group (n=37). We analyzed the difference of survival outcome between CR group and MEL group. The median progression-free survival (PFS) in the CR group was significantly better than that of the MEL group (18.0months vs. 3.0months, p=0.004). The median overall survival (OS) was also significantly longer in the CR group (25.0months vs. 15.0months, p=0.005). However, there was no significant difference in the survival outcome of the CR group compared with that of the subset of MEL group patients who showed PR or SD. Poor survival outcome was found only in MEL group patients who exhibited progression. Patients with a measurable enhancing lesion showing progression after completion of standard treatment protocol are appropriate candidates for further treatment.
authors.affiliation: Department of Neurosurgery, Gyeongsang National University School of Medicine, Changwon Gyeongsang National University Hospital, Changwon, South Korea.
authors.forename: Sung Kwon
authors.initials: SK
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Tae Min
authors.initials: TM
authors.lastname: Kim
authors.affiliation: Department of Neurology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea; Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Soon-Tae
authors.initials: ST
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Se-Hoon
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Dae Seog
authors.initials: DS
authors.lastname: Heo
authors.affiliation: Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Il Han
authors.initials: IH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea; Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Dong Gyu
authors.initials: DG
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, 103 Daehak-ro, Jongno-gu, Seoul 03080, South Korea; Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Hee-Won
authors.initials: HW
authors.lastname: Jung
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea; Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Seung Hong
authors.initials: SH
authors.lastname: Choi
authors.affiliation: Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, 103 Daehak-ro, Jongno-gu, Seoul 03080, South Korea; Department of Neurosurgery, Seoul National University Boramae Medical Center, Seoul, South Korea. Electronic address: nslee@snu.ac.kr.
authors.forename: Sang Hyung
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, 103 Daehak-ro, Jongno-gu, Seoul 03080, South Korea; Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea. Electronic address: nsckpark@snu.ac.kr.
authors.forename: Chul-Kee
authors.initials: CK
authors.lastname: Park
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000628:therapy; D015254:DNA Modification Methylases / Q000378:metabolism; D045643:DNA Repair Enzymes / Q000378:metabolism; D003606:Dacarbazine / Q000031:analogs & derivatives / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D005909:Glioblastoma / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008745:Methylation; D008875:Middle Aged; D012189:Retrospective Studies; D000077204:Temozolomide; D016896:Treatment Outcome; D025521:Tumor Suppressor Proteins / Q000378:metabolism; D055815:Young Adult
chemical_list: D018906:Antineoplastic Agents, Alkylating; D025521:Tumor Suppressor Proteins; D003606:Dacarbazine; D015254:DNA Modification Methylases; C515491:MGMT protein, human; D045643:DNA Repair Enzymes; D000077204:Temozolomide
keywords: Adjuvant temozolomide; Glioblastoma; Measurable enhancing lesion; Prolonged temozolomide; Standard treatment