title: Temozolomide during radiotherapy of glioblastoma multiforme : Daily administration improves survival.
abstract: BACKGROUND
  Temozolomide-(TMZ)-based chemoradiotherapy defines the current gold standard for the treatment of newly diagnosed glioblastoma. Data regarding the influence of TMZ dose density during chemoradiotherapy are currently not available. We retrospectively compared outcomes in patients receiving no TMZ, TMZ during radiotherapy on radiotherapy days only, and TMZ constantly 7 days a week.
  
  
  METHODS
  From 2002-2012, a total of 432 patients with newly diagnosed glioblastoma received radiotherapy in our department: 118 patients had radiotherapy alone, 210 had chemoradiotherapy with TMZ (75 mg/m2) daily (7/7), and 104 with TMZ only on radiotherapy days (5/7). Radiotherapy was applied to a total dose of 60 Gy.
  
  
  RESULTS
  Median survival after radiotherapy alone was 9.1 months, compared to 12.6 months with 5/7-TMZ and to 15.7 months with 7/7-TMZ. The 1‑year survival rates were 33, 52, and 64%, respectively. Kaplan-Meier analysis showed a significant improvement of TMZ-7/7 vs. 5/7 (p = 0.01 by the log-rank test), while 5/7-TMZ was still superior to no TMZ at all (p = 0.02). Multivariate Cox regression showed a significant influence of TMZ regimen (p = 0.009) on hazard rate (+58% between groups) even in the presence of confounding factors age, sex, resection status, and radiotherapy dose concept.
  
  
  CONCLUSIONS
  Our results confirm the findings of the EORTC/NCIC trial. It seems that also a reduced TMZ scheme can at first prolong the survival of glioblastoma patients, but not as much as the daily administration.
authors.affiliation: Department of Radiation Oncology, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany. silke.nachbichler@med.uni-muenchen.de.
authors.forename: Silke Birgit
authors.initials: SB
authors.lastname: Nachbichler
authors.affiliation: Department of Radiation Oncology, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.
authors.forename: Gabi
authors.initials: G
authors.lastname: Schupp
authors.affiliation: Department of Radiation Oncology, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Ballhausen
authors.affiliation: Department of Radiation Oncology, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Niyazi
authors.affiliation: Department of Radiation Oncology, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.
authors.forename: Claus
authors.initials: C
authors.lastname: Belka
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D059248:Chemoradiotherapy / Q000379:methods*; D003131:Combined Modality Therapy; D003606:Dacarbazine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D005909:Glioblastoma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D015996:Survival Rate; D000077204:Temozolomide; D055815:Young Adult
chemical_list: D003606:Dacarbazine; D000077204:Temozolomide
keywords: Adjuvant chemotherapy; Chemoradiotherapy; Radiosensitizing agents; Schemes; Temozolomide