Evaluation of outcome and prognostic factors in patients of glioblastoma multiforme: A single institution experience

Aims: We present retrospective analysis of patients of glioblastoma multiforme (GBM) and discuss clinical characteristics, various treatment protocols, survival outcomes, and prognostic factors influencing survival. Materials and Methods: From January 2002 to June 2009, 439 patients of GBM were registered in our department. The median age of patients was 50 years, 66.1% were males, and 75% underwent complete or near-total excision. We evaluated those 360 patients who received radiotherapy (RT). Radiotherapy schedule was selected depending upon pre-RT Karnofsky Performance Status (KPS). Patients with KPS < 70 (Group I, n = 48) were planned for RT dose of 30-35 Gy in 10-15 fractions, and patients with KPS ≥ 70 (Group II, n = 312) were planned for 60 Gy in 30 fractions. In group I, six patients and in group II, 89 patients received some form of chemotherapy (lomustine or temozolomide). Statistical Analysis Used: Statistical analysis was done using Statistical Package for Social Sciences, version 12.0. Overall survival (OS) was calculated using Kaplan-Meier method, and prognostic factors were determined by log rank test. The Cox proportional hazards model was used for multivariate analysis. Results: The median follow-up was 7.53 months. The median and 2-year survival rates were 6.33 months and 2.24% for group I and 7.97 months and 8.21% for group II patients, respectively (P = 0.001). In multivariate analysis, site of tumor (central vs. others; P = 0.006), location of tumor (parietal lobe vs. others; P = 0.003), RT dose (<60 Gy vs. 60 Gy; P = 0.0001), and use of some form of chemotherapy (P = 0.0001) were independent prognostic factors for survival. Conclusions: In patients with GBM, OS and prognosis remains dismal. Whenever possible, we should use concurrent and/or adjuvant chemotherapy to maximize the benefits of post-operative radiotherapy. Patients with poor performance status may be considered for hypofractionated RT schedules, which have similar median survival rates as conventional RT.

[1]  R. Sarin,et al.  Encouraging experience of concomitant Temozolomide with radiotherapy followed by adjuvant Temozolomide in newly diagnosed glioblastoma multiforme: single institution experience , 2007, British journal of neurosurgery.

[2]  Mitchel S Berger,et al.  An extent of resection threshold for newly diagnosed glioblastomas. , 2011, Journal of neurosurgery.

[3]  T. Cascino,et al.  Response criteria for phase II studies of supratentorial malignant glioma. , 1990, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[4]  W. Sauerbrei,et al.  Multivariate Analysis of Prognostic Factors in Patients with Glioblastoma , 2003, Strahlentherapie und Onkologie.

[5]  Yuta Shibamoto,et al.  Influence of extent of surgery and tumor location on treatment outcome of patients with glioblastoma multiforme treated with combined modality approach , 2005, Journal of Neuro-Oncology.

[6]  R. Müller,et al.  Randomized Study of Postoperative Radiotherapy and Simultaneous Temozolomide without Adjuvant Chemotherapy for Glioblastoma , 2008, Strahlentherapie und Onkologie.

[7]  B. Fisher,et al.  Hypofractionated radiotherapy with or without concurrent temozolomide in elderly patients with glioblastoma multiforme: a review of ten-year single institutional experience , 2012, Journal of Neuro-Oncology.

[8]  Jacob G. Scott,et al.  Recursive partitioning analysis of prognostic factors for glioblastoma patients aged 70 years or older , 2012, Cancer.

[9]  D. Nelson,et al.  Recursive partitioning analysis of prognostic factors in three Radiation Therapy Oncology Group malignant glioma trials. , 1993, Journal of the National Cancer Institute.

[10]  M. member.  Randomized trial of procarbazine, lomustine, and vincristine in the adjuvant treatment of high-grade astrocytoma: a medical research council trial. , 2001 .

[11]  N. Laperriere,et al.  Radiotherapy for newly diagnosed malignant glioma in adults: a systematic review. , 2002, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[12]  E. Hannisdal,et al.  Prognostic factors for glioblastoma multiforme--development of a prognostic index. , 1996, Acta oncologica.

[13]  Z L Gokaslan,et al.  A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. , 2001, Journal of neurosurgery.

[14]  R. Mirimanoff,et al.  Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. , 2009, The Lancet. Oncology.

[15]  Elizabeth Eisenhauer,et al.  Nomograms for predicting survival of patients with newly diagnosed glioblastoma: prognostic factor analysis of EORTC and NCIC trial 26981-22981/CE.3. , 2008, The Lancet. Oncology.

[16]  R. Hatlevoll,et al.  Combined modality therapy of operated astrocytomas grade III and IV. Confirmation of the value of postoperative irradiation and lack of potentiation of bleomycin on survival time: A prospective multicenter trial of the scandinavian glioblastoma study group , 1981, Cancer.

[17]  M. Shigemori,et al.  A pilot study of hypofractionated radiation therapy with temozolomide for adults with glioblastoma multiforme , 2011, Journal of Neuro-Oncology.

[18]  W. N. Brand,et al.  Radiotherapy of glioblastoma multiforme. , 1973, Journal of neurosurgery.

[19]  M. Mehta,et al.  The Impact of Mid-Treatment MRI on Defining Boost Volumes in the Radiation Treatment of Glioblastoma Multiforme , 2004, Technology in cancer research & treatment.

[20]  E. Alexander,et al.  Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas. A cooperative clinical trial. , 1978, Journal of neurosurgery.

[21]  L. Stewart,et al.  Chemotherapy in adult high-grade glioma: a systematic review and meta-analysis of individual patient data from 12 randomised trials , 2002, The Lancet.

[22]  Martin J. van den Bent,et al.  Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. , 2005, The New England journal of medicine.

[23]  M. Berger,et al.  GLIOMA EXTENT OF RESECTION AND ITS IMPACT ON PATIENT OUTCOME , 2008, Neurosurgery.

[24]  K. Nakagawa,et al.  High-dose conformal radiotherapy influenced the pattern of failure but did not improve survival in glioblastoma multiforme. , 1998, International journal of radiation oncology, biology, physics.

[25]  D. Schoenfeld,et al.  Comparison of postoperative radiotherapy and combined postoperative radiotherapy and chemotherapy in the multidisciplinary management of malignant gliomas . A joint radiation therapy oncology group and eastern cooperative oncology group study , 1983, Cancer.

[26]  D. González,et al.  Hypofractionation in glioblastoma multiforme. , 2000, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[27]  N. Bleehen,et al.  A Medical Research Council trial of two radiotherapy doses in the treatment of grades 3 and 4 astrocytoma. The Medical Research Council Brain Tumour Working Party. , 1991, British Journal of Cancer.

[28]  K. Narayan,et al.  A randomized trial comparing 35Gy in ten fractions with 60Gy in 30 fractions of cerebral irradiation for glioblastoma multiforme and older patients with anaplastic astrocytoma. , 2003, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[29]  Benedick A Fraass,et al.  Survival and failure patterns of high-grade gliomas after three-dimensional conformal radiotherapy. , 2002, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[30]  E. Gehan,et al.  Prognostic factors for patients with brain tumors. , 1977, National Cancer Institute monograph.

[31]  Sally P. Stenning,et al.  Prognostic factors in maligant glioma - development of a prognostic index. , 1990 .

[32]  M. Sautter‐Bihl,et al.  Radiotherapy of glioblastoma multiforme , 1998, Strahlentherapie und Onkologie.

[33]  D. Nelson,et al.  Influence of location and extent of surgical resection on survival of patients with glioblastoma multiforme: results of three consecutive Radiation Therapy Oncology Group (RTOG) clinical trials. , 1993, International journal of radiation oncology, biology, physics.

[34]  Anthony Asher,et al.  Survival following surgery and prognostic factors for recently diagnosed malignant glioma: data from the Glioma Outcomes Project. , 2003, Journal of neurosurgery.

[35]  M. Papadopoulos,et al.  Survival of patients with glioblastoma multiforme has not improved between 1993 and 2004: analysis of 625 cases , 2007, British journal of neurosurgery.

[36]  S. Grossman,et al.  Short course radiotherapy is an appropriate option for most malignant glioma patients. , 1997, International journal of radiation oncology, biology, physics.