Long-term outcomes of concomitant chemoradiotherapy with temozolomide for newly diagnosed glioblastoma patients

Jul 7, 2017Medicine

Long-term results of combined chemotherapy and radiation with temozolomide in new glioblastoma patients

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Abstract

The median overall survival for 252 patients with newly diagnosed glioblastoma who underwent surgery followed by chemoradiotherapy with temozolomide was 20.8 months.

Half of the patients underwent gross total resection, while others had varying degrees of resection or biopsy.
The median progression-free survival was 12.7 months.
The O-methylguanine-DNA methyltransferase promoter was methylated in 34.1% of patients tested.
An isocitrate dehydrogenase 1 mutation was present in 6.6% of patients analyzed.
Factors associated with overall survival included age, extent of resection, and MGMT promoter methylation.
Complete resection is linked to improved survival in patients receiving the combined treatment.

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The present study analyzed outcomes of surgery followed by concomitant chemoradiotherapy (CCRT) with temozolomide (TMZ) in patients with newly diagnosed glioblastoma (GBM) at a single institution. Outcomes were retrospectively reviewed in 252 consecutive patients with newly diagnosed GBM who underwent surgery followed by CCRT with TMZ at the authors' institution between 2005 and 2013. At initial operation, 126 (50.0%), 55 (21.8%), 45 (17.9%), and 26 (10.3%) patients underwent gross total resection (GTR), subtotal resection, partial resection (PR), and biopsy, respectively. Their median overall survival (OS) was 20.8 months (95% confidence interval [CI] 17.7-23.9 months) and their median progression-free survival was 12.7 months (95% CI 11.2-14.2 months). The O-methylguanine-DNA methyltransferase (MGMT) promoter was methylated in 78 (34.1%) of the 229 patients assayed, and an isocitrate dehydrogenase 1 mutation was detected in 7 (6.6%) of the 106 patients analyzed. Univariate analyses showed that patient age, involvement of eloquent areas, involvement of the subventricular zone, presence of leptomeningeal seeding, Karnofsky Performance Status, extent of resection (EOR), MGMT promoter methylation, and presence of an oligodendroglioma component were prognostic of OS. Multivariate analysis showed that age, involvement of eloquent areas, presence of leptomeningeal seeding, EOR, and MGMT promoter methylation were significantly predictive of survival. OS in patients with GBM who undergo surgery followed by CCRT with TMZ is enhanced by complete resection. Other factors significantly prognostic of OS include that age, involvement of eloquent areas, presence of leptomeningeal seeding, and MGMT promoter methylation.

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Long-term outcomes of concomitant chemoradiotherapy with temozolomide for newly diagnosed glioblastoma patients

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