Concurrent chemoradiotherapy versus radiotherapy alone for “biopsy‐only” glioblastoma multiforme

Abstract

BACKGROUND Combined temozolomide and radiotherapy (RT) is the standard postoperative therapy for glioblastoma multiforme (GBM). However, the clearest benefit of concurrent chemoradiotherapy (CRT) observed in clinical trials has been among patients who undergo surgical resection. Whether the improved survival with CRT extends to patients who undergo “biopsy only” is less certain. The authors compared overall survival (OS) in a national cohort of patients with GBM who underwent biopsy and received either RT alone or CRT during the temozolomide era. METHODS The US National Cancer Data Base was used to identify patients with histologically confirmed, biopsy‐only GBM who received either RT alone or CRT from 2006 through 2011. Demographic and clinicopathologic predictors of treatment were analyzed using the chi‐square test, the t test, and multivariable logistic regression. OS was evaluated using the log‐rank test, multivariable Cox proportional hazard regression, and propensity score‐matched analysis. RESULTS In total, 1479 patients with biopsy‐only GBM were included, among whom 154 (10.4%) received RT alone and 1325 (89.6%) received CRT. The median age at diagnosis was 61 years. CRT was associated with a significant OS benefit compared with RT alone (median, 9.2 vs 5.6 months; hazard ratio [HR], 0.64; 95% confidence interval [CI], 0.54‐0.76; P < .001). CRT was independently associated with improved OS compared with RT alone on multivariable analysis (HR, 0.71; 95% CI, 0.60‐0.85; P < .001). A significant OS benefit for CRT persisted in a propensity score‐matched analysis (HR, 0.72; 95% CI, 0.56‐0.93; P = .009). CONCLUSIONS The current data suggest that CRT significantly improves OS in patients with GBM who undergo biopsy only compared with RT alone and should remain the standard of care for patients who can tolerate therapy. Cancer 2016;122:2364–2370. © 2016 American Cancer Society.

Hypofractionated short‐course radiotherapy in elderly patients with glioblastoma multiforme: an analysis of the National Cancer Database

“…Other prospective and retrospective studies, including a recent analysis of the NCDB database for patients aged ≥65 years diagnosed with GBM between 2005 and 2011, show that patients treated with chemoradiation may have better outcomes than patients treated with chemotherapy or RT alone . A smaller NCDB analysis of GBM patients between 2006 and 2011 who received biopsy only also showed that chemoradiation was superior to RT alone . In addition, likely reflecting the use of SCRT in the setting of clinical trials, we found that academic centers were more likely to administer SCRT compared to community programs.…”

Risk Factors for Cognitive Impairment in High-Grade Glioma Patients Treated with Postoperative Radiochemotherapy

“…In recent years, CCRT followed by adjuvant TMZ is the standard treatment for postoperative HGG patients. The regimen had more favorable survival rates than those who did not undergo this treatment and tolerable toxicity [17,18]. The application of molecular biology for precision medicine can accurately reflect the molecular biological characteristics and clinical treatment effects and prognosis of glioma [19,20].…”

Interstitial high-dose-rate brachytherapy in the primary treatment of inoperable glioblastoma multiforme

“…At this, the effect of concurrent CRT compared to EBRT alone was analyzed by Kole et al . [20]. Using the National Cancer Database, the authors identified patients with histologically confirmed, biopsy only GBM who were treated from 2006-2011.…”