Defining the impact of adjuvant treatment on the prognosis of patients with inoperable glioblastoma undergoing biopsy only: does the survival benefit outweigh the treatment effort?

Abstract

Patients with inoperable glioblastoma (GBM) usually experience worse prognosis compared to those in whom gross total resection (GTR) is achievable. Considering the treatment duration and its side effects identification of patients with survival benefit from treatment is essential to guarantee the best achievable quality of life. The aim of this study was to evaluate the survival benefit from radio-chemotherapy and to identify clinical, molecular, and imaging parameters associated with better outcome in patients with biopsied GBMs. Consecutive patients with inoperable GBM who underwent tumor biopsy at our department from 2005 to 2019 were retrospectively analyzed. All patients had histologically confirmed GBM and were followed up until death. The overall survival (OS) was calculated from date of diagnosis to date of death. Clinical, radiological, and molecular predictors of OS were evaluated. A total of 95 patients with biopsied primary GBM were enrolled in the study. The mean age was 64.3 ± 13.2 years; 56.8% (54/95) were male, and 43.2% (41/95) female. Median OS in the entire cohort was 5.5 months. After stratification for adjuvant treatment, a higher median OS was found in the group with adjuvant treatment (7 months, range 2–88) compared to the group without treatment (1 month, range 1–5) log-rank test, p < 0.0001. Patients with inoperable GBM undergoing biopsy indeed experience a very limited OS. Adjuvant treatment is associated with significantly longer OS compared to patients not receiving treatment and should be considered, especially in younger patients with good clinical condition at presentation.

A prognostic model for overall survival in recurrent glioma patients treated with bevacizumab-containing therapy

“…Recent longitudinal data also supported the survival benefits of this treatment protocol outside clinical trials [34,35]. Even in patients with irresectable GBM, more intense adjuvant therapy was significantly associated with longer OS, as the radiochemotherapy group had the most prolonged OS, those with monotherapy of either radiation or chemotherapeutics followed, and the shortest OS was in the group without any adjuvant treatment [36]. As for low-grade glioma patients, chemotherapy of procarbazine, CCNU, and vincristine (PCV) or TMZ in combination with radiotherapy is recommended, despite active surveillance following surgery may be applied to low-risk individuals [4,5].…”

Small Molecule Immunomodulators as Next-Generation Therapeutics for Glioblastoma

“…Treatment options in the relapsed or recurrent stage of GBM lack a clear definition, with no established standard of care and limited evidence supporting interventions that extend overall survival [17,18]. Given that recent therapeutic advancements have only marginally increased the median survival to over 15 months in treated GBM patients [19][20][21][22][23], there is an urgent need to substantiate novel therapeutic strategies for GBM.…”

Penetrative and Sustained Drug Delivery Using Injectable Hydrogel Nanocomposites for Postsurgical Brain Tumor Treatment

“…The conventional adjuvant treatment of GBM by systemic chemotherapy and radiotherapy has shown limited efficacy due to the blood–brain barrier hindering drug penetration and a decreased response to radiation because of acquired tolerance . Patients whose GBM is unresectable due to the anatomical location or size of the tumor typically show even poorer prognoses and higher mortalities because they can only receive adjuvant treatments …”

“…6 Patients whose GBM is unresectable due to the anatomical location or size of the tumor typically show even poorer prognoses and higher mortalities because they can only receive adjuvant treatments. 7 Advanced strategies based on an understanding of the GBM microenvironment have been proposed to improve the therapeutic efficacy of systemic drug administration. 8−12 However, these methods have inherent limitations due to brain protection by the blood−brain barrier (BBB), resulting in poor therapeutic outcomes and systemic adverse effects.…”