Glioblastoma Survival Outcomes at a Tertiary Hospital in Appalachia: Factors Impacting the Survival of Patients Following Implementation of the Stupp Protocol

Urhie, Ogaga; Turner, Ryan; Lucke‐Wold, Brandon; Radwan, Walid; Ahn, Janice; Gyure, Kymberly A.; Bhatia, Sanjay

doi:10.1016/j.wneu.2018.03.163

Cited by 10 publications

(9 citation statements)

References 25 publications

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“…Glioblastoma has been and still is associated with a poor outcome for afflicted patients [1][2][3] with an overall survival rate below 6% [4]. It is also one of the most frequently occurring brain lesions [2,3] and can be, in the early stages of the disease, difficult to discern radiologically from low grade glioma [5], which have a better prognosis [6].…”

Section: Introductionmentioning

confidence: 99%

“…Even when using the current optimal treatment for glioblastoma, the STUPP protocol [1] consisting of gross total resection (GTR) with follow-up combined radiotherapy and chemotherapy (Temozolomide), the increase in survival is modest with regards to previous treatment regimens [7]. Moreover, there has not been a breakthrough in the reduction of recurrences after a few months of treatment [4].…”

Section: Introductionmentioning

confidence: 99%

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Assessment of Amide proton transfer weighted (APTw) MRI for pre-surgical prediction of final diagnosis in gliomas

et al. 2020

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Purpose Radiological assessment of primary brain neoplasms, both high (HGG) and low grade tumors (LGG), based on contrast-enhancement alone can be inaccurate. We evaluated the radiological value of amide proton transfer weighted (APTw) MRI as an imaging complement for pre-surgical radiological diagnosis of brain tumors. Methods Twenty-six patients were evaluated prospectively; (22 males, 4 females, mean age 55 years, range 26–76 years) underwent MRI at 3T using T1-MPRAGE pre- and post-contrast administration, conventional T2w, FLAIR, and APTw imaging pre-surgically for suspected primary/secondary brain tumor. Assessment of the additional value of APTw imaging compared to conventional MRI for correct pre-surgical brain tumor diagnosis. The initial radiological pre-operative diagnosis was based on the conventional contrast-enhanced MR images. The range, minimum, maximum, and mean APTw signals were evaluated. Conventional normality testing was performed; with boxplots/outliers/skewness/kurtosis and a Shapiro–Wilk’s test. Mann-Whitney U for analysis of significance for mean/max/min and range APTw signal. A logistic regression model was constructed for mean, max, range and Receiver Operating Characteristic (ROC) curves calculated for individual and combined APTw signals Results Conventional radiological diagnosis prior to surgery/biopsy was HGG (8 patients), LGG (12 patients), and metastasis (6 patients). Using the mean and maximum: APTw signal would have changed the pre-operative evaluation the diagnosis in 8 of 22 patients (two LGGs excluded, two METs excluded). Using a cut off value of >2.0% for mean APTw signal integral, 4 of the 12 radiologically suspected LGG would have been diagnosed as high grade glioma, which was confirmed by histopathological diagnosis. APTw mean of >2.0% and max >2.48% outperformed four separate clinical radiological assessments of tumor type, P-values = .004 and = .002, respectively. Conclusions Using APTw-images as part of the daily clinical pre-operative radiological evaluation may improve diagnostic precision in differentiating LGGs from HGGs, with potential improvement of patient management and treatment.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Assessment of Amide proton transfer weighted (APTw) MRI for pre-surgical prediction of final diagnosis in gliomas

et al. 2020

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“…Patient population relevant for such study would be relapsed patients after first line of treatment. IRM and SPECT-CT imaging modalities would be appropriate tools for pre-selection process and patient’s follow-up after treatment in order to monitor microparticles distribution and dosimetry ( 43 ).…”

Section: Discussionmentioning

confidence: 99%

Therapeutic efficacy of 166Holmium siloxane in microbrachytherapy of induced glioblastoma in minipig tumor model

et al. 2022

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Glioblastoma is considered the most common malignant primary tumor of central nervous system. In spite of the current standard and multimodal treatment, the prognosis of glioblastoma is poor. For this reason, new therapeutic approaches need to be developed to improve the survival time of the glioblastoma patient. In this study, we performed a preclinical experiment to evaluate therapeutic efficacy of 166Ho microparticle suspension administered by microbrachytherapy on a minipig glioblastoma model. Twelve minipigs were divided in 3 groups. Minipigs had injections into the tumor, containing microparticle suspensions of either 166Ho (group 1; n = 6) or 165Ho (group 2; n = 3) and control group (group 3; n = 3). The survival time from treatment to euthanasia was 66 days with a good state of health of all minipigs in group 1. The median survival time from treatment to tumor related death were 8.6 and 7.3 days in groups 2 and control, respectively. Statistically, the prolonged life of group 1 was significantly different from the two other groups (p < 0.01), and no significant difference was observed between group 2 and control (p=0.09). Our trial on the therapeutic effect of the 166Ho microparticle demonstrated an excellent efficacy in tumor control. The histological and immunohistochemical analysis showed that the efficacy was related to a severe 166Ho induced necrosis combined with an immune response due to the presence of the radioactive microparticles inside the tumors. The absence of reflux following the injections confirms the safety of the injection device.

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“…Despite advances in chemotherapy, the mainstay treatment of GBM is GTR, which is associated with the highest OS and PFS among GBM patients [28][29][30][31]. It has been commonly observed that a smaller residual tumor volume is correlated with a higher survival rate.…”

Section: Discussionmentioning

confidence: 99%

“…In 2012 the Chinese guidelines for the diagnosis and treatment of glioma of the CNS recommended the Stupp regimen as first-line therapy for newly diagnosed GBM. In the present study, compliance of GBM treatments with the Stupp regimen in 28 Glioblastoma multiforme (GBM) accounts for 47.1% of all primary malignant tumors in the CNS [1]. It is the most common malignant epithelial tumor of the CNS in both children and adults [2], but is mostly diagnosed in patients aged 45-70 years [3].…”

mentioning

confidence: 90%

Guideline Conformity to the Stupp Regimen in Patients with Newly Diagnosed Glioblastoma Multiforme in China

Wang

Zhang

et al. 2021

Future Oncol.

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Aims: To determine how consistently Chinese glioblastoma multiforme (GBM) patients were treated according to the Stupp regimen. Patients and methods: The proportion of treatments conforming to the Stupp regimen and reasons for nonconformity were evaluated in 202 newly diagnosed GBM patients. Results: Only 15.8% of GBM patients received treatments compliant with the Stupp regimen. The main deviations were temozolomide dosages >75 mg/m2 (58/120; 48.3%) and treatment durations <42 days (84/120; 70.0%) in the concomitant phase and temozolomide dosages <150 mg/m2 (89/101; 88.1%) in the maintenance phase. Median overall survival (27.09 vs 18.21 months) and progression-free survival (14.27 vs 12.10 months) were longer in patients who received Stupp regimen-compliant treatments. Conclusion: Increased conformity to the Stupp regimen is needed for GBM patients in China.

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Glioblastoma Survival Outcomes at a Tertiary Hospital in Appalachia: Factors Impacting the Survival of Patients Following Implementation of the Stupp Protocol

Cited by 10 publications

References 25 publications

Assessment of Amide proton transfer weighted (APTw) MRI for pre-surgical prediction of final diagnosis in gliomas

Assessment of Amide proton transfer weighted (APTw) MRI for pre-surgical prediction of final diagnosis in gliomas

Therapeutic efficacy of 166Holmium siloxane in microbrachytherapy of induced glioblastoma in minipig tumor model

Guideline Conformity to the Stupp Regimen in Patients with Newly Diagnosed Glioblastoma Multiforme in China

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