Patterns of Care and Survival in a Retrospective Analysis of 1059 Patients With Glioblastoma Multiforme Treated Between 2002 and 2007

Abstract

OBJECTIVE:To investigate the pattern of care and outcomes for newly diagnosed glioblastoma in Italy and compare our results with the previous Italian Patterns of Care study to determine whether significant changes occurred in clinical practice during the past 10 years. METHODS: Clinical, pathological, therapeutic, and survival data regarding 1059 patients treated in 18 radiotherapy centers between 2002 and 2007 were collected and retrospectively reviewed. RESULTS: Most patients underwent both computed tomography and magnetic resonance imaging either preoperatively (62.7%) or postoperatively (35.5%). Only 123 patients (11.6%) underwent a biopsy. Radiochemotherapy with temozolomide was the most frequent adjuvant treatment (70.7%). Most patients (88.2%) received 3-dimensional conformal radiotherapy. Median survival was 9.5 months. Two-and 5-year survival rates were 24.8% and 3.9%, respectively. Multivariate analysis showed the statistical significance of age, postoperative Karnofsky Performance Status scale score, surgical extent, use of 3-dimensional conformal radiotherapy, and use of chemotherapy. Use of a more aggressive approach was associated with longer survival in elderly patients. Comparing our results with those of the subgroup of patients included in our previous study who were treated between 1997 and 2001, relevant differences were found: more frequent use of magnetic resonance imaging, surgical removal more common than biopsy, and widespread use of 3-dimensional conformal radiotherapy + temozolomide. Furthermore, a significant improvement in terms of survival was noted (P < .001). CONCLUSION: Changes in the care of glioblastoma over the past few years are documented. Prognosis of glioblastoma patients has slightly but significantly improved with a small but noteworthy number of relatively long-term survivors.

Concluding Remarks and Perspectives for Future Research

“…In a comparison between two large series of GB patients collected over subsequent periods (633 cases, 1997-2001; 1059 cases, 2002-2007) by the Italian Patterns of Care Study Group on Gliomas, improved survival results were significantly related to the adoption of 3D-CRT vs. outdated techniques ( p < .001). This corresponds to the same signifi cance level of the introduction of TMZ chemotherapy [ 4 ]. However, the overall survival results remained poor (median survival: 9.5 months; 1-, 2-, and 5-year survival, respectively: 62.3, 24.8, and 3.9 %) in this report as well as in previous and subsequent similar studies [ 5 , 6 ].…”

Glioblastoma multiforme outcomes of 107 patients treated in two Singapore institutions

“…Mexican (16) 1987-1994 16 20 Chinese (13) 1999- 2004 12 17 Korean (2) 1999- 2004 11 20 Italian (17) 2002- 2007 9 25 French (18) 2004- 2006 9 12 Scottish (19) 2004-2009 15 19 Singaporean (present study) 2002-2011 15 24 in local populations and environments mean that these models and calculators need to be validated locally before they can be employed. (19) The present study has shown that the prognostic factors in our local population are similar to those reported worldwide.…”

“…(2,13,(15)(16)(17)(18)(19) Earlier studies reporting outcomes during the pre-temozolomide era tend to show poorer survival outcomes when compared to recent studies that were conducted during the chemotherapy era. While our study includes the period before and after data from Stupp's seminal trial was published in 2005, most of our patients had received adjuvant concurrent temozolomide chemotherapy, which likely accounted for their better survival outcome.…”

MIF Maintains the Tumorigenic Capacity of Brain Tumor–Initiating Cells by Directly Inhibiting p53

“…Glioblastoma, the most common form of primary malignant brain tumor, is nearly always fatal (1). Although neurosurgeons may be able to remove the main tumor mass, this procedure typically leaves behind a small population of tumor cells that retain the capacity for tumorigenesis (2).…”