Survival and prognostic factors of patients with unresectable glioblastoma multiforme

Abstract

The aim of this study was to assess survival and prognostic factors of 98 consecutive patients with unresectable glioblastoma multiforme (GBM) after stereotactic biopsy. Patients were diagnosed between 1993 and 1998, and the treatment modality subsequent to stereotactic biopsy was determined by the year of diagnosis. Before 1995, patients did not receive further specific therapy after stereotactic biopsy (n=36). In 1996, patients were administered radiotherapy starting within 6 weeks after stereotactic biopsy (n=24). From 1997 to 1998, patients received combined radio-/chemotherapy (RCT; CCNU orally) starting within 2 weeks after stereotactic biopsy (n=38). Patients' age ranged from 21 to 84 (median 64) years and their median Karnofsky performance score 2 weeks after stereotactic biopsy was 80 (range 60-100). Survival and prognostic factors were analyzed with respect to administered treatment modalities (without specific therapy versus radiotherapy versus combined RCT), with respect to age (>or<or=50 years), gender, Karnofsky performance score (>or=or<80), tumor location (frontal, parieto-temporal, central, occipital) and tumor size (>or<or=5 cm; tumor multiplicity was considered as diameter >5 cm) by the Kaplan-Meier method, by log-rank test and multivariate Cox regression analysis. Post-biopsy treatment modality was the strongest predictor for survival. Median (range) survival was 9 (3-47) weeks in those without specific therapy, 13 (5-54) weeks in patients receiving radiotherapy and 31 (11-101) weeks in patients receiving combined RCT (p<or=0.001). Age<or=50 years (p<or=0.05) in addition to tumor size in multivariate Cox analysis were found to be of significant influence onto survival, too. Combined RCT could be performed on a complete outpatient basis. Toxicity consisted of mild asymptomatic thrombocytopenia. We conclude that the administration of combined RCT within a minimum interval after stereotactic biopsy yielded a significant increase in survival. Patients' acceptance was excellent. These results encourage us to treat even patients with unresectable GBM with combined RCT.

Elderly Patients Affected by Glioblastoma Treated With Radiotherapy: The Role of Serum Hemoglobin Level

“…Perhaps, low Hb level correlated with the increase of tumor hypoxia, which was one of the causes of tumor radioresistance. The association between low serum Hb level and local RT failure has been widely studied for a lot of tumors [24][25][26][27], although the results published about this correlation are inconsistent for GBM [13][14][15][16][17].…”

Prognostic impact of hemoglobin level and other factors in patients with high-grade gliomas treated with postoperative radiochemotherapy and sequential chemotherapy based on temozolomide

“…Nevertheless, several trials provide evidence of a correlation between low a hemoglobin level and local failure or survival rates in patients treated with radiotherapy. The association between low hemoglobin level, hypoxia, and local radiotherapy failure for head and neck [1,2,6,23,28,30] and other solid tumors has also been established [12,[25][26][27]. Unfortunately, to date the impact of hypoxia and low hemoglobin level has not been extensively studied in malignant gliomas as in the other solid tumors; thus, only limited data are available on the influence of this factor on clinical outcome of gliomas.…”

Laser interstitial thermal therapy for newly diagnosed and recurrent glioblastoma

“…25,27 However, a significant number of GBMsup to 40%-are considered "unresectable" and are not amenable to aggressive resection. 5 These patients have a worse overall median survival of 9.4 months. 26 Unfortunately, the induction of a postoperative motor or language deficit is associated with a diminution of median survival by 3-4 months, 14 so attempting an aggressive resection on so-called unresectable tumors can result in patient harm in terms of both function and overall survival.…”