Temozolomide during and after Radiotherapy for Newly Diagnosed Glioblastomas : A Prospective Multicenter Study of Korean Patients

Joo, Jin Deok; Chang, Jong Hee; Kim, Jeong Hoon; Hong, Yong Kil; Kim, Young Hoon; Kim, Chae Yong

doi:10.3340/jkns.2012.52.2.92

Cited by 9 publications

(8 citation statements)

References 19 publications

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“…The percentage of patients who completed CCRT (94%) and adjuvant chemotherapy (51%) with temozolomide was similar to those of Stupp's study (85% and 47%, respectively) and the previous Korean multicenter study (93% and 52%, respectively) ( 6 13 ). This shows that the frequency of toxicities or disease progression during CCRT with temozolomide or adjuvant temozolomide chemotherapy is consistent.…”

Section: Discussionsupporting

confidence: 81%

“…Notably, the results of our study (median OS and PFS, 22.6 and 8.8 months, respectively) were more favorable than those of Stupp's study (median OS and PFS, 14.6 and 5.0 months, respectively) ( 6 17 ). The median OS of non-salvage treatment group (14.6 months) was very similar to total OS in Stupp's study.…”

Section: Discussioncontrasting

confidence: 65%

“…The protocol of Stupp et al has been used by the authors since July 2004 and has been accepted as a standard protocol in Korea since September 2006 with the government insurance system covering the procedure for newly diagnosed GBM patients ( 4 5 6 7 ). As this study shows the longest period of use and follow up in Korea, we report the outcome of CCRT and adjuvant chemotherapy with temozolomide in primary GBM patients at a single center for reappraisal of its effectiveness and safety.…”

Section: Introductionmentioning

confidence: 99%

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Validation of the Effectiveness and Safety of Temozolomide during and after Radiotherapy for Newly Diagnosed Glioblastomas: 10-year Experience of a Single Institution

Joo

Kim

et al. 2015

J Korean Med Sci

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This study was performed to validate the effectiveness and safety of concurrent chemoradiotherapy and adjuvant therapy with temozolomide for newly diagnosed glioblastoma multiforme as a standard treatment protocol. Between 2004 and 2011, patients newly diagnosed with glioblastoma who were treated with temozolomide during concurrent chemoradiotherapy and adjuvant chemotherapy were included from a single institution and analyzed retrospectively. The primary endpoint was overall survival, and the secondary endpoints were progression-free survival, response, and safety. A total of 71 patients were enrolled in this study. The response rate was 41% (29/71), and the tumor control rate was 80% (57/71). In the 67 patients who completed the concurrent chemoradiotherapy with temozolomide, the median overall survival was 19 months and the 1- and 2-yr overall survival rates were 78.3% and 41.7%, respectively. The median progression free survival was 9 months, and the 1- and 2-yr progression free survival rates were 33.8% and 14.3%, respectively. The mean duration of survival after progression of disease in salvage treatment group was 11.9 (1.3-53.2) months. Concurrent chemoradiotherapy with temozolomide resulted in grade 3 or 4 hematologic toxic effects in 2.8% of the patients. The current protocol of temozolomide during and after radiation therapy is both effective and safe and is still appropriate as the standard protocol for treatment of glioblastoma. An active salvage treatment might be required for a better prognosis.

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Section: Discussionsupporting

confidence: 81%

Section: Discussioncontrasting

confidence: 65%

Section: Introductionmentioning

confidence: 99%

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Validation of the Effectiveness and Safety of Temozolomide during and after Radiotherapy for Newly Diagnosed Glioblastomas: 10-year Experience of a Single Institution

Joo

Kim

et al. 2015

J Korean Med Sci

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“…In contrast to the CCRT period, the incidence of hematologic toxicity of grade 3 or 4 during the adjuvant TMZ period was lower in the present study than in Stupp’s trial (10.2% vs. 14.3%). Hematologic toxicity of grade 3 or 4 was considered tolerable compared to other studies [ 5 , 10 , 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

Concurrent Chemoradiotherapy with Temozolomide Followed by Adjuvant Temozolomide for Newly Diagnosed Glioblastoma Patients: A Retrospective Multicenter Observation Study in Korea

et al. 2017

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PurposeThe purpose of this study was to investigate the feasibility and survival benefits of combined treatment with radiotherapy and adjuvant temozolomide (TMZ) in a Korean sample.Materials and MethodsA total of 750 Korean patients with histologically confirmed glioblastoma multiforme, who received concurrent chemoradiotherapy with TMZ (CCRT) and adjuvant TMZ from January 2006 until June 2011, were analyzed retrospectively.ResultsAfter the first operation, a gross total resection (GTR), subtotal resection (STR), partial resection (PR), biopsy alone were achieved in 388 (51.7%), 159 (21.2%), 96 (12.8%), and 107 (14.3%) patients, respectively. The methylation status of O6-methylguanine-DNA methyltransferase (MGMT) was reviewed retrospectively in 217 patients. The median follow-up period was 16.3 months and the median overall survival (OS) was 17.5 months. The actuarial survival rates at the 1-, 3-, and 5-year OS were 72.1%, 21.0%, and 9.0%, respectively. The median progression-free survival (PFS) was 10.1 months, and the actuarial PFS at 1-, 3-, and 5-year PFS were 42.2%, 13.0%, and 7.8%, respectively. The patients who received GTR showed a significantly longer OS and PFS than those who received STR, PR, or biopsy alone, regardless of the methylation status of the MGMT promoter. Patients with a methylated MGMT promoter also showed a significantly longer OS and PFS than those with an unmethylated MGMT promoter. Patients who received more than six cycles of adjuvant TMZ had a longer OS and PFS than those who received six or fewer cycles. Hematologic toxicity of grade 3 or 4 was observed in 8.4% of patients during the CCRT period and in 10.2% during the adjuvant TMZ period.ConclusionPatients treated with CCRT followed by adjuvant TMZ had more favorable survival rates and tolerable toxicity than those who did not undergo this treatment.

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“…One of the limitations of the current study is showing high OS than other reported data, and this may be due to censored data, as 9 of the patients were unavailable for follow-up9). When recurrence was suspected, salvage treatment varied among patients because until now there is no standard chemotherapy regimen in the management of high-grade glioma.…”

Section: Discussionmentioning

confidence: 74%

Pseudoprogression and Pseudoresponse in the Management of High-Grade Glioma : Optimal Decision Timing According to the Response Assessment of the Neuro-Oncology Working Group

Chang

Kim

Choi

et al. 2014

J Korean Neurosurg Soc

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ObjectiveWe evaluated pseudoprogression (PsPD) following radiation therapy combined with concurrent temozolomide (TMZ), and we assessed pseudoresponse following anti-angiogenic therapy for patients with recurrent disease using the Response Assessment of the Neuro-Oncology Working Group.MethodsPatients who were pathologically confirmed as having high-grade glioma received radiotherapy with concurrent TMZ followed by adjuvant TMZ. Bevacizumab (Avastin) with CPT-11 were used as a salvage option for cases of radiologic progression. Magnetic resonance imaging (MRI) was routinely performed 1 month after concurrent radiochemotherapy (CRT) and every 3 months thereafter. For cases treated with the bevacizumab-containing regimen for progressive disease, MRI was performed every 2 months.ResultsOf 55 patients, 21 (38%) showed radiologic progression within 4 weeks after CRT. Of these patients, 16 (29%) showed progression at second post-CRT MRI (etPD) and five (9%) showed improvement (PsPD). Seven of thirty-four initially non-progressed patients showed progression at the second post-CRT MRI (ltPD). No difference in survival was observed between the etPD and ltPD groups (p=0.595). Five (50%) of ten patients showed a radiological response after salvage bevacizumab therapy. Four of those patients exhibited rapid progression immediately after discontinuation of the drug (drug holiday).ConclusionTwelve weeks following treatment could be the optimal timing to determine PsPD or true progression. MRI with gadolinium enhancement alone is not sufficient to characterize tumor response or growth. Clinical correlation with adequate follow-up duration and histopathologic validation may be helpful in discriminating PsPD from true progression.

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Temozolomide during and after Radiotherapy for Newly Diagnosed Glioblastomas : A Prospective Multicenter Study of Korean Patients

Cited by 9 publications

References 19 publications

Validation of the Effectiveness and Safety of Temozolomide during and after Radiotherapy for Newly Diagnosed Glioblastomas: 10-year Experience of a Single Institution

Validation of the Effectiveness and Safety of Temozolomide during and after Radiotherapy for Newly Diagnosed Glioblastomas: 10-year Experience of a Single Institution

Concurrent Chemoradiotherapy with Temozolomide Followed by Adjuvant Temozolomide for Newly Diagnosed Glioblastoma Patients: A Retrospective Multicenter Observation Study in Korea

Pseudoprogression and Pseudoresponse in the Management of High-Grade Glioma : Optimal Decision Timing According to the Response Assessment of the Neuro-Oncology Working Group

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