TY - JOUR
T1 - Treatment outcome of patients with recurrent glioblastoma multiforme: a retrospective multicenter analysis
T2 - a retrospective multicenter analysis
AU - van Linde, Myra E.
AU - Brahm, Cyrillo G.
AU - de Witt Hamer, Philip C.
AU - Reijneveld, Jaap C.
AU - Bruynzeel, Anna M. E.
AU - Vandertop, W. Peter
AU - van de Ven, Peter M.
AU - Wagemakers, Michiel
AU - van der Weide, Hiske L.
AU - Enting, Roelien H.
AU - Walenkamp, Annemiek M. E.
AU - Verheul, Henk M. W.
PY - 2017/10/1
Y1 - 2017/10/1
N2 - Glioblastoma multiforme (GBM) universally recurs with dismal prognosis. We evaluated the efficacy of standard treatment strategies for patients with recurrent GBM (rGBM). From two centers in the Netherlands, 299 patients with rGBM after first-line treatment, diagnosed between 2005 and 2014, were retrospectively evaluated. Four different treatment strategies were defined: systemic treatment (SYST), re-irradiation (RT), re-resection followed by adjuvant treatment (SURG) and best supportive care (BSC). Median OS for all patients was 6.5 months, and median PFS (excluding patients receiving BSC) was 5.5 months. Older age, multifocal lesions and steroid use were significantly associated with a shorter survival. After correction for confounders, patients receiving SYST (34.8%) and SURG (18.7%) had a significantly longer survival than patients receiving BSC (39.5%), 7.3 and 11.0 versus 3.1 months, respectively [HR 0.46 (p < 0.001) and 0.36 (p < 0.001)]. Median survival for patients receiving RT (7.0%) was 9.2 months, but this was not significantly different from patients receiving BSC (p = 0.068). Patients receiving SURG compared to SYST had a longer PFS (9.0 vs. 4.3 months, respectively; p < 0.001), but no difference in OS was observed. After adjustments for confounders, patients with rGBM selected for treatment with SURG or SYST do survive significantly longer than patients who are selected for BSC based on clinical parameters. The value of reoperation versus systemic treatment strategies needs further investigation
AB - Glioblastoma multiforme (GBM) universally recurs with dismal prognosis. We evaluated the efficacy of standard treatment strategies for patients with recurrent GBM (rGBM). From two centers in the Netherlands, 299 patients with rGBM after first-line treatment, diagnosed between 2005 and 2014, were retrospectively evaluated. Four different treatment strategies were defined: systemic treatment (SYST), re-irradiation (RT), re-resection followed by adjuvant treatment (SURG) and best supportive care (BSC). Median OS for all patients was 6.5 months, and median PFS (excluding patients receiving BSC) was 5.5 months. Older age, multifocal lesions and steroid use were significantly associated with a shorter survival. After correction for confounders, patients receiving SYST (34.8%) and SURG (18.7%) had a significantly longer survival than patients receiving BSC (39.5%), 7.3 and 11.0 versus 3.1 months, respectively [HR 0.46 (p < 0.001) and 0.36 (p < 0.001)]. Median survival for patients receiving RT (7.0%) was 9.2 months, but this was not significantly different from patients receiving BSC (p = 0.068). Patients receiving SURG compared to SYST had a longer PFS (9.0 vs. 4.3 months, respectively; p < 0.001), but no difference in OS was observed. After adjustments for confounders, patients with rGBM selected for treatment with SURG or SYST do survive significantly longer than patients who are selected for BSC based on clinical parameters. The value of reoperation versus systemic treatment strategies needs further investigation
KW - Recurrent glioblastoma multiforme
KW - Survival outcome
KW - Treatment effectiveness
KW - Treatment strategies
UR - http://www.scopus.com/inward/record.url?scp=85025098220&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s11060-017-2564-z
DO - https://doi.org/10.1007/s11060-017-2564-z
M3 - Article
C2 - 28730289
SN - 0167-594X
VL - 135
SP - 183
EP - 192
JO - Journal of Neuro-Oncology
JF - Journal of Neuro-Oncology
IS - 1
ER -