Glioblastoma multiforme in the cerebral hemisphere. Survival analysis of 65 cases seen at the Oncology Department of the ClÃnicas Hospital from 1980 through 2000
Keywords:
GLIOBLASTOMA, SURVIVAL ANALYSISAbstract
Introduction: glioblastoma multiforme (GBM) is the most agressive kind of gliomas. The 5-year survival rate for exclusive surgical treatment is null. Additional chemotherapy and radiotherapy increases survival.
Objective: to evaluate the impact of treatment in the survival of patients suffering from GBM.
Method: patients with a histological diagnosis of GBM who were seen at the Neuro-Oncology Unit of the Clínicas Hospital, from 1980 through 2000. Clinical, paraclinical and patronymic data was collected, the same as information on the evolution of medical records. Survival rates were calculated through the Kaplan Meier and Mantel Cox method.
Results: 65 patients with an average age of 58 years old were studied, (range: 6-79). All of them underwent surgery (complete in 22 patients, subtotal in 9, partial in 32 and biopsy in 2 patients). Ninety two percent of patients were treated with radiotherapy and 25% with chemotherapy. Median survival was 46.6 weeks and global survival one year after was 28%. The probability for survival one year after was 0 in patients who were treated only with surgery; 0.23 in those who also received radiotherapy and 0.62 with chemotherapy QT (p=0,0001).
Multivariable analysis identified the following independent variables: multimodal treatment including chemotherapy (p=0,003) and a good postoperative general condition (p=0,007).
Conclusions: median survival in this series was similar to that described in literature, there existing a longer survival rate for patients with a good neurologic condition who are treated with radiotherapy and chemotherapy after surgery.
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(37) Stupp R, Hegi ME, Mason WP, van den Bent MJ, Taphoorn MJ, Janzer RC, et al. Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol 2009; 10(5):459-66.
(38) Kelly PJ, Olsen MH, Wrght AE. Stereotactic implantation of iridium 192 into CNS neoplasms. Surg Neurol 1978; 10(6):349-54.
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(2) Vasallo JA, Barrios E, De Stefani E, Ronco A. Atlas de Incidencia por Cáncer en Uruguay: período 1996-1997. Montevideo: Comisión Honoraria de Lucha contra el Cáncer, 2001. p. 150-1.
(3) Kleihues P, Cavenee K, eds. World Health Organization classification of tumours: pathology and genetics. Tumours of the nervous system. Lyon: IARC Press, 2000. 314 p.
(4) Gordon Firing S, Garbino C. Clasificación e histogénesis de los tumores primitivos del sistema nervioso central. In: Tratamiento de los tumores primitivos del sistema nervioso central: nuestra experiencia desde 1975 a 1993. Montevideo: Oficina del Libro AEM, 1995. p. 19-29.
(5) Rodríguez R, Luongo A, Mañana G, Wilson E. Tumores primarios del sistema nervioso central. In: Musé IM, Viola A, Sabini G, eds. Aspectos prácticos de la clínica oncológica. Montevideo: Sudamericana, 2004. p. 411-8.
(6) Blake LC, Maravilla KR. Computed Tomografhy. In: Berger M, Wilson CB, eds. The gliomas. Philadelphia: WB Saunders, 1999. p. 242-74.
(7) Preston Martin S. Epidemiology. IEn: Berger M, Wilson CB, eds. The gliomas. Philadelphia: WB Saunders, 1999. p. 2-11.
(8) Matías Riu J. Diagnóstico por imagen de las neoplasias intracraneales. In: Rosell R, Ariza A, Ley A, eds. Tumores del sistema nervioso central: epidemiología, nosología y terapéutica. Barcelona: Doyma, 1993. p. 31-53.
(9) Gold RL, Dillon WP. Magnetic resonance imaging. In: Berger M, Wilson CB, eds. The gliomas. Philadelphia: WB Saunders, 1999. p. 275-93.
(10) Levin VA, Kyristsis AP. Gliomas, medulloblastoma and CNS germ cell tumors. In: Cavalli F, Hansen HH, Kaye SB, eds. Textbook of medical oncology. 2 ed. London: Martin Dunitz, 2000. p. 493-520.
(11) Kowalczuk A, Macdonald RL, Amidei C, Dohrmann G 3rd, Erickson RK, Hekmatpanah J, et al. Quantitative imaging study of extent of surgical resection and prognosis of malignant astrocytomas. Neurosurgery 1997; 41(5):1028-36; discussion 1036-8.
(12) Brandes AA. State of the art treatment of high-grade brain tumors. Semin Oncol 2003; 30(6 Suppl 19):4-9.
(13) Shrieve DC, Deen DF, Larson DA. Basic Principles of Radiobiology and Radiotherapy. In: Berger M, Wilson CB, eds. The gliomas. Philadelphia: WB Saunders, 1999. p. 464-97.
(14) Leibel SA, Sheline GE. Radiotherapy in the treatment of cerebral astrocytomas. In: Thomas, D GT, ed. Neuro-oncology: primary malignant brain tumours. London: Edward Arnold, 1990. p. 193-221.
(15) Biete A, Verger E, Conill C. Radioterapia en el tratamiento de los tumores del sistema nervioso central. In: Rosell R, Ariza A, Ley A, eds. Tumores del sistema nervioso central: epidemiología, nosología y terapéutica. Barcelona: Doyma, 1993. p. 65-81.
(16) National Cancer Institute. NCI/PDQ(r) Pacientes: Tumores cerebrales en adultos: Tratamiento (PDQ(r)). Disponible en: http://www.oncolink.org/types/article.cfm?c=2&s=4&ss= 32&id=9320 Consulta: 11 oct de 2010
(17) Fink K, Schold S. Tumor dissemination and management. In: Berger M, Wilson CB, eds. The gliomas. Philadelphia: WB Saunders, 1999. p. 636- 48.
(18) Fiveash JB, Spencer SA. Role of radiation therapy and radiosurgery in glioblastoma multiforme. Cancer J 2003; 9(3):222-9.
(19) Walker MD, Alexander E Jr, Hunt WE, MacCarty CS, Mahaley MS Jr, Mealey J Jr, et al. Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas: a cooperative clinical trial. J Neurosurg 1978; 49(3):33-43.
(20) Walker MD, Green SB, Byar DP, Alexander E Jr, Batzdorf U, Brooks WH, et al. Randomized comparisons of radiotherapy and nitrosoureas for the treatment of malignant glioma after surgery. N Engl J Med 1980; 303(23):1323-9.
(21) Green SB, Byar DP, Walker MD, Pistenmaa DA, Alexander E Jr, Batzdorf U, et al. Comparisions of carmustine, procarbazine, and high dose methylprednisolone as additios to surgery and radiotherapy for treatment of malignan gliomas. Cancer Treat Rep 1983; 67(2):121-32.
(22) Fine HA, Dear KB, Loeffler JS, Black PM, Canellos GP. Meta- analysis of radiation therapy with and without adjuvant chemotherapy for malignant gliomas in adults. Cancer 1993; 71(8):2585-97.
(23) Hildebrand J, Sahmoud T, Mignolet F, Brucher JM, Afra D. Adjuvant therapy with dibromodulcitol and BCNU increases survival of adults with malignant gliomas: EORTC Brain Tumor Group. Neurology 1994; 44(8):1479-83.
(24) Medical Research Council Brain Tumor Working Party. Randomized trial of procarbazine, lomustine, and vincristine in the adjuvant treatment of high-grade astrocytoma: a Medical Research Council Trial. J Clin Oncol 2001; 19(2):509-18.
(25) Stewart LA. Chemotherapy in adult high-grade glioma: a systematic review and meta-analysis of individual patient data from 12 randomized trials. Lancet 2002; 359(9311): 1011-8.
(26) Rodríguez R, Alonso I, Suárez L, Gordon-Firing S, Aguiar S. Gliomas astrocitarios malignos. Estudio randomizado fase III comparando cirugía con radioterapia vs cirugía y quimioterapia con tenipósido. Arch Inst Neurol 2000; 3(2):78-86.
(27) Huncharek M, Muscat J, Geschwind JF. Multi-drug versus single agent chemotherapy for high grade astrocytoma; results of a meta-analysis. Anticancer Res 1998; 18(6B):4693-7.
(28) Yung WK, Albright RE, Olson J, Fredericks R, Fink K, Prados MD, et al. A phase II study of temozolomide vs. procarbazine in patients with glioblastoma multiforme at first relapse. Br J Cancer 2000; 83(5):588-93.
(29) Brandes AA, Ermani M, Basso U, Paris MK, Lumachi F, Berti F, et al. Temozolomide in patients with glioblastoma at second relapse after first line nitrosourea-procarbazine failure: a phase II estudy. Oncology 2002; 63(1):38-41.
(30) Yung WK. Temozolomide in malignant gliomas. Semin Oncol 2000; 27(3 Suppl 6):27-34.
(31) Prados MD. Future directions in the treatment of malignant gliomas with temozolomide. Semin Oncol 2000; 27(3 suppl 6):41-6.
(32) Prados MD, Levin V. Biology an treatment of malignant glioma. Semin Oncol 2000; 27(3 Suppl 6):1-10.
(33) Osoba D, Brada M, Yung WK, Prados M. Health-related quality of life in patients treated with Temozolomide versus Procarbazine for recurrent glioblastoma multiforme. J Clin Oncol 2000; 18(7):1481-91.
(34) Dinnes J, Cave C, Huang S, Milne R. A rapid and systematic review of the effectiveness of temozolomide for the treatment of recurrent malignant glioma. Br J Cancer 2002; 86(4):501-5.
(35) Stupp R, Dietrich PY, Ostermann Kraljevic S, Pica A, Maillard I, Maeder P, et al. Promising survival for patients with newly diagnosed glioblastoma multiforme treated with concomitant radiation plus temozolomide followed by adjuvant temozolomide. J Clin Oncol 2002; 20(5):1375-82.
(36) Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, et al. Radiotherapy plus Concomitant and adjuvant Temozolomide for Glioblastoma. N Engl J Med 2005; 352(10):987-96.
(37) Stupp R, Hegi ME, Mason WP, van den Bent MJ, Taphoorn MJ, Janzer RC, et al. Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol 2009; 10(5):459-66.
(38) Kelly PJ, Olsen MH, Wrght AE. Stereotactic implantation of iridium 192 into CNS neoplasms. Surg Neurol 1978; 10(6):349-54.
(39) Gordon-Firing S, Ferrari A, Rodríguez R, Alonso I, Garbino C. Tumores del sistema nervioso central. In: Vázquez T. Los cánceres más frecuentes. Montevideo: Oficina del Libro AEM, 2000. Tomo 2; p.141-88.
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2012-12-31
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Rodríguez R, Lombardo K, Roldán G, Silvera J, Lagomarsino R. Glioblastoma multiforme in the cerebral hemisphere. Survival analysis of 65 cases seen at the Oncology Department of the ClÃnicas Hospital from 1980 through 2000. Rev. Méd. Urug. [Internet]. 2012 Dec. 31 [cited 2024 Nov. 21];28(4):250-61. Available from: https://revista.rmu.org.uy/index.php/rmu/article/view/324
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