Evaluation of outcome and prognostic factors in patients of glioblastoma multiforme: A single institution experience

Narendra Kumar; Pankaj Kumar; Shabab Lalit Angurana; Divya Khosla; Kanchan Kumar Mukherjee; Rupali Aggarwal; Ritesh Kumar; Anjan Bera; Suresh Chander Sharma

doi:10.4103/0976-3147.116455

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Original Article

4 (

Supp 1

); S46-S55

doi:

10.4103/0976-3147.116455

Evaluation of outcome and prognostic factors in patients of glioblastoma multiforme: A single institution experience

Narendra Kumar, Pankaj Kumar^,, Shabab Lalit Angurana, Divya Khosla, Kanchan Kumar Mukherjee, Rupali Aggarwal, Ritesh Kumar, Anjan Bera, Suresh Chander Sharma

Department of Radiotherapy and Oncology,India

1 Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Sector - 12, Chandigarh, India

Dr. Narendra Kumar Department of Radiotherapy, Regional Cancer Centre, Postgraduate Institute of Medical Education and Research Sector - 12, Chandigarh - 160 012 India drnarendra74@gmail.com

Journal of Neurosciences in Rural Practice

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This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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This article was originally published by Thieme Medical and Scientific Publishers Private Ltd. and was migrated to Scientific Scholar after the change of Publisher.

Abstract

ABSTRACT

Aims: We present retrospective analysis of patients of glioblastoma multiforme (GBM) and discuss clinical characteristics, various treatment protocols, survival outcomes, and prognostic factors influencing survival. Materials and Methods: From January 2002 to June 2009, 439 patients of GBM were registered in our department. The median age of patients was 50 years, 66.1% were males, and 75% underwent complete or near-total excision. We evaluated those 360 patients who received radiotherapy (RT). Radiotherapy schedule was selected depending upon pre-RT Karnofsky Performance Status (KPS). Patients with KPS < 70 (Group I, n = 48) were planned for RT dose of 30-35 Gy in 10-15 fractions, and patients with KPS ≥ 70 (Group II, n = 312) were planned for 60 Gy in 30 fractions. In group I, six patients and in group II, 89 patients received some form of chemotherapy (lomustine or temozolomide). Statistical Analysis Used: Statistical analysis was done using Statistical Package for Social Sciences, version 12.0. Overall survival (OS) was calculated using Kaplan-Meier method, and prognostic factors were determined by log rank test. The Cox proportional hazards model was used for multivariate analysis. Results: The median follow-up was 7.53 months. The median and 2-year survival rates were 6.33 months and 2.24% for group I and 7.97 months and 8.21% for group II patients, respectively ( P = 0.001). In multivariate analysis, site of tumor (central vs. others; P = 0.006), location of tumor (parietal lobe vs. others; P = 0.003), RT dose (<60 Gy vs. 60 Gy; P = 0.0001), and use of some form of chemotherapy ( P = 0.0001) were independent prognostic factors for survival. Conclusions: In patients with GBM, OS and prognosis remains dismal. Whenever possible, we should use concurrent and/or adjuvant chemotherapy to maximize the benefits of post-operative radiotherapy. Patients with poor performance status may be considered for hypofractionated RT schedules, which have similar median survival rates as conventional RT.

Keywords

Glioblastoma multiforme

prognostic factors

radiotherapy

survival

temozolomide

Show Related Articles from PubMed

Conflict of Interest

None declared

References

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[Google Scholar]
Curran W. J., Scott C. B., Horton J, Nelson J. S., Weinstein A. S., Fischbach A. J., et al . Recursive partitioning analysis of prognostic factors in three Radiation Therapy Oncology Group malignant glioma Trials. J Natl Cancer Inst. 1993;85:704-10.
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Lutterbach J, Sauerbrei W, Guttenberger R, . Multivariate analysis of Prognostic factors in patients with glioblastoma. Strahlenther Onkol. 2003;179:8-15.
[Google Scholar]
Stupp R, Mason W. P., van den Bent M. J., Weller M, Fisher B, Taphoorn M. J., et al . Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005;352:987-96.
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Stupp R, Hegi M. E., Mason W. P., van den Bent M. J., Taphoorn M. J., Janzer R. C., 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;10:459-66.
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Chang C. H., Horton J, Schoenfeld D, Salazer O, Perez-Tamayo R, Kramer S, et al . Comparison of postoperative radiotherapy and combined postoperative radiotherapy and chemotherapy in the multidisciplinary management of malignant gliomas. Cancer. 1983;52:997-1007.
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Nakagawa K, Aoki Y, Fujimaki T, Tago M, Terahara A, Karasawa K, et al . High-dose conformal radiotherapy influenced the pattern of failure but did not improve survival in glioblastoma multiforme. Int J Radiat Oncol Biol Phys. 1998;40:1141-9.
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Chan J. L., Lee S. W., Frass B. A., . Survival and failure patterns of high grade glioma after three-dimensional conformal radiotherapy. J Clin Oncol. 2002;20:1635-42.
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Kleinberg L, Slick T, Enger C, Grossman S, Brem H, Wharam M. D. Jr, . Short course radiotherapy is an appropriate option for most malignant glioma patients. Int J Radiat Oncol Biol Phys. 1997;38:31-6.
[Google Scholar]
Lang O, Liebermeister E, Liesegang J, Sautter-Bihl M. L., . Radiotherapy of glioblastoma multiforme. Strahlenther Onkol. 1998;174:629-32.
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Phillips C, Guiney M, Smith J, Hughes P, Narayan K, Quong G, . A randomized trial comparing 35Gy in ten fractions with 60Gy in 30 fractions of cerebral irradiation for glioblastoma multiforme and older patients with anaplastic astrocytoma. Radiother Oncol. 2003;68:23-6.
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Gundersen S, Lote K, Hannisdal E, . Prognostic factors for glioblastoma multiforme-development of a prognostic index. Acta Oncol. 1996;35:123-7.
[Google Scholar]
Gorlia T, van den Bent M. J., Hegi M. E., Mirimanoff R. O., Weller M, Cairncross J. G., et al . Nomograms for predicting survival of patients with newly diagnosed glioblastoma: Prognostic factor analysis of EORTC and NCIC trial 26981-22981/CE.3. Lancet Oncol. 2008;9:29-38.
[Google Scholar]
Stenning S. P., Freedman L. S., Bleehen N. M., . Prognostic factors for high-grade malignant glioma: Development of a prognostic index. J Neurooncol. 1990;9:47-55.
[Google Scholar]
Hulshof M. C., Schimmel E. C., Andries Bosch D, Gonzalez Gonzalez D, . Hypofractionation in glioblastoma multiforme. Radiother Oncol. 2000;54:143-8.
[Google Scholar]
Terasaki M, Eto T, Nakashima S, Okada Y, Ogo E, Sugita Y, et al . A pilot study of hypofractionated radiation therapy with temozolomide for adults with glioblastoma multiforme. J Neurooncol. 2011;102:247-53.
[Google Scholar]
Cao J. Q., Fisher B. J., Bauman G. S., Megyesi J. F., Watling C. J., Macdonald D. R., . Hypofractionated radiotherapy with or without concurrent temozolomide in elderly patients with glioblastoma multiforme: A review of ten-year single institutional experience. J Neurooncol. 2012;107:395-405.
[Google Scholar]
Simpson J. R., Horton J, Scott C, Curran W. J., Rubin P, Fischbach J, et al . Influence of location and extent of surgical resection on survival of patients with glioblastoma multiforme: Results of three consecutive Radiation Therapy Oncology Group (RTOG) clinical trials. Int J Radiat Oncol Biol Phys. 1993;26:239-41.
[Google Scholar]
Jeremic B, Grujicic D, Antunovic V, Djuric L, Stonjanovic M, Shibamoto Y, . Influence of extent of surgery and tumor location on treatment outcome of patients with glioblastoma multiforme treated with combined modality approach. J Neurooncol. 1994;21:177-85.
[Google Scholar]
Tait M. J., Petrik V, Loosemore A, Bell B. A., Papadopoulos M. C., . Survival of patients with glioblastoma multiforme has not improved between 1993 and 2004: Analysis of 625 cases. Br J Neurosurg. 2007;21:496-500.
[Google Scholar]
Gehan E. A., Walker M. D., . Prognostic factors for patients with brain tumors. Natl Cancer Inst Monogr. 1977;46:189-95.
[Google Scholar]
Sanai N, Berger M. S., . Glioma extent of resection and its impact on patient outcome. Neurosurgery. 2008;62:753-64.
[Google Scholar]
Sanai N, Polley M. Y., McDermott M. W., Parsa A. T., Berger M. S., . An extent of resection threshold for newly diagnosed glioblastomas. J Neurosurg. 2011;115:3-8.
[Google Scholar]
Scott J. G., Bauchet L, Fraum T. J., Nayak L, Cooper A. R., Chao S. T., et al . Recursive partitioning analysis of prognostic factors for glioblastoma patients aged 70 years or older. Cancer. 2012;118:5595-600.
[Google Scholar]
Jalali R, Basu A, Gupta T, Munshi A, Menon H, Sarin R, Goel A, . Encouraging experience of concomitant Temozolomide with radiotherapy followed by adjuvant Temozolomide in newly diagnosed glioblastoma multiforme: Single institution experience. Br J Neurosurg. 2007;21:583-7.
[Google Scholar]
Demirci U, Buyukberber S, Coskun U, Akmansu M, Yaman E, Baykara M, et al . Long term experience in high grade glial tumors with temozolomide. J Buon. 2012;17:357-62.
[Google Scholar]
Kocher M, Frommolt P, Borberg S. K., Ruhi U, Steingraber M, Niewald M, et al . Randomized study of postoperative radiotherapy and simultaneous temozolomide without adjuvant chemotherapy for glioblastoma. Strahlenther Onkol. 2008;184:572-9.
[Google Scholar]

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[1] Lacroix M, Abi-Said D, Fourney D. R., Gokaslan Z. L., Shi W, DeMonte F, et al . A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection and survival. J Neurosurg. 2001;95:190-8.
[Google Scholar]

[2] Curran W. J., Scott C. B., Horton J, Nelson J. S., Weinstein A. S., Fischbach A. J., et al . Recursive partitioning analysis of prognostic factors in three Radiation Therapy Oncology Group malignant glioma Trials. J Natl Cancer Inst. 1993;85:704-10.
[Google Scholar]

[3] Lutterbach J, Sauerbrei W, Guttenberger R, . Multivariate analysis of Prognostic factors in patients with glioblastoma. Strahlenther Onkol. 2003;179:8-15.
[Google Scholar]

[4] Stupp R, Mason W. P., van den Bent M. J., Weller M, Fisher B, Taphoorn M. J., et al . Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005;352:987-96.
[Google Scholar]

[5] Stupp R, Hegi M. E., Mason W. P., van den Bent M. J., Taphoorn M. J., Janzer R. C., 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;10:459-66.
[Google Scholar]

[6] Macdonald D. R., Cascino T. L., Schold S. C. Jr, Cairncross J. G., . Response criteria for phase II studies of supratentorial malignant glioma. J Clin Oncol. 1990;8:1277-80.
[Google Scholar]

[7] Kristiansen K, Hagen S, Kollevold T, Torvik A, Holme I, Nesbakken R, et al . Combined modality therapy of operated astrocytomas grade III and IV. Cancer. 1981;47:649-52.
[Google Scholar]

[8] Laperriere N, Zuraw L, Cairncross G, . The cancer care ontario practice guidelines initiative neuro-oncology disease site group. Radiother Oncol. 2002;64:259-73.
[Google Scholar]

[9] Stewart L. A., . Chemotherapy in adult high-grade glioma: A systematic review and meta-analysis of individual patient data from 12 randomised trials. Lancet. 2002;359:1011-8.
[Google Scholar]

[10] 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;19:509-18.
[Google Scholar]

[11] Laws E. R., Parney I. F., Huang W, Anderson F, Morris A. M., Asher A, et al . Survival following surgery and prognostic factors for recently diagnosed malignant glioma: Data from the glioma outcomes project. J Neurosurg. 2003;99:467-73.
[Google Scholar]

[12] Walker M. D., Alexander E Jr, Hunt W. E., MacCarty C. S., Mahaley M. S. Jr, Mealey J Jr, et al . Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas. J Neurosurg. 1978;49:333-43.
[Google Scholar]

[13] Bleehen N. M., Stenning S. P., . A medical research council trial of two radiotherapy doses in the treatment of 3 and 4 astrocytoma. Br J Cancer. 1991;64:769-74.
[Google Scholar]

[14] Chang C. H., Horton J, Schoenfeld D, Salazer O, Perez-Tamayo R, Kramer S, et al . Comparison of postoperative radiotherapy and combined postoperative radiotherapy and chemotherapy in the multidisciplinary management of malignant gliomas. Cancer. 1983;52:997-1007.
[Google Scholar]

[15] Nakagawa K, Aoki Y, Fujimaki T, Tago M, Terahara A, Karasawa K, et al . High-dose conformal radiotherapy influenced the pattern of failure but did not improve survival in glioblastoma multiforme. Int J Radiat Oncol Biol Phys. 1998;40:1141-9.
[Google Scholar]

[16] Chan J. L., Lee S. W., Frass B. A., . Survival and failure patterns of high grade glioma after three-dimensional conformal radiotherapy. J Clin Oncol. 2002;20:1635-42.
[Google Scholar]

[17] Kleinberg L, Slick T, Enger C, Grossman S, Brem H, Wharam M. D. Jr, . Short course radiotherapy is an appropriate option for most malignant glioma patients. Int J Radiat Oncol Biol Phys. 1997;38:31-6.
[Google Scholar]

[18] Lang O, Liebermeister E, Liesegang J, Sautter-Bihl M. L., . Radiotherapy of glioblastoma multiforme. Strahlenther Onkol. 1998;174:629-32.
[Google Scholar]

[19] Phillips C, Guiney M, Smith J, Hughes P, Narayan K, Quong G, . A randomized trial comparing 35Gy in ten fractions with 60Gy in 30 fractions of cerebral irradiation for glioblastoma multiforme and older patients with anaplastic astrocytoma. Radiother Oncol. 2003;68:23-6.
[Google Scholar]

[20] Manon R, Hui S, Chinnaiyan P, Suh J, Chang E, Timmerman R, et al . The impact of mid-treatment MRI on defining boost volumes in the radiation treatment of glioblastoma multiforme. Technol Cancer Res Treat. 2004;3:303-7.
[Google Scholar]

[21] Gundersen S, Lote K, Hannisdal E, . Prognostic factors for glioblastoma multiforme-development of a prognostic index. Acta Oncol. 1996;35:123-7.
[Google Scholar]

[22] Gorlia T, van den Bent M. J., Hegi M. E., Mirimanoff R. O., Weller M, Cairncross J. G., et al . Nomograms for predicting survival of patients with newly diagnosed glioblastoma: Prognostic factor analysis of EORTC and NCIC trial 26981-22981/CE.3. Lancet Oncol. 2008;9:29-38.
[Google Scholar]

[23] Stenning S. P., Freedman L. S., Bleehen N. M., . Prognostic factors for high-grade malignant glioma: Development of a prognostic index. J Neurooncol. 1990;9:47-55.
[Google Scholar]

[24] Hulshof M. C., Schimmel E. C., Andries Bosch D, Gonzalez Gonzalez D, . Hypofractionation in glioblastoma multiforme. Radiother Oncol. 2000;54:143-8.
[Google Scholar]

[25] Terasaki M, Eto T, Nakashima S, Okada Y, Ogo E, Sugita Y, et al . A pilot study of hypofractionated radiation therapy with temozolomide for adults with glioblastoma multiforme. J Neurooncol. 2011;102:247-53.
[Google Scholar]

[26] Cao J. Q., Fisher B. J., Bauman G. S., Megyesi J. F., Watling C. J., Macdonald D. R., . Hypofractionated radiotherapy with or without concurrent temozolomide in elderly patients with glioblastoma multiforme: A review of ten-year single institutional experience. J Neurooncol. 2012;107:395-405.
[Google Scholar]

[27] Simpson J. R., Horton J, Scott C, Curran W. J., Rubin P, Fischbach J, et al . Influence of location and extent of surgical resection on survival of patients with glioblastoma multiforme: Results of three consecutive Radiation Therapy Oncology Group (RTOG) clinical trials. Int J Radiat Oncol Biol Phys. 1993;26:239-41.
[Google Scholar]

[28] Jeremic B, Grujicic D, Antunovic V, Djuric L, Stonjanovic M, Shibamoto Y, . Influence of extent of surgery and tumor location on treatment outcome of patients with glioblastoma multiforme treated with combined modality approach. J Neurooncol. 1994;21:177-85.
[Google Scholar]

[29] Tait M. J., Petrik V, Loosemore A, Bell B. A., Papadopoulos M. C., . Survival of patients with glioblastoma multiforme has not improved between 1993 and 2004: Analysis of 625 cases. Br J Neurosurg. 2007;21:496-500.
[Google Scholar]

[30] Gehan E. A., Walker M. D., . Prognostic factors for patients with brain tumors. Natl Cancer Inst Monogr. 1977;46:189-95.
[Google Scholar]

[31] Sanai N, Berger M. S., . Glioma extent of resection and its impact on patient outcome. Neurosurgery. 2008;62:753-64.
[Google Scholar]

[32] Sanai N, Polley M. Y., McDermott M. W., Parsa A. T., Berger M. S., . An extent of resection threshold for newly diagnosed glioblastomas. J Neurosurg. 2011;115:3-8.
[Google Scholar]

[33] Scott J. G., Bauchet L, Fraum T. J., Nayak L, Cooper A. R., Chao S. T., et al . Recursive partitioning analysis of prognostic factors for glioblastoma patients aged 70 years or older. Cancer. 2012;118:5595-600.
[Google Scholar]

[34] Jalali R, Basu A, Gupta T, Munshi A, Menon H, Sarin R, Goel A, . Encouraging experience of concomitant Temozolomide with radiotherapy followed by adjuvant Temozolomide in newly diagnosed glioblastoma multiforme: Single institution experience. Br J Neurosurg. 2007;21:583-7.
[Google Scholar]

[35] Demirci U, Buyukberber S, Coskun U, Akmansu M, Yaman E, Baykara M, et al . Long term experience in high grade glial tumors with temozolomide. J Buon. 2012;17:357-62.
[Google Scholar]

[36] Kocher M, Frommolt P, Borberg S. K., Ruhi U, Steingraber M, Niewald M, et al . Randomized study of postoperative radiotherapy and simultaneous temozolomide without adjuvant chemotherapy for glioblastoma. Strahlenther Onkol. 2008;184:572-9.
[Google Scholar]

Evaluation of outcome and prognostic factors in patients of glioblastoma multiforme: A single institution experience

Abstract

ABSTRACT

Keywords

Glioblastoma multiforme

prognostic factors

radiotherapy

survival

temozolomide

Conflict of Interest

References

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