Abstract
Background
The introduction of ALA-Fluorescence-guided surgery (FGS) followed by concomitant radiochemotherapy according to the Stupp-protocol is representative of the major changes in glioblastoma therapy in the past years. We were interested in the impact of this new first-line treatment on the overall survival of patients suffering from newly diagnosed primary glioblastoma in a retrospective single-centre study.
Method
For this retrospective analysis, data was derived from a prospective single-centre database. Patients were divided into three treatment groups: A (FGS−/radiochemotherapy−), B (FGS−/radiochemotherapy+) and C (FGS+/radiochemotherapy+). Further stratification was applied regarding MGMT-methylation status and degree of resection. Statistical analysis was performed to determine factors (treatment regime, age, gender, performance status, MGMT promoter methylation status) significantly influencing overall survival (OAS).
Results
Two hundred and fifty-three patients suffering from primary glioblastoma treated by cytoreductive surgery between 2002 and 2009 were included in this survey. Median OAS differed significantly between the treatment groups (A = 8.8, B = 16.6, C = 20.1, p < 0.01). Resection data was available in all 253 patients. The usage of FGS highly significantly correlated with a complete resection (p < 0.01). Complete resection was positively correlated with an increase in OAS (complete 20.3 months vs. incomplete 9.3 months, p < 0.01).
Conclusions
FGS and radiochemotherapy according to the Stupp protocol have induced an impressive improvement in overall survival in glioblastoma patients. This effect is not limited to clinical trials, but is reproducible in daily routine.
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This survey has been presented in part in an oral presentation at the annual 2012 meeting of the German Society of Neurosurgery (DGNC)
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Comment
This paper is timely due to its main message, that the effects of FGS and modern radiochemotherapy protocols on overall survival in GBM patients is not limited to the context of sophisticated multicenter trials. This reviewer is fully convinced that FGS is a important adjunct to our surgical armamentarium, and recognises the Authors for the merit of demonstrating that this can be transferred to daily practice. It must be recognised, however, that a single Institution-based investigational design has many inherent flaws that somehow limit the soundness of the statistical analyses.
Domenico d’Avella
Padova, Italy
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Slotty, P.J., Siantidis, B., Beez, T. et al. The impact of improved treatment strategies on overall survival in glioblastoma patients. Acta Neurochir 155, 959–963 (2013). https://doi.org/10.1007/s00701-013-1693-1
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DOI: https://doi.org/10.1007/s00701-013-1693-1