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Strahlentherapie und Onkologie

, Volume 193, Issue 11, pp 890–896 | Cite as

Temozolomide during radiotherapy of glioblastoma multiforme

Daily administration improves survival
  • Silke Birgit NachbichlerEmail author
  • Gabi Schupp
  • Hendrik Ballhausen
  • Maximilian Niyazi
  • Claus Belka
Original Article

Abstract

Background

Temozolomide-(TMZ)-based chemoradiotherapy defines the current gold standard for the treatment of newly diagnosed glioblastoma. Data regarding the influence of TMZ dose density during chemoradiotherapy are currently not available. We retrospectively compared outcomes in patients receiving no TMZ, TMZ during radiotherapy on radiotherapy days only, and TMZ constantly 7 days a week.

Patients and methods

From 2002–2012, a total of 432 patients with newly diagnosed glioblastoma received radiotherapy in our department: 118 patients had radiotherapy alone, 210 had chemoradiotherapy with TMZ (75 mg/m2) daily (7/7), and 104 with TMZ only on radiotherapy days (5/7). Radiotherapy was applied to a total dose of 60 Gy.

Results

Median survival after radiotherapy alone was 9.1 months, compared to 12.6 months with 5/7-TMZ and to 15.7 months with 7/7-TMZ. The 1‑year survival rates were 33, 52, and 64%, respectively. Kaplan–Meier analysis showed a significant improvement of TMZ-7/7 vs. 5/7 (p = 0.01 by the log-rank test), while 5/7-TMZ was still superior to no TMZ at all (p = 0.02). Multivariate Cox regression showed a significant influence of TMZ regimen (p = 0.009) on hazard rate (+58% between groups) even in the presence of confounding factors age, sex, resection status, and radiotherapy dose concept.

Conclusion

Our results confirm the findings of the EORTC/NCIC trial. It seems that also a reduced TMZ scheme can at first prolong the survival of glioblastoma patients, but not as much as the daily administration.

Keywords

Radiosensitizing agents Chemoradiotherapy Adjuvant chemotherapy Temozolomide Schemes 

Temozolomid zur Strahlentherapie von Glioblastoma multiforme

Tägliche Gabe verbessert das Überleben

Zusammenfassung

Hintergrund

Eine Temozolomid-(TMZ-)basierte Radiochemotherapie ist der gegenwärtige Goldstandard in der Behandlung von neu diagnostizierten Glioblastomen. Daten bezüglich des Einflusses der TMZ-Dosisdichte während der Radiochemotherapie sind derzeit nicht vorhanden. Wir haben retrospektiv die Ergebnisse von Patienten verglichen, die entweder kein TMZ, TMZ zur Strahlentherapie nur an Bestrahlungstagen oder TMZ konstant 7 Tage/Woche erhalten hatten.

Patienten und Methoden

Von 2002–2012 bekamen insgesamt 432 Patienten mit einem neu diagnostizierten Glioblastom eine Strahlentherapie in unserer Abteilung: 118 Patienten wurden nur bestrahlt, 210 erhielten eine Radiochemotherapie mit TMZ (75 mg/m2) täglich (7/7) und 104 mit TMZ nur an den Bestrahlungstagen (5/7). Bestrahlt wurde mit einer Gesamtdosis von 60 Gy.

Ergebnisse

Das mediane Überleben nach Strahlentherapie alleine betrug 9,1 Monate; im Vergleich dazu 12,6 Monate mit 5/7-TMZ und 15,7 Monate mit 7/7-TMZ. Die Ein-Jahres-Überlebensraten waren entsprechend 33, 52 und 64 %. Kaplan-Meier-Analysen zeigten eine signifikante Verbesserung durch TMZ 7/7 vs. 5/7 (p = 0,01 im Log-rank-Test), während 5/7-TMZ gegenüber keinem TMZ immer noch überlegen war (p = 0,02). Die multivariate Cox-Regression zeigte einen signifikanten Einfluss des TMZ-Schemas (p = 0,009) auf die Hazard Rate (+58 % zwischen den Gruppen), auch unter Berücksichtigung der Störfaktoren Alter, Geschlecht, Resektionsstatus und Strahlentherapiedosiskonzept.

Schlussfolgerung

Unsere Ergebnisse bestätigen die Resultate der EORTC/NCIC-Studie. Es scheint, dass auch ein reduziertes TMZ-Schema zunächst das Überleben von Glioblastompatienten verlängern kann, aber nicht in dem Ausmaß wie die tägliche Applikation.

Schlüsselwörter

Strahlensensibilisierendes Agens Radiochemotherapie Adjuvante Chemotherapie Temozolomid Schemata 

Notes

Compliance with ethical guidelines

Conflict of interest

S.B. Nachbichler, G. Schupp, H. Ballhausen, M. Niyazi, and C. Belka declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Silke Birgit Nachbichler
    • 1
    Email author
  • Gabi Schupp
    • 1
  • Hendrik Ballhausen
    • 1
  • Maximilian Niyazi
    • 1
  • Claus Belka
    • 1
  1. 1.Department of Radiation OncologyLMU MunichMunichGermany

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