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Journal of Neuro-Oncology

, Volume 88, Issue 1, pp 105–113 | Cite as

Treatment of recurrent glioblastoma: can local delivery of mitoxantrone improve survival?

  • Amerigo Boiardi
  • Antonio Silvani
  • Marica Eoli
  • Elena Lamperti
  • Andrea Salmaggi
  • Paola Gaviani
  • Anna Fiumani
  • Andrea Botturi
  • Chiara Falcone
  • Alessandra Solari
  • Graziella Filippini
  • Francesco Di Meco
  • Giovanni Broggi
Clinical-Patient Studies

Abstract

In this study, the records of 276 adult patients with recurrent glioblastoma (GBM) treated at recurrence at our institution between 2004 and 2006 were reviewed for progression-free survival (PFS), overall survival (OS), and toxicity. At recurrence, all patients underwent systemic treatment with temozolomide (200 mg/sqm on days 1–5 every 28 days) until tumor progression. Patients, whose tumor was judged resectable without risk of adjunctive neurological deficit, underwent a second surgery with or without positioning of a Rickam/Ommaya reservoir. The reservoir was used for locoregional chemotherapy with mitoxantrone. Two hundred seventy-six rGBL patients (pts) were divided into three subgroups: A 161 pts treated only with temozolomide, B 50 pts re-operated-on +temozolomide, and C 65 pts re-operated on + temozolomide + locoregional CHT. For group A, the 6 month PFS and 6 month survival (ST) were 39.3 and 43%, respectively, with a median survival time (mST) of 5 months (range 4–6) and 25% of pts alive at 9 months. For group B, the 6 month PFS and 6 month survivors were 64 and 74.1%, respectively, with a mST of 8 months (range 6–10) and 25% of pts alive at 12 months. For group C, the 6 month PFS and 6 month survivors were 70.7 and 87.7%, respectively, with a mST of 11 months (range 9–13) and 25% of pts alive at 18 months (A vs. B vs. C, log-rank P < 0.001) (B vs. C, P = 0.041) (A vs. B P = 0.009). Cox proportional hazard model was used to obtain Hazard Ratio (HR) for type of treatment corrected by age and time (in months) between diagnosis and first recurrence: second tumor debulking was statistically effective for survival, reducing by 36% the risk of death (HR = 0.64; 0.46–0.89), but the most significant favorable prognostic factor for survival was the local delivery of mitoxantrone which reduced the risk of death to 50% (HR = 0.50; 0.38–0.68).

Keywords

Recurrent glioblastoma Ommaya reservoir Rickam Reservoir Mitoxantrone Locoregional chemotherapy 

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Copyright information

© Springer Science+Business Media, LLC. 2008

Authors and Affiliations

  • Amerigo Boiardi
    • 1
  • Antonio Silvani
    • 1
  • Marica Eoli
    • 1
  • Elena Lamperti
    • 1
  • Andrea Salmaggi
    • 1
  • Paola Gaviani
    • 1
  • Anna Fiumani
    • 1
  • Andrea Botturi
    • 1
  • Chiara Falcone
    • 2
  • Alessandra Solari
    • 2
  • Graziella Filippini
    • 2
  • Francesco Di Meco
    • 3
  • Giovanni Broggi
    • 3
  1. 1.Department of Neuro-oncologyFondazione IRCSS Istituto Neurologico Carlo BestaMilanItaly
  2. 2.Unit of Neuro-epidemiologyFondazione IRCSS Istituto Neurologico Carlo BestaMilanItaly
  3. 3.Department of NeurosurgeryFondazione IRCSS Istituto Neurologico Carlo BestaMilanItaly

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