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Survival improvement in patients with glioblastoma multiforme during the last 20 years in a single tertiary-care center

Überlebensverlängerung von Patienten mit Glioblastoma multiforme während der letzten 20 Jahre in einem tertiären Versorgungszentrum

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Zusammenfassung

Studienziel

Ziel der retrospektiven Analyse war es, die Überlebensdauer und einen eventuellen Fortschritt von 357 konsekutiven Patienten mit Gliob lastoma multiforme (GBM) innerhalb von 3 Gruppen aus unterschiedlichen Diagnose-Zeiträumen (Gruppe A: 1982–1984, B: 1994/1995; C: 1996–1998), die während der letzten 20 Jahre an unserem tertiärem Zentrum behandelt wurden, zu untersuchen.

Patienten und Methoden

Patienten der Gruppe A (n=100) wurden zwischen 1982 und 1984 diagnostiziert und dienten als historische Kontrolle. Patienten der Gruppe B (n=93) wurden 1994/1995 und Patienten der Gruppe C (n=164) zwischen 1996 und 1998 diagnostiziert.

Die Überlebens-Analyse wurde durchgeführt in Bezug auf die drei Patientengruppen (A versus B versus C), in Bezug auf die applizierten Therapiemodalitäten nach neurochirurgischer Intervention (keine spezifische Therapie versus Radiotherapie versus kombinierte Radio-/Chemotherapie), in Bezug auf die unterschiedlichen first-line Chemotherapien, in Bezug auf Alter, Geschlecht und Tumorlokalisation. Die non-parametrische Kaplan-Meier Methode wurde angewandt. Ein p-Wert <0,05 wurde als statistisch signifikant angesehen.

Patienten der Gruppen A und B erhielten Radio- und/oder Chemotherapie in einem unterschiedlichen Ausmaß (Radiotherapie: Gruppe A: 22%, Gruppe B: 62%; Chemotherapie: Gruppe A: 6%, Gruppe B: 33%). Die Chemotherapie wurde in beiden Gruppen nach Abschluss der Radiotherapie appliziert. In Gruppe C erhielten 96% der Patienten eine kombinierte Radio-/Chemotherapie innerhalb von 3 Wochen nach der neurochriurgischen Intervention.

Ergbnisse

Das mediane Überleben betrug in Gruppe A 5,2 Monate, in Gruppe B 5, 1 Monate und in Gruppe C 14,5 Monate (p<0,0001). Länger als 18 Monate lebten 9% der Patienten in Gruppe A, 10% der Patienten in Gruppe B und 25% der Patienten in Gruppe C (p<0,05).

Schlussfolgerung

Die Überlebenszeitverbesserung in Gruppe C ist auf die frühzeitige und kombineierte Applikation von Radio-/Chemotherapie zurückzuführen. Die Therapie wurde ambulant durchgeführt; dies wurde durch ein interdisziplinäres neuro-onkologisches Team ermöglicht. Die Nebenwirkungen waren mild und die Akzeptanz bei den Patienten hervorragend.

Summary

Methodology

The survival of 357 consecutive patients with newly diagnosed glioblastoma multiforme (GBM) in three treatment groups reflecting different time-periods of diagnosis (A: 1982–1984; B: 1994/1995; C: 1996–1998) was analysed to assess the impact and the potential improvement of changing treatment strategies in our tertiary-care center.

Patients and methods

Group A (n=100) included all consecutive patients diagnosed from 1982 to 1984 and served as the historical control. Group B (n=93) included all consecutive patients diagnosed in 1994/1995 and group C (n=164) those diagnosed from 1996 to 1998. Survival in the three treatment groups (A vs. B vs. C) was analysed according to treatment given after neurosurgical intervention (i.e. no specific therapy versus radiotherapy versus combined radio-/chemotherapy), and according to first-line chemotherapy, age (<40, 40–60, ≥60), sex, and tumor location (hemispheric versus bilateral or multifocal tumors, and tumors involving eloquent brain areas). Survival was analysed using Kaplan-Meier’s non-parametric method. A p-value <0.05 was considered statistically significant.

Results

Patients in groups A and B received radio-and/or chemotherapy to a varying extent (radiotherapy: group A: 22%, group B: 62%; chemotherapy: group A: 6%, group B: 33%). Chemotherapy was administered after termination of radiotherapy in both groups. In group C, 96% of patients received combined radio-/chemotherapy which was administered concomitantly and started within three weeks after surgery.

Median survival was 5.2 months in group A, 5.1 months in group B and 14.5 months in C (p<0.0001). Nine patients in group A (9%), 9 in group B (10%) and 40 in group C (25%) survived more than 18 months (p<0.05).

Conclusions

Survival improvement in group C might be attributable to the early start of combined radio-/chemotherapy. Therapy was administered on a complete outpatient basis, enabled by a dedicated interdisciplinary neuro-oncologic team caring for group C. Toxicity was mild and patients’ acceptance excellent.

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Authors and Affiliations

  1. Clinical Division of Oncology & Ludwig Boltzmann Intitute for Clinical Experimental Oncology, Department of Medicine 1, University of Vienna, Währinger Gürtel 18-20, A-1090, Wien, Austria

    Barbara Fazeny-Dörner, Anwar Gyries, Alexandra Budinsky, Maria Piribauer & Christine Marosi MD

  2. Department of Neurosurgery, University of Vienna, Vienna, Austria

    Karl Rössler, Karl Ungersböck, Thomas Czech & Monika Killer

  3. Department for Radiooncology, University of Vienna, Vienna, Austria

    Karin Dieckmann

  4. 5th Medical Department, Hospital Lainz, Vienna, Austria

    Gerhart Baumgartner

  5. Department of Neuroradiology, University of Vienna, Vienna, Austria

    Daniela Prayer

  6. Clinical Institute for Medical and Chemical Laboratory Diagnostics, University of Vienna, Vienna, Austria

    Mario Veitl

  7. Department of Anesthesiology and University of Vienna, Vienna, Austria

    Manfred Mulim

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  1. Barbara Fazeny-Dörner
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  2. Anwar Gyries
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  3. Karl Rössler
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  4. Karl Ungersböck
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  5. Thomas Czech
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  7. Monika Killer
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  8. Karin Dieckmann
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  9. Maria Piribauer
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  10. Gerhart Baumgartner
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  11. Daniela Prayer
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  13. Manfred Mulim
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  14. Christine Marosi MD
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Correspondence to Christine Marosi MD.

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Fazeny-Dörner, B., Gyries, A., Rössler, K. et al. Survival improvement in patients with glioblastoma multiforme during the last 20 years in a single tertiary-care center. Wien Klin Wochenschr 115, 389–397 (2003). https://doi.org/10.1007/BF03040358

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  • DOI: https://doi.org/10.1007/BF03040358

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