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Journal of Neuro-Oncology

, Volume 145, Issue 1, pp 75–83 | Cite as

Receipt of brachytherapy is an independent predictor of survival in glioblastoma in the Surveillance, Epidemiology, and End Results database

  • Jiri BartekJr
  • Ali A. Alattar
  • Sanjay Dhawan
  • Jun Ma
  • Tomoyuki Koga
  • Peter Nakaji
  • Kathryn E. Dusenbery
  • Clark C. ChenEmail author
Clinical Study

Abstract

Introduction

There has been a resurgence of interest in brachytherapy as a treatment for glioblastoma, with several currently ongoing clinical trials. To provide a foundation for the analysis of these trials, we analyze the Surveillance, Epidemiology, and End Results (SEER) database to determine whether receipt of brachytherapy conveys a survival benefit independent of traditional prognostic factors.

Materials and methods

We identified 60,456 glioblastoma patients, of whom 362 underwent brachytherapy. We grouped patients based on receipt of brachytherapy and compared clinical and demographic variables between groups using Student’s t-test and Pearson’s chi-squared test. We assessed survival using Kaplan–Meier curves and Cox proportional hazards models.

Results

Median overall survival was 16 months in patients who received brachytherapy compared to 9 months in those who did not (log-rank p < 0.001). Patients who underwent brachytherapy tended to be younger (p < 0.001), suffered from smaller tumors (< 4 cm, p < 0.001), and were more likely to have undergone gross total resection (GTR, p < 0.001). In univariable Cox models, these variables were independently associated with improved overall survival. Additionally, improved survival was associated with known receipt of chemotherapy (HR 0.459, p < 0.001), external beam radiation (HR 0.447, p < 0.001), and brachytherapy (HR 0.637, p < 0.001). The association between brachytherapy and improved survival remained robust (HR 0.859, p = 0.031) in a multivariable model that adjusted for patient age, tumor size, tumor location, GTR, receipt of chemotherapy, and receipt of external beam radiation.

Conclusion

Our SEER analysis indicates that brachytherapy is associated with improved survival in glioblastoma after controlling for age, tumor size/location, extent of resection, chemotherapy, and external beam radiation.

Keywords

Brachytherapy Glioblastoma Surveillance, Epidemiology, and End Results (SEER) Survival 

Notes

Funding

None.

Compliance with ethical standards

Conflict of interest

All authors declare no conflict of interest.

Ethical approval

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.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Medicine and the Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
  2. 2.Department of NeurosurgeryKarolinska University HospitalStockholmSweden
  3. 3.Department of NeurosurgeryRigshospitaletCopenhagenDenmark
  4. 4.Faculty of Health SciencesUCSDSan DiegoUSA
  5. 5.Department of NeurosurgeryUniversity of MinnesotaMinneapolisUSA
  6. 6.Barrow Brain and SpinePhoenixUSA
  7. 7.Department of Radiation OncologyUniversity of MinnesotaMinneapolisUSA
  8. 8.Department of NeurosurgeryUniversity of MinnesotaMinneapolisUSA

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