Abstract
Population-wide, only a disappointingly small number of patients with glioblastoma survives for more than 5 years. Hopefully, these figures will improve in the coming years as a result of improved neurosurgical techniques and the use of radiochemotherapy according to the EORTC 26981 protocol also outside of clinical studies. Additionally, new and innovative therapies are hoped to contribute to better outcomes. In this review, we summarize current knowledge about prognosticators of long-term survival in glioblastoma patients. In addition, we address the functional status of long-term survivors including neurological deficits, neuropsychological impairment and quality of life. Younger age and higher Karnofsky performance score are known independent clinical factors associated with longer overall survival (OS). Extent of surgery and chemotherapy are also favorable factors supporting long-term survival. An abundance of molecular markers has been repeatedly screened for their influence on survival of glioblastoma patients. To date, only a methylated MGMT promoter status and more recently the presence of IDH1 mutations, have been shown to be associated with better survival rates in glioblastoma. Clinical outcome has special significance for long-term survivors. The reviewed data show that neurological deficits are common in these patients, and many patients additionally suffer from seizures and fatigue. Cognitive deficits are commonly underestimated if not carefully examined. Neuropsychological testing reveals deficits in one or several domains in the majority of long-term surviving patients, even in those with normal Mini-Mental status score. Nonetheless, only little reduction in overall quality of life and global health status were reported for the population of long-term survivors. With some patients in full remission for more than 10 years, the question arises, whether a glioblastoma can ever be considered to be cured. However, the occurrence of late and very late relapses after more than 5 and even more than 10 years in full remission rather argues for the maintenance of a tight control schedule for this remarkable population.
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Acknowledgment
The Dr. Senckenberg Institute of Neurooncology is supported by the Dr. Senckenberg Foundation and the Hertie Foundation. J.P.S. is “Hertie Professor of Neurooncology.”
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Bähr, O., Steinbach, J.P. (2011). Long-Term Survivors of Glioblastoma. In: Hayat, M. (eds) Tumors of the Central Nervous System, Volume 1. Tumors of the Central Nervous System, vol 1. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-0344-5_41
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