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Prolonged survival when temozolomide is added to accelerated radiotherapy for glioblastoma multiforme

Bei akzelerierter Bestrahlung des Glioblastoma multiforme verlängert Temozolomid das Gesamtüberleben

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Abstract

Background

The goal of this study was to evaluate accelerated radiotherapy with and without temozolomide (TMZ) for glioblastoma multiforme (GBM).

Methods

This retrospective analysis evaluated 86 patients with histologically proven GBM who were treated with accelerated radiotherapy of 1.8 Gy twice daily to a total dose of 54 Gy within 3 weeks. Median age was 62 years and median Karnofsky index was 90. A total of 41 patients received radiotherapy only from 2002–2005 and 45 patients were treated with TMZ concomitantly and after radiotherapy from 2005–2007.

Results

Median overall survival (OS) was 12.5 months and 2-year OS was 15.4%. Patient characteristics were well balanced between the two groups except for better performance status (p = 0.05) and higher frequency of retreatment for the first recurrence (p = 0.02) in the TMZ group. Age at diagnosis (HR 2.83) and treatment with TMZ (HR 0.60) were correlated with OS in the multivariate analysis: treatment with and without TMZ resulted in median OS of 16 months and 11.3 months, respectively. Hematological toxicity grade > II was observed in 2/45 patients and 5/37 patients during simultaneous radiochemotherapy and adjuvant TMZ.

Conclusion

TMZ added to accelerated radiotherapy for GBM resulted in prolonged overall survival with low rates of severe hematological toxicity.

Zusammenfassung

Hintergrund

Untersucht wurde die Behandlung des Glioblastoma multiforme (GBM) mittels akzelerierter Radiotherapie mit und ohne Temozolomid-(TMZ-)Chemotherapie.

Methodik

In dieser retrospektiven Auswertung wurden 86 Patienten mit histologisch gesichertem GBM erfasst, die mittels akzelerierter Strahlentherapie (zweimal täglich 1,8 Gy bis zu einer Gesamtdosis von 54 Gy in drei Wochen) behandelt wurden. Das mediane Alter war 62 Jahre, und der mediane Karnofsky-Index betrug 90. Im Zeitraum 2002–2005 wurden 41 Patienten mit alleiniger Strahlentherapie behandelt; im Zeitraum 2005–2007 erfolgte bei 45 Patienten zusätzlich zur Radiotherapie die simultane und adjuvante Gabe von TMZ.

Ergebnisse

Das mediane Überleben in der Gesamtkohorte betrug 12,5 Monate und das Zweijahresüberleben 15,4 %. Die Patienten- und Behandlungscharakteristika waren zwischen den beiden Gruppen ausgeglichen bis auf einen besseren Allgemeinzustand (p = 0,05) und eine höhere Rate an Rebehandlung beim ersten Rezidiv (p = 0,02) in der TMZ-Gruppe. Alter bei Diagnosestellung (HR 2,83) und Therapie mit TMZ (HR 0,60) waren in der multivariaten Analyse mit dem Gesamtüberleben korreliert. Das mediane Gesamtüberleben betrug 16 Monate und 11,3 Monate bei Therapie mit bzw. ohne TMZ. Hämatologische Toxizitäten Grad > II wurde bei 2/45 Patienten und 5/37 während Radiochemotherapie bzw. während adjuvanter TMZ-Therapie beobachtet.

Schlussfolgerungen

TMZ verbesserte im Kontext der akzelerierten Strahlentherapie das Gesamtüberleben bei gleichzeitig günstigem Toxizitätsprofil.

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Authors and Affiliations

  1. Department of Radiation Oncology, University Hospital Würzburg, Würzburg, Germany

    Matthias Guckenberger MD, Mario Mayer, Reinhart A. Sweeney & Michael Flentje

  2. Department of Neurology, University Hospital Würzburg, Würzburg, Germany

    Mathias Buttmann

  3. Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany

    Giles H. Vince

  4. Department of Radiation Oncology, University Hospital Würzburg, Josef-Schneider-St. 11, 97080, Würzburg, Germany

    Matthias Guckenberger MD

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  1. Matthias Guckenberger MD
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  2. Mario Mayer
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Correspondence to Matthias Guckenberger MD.

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Guckenberger, M., Mayer, M., Buttmann, M. et al. Prolonged survival when temozolomide is added to accelerated radiotherapy for glioblastoma multiforme. Strahlenther Onkol 187, 548–554 (2011). https://doi.org/10.1007/s00066-011-2242-6

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  • DOI: https://doi.org/10.1007/s00066-011-2242-6

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