Abstract
The aim of this retrospective study is to provide real-world evidence in glioblastoma treatment and to compare overall survival after Stupp's regimen treatment today and a decade ago. A current consecutive cohort of histologically confirmed glioblastoma irradiated from 1/2014 to 12/2017 in our cancer center was compared with an already published historical control of patients treated in 1/2003–12/2009. A total of new 155 patients was analyzed, median age 60.9 years, 61% men, 58 patients (37%) underwent gross total tumor resection. Stupp's regimen was indicated in 90 patients (58%), 65 patients (42%) underwent radiotherapy alone. Median progression-free survival in Stupp's regimen cohort was 6.7 months, median OS 16.0 months, and 2-year OS 30.7%. OS was longer if patients were able to finish at least three cycles of adjuvant chemotherapy (median 23.3 months and 43.9% of patients lived at 2 years after surgery). Rapid early progression prior to radiotherapy was a negative prognostic factor with HR 1.87 (p = 0.007). The interval between surgery and the start of radiotherapy (median 6.7 weeks) was not prognostically significant (p = 0.825). The median OS in the current cohort was about 2 months longer than in the historical control group treated 10 years ago (16 vs. 13.8 months) using the same Stupp's regimen. Taking into account differences in patient's characteristics between current and historical cohorts, age, extent of resection, and ECOG patient performance status adjusted HR (Stupp's regimen vs. RT alone) for OS was determined as 0.45 (p = 0.002).
Highlights
Despite intensive multimodal treatment of glioblastoma consisting of maximal safe resection followed by combined chemoradiotherapy, all patients develop tumor recurrence and subsequently die for further glioblastoma progression [1, 2]
All patients after glioma surgery were discussed in the multidisciplinary neurooncology tumor board and those eligible for postsurgery oncology treatment were referred to radiotherapy consultation
Gross total resection was achieved in 58 (37%) patients and more than 80% were in good general condition (ECOG 0–1)
Summary
Despite intensive multimodal treatment of glioblastoma consisting of maximal safe resection followed by combined chemoradiotherapy (well-known Stupp’s regimen), all patients develop tumor recurrence and subsequently die for further glioblastoma progression [1, 2]. Real-world evidence data are an increasingly important supplement to clinical and translational research. These analyses of current real-world patients treated outside controlled clinical trials may identify hidden needs as well as provide survival data for proper powering in future clinical trials. This is especially relevant in glioblastoma where no positive practice changing trial, focused on the treatment of the best prognostic glioblastoma subcohort, was published during the last 15 years despite huge advances in the understanding of glioblastoma in general [9, 10]
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