Long-term survival in a patient with supratentorial glioblastoma: clinical considerations

Quantifying the angiogenesis of C6 glioma in rats based on CT quantitative parameters

Background

Glioma is the most common neoplasm that is neuroepithelial in nature. However, Spectral computed tomography (CT) has rarely been reported to detect angiogenesis in tumors.

Purpose

To investigate the value of multi-parameter spectral CT for the detection of angiogenesis in C6 glioma in rats.

Material and Methods

Fifteen male Wistar rats were seeded with C6 glioma cells in the right basal ganglia and spectral CT-enhanced scanning was performed at days 7, 10, and 14 after the C6 glioma cells were seeded. The spectral CT parameters were measured in three areas: the solid tumor; the peritumoral area; and the contralateral mirror area. After different periods of scanning, the rats’ brain tissue was stained with HE and CD105 immunohistochemical staining. Different periods of spectral CT quantitative parameters and pathological images were analyzed.

Results

The spectral CT parameter and CD105 among the solid tumor, peritumoral area, and contralateral mirror area were significantly different: monochromatic CT value (211.30 ± 34.67 HU, 119.16 ± 13.31 HU, and 55.59 ± 7.87 HU, P < 0.001); CD105 (16.14 ± 1.91, 6.79 ± 1.31, and 2.50 ± 0.51, P < 0.001); spectral curve slope (10.35 ± 1.89, 5.33 ± 0.87, 0.88 ± 0.26, P < 0.001); iodine (water) value (49.75 ± 9.02, 26.04 ± 4.32, 4.36 ± 1.18, P < 0.001). CD105 correlated strongly with the CT value at 65 keV (correlation coefficient r = 0.98, P < 0.001).

Conclusion

Multi-parameter spectral CT can reflect the formation of tumor angiogenesis in rat C6 glioma to a certain extent and can be used as an effective means to evaluate glioma.

Ten-year survival in glioblastoma. A systematic review

Glioblastoma (GBM) is among the most deadly neoplasms associated with one of the worst 5-year overall survival (OS) rates among all human cancers. The aim of this systematic review is to present all cases with OS of a decade or more and to perform a descriptive analysis of the group. This systematic review was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. A comprehensive search for relevant articles was performed on PubMed, Embase and Google Scholar for a period until June 10, 2016, using the following search words: glioblastoma multiforme, glioblastoma, GBM, long-term survival/survivors. Reports containing cases with the long-term survival of 10 years or longer were included in the review. The search produced 36 studies with 162 cases published in the years 1950-2014. The rate of long survivors in the cohort studied was established 0.76%. Mean age at diagnosis, OS and PFS were 31.1 ± 11.1, 15.9 ± 6.3, 11.9 ± 5.6 years respectively. Total and subtotal resections were found in 82 and 58 patients respectively. Nine cases received a biopsy alone. No statistical differences were found in a comparison of PFS, OS and age between total and subtotal resection groups. A regression analysis showed a significant correlation between PFS and OS, with an inverse relationship stated between age at diagnosis and OS. The 10-year survival rate in the cohort studied with GBM was estimated 0.71%. OS was positively correlated with the length of PFS and inversely related with age at diagnosis.

Prognostic factors for long-term survival after glioblastoma

Long-term survivors of glioblastoma (GB) are rare. Several variables besides tumor size and location determine a patient's survival chances: age at diagnosis, where younger patients often receive more aggressive treatment that is multimodal; functional status, which has a significant negative correlation with age; and histologic and genetic markers.

Surgery for malignant gliomas: mechanistic reasoning and slippery statistics

Current surgical treatment of malignant gliomas largely depends on mechanistic reasoning and data collected in non-randomised studies. Technological advance has enabled more accurate resection of tumours and preservation of eloquent brain areas but ethical considerations have restricted randomised trials on the efficacy of surgery to one small trial that found a 3 month survival advantage for patients over age 65 years who received surgery and interim analysis of a larger trial. There is an argument for surgery as a palliative measure in patients with symptoms caused by mechanisms that are surgically remediable. Whether there is any survival advantage from surgery in patients other than those with immediately life-threatening, surgically remediable complications, such as raised intracranial pressure, is unclear. The available data show that if such an advantage does exist, it is modest at best. Adjuvant treatments given surgically are being studied. Chemotherapy wafers are the most prominent of the adjuvant treatments but the evidence available is insufficient to recommend their use in routine practice. In this review we examine the prevailing mechanistic model and observational data; we assess how these are applied and the priorities they indicate for future research.

The influence of sex and the presence of giant cells on postoperative long-term survival in adult patients with supratentorial glioblastoma multiforme

OBJECT

Glioblastoma multiforme (GBM) remains incurable by conventional treatments, although some patients experience long-term survival. A younger age, a higher Karnofsky Performance Scale (KPS) score, more aggressive treatment, and long progression-free intervals have been reported to be positively associated with long-term postoperative patient survival. The aim of this retrospective study was the identification of additional favorable prognostic factors affecting long-term survival in surgically treated adult patients with supratentorial GBM.

METHODS

Of 113 adult patients newly diagnosed with histologically verified supratentorial GBM who were enrolled in Phase III trials during the period between 1987 and 1998, six (5.3%) who survived for longer than 5 years were defined as long-term survivors, whereas the remaining 107 patients served as controls. All six were women and were compared with the controls; they were younger (mean age 44.2 years, range 31-60 years), and their preoperative KPS scores were higher (mean 85, range 60-100). Four of the six patients underwent gross-total resection. In five patients (83.3%) the progression-free interval was longer than 5 years and in three a histopathological diagnosis of giant cell GBM was made. This diagnosis was not made in the other 107 patients.

CONCLUSIONS

Among adult patients with supratentorial GBM, female sex and histopathological characteristics consistent with giant cell GBM may be predictive of a better survival rate, as may traditional factors (that is, younger age, good KPS score, more aggressive resection, and a long progression-free interval).