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Lenffer B, Ruben J, Senthi S, Millar J, Ong WL. Management and outcomes of glioblastoma: 20-year experience in a single Australian institution. J Med Imaging Radiat Oncol 2023. [PMID: 37997616 DOI: 10.1111/1754-9485.13607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION We aimed to evaluate the changing patterns in the management of glioblastoma (GBM) and impact on survival outcomes over a 20-year period. METHODS This is a retrospective study of patients diagnosed with GBM between 2001 and 2020, who had radiation therapy (RT) in an Australian institution. The primary outcomes were changes in treatment modalities (including surgery, RT, and chemotherapy) over time and overall survival (OS). Multivariable Cox regressions were used to evaluate factors associated with OS, including age, sex, ECOG performance status, treatment modalities, treatment facility, and year of treatment. RESULTS 1079 patients were included in this study. Thirty-five per cent of patients had gross total resection, increasing from 31% in 2001-2005 to 45% in 2016-2020 (P < 0.001). Sixty-four per cent of patients had ≥60 Gy RT, increasing from 57% in 2001-2005 to 66% in 2016-2020 (P < 0.001). Seventy-five per cent of patients had chemotherapy, increasing from 22% in 2001-2005 to 89% in 2016-2020 (P < 0.001). Treatment received varied based on patients' age and ECOG performance status. The median OS for the entire cohort was 13.0 months (95% CI = 12.0-13.7). Median OS in patients who had maximal treatment (i.e., gross total resection, ≥60 Gy RT and chemotherapy) was 20.6 months (95% CI = 17.3-22.8). In multivariable analyses, age, sex, treatment facility, extent of surgical resection, RT dose, and chemotherapy use were associated with OS. CONCLUSION This is one of the largest Australian series on the management and outcomes of GBM spanning a 20-year period. We observed improvement in OS over time, which is likely associated with evolving treatment options over the study period.
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Affiliation(s)
- Bianca Lenffer
- Alfred Health Radiation Oncology, Melbourne, Victoria, Australia
| | - Jeremy Ruben
- Alfred Health Radiation Oncology, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Sashendra Senthi
- Alfred Health Radiation Oncology, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jeremy Millar
- Alfred Health Radiation Oncology, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Wee Loon Ong
- Alfred Health Radiation Oncology, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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2
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Basiri Z, Yang Y, Bruinsma FJ, Nowak AK, McDonald KL, Drummond KJ, Rosenthal MA, Koh ES, Harrup R, Hovey E, Joseph D, Benke G, Leonard R, MacInnis RJ, Milne RL, Giles GG, Vajdic CM, Lynch BM. Physical activity and glioma: a case-control study with follow-up for survival. Cancer Causes Control 2022; 33:749-757. [PMID: 35184245 PMCID: PMC9010385 DOI: 10.1007/s10552-022-01559-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 02/01/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE High-grade disease accounts for ~ 70% of all glioma, and has a high mortality rate. Few modifiable exposures are known to be related to glioma risk or mortality. METHODS We examined associations between lifetime physical activity and physical activity at different ages (15-18 years, 19-29 years, 30-39 years, last 10 years) with the risk of glioma diagnosis, using data from a hospital-based family case-control study (495 cases; 371 controls). We followed up cases over a median of 25 months to examine whether physical activity was associated with all-cause mortality. Physical activity and potential confounders were assessed by self-administered questionnaire. We examined associations between physical activity (metabolic equivalent [MET]-h/wk) and glioma risk using unconditional logistic regression and with all-cause mortality in cases using Cox regression. RESULTS We noted a reduced risk of glioma for the highest (≥ 47 MET-h/wk) versus lowest (< 24 METh/wk) category of physical activity for lifetime activity (OR = 0.58, 95% CI: 0.38-0.89) and at 15-18 years (OR = 0.57, 95% CI: 0.39-0.83). We did not observe any association between physical activity and all-cause mortality (HR for lifetime physical activity = 0.91, 95% CI: 0.64-1.29). CONCLUSION Our findings are consistent with previous research that suggested physical activity during adolescence might be protective against glioma. Engaging in physical activity during adolescence has many health benefits; this health behavior may also offer protection against glioma.
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Affiliation(s)
- Zohreh Basiri
- Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia
| | - Yi Yang
- Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia.,Cancer Epidemiology Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Fiona J Bruinsma
- Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia.,Cancer Epidemiology Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Anna K Nowak
- Medical School, QEII Medical Centre Unit, University of Western Australia, Nedlands, WA, Australia.,Department of Medical Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Kerrie L McDonald
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | | | | | - Eng-Siew Koh
- South Western Sydney Clinical School, University of New South Wales, Liverpool, NSW, Australia.,Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Rosemary Harrup
- Royal Hobart Hospital, University of Tasmania, Hobart, TAS, Australia
| | - Elizabeth Hovey
- Department Medical Oncology Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, University of New South Wales, Sydney, NSW, Australia.,Department Medicine, University of New South Wales, Sydney, NSW, Australia
| | - David Joseph
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Geza Benke
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Robyn Leonard
- Brain Cancer Biobanking Australia, University of Sydney, Sydney, NSW, Australia
| | - Robert J MacInnis
- Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia.,Cancer Epidemiology Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Roger L Milne
- Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia.,Cancer Epidemiology Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia.,Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Graham G Giles
- Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia.,Cancer Epidemiology Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia.,Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Claire M Vajdic
- Centre for Big Data Research in Health, University of NSW, Sydney, NSW, Australia
| | - Brigid M Lynch
- Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia. .,Cancer Epidemiology Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia. .,Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
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3
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Kommers I, Bouget D, Pedersen A, Eijgelaar RS, Ardon H, Barkhof F, Bello L, Berger MS, Conti Nibali M, Furtner J, Fyllingen EH, Hervey-Jumper S, Idema AJS, Kiesel B, Kloet A, Mandonnet E, Müller DMJ, Robe PA, Rossi M, Sagberg LM, Sciortino T, van den Brink WA, Wagemakers M, Widhalm G, Witte MG, Zwinderman AH, Reinertsen I, Solheim O, De Witt Hamer PC. Glioblastoma Surgery Imaging-Reporting and Data System: Standardized Reporting of Tumor Volume, Location, and Resectability Based on Automated Segmentations. Cancers (Basel) 2021; 13:2854. [PMID: 34201021 PMCID: PMC8229389 DOI: 10.3390/cancers13122854] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/28/2021] [Accepted: 06/02/2021] [Indexed: 01/01/2023] Open
Abstract
Treatment decisions for patients with presumed glioblastoma are based on tumor characteristics available from a preoperative MR scan. Tumor characteristics, including volume, location, and resectability, are often estimated or manually delineated. This process is time consuming and subjective. Hence, comparison across cohorts, trials, or registries are subject to assessment bias. In this study, we propose a standardized Glioblastoma Surgery Imaging Reporting and Data System (GSI-RADS) based on an automated method of tumor segmentation that provides standard reports on tumor features that are potentially relevant for glioblastoma surgery. As clinical validation, we determine the agreement in extracted tumor features between the automated method and the current standard of manual segmentations from routine clinical MR scans before treatment. In an observational consecutive cohort of 1596 adult patients with a first time surgery of a glioblastoma from 13 institutions, we segmented gadolinium-enhanced tumor parts both by a human rater and by an automated algorithm. Tumor features were extracted from segmentations of both methods and compared to assess differences, concordance, and equivalence. The laterality, contralateral infiltration, and the laterality indices were in excellent agreement. The native and normalized tumor volumes had excellent agreement, consistency, and equivalence. Multifocality, but not the number of foci, had good agreement and equivalence. The location profiles of cortical and subcortical structures were in excellent agreement. The expected residual tumor volumes and resectability indices had excellent agreement, consistency, and equivalence. Tumor probability maps were in good agreement. In conclusion, automated segmentations are in excellent agreement with manual segmentations and practically equivalent regarding tumor features that are potentially relevant for neurosurgical purposes. Standard GSI-RADS reports can be generated by open access software.
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Affiliation(s)
- Ivar Kommers
- Department of Neurosurgery, Amsterdam University Medical Centers, Vrije Universiteit, 1081 HV Amsterdam, The Netherlands; (I.K.); (R.S.E.); (D.M.J.M.)
- Cancer Center Amsterdam, Brain Tumor Center, Amsterdam University Medical Centers, 1081 HV Amsterdam, The Netherlands
| | - David Bouget
- Department of Health Research, SINTEF Digital, NO-7465 Trondheim, Norway; (D.B.); (A.P.); (I.R.)
| | - André Pedersen
- Department of Health Research, SINTEF Digital, NO-7465 Trondheim, Norway; (D.B.); (A.P.); (I.R.)
| | - Roelant S. Eijgelaar
- Department of Neurosurgery, Amsterdam University Medical Centers, Vrije Universiteit, 1081 HV Amsterdam, The Netherlands; (I.K.); (R.S.E.); (D.M.J.M.)
- Cancer Center Amsterdam, Brain Tumor Center, Amsterdam University Medical Centers, 1081 HV Amsterdam, The Netherlands
| | - Hilko Ardon
- Department of Neurosurgery, Twee Steden Hospital, 5042 AD Tilburg, The Netherlands;
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Vrije Universiteit, 1081 HV Amsterdam, The Netherlands;
- Institutes of Neurology and Healthcare Engineering, University College London, London WC1E 6BT, UK
| | - Lorenzo Bello
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Humanitas Research Hospital, Università Degli Studi di Milano, 20122 Milano, Italy; (L.B.); (M.C.N.); (M.R.); (T.S.)
| | - Mitchel S. Berger
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94143, USA; (M.S.B.); (S.H.-J.)
| | - Marco Conti Nibali
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Humanitas Research Hospital, Università Degli Studi di Milano, 20122 Milano, Italy; (L.B.); (M.C.N.); (M.R.); (T.S.)
| | - Julia Furtner
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, 1090 Wien, Austria;
| | - Even H. Fyllingen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway;
- Department of Radiology and Nuclear Medicine, St. Olav’s Hospital, Trondheim University Hospital, NO-7030 Trondheim, Norway
| | - Shawn Hervey-Jumper
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94143, USA; (M.S.B.); (S.H.-J.)
| | - Albert J. S. Idema
- Department of Neurosurgery, Northwest Clinics, 1815 JD Alkmaar, The Netherlands;
| | - Barbara Kiesel
- Department of Neurosurgery, Medical University Vienna, 1090 Wien, Austria; (B.K.); (G.W.)
| | - Alfred Kloet
- Department of Neurosurgery, Haaglanden Medical Center, 2512 VA The Hague, The Netherlands;
| | - Emmanuel Mandonnet
- Department of Neurological Surgery, Hôpital Lariboisière, 75010 Paris, France;
| | - Domenique M. J. Müller
- Department of Neurosurgery, Amsterdam University Medical Centers, Vrije Universiteit, 1081 HV Amsterdam, The Netherlands; (I.K.); (R.S.E.); (D.M.J.M.)
- Cancer Center Amsterdam, Brain Tumor Center, Amsterdam University Medical Centers, 1081 HV Amsterdam, The Netherlands
| | - Pierre A. Robe
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Marco Rossi
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Humanitas Research Hospital, Università Degli Studi di Milano, 20122 Milano, Italy; (L.B.); (M.C.N.); (M.R.); (T.S.)
| | - Lisa M. Sagberg
- Department of Neurosurgery, St. Olav’s Hospital, Trondheim University Hospital, NO-7030 Trondheim, Norway;
| | - Tommaso Sciortino
- Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Humanitas Research Hospital, Università Degli Studi di Milano, 20122 Milano, Italy; (L.B.); (M.C.N.); (M.R.); (T.S.)
| | | | - Michiel Wagemakers
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
| | - Georg Widhalm
- Department of Neurosurgery, Medical University Vienna, 1090 Wien, Austria; (B.K.); (G.W.)
| | - Marnix G. Witte
- Department of Radiation Oncology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands;
| | - Aeilko H. Zwinderman
- Department of Clinical Epidemiology and Biostatistics, Amsterdam University Medical Centers, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands;
| | - Ingerid Reinertsen
- Department of Health Research, SINTEF Digital, NO-7465 Trondheim, Norway; (D.B.); (A.P.); (I.R.)
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway;
| | - Ole Solheim
- Department of Neurosurgery, St. Olav’s Hospital, Trondheim University Hospital, NO-7030 Trondheim, Norway;
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway
| | - Philip C. De Witt Hamer
- Department of Neurosurgery, Amsterdam University Medical Centers, Vrije Universiteit, 1081 HV Amsterdam, The Netherlands; (I.K.); (R.S.E.); (D.M.J.M.)
- Cancer Center Amsterdam, Brain Tumor Center, Amsterdam University Medical Centers, 1081 HV Amsterdam, The Netherlands
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4
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McAlpine H, Sejka M, Drummond KJ. Brain tumour patients' use of social media for disease management: Current practices and implications for the future. PATIENT EDUCATION AND COUNSELING 2021; 104:395-402. [PMID: 32771243 DOI: 10.1016/j.pec.2020.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 05/11/2020] [Accepted: 07/14/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The role of social media in disease management is evolving. We aimed to define current use of social media for patients with primary brain tumours. METHODS This was a single-centre cross-sectional prospective study; a questionnaire was administered on electronic tablets to patients in the Outpatient Department of Royal Melbourne Hospital. RESULTS Of the 201 participants, 55.7 % were female and 61.2 % were aged 30-59 years. The Internet was used by 84.5 % of participants, 70.6 % of those used social media. This included social networking sites (33.1 %), wikis (28.1 %) and blogs (14.0 %) to access information, for communication or for interaction related to their brain tumour. Participants indicated preferences for privacy and flexibility and valued when health professionals contributed. Subjective social functioning and activities of daily living benefits were reported from use, however no difference in Health Related Quality of Life was found between social media users and non-users. CONCLUSIONS This study is the first to examine social media use in disease management for brain tumour patients and defines its use and potential for targeted online interventions. PRACTICE IMPLICATIONS Through identifying concerns regarding current social media sites and determining preferences of patients we have created recommendations to direct design of online content for patients.
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Affiliation(s)
- Heidi McAlpine
- Department of Neurosurgery, The Royal Melbourne Hospital, Parkville, Australia.
| | - Magdalena Sejka
- Department of Neurosurgery, The Royal Melbourne Hospital, Parkville, Australia
| | - Katharine J Drummond
- Department of Neurosurgery, The Royal Melbourne Hospital, Parkville, Australia; Department of Surgery, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia.
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5
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Poon MTC, Sudlow CLM, Figueroa JD, Brennan PM. Longer-term (≥ 2 years) survival in patients with glioblastoma in population-based studies pre- and post-2005: a systematic review and meta-analysis. Sci Rep 2020; 10:11622. [PMID: 32669604 PMCID: PMC7363854 DOI: 10.1038/s41598-020-68011-4] [Citation(s) in RCA: 162] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 02/25/2020] [Indexed: 02/06/2023] Open
Abstract
Translation of survival benefits observed in glioblastoma clinical trials to populations and to longer-term survival remains uncertain. We aimed to assess if ≥ 2-year survival has changed in relation to the trial of radiotherapy plus concomitant and adjuvant temozolomide published in 2005. We searched MEDLINE and Embase for population-based studies with ≥ 50 patients published after 2002 reporting survival at ≥ 2 years following glioblastoma diagnosis. Primary endpoints were survival at 2-, 3- and 5-years stratified by recruitment period. We meta-analysed survival estimates using a random effects model stratified according to whether recruitment ended before 2005 (earlier) or started during or after 2005 (later). PROSPERO registration number CRD42019130035. Twenty-three populations from 63 potentially eligible studies contributed to the meta-analyses. Pooled 2-year overall survival estimates for the earlier and later study periods were 9% (95% confidence interval [CI] 6-12%; n/N = 1,488/17,507) and 18% (95% CI 14-22%; n/N = 5,670/32,390), respectively. Similarly, pooled 3-year survival estimates increased from 4% (95% CI 2-6%; n/N = 325/10,556) to 11% (95% CI 9-14%; n/N = 1900/16,397). One study with a within-population comparison showed similar improvement in survival among the older population. Pooled 5-year survival estimates were 3% (95% CI 1-5%; n/N = 401/14,919) and 4% (95% CI 2-5%; n/N = 1,291/28,748) for the earlier and later periods, respectively. Meta-analyses of real-world data suggested a doubling of 2- and 3-year survival in glioblastoma patients since 2005. However, 5-year survival remains poor with no apparent improvement. Detailed clinically annotated population-based data and further molecular characterization of longer-term survivors may explain the unchanged survival beyond 5 years.
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Affiliation(s)
- Michael T C Poon
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Brain Tumour Centre of Excellence, Cancer Research UK Edinburgh Centre, University of Edinburgh, Edinburgh, UK
| | - Cathie L M Sudlow
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Brain Tumour Centre of Excellence, Cancer Research UK Edinburgh Centre, University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, Edinburgh BioQuarter, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Jonine D Figueroa
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Brain Tumour Centre of Excellence, Cancer Research UK Edinburgh Centre, University of Edinburgh, Edinburgh, UK
| | - Paul M Brennan
- Brain Tumour Centre of Excellence, Cancer Research UK Edinburgh Centre, University of Edinburgh, Edinburgh, UK.
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, Edinburgh BioQuarter, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
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6
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Johnston A, Creighton N, Parkinson J, Koh ES, Wheeler H, Hovey E, Rodriguez M, Currow DC. Ongoing improvements in postoperative survival of glioblastoma in the temozolomide era: a population-based data linkage study. Neurooncol Pract 2019; 7:22-30. [PMID: 32257281 DOI: 10.1093/nop/npz021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Translating outcomes achieved by clinical trials into routine care is crucial to improving outcomes of glioblastoma (GBM). This study examines the extent to which an advance in treatment for GBM has translated into meaningful, population-level survival benefits in New South Wales (NSW), Australia. Methods This retrospective cohort study used linked population-based cancer registry, admitted patient, and mortality datasets. The cohort (n = 2604) included NSW residents aged ≥18 years with a histologically confirmed GBM and a surgical resection between July 2001 and December 2012. The study outcome was all-cause survival, examined using multivariable proportional hazard models. The main study factor was period of surgery, categorized into 4 periods corresponding to different eras in temozolomide (TMZ) use. Survival was examined over time by age (≤70 and >70 years) and for a subcohort selected to approximate the seminal European Organisation for Research and Treatment of Cancer (Stupp) protocol trial cohort. TMZ use was estimated using aggregate prescription claims data. Results Median survival in 2001-2003, 2004-2006, 2007-2009, and 2010-2012 was 7.4, 9.0, 9.8, and 10.6 months, and risk-adjusted 2-year survival was 8.2%, 13.8%, 15.5%, and 18.3%, respectively. Survival improved for those aged ≤70 years and those aged >70 years. In the proxy trial subcohort, median and 2-year survival were 14.3 months and 27.3%, respectively. The volume of TMZ prescribed annually increased rapidly from 2005. Conclusions Introduction of TMZ into standard care in 2005 coincided with improvements in survival and a rapid increase in TMZ prescribing. Optimization of care has continued to improve survival of people with GBM in subsequent years.
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Affiliation(s)
| | | | - Jonathon Parkinson
- The Brain Cancer Group, Bill Walsh Translational Cancer Research Laboratory, Kolling Institute, St Leonards, NSW, Australia.,Northern Sydney Local Health District, St Leonards, NSW, Australia.,The University of Sydney Northern Clinical School, Royal North Shore Hospital, St. Leonards, NSW, Australia
| | - Eng-Siew Koh
- University of New South Wales, Sydney, Australia.,Ingham Institute of Applied Medical Research, Sydney, Australia.,Liverpool and Macarthur Cancer Therapy Centres, Sydney, Australia.,Department of Medical Oncology, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, Australia
| | - Helen Wheeler
- The Brain Cancer Group, Bill Walsh Translational Cancer Research Laboratory, Kolling Institute, St Leonards, NSW, Australia.,Northern Sydney Local Health District, St Leonards, NSW, Australia.,The University of Sydney Northern Clinical School, Royal North Shore Hospital, St. Leonards, NSW, Australia
| | - Elizabeth Hovey
- University of New South Wales, Sydney, Australia.,Department of Medical Oncology, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, Australia
| | - Michael Rodriguez
- Department of Anatomical Pathology, Prince of Wales Hospital, Sydney, Australia
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The 2016 revision of the WHO Classification of Central Nervous System Tumours: retrospective application to a cohort of diffuse gliomas. J Neurooncol 2017; 137:181-189. [PMID: 29218432 DOI: 10.1007/s11060-017-2710-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 12/05/2017] [Indexed: 10/18/2022]
Abstract
The classification of central nervous system tumours has more recently been shaped by a focus on molecular pathology rather than histopathology. We re-classified 82 glial tumours according to the molecular-genetic criteria of the 2016 revision of the World Health Organization (WHO) Classification of Tumours of the Central Nervous System. Initial diagnoses and grading were based on the morphological criteria of the 2007 WHO scheme. Because of the impression of an oligodendroglial component on initial histological assessment, each tumour was tested for co-deletion of chromosomes 1p and 19q and mutations of isocitrate dehydrogenase (IDH-1 and 2) genes. Additionally, expression of proteins encoded by alpha-thalassemia X-linked mental retardation (ATRX) and TP53 genes was assessed by immunohistochemistry. We found that all but two tumours could be assigned to a specific category in the 2016 revision. The most common change in diagnosis was from oligoastrocytoma to specifically astrocytoma or oligodendroglioma. Analysis of progression free survival (PFS) for WHO grade II and III tumours showed that the objective criteria of the 2016 revision separated diffuse gliomas into three distinct molecular categories: chromosome 1p/19q co-deleted/IDH mutant, intact 1p/19q/IDH mutant and IDH wild type. No significant difference in PFS was found when comparing IDH mutant grade II and III tumours suggesting that IDH status is more informative than tumour grade. The segregation into distinct molecular sub-types that is achieved by the 2016 revision provides an objective evidence base for managing patients with grade II and III diffuse gliomas based on prognosis.
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8
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Tully PA, Gogos AJ, Love C, Liew D, Drummond KJ, Morokoff AP. Reoperation for Recurrent Glioblastoma and Its Association With Survival Benefit. Neurosurgery 2017; 79:678-689. [PMID: 27409404 DOI: 10.1227/neu.0000000000001338] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Glioblastoma is the most common and aggressive primary brain tumor. Despite current treatment, recurrence is inevitable. There are no clear guidelines for treatment of recurrent glioblastoma. OBJECTIVE To investigate factors at initial surgery predictive of reoperation, and the prognostic variables associated with survival, including reoperation for recurrence. METHODS A retrospective cohort study was performed, including adult patients diagnosed with glioblastoma between January 2010 and December 2013. Student t test and Fisher exact test compared continuous and categorical variables between reoperation and nonreoperation groups. Univariable and Cox regression multivariable analysis was performed. RESULTS In a cohort of 204 patients with de novo glioblastoma, 49 (24%) received reoperation at recurrence. The median overall survival in the reoperation group was 20.1 months compared with 9.0 months in the nonreoperation group (P = .001). Reoperation was associated with longer overall survival in our total population (hazard ratio, 0.646; 95% confidence interval, 0.543-0.922; P = .016) but subject to selection bias. Subgroup analyses excluding patients unlikely to be considered for reoperation suggested a much less significant effect of reoperation on survival, which warrants further study with larger cohorts. Factors at initial surgery predictive for reoperation were younger age, smaller tumor size, initial extent of resection ≥50%, shorter inpatient stay, and maximal initial adjuvant therapy. When unfavorable patient characteristics are excluded, reoperation is not an independent predictor of survival. CONCLUSION Patients undergoing reoperation have favorable prognostic characteristics, which may be responsible for the survival difference observed. We recommend that a large clinical registry be developed to better aid consistent and homogenous data collection. ABBREVIATIONS ECOG, Eastern Cooperative Oncology GroupEOR, extent of resectionIDH-1, isocitrate dehydrogenase 1IP, inpatientMGMT, O-methylguanine methyltransferaseOS, overall survivalPFS, progression-free survivalRMH, Royal Melbourne Hospital.
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Affiliation(s)
- Patrick A Tully
- *Department of Neurosurgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia;‡The University of Notre Dame Australia, School of Medicine, Melbourne Clinical School, Werribee, Victoria;§The Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
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Langbecker D, Ekberg S, Yates P. Don't need help, don't want help, can't get help: How patients with brain tumors account for not using rehabilitation, psychosocial and community services. PATIENT EDUCATION AND COUNSELING 2017; 100:1744-1750. [PMID: 28433408 DOI: 10.1016/j.pec.2017.04.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 04/06/2017] [Accepted: 04/08/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To understand why some adults with primary brain tumors do not use support services despite indications of a need for help. METHODS Nineteen adults recently diagnosed with primary brain tumors participated in semi-structured interviews. Thematic analysis was used to identify recurrent ways participants explained their non-use of support services. RESULTS Some patients indicated that they did not use support services as they did not need help, in particular reporting positive experiences relative to their expectations or to others, that their needs were met, or difficulties recognizing their needs. Some patients reported not wanting help, citing preferences to self-manage, other priorities, or negative perceptions of the services available. Many patients identified barriers to support service utilization, particularly problems recognizing that services could address their needs and that their needs were valid concerns. CONCLUSION The gap between patients' needs and their service use may result from patients' expectations from the medical system, shifting of standards for well-being, cognitive changes, and access issues. PRACTICE IMPLICATIONS Addressing knowledge barriers and perceptions relating to help-seeking, as well as recognizing the challenges specific to this patient group in terms of need recognition and access issues, may assist in improving patients' physical, psychological and social well-being.
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Affiliation(s)
- Danette Langbecker
- Centre for Online Health, The University of Queensland, Brisbane, Australia; Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
| | - Stuart Ekberg
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
| | - Patsy Yates
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
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10
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Harris G, Jayamanne D, Wheeler H, Gzell C, Kastelan M, Schembri G, Brazier D, Cook R, Parkinson J, Khasraw M, Louw S, Back M. Survival Outcomes of Elderly Patients With Glioblastoma Multiforme in Their 75th Year or Older Treated With Adjuvant Therapy. Int J Radiat Oncol Biol Phys 2017; 98:802-810. [DOI: 10.1016/j.ijrobp.2017.02.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 01/01/2017] [Accepted: 02/14/2017] [Indexed: 10/20/2022]
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11
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Gzell C, Back M, Wheeler H, Bailey D, Foote M. Radiotherapy in Glioblastoma: the Past, the Present and the Future. Clin Oncol (R Coll Radiol) 2017; 29:15-25. [DOI: 10.1016/j.clon.2016.09.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 08/22/2016] [Accepted: 08/25/2016] [Indexed: 10/25/2022]
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12
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Altwairgi AK, Algareeb W, Yahya G, Maklad AM, Aly MM, Al Shakweer W, Balbaid A, Alsaeed E, Alhussain H, Orz Y, Lary A, Elyamany A. Outcome of patients with glioblastoma in Saudi Arabia: Single center experience. Mol Clin Oncol 2016; 4:756-762. [PMID: 27123275 PMCID: PMC4840558 DOI: 10.3892/mco.2016.818] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/25/2016] [Indexed: 11/21/2022] Open
Abstract
Glioblastoma multiforme (GBM), the most common primary brain tumor in adults, is associated with one of the worst 5 year survival rates among all human cancer types. To date, no published data are available for the outcome of this disease in Saudi Arabia. The present study performed a single-center, retrospective cohort study to evaluate the outcome of patients with GBM in Saudi Arabia. The Comprehensive Cancer Center at King Fahad Medical city (Riyadh, Saudi Arabia) was used in the present study. All adult patients (≥18 years) diagnosed with histologically proven GBM between January 2008 and December 2013 were included in the present study. A total of 90 patients were treated during the specified period. Of this, 73 (81%) patients underwent resection and 17 (19%) had biopsy only. The majority of patients (n=88; 98%) received radiotherapy (XRT): 67 (76%) with standard and 21 (24%) with hypo-fractionated dosage. Of the total patients, 65 (72%) received combined modality therapy [standard XRT concurrently with Temozolmide (TMZ)]. The 6 month progression-free survival rate was 43% for all patients and 55% for the combined modality subgroup. The median overall survival (OS) for all patients was 13.7 months. However, the median OS for patients treated with combined modality was 19.7 months. In this single-center retrospective study, the outcomes of patients with GBM were similar to those in previously reported studies. An improved outcome was associated with an improved performance status, absence of residual disease and use of adjuvant TMZ.
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Affiliation(s)
- Abdullah K Altwairgi
- Medical Oncology Department, Comprehensive Cancer Center, King Fahad Medical City, Riyadh 11525, Saudi Arabia
| | - Waleed Algareeb
- Medical Oncology Department, Comprehensive Cancer Center, King Fahad Medical City, Riyadh 11525, Saudi Arabia
| | - Gaaem Yahya
- Medical Oncology Department, Comprehensive Cancer Center, King Fahad Medical City, Riyadh 11525, Saudi Arabia
| | - Ahmed M Maklad
- Radiation Oncology Department, Comprehensive Cancer Center, King Fahad Medical City, Riyadh 11525, Saudi Arabia; Clinical Oncology and Nuclear Medicine Department, Sohag University, Sohag 11432, Egypt
| | - Moamen Mom Aly
- Radiation Oncology Department, Comprehensive Cancer Center, King Fahad Medical City, Riyadh 11525, Saudi Arabia; Radiotherapy and Nuclear Medicine Department, South Egypt Cancer Institute, Assiut University, Assiut 71515, Egypt
| | - Wafa Al Shakweer
- Pathology and Clinical Laboratory Medicine Department, King Fahad Medical City, Riyadh 11525, Saudi Arabia
| | - Ali Balbaid
- Radiation Oncology Department, Comprehensive Cancer Center, King Fahad Medical City, Riyadh 11525, Saudi Arabia
| | - Eyad Alsaeed
- Radiation Oncology Department, Comprehensive Cancer Center, King Fahad Medical City, Riyadh 11525, Saudi Arabia
| | - Hussain Alhussain
- Radiation Oncology Department, Comprehensive Cancer Center, King Fahad Medical City, Riyadh 11525, Saudi Arabia
| | - Yassir Orz
- National Neuroscience Institute, King Fahad Medical City, Riyadh 11525, Saudi Arabia
| | - Ahmed Lary
- National Neuroscience Institute, King Fahad Medical City, Riyadh 11525, Saudi Arabia
| | - Ashraf Elyamany
- Medical Oncology Department, Comprehensive Cancer Center, King Fahad Medical City, Riyadh 11525, Saudi Arabia
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13
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Primary brain tumor patients’ supportive care needs and multidisciplinary rehabilitation, community and psychosocial support services: awareness, referral and utilization. J Neurooncol 2015; 127:91-102. [DOI: 10.1007/s11060-015-2013-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 11/22/2015] [Indexed: 11/29/2022]
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14
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Parakh S, Thursfield V, Cher L, Dally M, Drummond K, Murphy M, Rosenthal MA, Gan HK. Recurrent glioblastoma: Current patterns of care in an Australian population. J Clin Neurosci 2015; 24:78-82. [PMID: 26549675 DOI: 10.1016/j.jocn.2015.08.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 08/14/2015] [Indexed: 11/25/2022]
Abstract
This retrospective population-based survey examined current patterns of care for patients with recurrent glioblastoma (rGBM) who had previously undergone surgery and post-operative therapy at original diagnosis. The patients were identified from the Victorian Cancer Registry (VCR) from 2006 to 2008. Patient demographics, tumour characteristics and oncological management were extracted using a standardised survey by the treating clinicians/VCR staff and results analysed by the VCR. Kaplan-Meier estimates of overall survival (OS) at diagnosis and progression were calculated. A total of 95 patients (48%) received treatment for first recurrence; craniotomy and post-operative treatment (38), craniotomy only (34) and non-surgical treatment (23). Patients receiving treatment at first progression had a higher median OS than those who did not (7 versus 3 months, p<0.0001). All patients progressed after treatment for first progression with 43 patients (45%) receiving treatment at second progression. To our knowledge this is the first population-based pattern of care survey of treatment for rGBM in an era where post-operative "Stupp" chemo-radiation is standard. First and second line therapy for rGBM is common and associated with significant benefit. Treatment generally includes re-resection and/or systemic therapy.
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Affiliation(s)
- Sagun Parakh
- Department of Medical Oncology, Austin Health, 145 Studley Road, Heidelberg, Melbourne, VIC 3084, Australia
| | - Vicky Thursfield
- Cancer Epidemiology Centre, Cancer Council of Victoria, Melbourne, VIC, Australia
| | - Lawrence Cher
- Department of Medical Oncology, Austin Health, 145 Studley Road, Heidelberg, Melbourne, VIC 3084, Australia
| | | | - Katharine Drummond
- Department of Neurosurgery, Royal Melbourne Hospital, Parkville, Melbourne, VIC, Australia; Department of Surgery, Melbourne University, Melbourne, VIC, Australia
| | - Michael Murphy
- St. Vincent's Hospital, Fitzroy, Melbourne, VIC, Australia
| | - Mark A Rosenthal
- Department of Clinical Haematology and Medical Oncology, Royal Melbourne Hospital, Grattan Street, Parkville, VIC, Australia
| | - Hui K Gan
- Department of Medical Oncology, Austin Health, 145 Studley Road, Heidelberg, Melbourne, VIC 3084, Australia; Olivia Newton-John Cancer Research Institute, Austin Health, Melbourne, VIC, Australia; School of Cancer Medicine, La Trobe University, Melbourne, VIC, Australia.
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15
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Mason M, Laperriere N, Wick W, Reardon DA, Malmstrom A, Hovey E, Weller M, Perry JR. Glioblastoma in the elderly: making sense of the evidence. Neurooncol Pract 2015; 3:77-86. [PMID: 31386084 DOI: 10.1093/nop/npv027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Indexed: 11/14/2022] Open
Abstract
Glioblastoma is a highly malignant neoplasm, notorious for its poor prognosis. The median age of diagnosis is 64 years, with an increasing number of patients diagnosed over the age of seventy. Managing elderly patients with this condition is challenging. Management pathways may include surgery, radiotherapy, chemotherapy, and best supportive care. Many clinical trials in oncology exclude elderly patients, including some of those for malignant brain tumors, leaving less evidence to guide treatment in these patients. Recent advances in molecular diagnostics and biomarkers, such as 06-methylguanine-DNA-methyltransferase (MGMT) promoter methylation status, may help guide optimal treatment selection. Focusing on available randomized data, this review provides a practical overview of the evidence for treating newly diagnosed glioblastoma in the elderly, including management recommendations.
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Affiliation(s)
- Matthew Mason
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada (M.M., N.L.); Neurology Clinic and National Center for Tumor Disease and Neurology Clinic, Heidelberg University Medical Center and DKFZ, Heidelberg, Germany (W.W); Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA(D.A.R.); Department of Advanced Home Care and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden (A.M.); Department of Medical Oncology, Prince of Wales Hospital, Randwick NSW, Australia (E.H.); Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, Zürich, Switzerland (M.W.); Division of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (J.R.P.)
| | - Normand Laperriere
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada (M.M., N.L.); Neurology Clinic and National Center for Tumor Disease and Neurology Clinic, Heidelberg University Medical Center and DKFZ, Heidelberg, Germany (W.W); Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA(D.A.R.); Department of Advanced Home Care and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden (A.M.); Department of Medical Oncology, Prince of Wales Hospital, Randwick NSW, Australia (E.H.); Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, Zürich, Switzerland (M.W.); Division of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (J.R.P.)
| | - Wolfgang Wick
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada (M.M., N.L.); Neurology Clinic and National Center for Tumor Disease and Neurology Clinic, Heidelberg University Medical Center and DKFZ, Heidelberg, Germany (W.W); Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA(D.A.R.); Department of Advanced Home Care and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden (A.M.); Department of Medical Oncology, Prince of Wales Hospital, Randwick NSW, Australia (E.H.); Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, Zürich, Switzerland (M.W.); Division of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (J.R.P.)
| | - David A Reardon
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada (M.M., N.L.); Neurology Clinic and National Center for Tumor Disease and Neurology Clinic, Heidelberg University Medical Center and DKFZ, Heidelberg, Germany (W.W); Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA(D.A.R.); Department of Advanced Home Care and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden (A.M.); Department of Medical Oncology, Prince of Wales Hospital, Randwick NSW, Australia (E.H.); Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, Zürich, Switzerland (M.W.); Division of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (J.R.P.)
| | - Annika Malmstrom
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada (M.M., N.L.); Neurology Clinic and National Center for Tumor Disease and Neurology Clinic, Heidelberg University Medical Center and DKFZ, Heidelberg, Germany (W.W); Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA(D.A.R.); Department of Advanced Home Care and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden (A.M.); Department of Medical Oncology, Prince of Wales Hospital, Randwick NSW, Australia (E.H.); Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, Zürich, Switzerland (M.W.); Division of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (J.R.P.)
| | - Elizabeth Hovey
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada (M.M., N.L.); Neurology Clinic and National Center for Tumor Disease and Neurology Clinic, Heidelberg University Medical Center and DKFZ, Heidelberg, Germany (W.W); Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA(D.A.R.); Department of Advanced Home Care and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden (A.M.); Department of Medical Oncology, Prince of Wales Hospital, Randwick NSW, Australia (E.H.); Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, Zürich, Switzerland (M.W.); Division of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (J.R.P.)
| | - Michael Weller
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada (M.M., N.L.); Neurology Clinic and National Center for Tumor Disease and Neurology Clinic, Heidelberg University Medical Center and DKFZ, Heidelberg, Germany (W.W); Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA(D.A.R.); Department of Advanced Home Care and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden (A.M.); Department of Medical Oncology, Prince of Wales Hospital, Randwick NSW, Australia (E.H.); Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, Zürich, Switzerland (M.W.); Division of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (J.R.P.)
| | - James R Perry
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada (M.M., N.L.); Neurology Clinic and National Center for Tumor Disease and Neurology Clinic, Heidelberg University Medical Center and DKFZ, Heidelberg, Germany (W.W); Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA(D.A.R.); Department of Advanced Home Care and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden (A.M.); Department of Medical Oncology, Prince of Wales Hospital, Randwick NSW, Australia (E.H.); Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, Zürich, Switzerland (M.W.); Division of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (J.R.P.)
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16
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Management of glioblastoma in Victoria, Australia (2006-2008). J Clin Neurosci 2015; 22:1462-6. [PMID: 26117358 DOI: 10.1016/j.jocn.2015.03.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 02/27/2015] [Accepted: 03/03/2015] [Indexed: 11/22/2022]
Abstract
We describe the management of patients with newly diagnosed glioblastoma multiforme (GBM) in a population-based cohort and compare this to a previously studied cohort. We performed a retrospective cohort study of patients diagnosed with GBM from 2006-2008 in Victoria, Australia. Patients were identified from the population-based Victorian Cancer Registry and their treating doctors surveyed by questionnaire. Outcomes were then compared to a study of GBM patients who were diagnosed between 1998 and 2000 using an identical methodology. We reviewed 351 eligible patients. There were slightly more males (62%) and a minority had multifocal disease (13%). Total macroscopic resection, partial resection or biopsy only was performed in 32%, 37% and 24% of patients, respectively. The majority of patients were referred to a radiation oncologist and medical oncologist postoperatively. A total of 56% of patients were treated with postoperative radiotherapy with concurrent and sequential temozolomide and had a median survival of 14.4 months. This was significantly better than patients treated with postoperative radiotherapy alone in the current or earlier cohorts (2006-2008: median survival 6.2 months, p<0.0001 versus 1998-2000: 8.9 months, p<0.0001). This study demonstrates that postoperative chemoradiation has become the standard of care in this Victorian population with an associated improvement in median survival.
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17
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Holmes ACN, Adams SJ, Hall S, Rosenthal MA, Drummond KJ. Liaison psychiatry in a central nervous system tumor service. Neurooncol Pract 2015; 2:88-92. [PMID: 31386066 DOI: 10.1093/nop/npv001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Indexed: 11/13/2022] Open
Abstract
Background Tumors of the central nervous system (CNS) have physical and psychological effects that commonly interact and change over time. Although well suited to addressing problems at the interface between physical and psychological medicine, the role of the consultation-liaison psychiatrist has not been previously described in the management of these patients. The purpose of this paper is to summarize the experience of psychiatry liaison attachment within a CNS tumor service and to reflect on its utility within a complex multidisciplinary environment. Methods A retrospective file review was performed on all cases seen by a psychiatrist in a CNS tumor service over the previous 5 years. A simple thematic inductive analysis was conducted of the common problems experienced by patients and their management by the psychiatrist and within the team. Results Five common themes were identified: (i) facilitating adaptation to diagnosis; (ii) supporting living with lower-grade tumors; (iii) managing mental disorders; (iv) neuropsychiatric symptoms of tumor progression; and (v) grief and uncertainty in the advanced stages of illness. The capacity of the psychiatrist to understand and integrate the clinical, pathological, radiological, and treatment information, in communication with colleagues, helped address these challenges. Conclusions Psychological challenges in CNS tumor patients have both psychological and neurological underpinnings. In our experience, the addition of a liaison psychiatrist to a CNS tumor service was efficient and effective in improving patient management and led to enhanced communication and decision-making within the team.
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Affiliation(s)
- Alex C N Holmes
- Consultation-liaison Psychiatry, Royal Melbourne Hospital, Parkville, Australia (A.C.N.H., S.J.A., S.H.); Department of Psychiatry, University of Melbourne, Parkville, Australia (A.C.N.H.); Department of Medicine, University of Melbourne, Parkville, Australia (M.A.R.); Department of Oncology, Royal Melbourne Hospital, Parkville,Australia (M.A.R.); Department of Neurosurgery, Royal Melbourne Hospital, Parkville, Australia (K.J.D.); Department of Surgery, University of Melbourne, Parkville, Australia (K.J.D.)
| | - Sophia J Adams
- Consultation-liaison Psychiatry, Royal Melbourne Hospital, Parkville, Australia (A.C.N.H., S.J.A., S.H.); Department of Psychiatry, University of Melbourne, Parkville, Australia (A.C.N.H.); Department of Medicine, University of Melbourne, Parkville, Australia (M.A.R.); Department of Oncology, Royal Melbourne Hospital, Parkville,Australia (M.A.R.); Department of Neurosurgery, Royal Melbourne Hospital, Parkville, Australia (K.J.D.); Department of Surgery, University of Melbourne, Parkville, Australia (K.J.D.)
| | - Scott Hall
- Consultation-liaison Psychiatry, Royal Melbourne Hospital, Parkville, Australia (A.C.N.H., S.J.A., S.H.); Department of Psychiatry, University of Melbourne, Parkville, Australia (A.C.N.H.); Department of Medicine, University of Melbourne, Parkville, Australia (M.A.R.); Department of Oncology, Royal Melbourne Hospital, Parkville,Australia (M.A.R.); Department of Neurosurgery, Royal Melbourne Hospital, Parkville, Australia (K.J.D.); Department of Surgery, University of Melbourne, Parkville, Australia (K.J.D.)
| | - Mark A Rosenthal
- Consultation-liaison Psychiatry, Royal Melbourne Hospital, Parkville, Australia (A.C.N.H., S.J.A., S.H.); Department of Psychiatry, University of Melbourne, Parkville, Australia (A.C.N.H.); Department of Medicine, University of Melbourne, Parkville, Australia (M.A.R.); Department of Oncology, Royal Melbourne Hospital, Parkville,Australia (M.A.R.); Department of Neurosurgery, Royal Melbourne Hospital, Parkville, Australia (K.J.D.); Department of Surgery, University of Melbourne, Parkville, Australia (K.J.D.)
| | - Katharine J Drummond
- Consultation-liaison Psychiatry, Royal Melbourne Hospital, Parkville, Australia (A.C.N.H., S.J.A., S.H.); Department of Psychiatry, University of Melbourne, Parkville, Australia (A.C.N.H.); Department of Medicine, University of Melbourne, Parkville, Australia (M.A.R.); Department of Oncology, Royal Melbourne Hospital, Parkville,Australia (M.A.R.); Department of Neurosurgery, Royal Melbourne Hospital, Parkville, Australia (K.J.D.); Department of Surgery, University of Melbourne, Parkville, Australia (K.J.D.)
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18
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Gzell C, Wheeler H, Guo L, Kastelan M, Back M. Elderly patients aged 65-75 years with glioblastoma multiforme may benefit from long course radiation therapy with temozolomide. J Neurooncol 2014; 119:187-96. [PMID: 24830984 DOI: 10.1007/s11060-014-1472-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 05/04/2014] [Indexed: 10/25/2022]
Abstract
To determine the outcome of elderly patients with glioblastoma managed with hypofractionated [40 Gray (Gy)] or long-course (60 Gy) radiation therapy (RT). Patients aged >60 years diagnosed with WHO grade IV glioma managed with RT between October 2006 and July 2012 were retrospectively identified. Baseline data including ECOG performance status, RT dose and use of temozolomide (TMZ) were recorded. Overall survival was calculated in months from date of diagnosis. 109 patients were included with age distribution from 61 to 88 years (13 % <65, 63 % 65-75, and 24 % >75). Median survival (MS) of total group was 12 months (95 % CI 11-13) with 12 % surviving beyond 2 years. For age groups <65, 65-75, >75 the survival was 17, 12, and 9 months respectively (p = 0.001). Near total resection (p = 0.027), but not ECOG 0-1 (p = 0.34) was associated with improved MS. For the 69 patients aged 65-75, 55 % were managed with 40 Gy and 45 % 60 Gy. Longer survival was associated with the use of 60 Gy (15 vs. 9 months, p < 0.0001), and use of TMZ (13 vs. 7 months, p < 0.0001). In the 48 patients (70 %) managed with TMZ, the MS was 15 months with 60 Gy (95 % CI 13-17) compared with 11 months (95 % CI 9-13) in those with 40 Gy. Performance status with ECOG 0-1 was not associated with improved survival (p = 0.25). Within the limitations of a retrospective study, we demonstrate improved MS in the elderly population when TMZ is added to RT. Those in the age group 65-75 may benefit from long-course RT with TMZ.
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Affiliation(s)
- C Gzell
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Pacific Highway, St Leonards, Sydney, NSW, 2065, Australia,
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19
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Lin E, Rosenthal MA, Eastman P, Le BH. Inpatient palliative care consultation for patients with glioblastoma in a tertiary hospital. Intern Med J 2014; 43:942-5. [PMID: 23919337 DOI: 10.1111/imj.12211] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 01/25/2013] [Indexed: 11/27/2022]
Abstract
Glioblastoma (GBM) is an uncommon disease with significant mortality and morbidity, but there is a lack of published evidence on palliative care involvement with this population. This audit highlights the heavy symptom burden, extensive allied health involvement and discharge outcomes of GBM inpatients referred to the palliative care service at The Royal Melbourne Hospital. This information can provide an important framework for further research and also supports the role of multidisciplinary palliative care in the care of patients with GBM.
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Affiliation(s)
- E Lin
- Department of Palliative Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
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A combination of radiosurgery and soluble tissue factor enhances vascular targeting for experimental glioblastoma. BIOMED RESEARCH INTERNATIONAL 2013; 2013:390714. [PMID: 24307995 PMCID: PMC3838847 DOI: 10.1155/2013/390714] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Accepted: 09/25/2013] [Indexed: 11/17/2022]
Abstract
Radiosurgery for glioblastoma is limited to the development of resistance, allowing tumor cells to survive and initiate tumor recurrence. Based on our previous work that coadministration of tissue factor and lipopolysaccharide following radiosurgery selectively induced thrombosis in cerebral arteriovenous malformations, achieving thrombosis of 69% of the capillaries and 39% of medium sized vessels, we hypothesized that a rapid and selective shutdown of the capillaries in glioblastoma vasculature would decrease the delivery of oxygen and nutrients, reducing tumor growth, preventing intracranial hypertension, and improving life expectancy. Glioblastoma was formed by implantation of GL261 cells into C57Bl/6 mouse brain. Mice were intravenously injected tissue factor, lipopolysaccharide, a combination of both, or placebo 24 hours after radiosurgery. Control mice received both agents after sham irradiation. Coadministration of tissue factor and lipopolysaccharide led to the formation of thrombi in up to 87 ± 8% of the capillaries and 46 ± 4% of medium sized vessels within glioblastoma. The survival rate of mice in this group was 80% versus no survivor in placebo controls 30 days after irradiation. Animal body weight increased with time in this group (r = 0.88, P = 0.0001). Thus, radiosurgery enhanced treatment with tissue factor, and lipopolysaccharide selectively induces thrombosis in glioblastoma vasculature, improving life expectancy.
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Pinkham MB, Bertrand KC, Olson S, Zarate D, Oram J, Pullar A, Foote MC. Hippocampal-sparing radiotherapy: the new standard of care for World Health Organization grade II and III gliomas? J Clin Neurosci 2013; 21:86-90. [PMID: 24090519 DOI: 10.1016/j.jocn.2013.04.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 03/31/2013] [Accepted: 04/07/2013] [Indexed: 01/18/2023]
Abstract
The neurocognitive effects of cranial radiotherapy in patients with gliomas are well-recognised and may be related to the dose delivered to the hippocampi. Intensity modulated radiotherapy (IMRT) is a radiotherapy technique that can be used to selectively spare the hippocampi without compromising the dose delivered to the tumour. This study aimed to evaluate if hippocampal-sparing IMRT is achievable in patients with World Health Organization (WHO) grade II and III gliomas. A retrospective review of consecutive patients with WHO grade II and III gliomas treated with IMRT at our institution between January 2009 and August 2012 was performed. Hippocampal-sparing was defined as a mean dose to at least one hippocampus of less than 30 Gy. The dose delivered to the tumour was never compromised to achieve the hippocampal dose constraint. Logistic regression analyses were performed to identify predictive factors for achieving hippocampal-sparing treatment. Eighteen patients were identified and hippocampal-sparing was achieved in 14 (78%). The median dose prescribed was 59.4 Gy in 33 fractions and 11 patients had WHO grade III gliomas. The mean dose to the contralateral hippocampus was 24.9 Gy. Planning target volumes less than 420.5 cm3 were more likely to enable hippocampal-sparing treatment to be given (hazard ratio 1.7, p=0.03) and there was a trend with oligodendrogliomas and anaplastic oligodendrogliomas. Hippocampal-sparing radiotherapy is feasible in patients with WHO grade II and III gliomas. Oncologic outcomes are yet to be assessed prospectively. The relationship between hippocampal dose and neurocognitive function in adults is currently under investigation.
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Affiliation(s)
- M B Pinkham
- Department of Radiation Oncology, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia; University of Queensland, Brisbane, QLD, Australia.
| | - K C Bertrand
- University of Queensland, Brisbane, QLD, Australia
| | - S Olson
- Department of Neurosurgery, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - D Zarate
- Consultant, statistics and data analysis, Brisbane, QLD, Australia
| | - J Oram
- Department of Neurosurgery, Princess Alexandra Hospital, Woolloongabba, QLD, Australia; Department of Neuropsychology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - A Pullar
- Department of Radiation Oncology, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia; University of Queensland, Brisbane, QLD, Australia
| | - M C Foote
- Department of Radiation Oncology, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia; Diamantina Institute, University of Queensland, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia
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Lin E, Rosenthal MA, Le BH, Eastman P. Neuro-oncology and palliative care: a challenging interface. Neuro Oncol 2013; 14 Suppl 4:iv3-7. [PMID: 23095828 DOI: 10.1093/neuonc/nos209] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Esther Lin
- Department of Palliative Care, The Royal Melbourne Hospital, Victoria, Australia.
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Sia Y, Field K, Rosenthal M, Drummond K. Socio-demographic factors and their impact on the number of resections for patients with recurrent glioblastoma. J Clin Neurosci 2013; 20:1362-5. [PMID: 23769599 DOI: 10.1016/j.jocn.2013.02.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 02/09/2013] [Indexed: 11/19/2022]
Abstract
Glioblastoma multiforme (GBM) is the most aggressive malignant brain tumour. Having a second or subsequent operation at recurrence may be a positive prognostic factor for survival. Recent studies suggest that socio-demographic variables may influence survival, raising the question whether surgical care differs based on these variables. We examined the relationship between selected socio-demographic variables and the number of repeat operations undergone by patients with recurrent GBM. Data from all patients diagnosed with GBM between 2001 and 2011 was obtained from a clinical database maintained across two institutions (one public, one private). The clinical and socio-demographic factors for patients who received one operation were compared to those who had two or more operations, using chi-squared analyses to determine statistical differences between groups. Socioeconomic status was measured using the Index of Relative Socioeconomic Advantage and Disadvantage scores. Of 553 patients, 449 (81%) had one operation and 104 (19%) had ≥2 operations. Patients who had ≥2 operations were significantly younger (median 55 years versus 64 years, p<0.001), less likely to have multifocal (p=0.043) or bilateral (p=0.037) disease and more likely to have initial macroscopic resection (p=0.006), than those who had only one operation. Socioeconomic status did not significantly differ between the groups (p=0.31). Similarly, there was no significant difference between the number of operations in patients from regional versus city residence and public versus private hospital. This is reassuring as it suggests similar surgical management options are available for patients regardless of socio-demographic background.
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Affiliation(s)
- Y Sia
- Royal Melbourne Hospital, Grattan Street, Parkville, Melbourne, VIC 3050, Australia.
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Chen JY, Hovey E, Rosenthal M, Livingstone A, Simes J. Neuro-oncology practices in Australia: a Cooperative Group for Neuro-Oncology patterns of care study. Asia Pac J Clin Oncol 2013; 10:162-7. [PMID: 23714694 DOI: 10.1111/ajco.12079] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2013] [Indexed: 11/25/2022]
Abstract
AIMS To provide data on the patterns of care in neuro-oncology practices at Australian cancer centres over the previous 12-month period. METHODS A 5-page questionnaire was sent to Cooperative Trials Group for Neuro-Oncology members at 28 Australia cancer centres. The questions included access to neuro-oncology services; treatment protocols and patterns of supportive care. RESULTS Provision of neuro-oncology services was consistent in metropolitan cancer centres. Treatment protocols are virtually identical for patients with an initial diagnosis of glioblastoma multiforme (GBM), with the main variation being for older or less fit patients. Most patients (70%) received chemotherapy at recurrence, most commonly modified schedule temozolomide, with half of the cancer centers offering bevacizumab. For anaplastic astrocytoma (AA), most clinicians offer radiotherapy alone but 30% would use radiotherapy with concurrent and adjuvant temozolomide. Half of clinicians continued to use prophylactic anticonvulsants; 25% do not prescribe prophylactic antibiotics during chemoradiotherapy and half would continue anti-coagulation therapy indefinitely for thromboembolism. CONCLUSION This is the first Australia-wide patterns of study of care in the management of gliomas. There is general consensus on the use of radiotherapy with concurrent and adjuvant temozolomide and the use of chemotherapy for recurrent GBM. The choice of chemotherapy at recurrence is not standard and the provision of bevacizumab is inconsistent. This survey highlights variation in the treatment of the elderly GBM and patients with AA as well as in areas of supportive care, in particular, the ongoing use of prophylactic anticonvulsants despite guidelines.
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Affiliation(s)
- James Y Chen
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney
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Field KM, Rosenthal MA, Yilmaz M, Tacey M, Drummond K. Comparison between poor and long-term survivors with glioblastoma: Review of an Australian dataset. Asia Pac J Clin Oncol 2013; 10:153-61. [DOI: 10.1111/ajco.12076] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Kathryn Maree Field
- Department of Medical Oncology; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - Mark Andrew Rosenthal
- Department of Medical Oncology; Royal Melbourne Hospital; Melbourne Victoria Australia
- Department of Medicine; University of Melbourne; Melbourne Victoria Australia
| | - Merve Yilmaz
- University of Melbourne Medical School; Melbourne Victoria Australia
| | - Mark Tacey
- Melbourne EpiCentre; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - Kate Drummond
- Department of Neurosurgery; Royal Melbourne Hospital; Melbourne Victoria Australia
- Department of Surgery; University of Melbourne; Melbourne Victoria Australia
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Field KM, Drummond KJ, Yilmaz M, Tacey M, Compston D, Gibbs P, Rosenthal MA. Clinical trial participation and outcome for patients with glioblastoma: multivariate analysis from a comprehensive dataset. J Clin Neurosci 2013; 20:783-9. [PMID: 23639619 DOI: 10.1016/j.jocn.2012.09.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 09/14/2012] [Indexed: 11/28/2022]
Abstract
Glioblastoma multiforme (GBM) is the most common malignant brain tumor in adults. Although multiple clinical and tumor-related variables affect survival outcomes, the effect of clinical trial participation has not been explored. The aim of this study was to determine whether clinical trial participation improves outcome for patients with GBM. Data from patients with GBM were accessed from a dataset collected over 12 years (1998-2010) at two institutions. Univariable and multivariate logistic regression analyses were performed to look for relationships between clinical trial participation, other baseline clinical and sociodemographic variables and overall survival (OS). In total, 542 patients were identified and included in the analysis; median age was 62 years. Sixty-one patients (11%) were enrolled in a clinical trial. Clinical trial enrollment was associated with improved median survival (14.5 months compared to 6.3 months, p < 0.001) and this difference remained significant in multivariate analysis (hazard ratio 0.67, p = 0.046). Age, poor performance status and operation type were also independent predictors for OS in multivariate analysis. Disease site, socioeconomic status and co-morbidity did not affect survival outcome. This is the first study in patients with GBM to suggest a survival benefit from clinical trial participation, independent of age and performance status; while also confirming the importance of other previously reported prognostic factors. This should encourage clinicians to offer trial therapies to patients with GBM and encourage patients to participate in available studies.
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Affiliation(s)
- Kathryn M Field
- Department of Medical Oncology, Royal Melbourne Hospital, Victoria, Australia.
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Graus F, Bruna J, Pardo J, Escudero D, Vilas D, Barceló I, Brell M, Pascual C, Crespo JA, Erro E, García-Romero JC, Estela J, Martino J, García-Castaño A, Mata E, Lema M, Gelabert M, Fuentes R, Pérez P, Manzano A, Aguas J, Belenguer A, Simón A, Henríquez I, Murcia M, Vivanco R, Rojas-Marcos I, Muñoz-Carmona D, Navas I, de Andrés P, Mas G, Gil M, Verger E. Patterns of care and outcome for patients with glioblastoma diagnosed during 2008-2010 in Spain. Neuro Oncol 2013; 15:797-805. [PMID: 23460319 DOI: 10.1093/neuonc/not013] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To assess management patterns and outcome in patients with glioblastoma multiforme (GBM) treated during 2008-2010 in Spain. METHODS Retrospective analysis of clinical, therapeutic, and survival data collected through filled questionnaires from patients with histologically confirmed GBM diagnosed in 19 Spanish hospitals. RESULTS We identified 834 patients (23% aged >70 years). Surgical resection was achieved in 66% of patients, although the extent of surgery was confirmed by postoperative MRI in only 41%. There were major postoperative complications in 14% of patients, and age was the only independent predictor (Odds ratio [OR], 1.03; 95% confidence interval [CI],1.01-1.05; P = .006). After surgery, 57% received radiotherapy (RT) with concomitant and adjuvant temozolomide, 21% received other regimens, and 22% were not further treated. In patients treated with surgical resection, RT, and chemotherapy (n = 396), initiation of RT ≤42 days was associated with longer progression-free survival (hazard ratio [HR], 0.8; 95% CI, 0.64-0.99; P = .042) but not with overall survival (HR, 0.79; 95% CI, 0.62-1.00; P = .055). Only 32% of patients older than 70 years received RT with concomitant and adjuvant temozolomide. The median survival in this group was 10.8 months (95% CI, 6.8-14.9 months), compared with 17.0 months (95% CI, 15.5-18.4 months; P = .034) among younger patients with GBM treated with the same regimen. CONCLUSIONS In a community setting, 57% of all patients with GBM and only 32% of older patients received RT with concomitant and adjuvant temozolomide. In patients with surgical resection who were eligible for chemoradiation, initiation of RT ≤42 days was associated with better progression-free survival.
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Affiliation(s)
- Francesc Graus
- Service of Neurology, Hospital Clínic, Villarroel 170, Barcelona 08036, Spain.
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Jackson M, Bydder S, Maujean E, Taylor M, Nowak A. Radiotherapy in the management of high-grade gliomas diagnosed in Western Australia: A patterns of care study. J Med Imaging Radiat Oncol 2012; 56:109-15. [PMID: 22339754 DOI: 10.1111/j.1754-9485.2011.02334.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Melanie Jackson
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
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Céfaro GA, Genovesi D, Vinciguerra A, Trignani M, Taraborrelli M, Augurio A, Buonaguidi R, Galzio RJ, Di Nicola M. Prognostic impact of hemoglobin level and other factors in patients with high-grade gliomas treated with postoperative radiochemotherapy and sequential chemotherapy based on temozolomide: a 10-year experience at a single institution. Strahlenther Onkol 2011; 187:778-83. [PMID: 22127356 DOI: 10.1007/s00066-011-1129-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 09/15/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND AND PURPOSE To evaluate the influence of serum hemoglobin level prior to radiotherapy and other prognostic factors on survival in patients with high-grade gliomas. MATERIAL AND METHODS From 2001-2010, we retrospectively evaluated a total of 48 patients with malignant glioma treated with surgery and postoperative radiochemotherapy with temozolomide. A total of 37 of 48 patients received sequential temozolomide. Hemoglobin levels were assayed before radiotherapy in all patients. The Kaplan-Meier method was applied to estimate the overall survival, while the log-rank test was applied to evaluate the differences on survival probability between prognostic subgroups. RESULTS Results were assessed in 43 patients. The median overall survival time was 18 months (95% confidence interval: 12-40 months). The 1- and 2-year survival rates were 62.2% and 36.3%, respectively. The prognostic factors analyzed were gender, age, extent of surgery, performance status before and after radiotherapy, sequential chemotherapy, hemoglobin level, and methylation of the O-6-methylguanine-DNA methyltransferase gene (MGMT). In univariate analysis, the variables significantly related to survival were performance status before and after radiotherapy, sequential chemotherapy, and hemoglobin level. The median overall survival in patients with a hemoglobin level ≤ 12 g/dl was 12 months and 23 months in patients with a hemoglobin level > 12 g/dl. The 1- and 2-year survival rates were 46.7% and 20.0%, respectively, for patients with a hemoglobin level ≤ 12 mg/dl and 69.6% and 45.7%, respectively, for patients with a hemoglobin level > 12 g/dl. CONCLUSION Our results confirm the impact of well-known prognostic factors on survival. In this research, it was found that a low hemoglobin level before radiotherapy can adversely influence the prognosis of patients with malignant gliomas.
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Affiliation(s)
- Giampiero Ausili Céfaro
- Department of Radiation Oncology, G. d'Annunzio University of Chieti, SS. Annunziata Hospital, Chieti, Italy
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Patterns of care and survival for glioblastoma patients in the Veterans population. J Neurooncol 2011; 106:627-35. [PMID: 21881877 DOI: 10.1007/s11060-011-0702-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Accepted: 08/16/2011] [Indexed: 12/11/2022]
Abstract
Survival outcomes and patterns of care for brain tumor patients in the USA Veterans population have not been previously published and the extent of variation in outcomes between Veterans and the rest of the USA is currently unknown. The Veterans healthcare administration (VA) provides comprehensive care to Veterans and their families and maintains the Veterans affairs central cancer registry (VACCR). This was a retrospective review of microscopically-confirmed, supratentorial glioblastoma multiforme in male Veterans actively followed by the VACCR; survival was analyzed and compared to a national cohort from the surveillance, epidemiology and end results program. We analyzed 1,219 Veterans with glioblastomas diagnosed between 1997 and 2006. Median survival was 6.5 months and 1, 2, and 5 years survival rates were 26.8, 5.4, and 0.5%, respectively. Patients receiving all three treatment modalities (surgical resection, radiotherapy, and chemotherapy) did best; these findings remained true among patients aged 70 and older such that these patients had an overall survival similar to those age <70. A comparable national cohort had longer median survival (9.0 months) and greater 1, 2, and 5 years survival rates (37.8, 12.8, and 4.1%) than the VA cohort. Survival and patterns of care are presented for the first time for Veterans with glioblastoma multiforme. In conclusion, we found that more aggressive therapy was associated with better survival, even among elderly Veterans and whether compared overall or by age group, VA patients showed decreased survival relative to a national cohort. We believe this potential disparity warrants further investigation.
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Erridge SC, Hart MG, Kerr GR, Smith C, McNamara S, Grant R, Gregor A, Whittle IR. Trends in classification, referral and treatment and the effect on outcome of patients with glioma: a 20 year cohort. J Neurooncol 2011; 104:789-800. [PMID: 21384218 DOI: 10.1007/s11060-011-0546-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Accepted: 02/18/2011] [Indexed: 10/18/2022]
Abstract
This retrospective audit was conducted to examine the changes in patient characteristics, referral, treatment and outcome over a 20-year period in a large regional neuro-oncology centre, focusing on the impact of the changes in pathological classification of gliomas. Using the Edinburgh Cancer Centre (ECC) database all cases of glioma were identified and patient, tumour and treatment characteristics noted. Survival was calculated from date of surgery or, if no operation was performed, the date of referral. Comparison was made between four periods 1988-1992 (c1), 1993-1997(c2), 1998-2002(c3) and 2003-2007 (c4). During the 20 years, 1175 patients with a glioma were referred to ECC. The median age increased from 53 years to 57 years (p < 0.001) but the proportion without pathology remained unchanged (10%). The distribution of pathological grades changed over time Grade I-II: 24, 6, 6, and 6%, Grade III: 42, 27, 17, and 13% and Grade IV: 24, 61, 68, and 68% in c1, c2, c3 and c4, respectively (p < 0.001). Immediate RT was given to 68% (c1), 70% (c2), 78% (c3) and 79% (c4). Median interval from resection to RT reduced from 43 days (c1) to 36 days (c4) (p < 0.001). 5-year overall survival for patients with Grade III lesions increased: 21% (c1), 35% (c2), 37% (c3), 33% (c4) as did 1-year overall survival for Grade IV lesions: 18% (c1), 26% (c2), 29% (c3), 27% (c4)). This improvement probably reflects the change in pathological classification rather than a change in management. Proportional hazards analysis of grade IV 1993-2007 only (to reduce pathological variation) showed that younger age, frontal lesions, excision, higher RT dose had reduced hazard of death. Interval from surgery to RT had no impact on survival in this series.
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Affiliation(s)
- S C Erridge
- Edinburgh Centre for Neuro-Oncology, University of Edinburgh, Western General Hospital, Edinburgh, EH4 1EU, UK.
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Jacob S, Ng W, Delaney G, Barton M. Estimation of an Optimal Chemotherapy Utilisation Rate for Primary Malignant Brain Tumours: an Evidence-based Benchmark for Cancer Care. Clin Oncol (R Coll Radiol) 2011; 23:48-54. [DOI: 10.1016/j.clon.2010.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Revised: 06/01/2010] [Accepted: 06/15/2010] [Indexed: 11/28/2022]
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Nowak AK, Maujean JE, Jackson M, Knuckey N. A prospective study of surgical patterns of care for high grade glioma in the current era of multimodality therapy. J Clin Neurosci 2010; 18:227-31. [PMID: 21185727 DOI: 10.1016/j.jocn.2010.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Revised: 05/13/2010] [Accepted: 05/15/2010] [Indexed: 11/30/2022]
Abstract
Previous surgical patterns of care reports in high grade glioma (HGG) antedated the use of chemo-radiotherapy. This study, from an elective neurosurgical centre serving an isolated population of over 2 million, identified adult patients with HGG from a prospective multidisciplinary database. Of 328 patients in Western Australia who were diagnosed with HGG between 1 June 2006 and 30 June 2008, 283 patients (86%) received care at the study site. A total of 4% were diagnosed on imaging and clinical factors alone; 12% had surgery outside the study site. The remaining 231 patients had 264 surgical procedures; 78% resection and 22% biopsy. Median survival (grade IV) was 9.4 months. Resection predicted improved survival (hazard ratio 0.64; 95% confidence interval 0.4-0.89); however, in multivariable analysis, only age and grade predicted outcome. The proportion of patients having no tissue diagnosis, or biopsy alone, compares favourably with data before the use of chemo-radiotherapy, as does survival. The therapeutic nihilism surrounding HGG may have decreased since the introduction of temozolomide.
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Affiliation(s)
- A K Nowak
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
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Scoccianti S, Magrini SM, Ricardi U, Detti B, Buglione M, Sotti G, Krengli M, Maluta S, Parisi S, Bertoni F, Mantovani C, Tombolini V, De Renzis C, Lioce M, Fatigante L, Fusco V, Muto P, Berti F, Rubino G, Cipressi S, Fariselli L, Lupattelli M, Santoni R, Pirtoli L, Biti G. Patterns of Care and Survival in a Retrospective Analysis of 1059 Patients With Glioblastoma Multiforme Treated Between 2002 and 2007: A Multicenter Study by the Central Nervous System Study Group of Airo (Italian Association of Radiation Oncology). Neurosurgery 2010; 67:446-58. [DOI: 10.1227/01.neu.0000371990.86656.e8] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
To investigate the pattern of care and outcomes for newly diagnosed glioblastoma in Italy and compare our results with the previous Italian Patterns of Care study to determine whether significant changes occurred in clinical practice during the past 10 years.
METHODS
Clinical, pathological, therapeutic, and survival data regarding 1059 patients treated in 18 radiotherapy centers between 2002 and 2007 were collected and retrospectively reviewed.
RESULTS
Most patients underwent both computed tomography and magnetic resonance imaging either preoperatively (62.7%) or postoperatively (35.5%). Only 123 patients (11.6%) underwent a biopsy. Radiochemotherapy with temozolomide was the most frequent adjuvant treatment (70.7%). Most patients (88.2%) received 3-dimensional conformal radiotherapy. Median survival was 9.5 months. Two- and 5-year survival rates were 24.8% and 3.9%, respectively. Multivariate analysis showed the statistical significance of age, postoperative Karnofsky Performance Status scale score, surgical extent, use of 3-dimensional conformal radiotherapy, and use of chemotherapy. Use of a more aggressive approach was associated with longer survival in elderly patients. Comparing our results with those of the subgroup of patients included in our previous study who were treated between 1997 and 2001, relevant differences were found: more frequent use of magnetic resonance imaging, surgical removal more common than biopsy, and widespread use of 3-dimensional conformal radiotherapy + temozolomide. Furthermore, a significant improvement in terms of survival was noted (P < .001).
CONCLUSION
Changes in the care of glioblastoma over the past few years are documented. Prognosis of glioblastoma patients has slightly but significantly improved with a small but noteworthy number of relatively long-term survivors.
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Affiliation(s)
- Silvia Scoccianti
- Radioterapia, Università di Firenze, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - Stefano Maria Magrini
- Radioterapia, Università di Firenze, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - Umberto Ricardi
- Radioterapia Oncologica, Universita' di Torino, Azienda Ospedaliera Universitaria San Giovanni Battista, Torino, Italy
| | - Beatrice Detti
- Radioterapia, Università di Firenze, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - Michela Buglione
- Radioterapia, Università di Firenze, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - Guido Sotti
- Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Marco Krengli
- Radioterapia, Università del Piemonte Orientale, Novara, Italy
| | - Sergio Maluta
- Radioterapia Oncologica, Azienda Ospedaliera di Verona, Verona, Italy
| | - Salvatore Parisi
- Radioterapia, IRCCS Ospedale “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, Italy
| | - Filippo Bertoni
- Radioterapia Oncologica AOU Policlinico di Modena, Modena, Italy
| | - Cristina Mantovani
- Radioterapia Oncologica, Universita' di Torino, Azienda Ospedaliera Universitaria San Giovanni Battista, Torino, Italy
| | - Vincenzo Tombolini
- Cattedra di Radioterapia, Facoltà Medicina e Chirurgia, Università de L'Aquila, L'Aquila, Italy
| | - Costantino De Renzis
- Radioterapia Oncologica, Dipartimento di Scienze Radiologiche, AOU Policlinico G. Martino, Messina, Italy
| | - Marco Lioce
- Radioterapia Oncologica, A.O.R.N. “G. Rummo”, Benevento, Italy
| | | | | | - Paolo Muto
- Radioterapia, P.O. Ascalesi, Naples, Italy
| | - Franco Berti
- Radioterapia Oncologica, Dipartimento di Patologia umana e Oncologia, Università di Siena, Siena, Italy
| | - Giovanni Rubino
- Radioterapia Oncologica, Dipartimento di Patologia umana e Oncologia, Università di Siena, Siena, Italy
| | - Samantha Cipressi
- Radioterapia, Università di Firenze, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - Laura Fariselli
- Radioterapia, Fondazione Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marco Lupattelli
- Radioterapia Oncologica, Università di Perugia, Ospedale Santa Maria Misericordia, Perugia, Italy
| | | | - Luigi Pirtoli
- Radioterapia, Università di Firenze, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - Giampaolo Biti
- Radioterapia, Università di Firenze, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
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Bauchet L, Mathieu-Daudé H, Fabbro-Peray P, Rigau V, Fabbro M, Chinot O, Pallusseau L, Carnin C, Lainé K, Schlama A, Thiebaut A, Patru MC, Bauchet F, Lionnet M, Wager M, Faillot T, Taillandier L, Figarella-Branger D, Capelle L, Loiseau H, Frappaz D, Campello C, Kerr C, Duffau H, Reme-Saumon M, Trétarre B, Daures JP, Henin D, Labrousse F, Menei P, Honnorat J. Oncological patterns of care and outcome for 952 patients with newly diagnosed glioblastoma in 2004. Neuro Oncol 2010; 12:725-35. [PMID: 20364023 PMCID: PMC2940657 DOI: 10.1093/neuonc/noq030] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Accepted: 12/07/2009] [Indexed: 11/14/2022] Open
Abstract
This report, an audit requested by the French government, describes oncological patterns of care, prognostic factors, and survival for patients with newly diagnosed and histologically confirmed glioblastoma multiforme (GBM) in France. The French Brain Tumor DataBase, which is a national multidisciplinary (neurosurgeons, neuropathologists, radiotherapists, neurooncologists, epidemiologists, and biostatisticians) network, prospectively collected initial data for the cases of GBM in 2004, and a specific data card was used to retrospectively collect data on the management and follow-up care of these patients between January 1, 2004, and December 1, 2006. We recorded 952 cases of GBM (male/female ratio 1.6, median age 63.9 years, mean preoperative Karnofsky performance status [KPS] 79). Surgery consisted of resection (RS; n = 541) and biopsy (n = 411); 180 patients did not have subsequent oncological treatment. After surgery, first-line treatment (n = 772) consisted of radiotherapy (RT) and temozolomide (TMZ) concomitant +/- adjuvant in 314 patients, RT alone in 236 patients, chemotherapy (CT) alone in 157 patients, and other treatment modalities in 65 patients. Median overall survival was 286 days (95% CI, 266-314) and was significantly affected by age, KPS, and tumor location. Median survival (days, 95% CI) associated with these main strategies, when analyzed by a surgical group, were as follows: RS + RT-TMZ((n=224)): 476 (441-506), biopsy + RT-TMZ((n=90)): 329 (301-413), RS + RT((n=147)): 363 (331-431), biopsy + RT((n=89)): 178 (153-237), RS + CT((n=61)): 245 (190-361), biopsy + CT((n=96)): 244 (198-280), and biopsy only((n=118)): 55 (46-71). This study illustrates the usefulness of a national brain tumor database. To our knowledge, this work is the largest report of recent GBM management in Europe.
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Affiliation(s)
- Luc Bauchet
- Department of Neurosurgery, Hospital Gui de Chauliac, CHU Montpellier, 80 avenue A. Fliche, 34295 Montpellier cedex 5, France.
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Jeon HJ, Kong DS, Park KB, Lee JI, Park K, Kim JH, Kim ST, Lim DH, Kim WS, Nam DH. Clinical outcome of concomitant chemoradiotherapy followed by adjuvant temozolomide therapy for glioblastaomas: single-center experience. Clin Neurol Neurosurg 2009; 111:679-82. [PMID: 19640635 DOI: 10.1016/j.clineuro.2009.06.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Revised: 06/25/2009] [Accepted: 06/27/2009] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The use of radiotherapy plus temozolomide administered concomitantly with and after radiotherapy for glioblastoma was recently shown to improve median and 2-year survival in a large international multicenter study. To compare this result in routine clinical practice, an audit of the management and outcome of patients with glioblastoma at our institute was performed. METHODS A total of 79 patients with pathologically confirmed glioblastoma were treated with radiotherapy (daily fractions of 2 Gy for a total of 60 Gy) combined with temozolomide at a dose of 75 mg/m(2) per day, followed by 6 cycles of adjuvant temozolomide (150-200 mg/m(2), 5 consecutive days per month). The primary end point was overall survival (OS). Secondary endpoints included progression-free survival (PFS) and toxicity. We evaluated the clinical outcome of concomitant chemoradiotherapy for newly diagnosed glioblastomas at a single institute in Korea. RESULTS The median age was 52 years (15-76 years), 47 patients were male and 32 patients were female. 92.4% of the patients had undergone debulking surgery. The median overall survival (OS) was 18.3 months (95% CI, 16.3-20.1 months), and the time to progression was 6.7 months (95% CI, 5.2-8.3 months). The 1-year and 2-year survival rates were 70.1% and 37.1%, respectively. In the retrospective analysis, the patients with a post-operative KPS over 80 showed more prolonged survival than those who had a KPS less 80 (23.1 months vs. 13.4 months; p<0.001). Age and extent of surgery did not emerge as significant factors. Twenty-four patients (30%) were treated with low-dose continuous temozolomide therapy after the tumor had recurred. Hematologic toxicity was the main adverse effect, occurring in seven patients (8.8%). Patients with lymphopenia were not reported. CONCLUSIONS This study is the largest study of radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma in Korean patients, who share a common genetic feature. The median and 2-year survival outcomes in this study are comparable to the previous reports. However, for the recurrent glioblastomas refractory to temozolomide, further clinical trials using other agents should be studied continuously in the future.
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Affiliation(s)
- Hyung Jun Jeon
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Dally M, Rosenthal M, Drummond K, Murphy M, Cher L, Ashley D, Thursfield V, Giles G. Radiotherapy management of patients diagnosed with glioma in Victoria (1998-2000): A retrospective cohort study. J Med Imaging Radiat Oncol 2009; 53:318-24. [DOI: 10.1111/j.1754-9485.2009.02072.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Iwamoto FM, Reiner AS, Panageas KS, Elkin EB, Abrey LE. Patterns of care in elderly glioblastoma patients. Ann Neurol 2009; 64:628-34. [PMID: 19107984 DOI: 10.1002/ana.21521] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To evaluate the patterns of care in elderly glioblastoma (GBM) patients from a large population-based registry. METHODS We identified a cohort of GBM patients 65 years or older from Surveillance, Epidemiology, and End Results cancer registry data linked with Medicare claims between 1994 and 2002. We assessed the impact of demographic characteristics and comorbidities on the probability of undergoing surgical resection, radiotherapy (RT), and chemotherapy within 3 months of diagnosis using multivariate logistic regression. RESULTS A total of 4,137 patients with GBM were included, with a median overall survival of 4 months. Sixty-one percent of patients underwent resection at diagnosis; 65% received RT and 10% received chemotherapy within 3 months of diagnosis. In a multivariate regression analysis, age was the most significant predictor of resection, RT, or chemotherapy. Black race (odds ratio [OR], 0.64; p = 0.008) was associated with lower rates of surgical resection. Factors associated with decreased likelihood of receiving RT included unmarried marital status (OR, 0.64; p < 0.0001) and more comorbidities (OR, 0.55; p < 0.0001). Factors associated with decreased likelihood of receiving chemotherapy included unmarried marital status (OR, 0.59; p = 0.0002) and more comorbidities (OR, 0.56; p = 0.02). INTERPRETATION Survival of elderly GBM patients was poor in this population-based study. Age, marital status, and comorbidities influenced the probability of receiving RT or chemotherapy in this cohort.
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Affiliation(s)
- Fabio M Iwamoto
- Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
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ROSENTHAL MA, ASHLEY DM, DRUMMOND K, DALLY M, MURPHY M, CHER L, THURSFIELD V, GILES GG. Intramedullary spinal cord tumors: Patterns of care in Victoria from 1998–2000. Asia Pac J Clin Oncol 2008. [DOI: 10.1111/j.1743-7563.2008.00151.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Salmaggi A, Silvani A, Merli R, Caroli M, Tomei G, Russo A, Riva M, Marchioni E, Imbesi F. Multicentre prospective collection of newly diagnosed glioblastoma patients: update on the Lombardia experience. Neurol Sci 2008; 29:77-83. [PMID: 18483704 DOI: 10.1007/s10072-008-0865-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2007] [Accepted: 03/12/2008] [Indexed: 11/24/2022]
Abstract
A prospective collection of newly diagnosed cases of grade IV glioma in Lombardia, Italy, was started in 2003. In the present report, data are shown on 349 adult patients recruited up to 2005. The clinical features, pattern of care and outcome are discussed, together with the main prognostic factors. Males were affected more frequently than women; median age at onset was 60. Overall, gross total tumour resection was performed in roughly 50% of the patients, and partial resection and biopsy in 25% each; only 5 patients did not undergo histology. Adjuvant radiotherapy was delivered to 89% and chemotherapy to 82% of patients. Median survival was of 54 weeks. Most patients received protracted therapy with antiepileptic drugs, despite absence of seizures; over the course of the study, the practice pattern tended to change, shifting to the use of non-enzyme-inducing anti-epileptic drugs.
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Affiliation(s)
- Andrea Salmaggi
- Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy.
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Cher L, Rosenthal MA, Drummond KJ, Dally M, Murphy M, Ashley D, Thursfield V, Giles GG. The use of chemotherapy in patients with gliomas: Patterns of care in Victoria from 1998–2000. J Clin Neurosci 2008; 15:398-401. [DOI: 10.1016/j.jocn.2007.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2006] [Revised: 03/28/2007] [Accepted: 04/03/2007] [Indexed: 10/22/2022]
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Brain stem gliomas: Patterns of Care in Victoria from 1998–2000. J Clin Neurosci 2008; 15:237-40. [DOI: 10.1016/j.jocn.2007.04.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2006] [Revised: 03/28/2007] [Accepted: 04/03/2007] [Indexed: 11/21/2022]
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Back MF, Ang ELL, Ng WH, See SJ, Lim CCT, Chan SP, Yeo TT. Improved Median Survival for Glioblastoma Multiforme Following Introduction of Adjuvant Temozolomide Chemotherapy. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2007. [DOI: 10.47102/annals-acadmedsg.v36n5p338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Introduction: The use of adjuvant temozolomide (TMZ) in patients managed with surgery and adjuvant radiation therapy (RT) for glioblastoma multiforme (GBM) has been demonstrated to improve median and 2-year survival in a recent large international multicentre study. To confirm this result in routine clinical practice, an audit of the management and outcome of patients with GBM at The Cancer Institute Radiation Oncology was performed.
Materials and Methods: All patients with GBM managed radically at The Cancer Institute Radiation Oncology from May 2002 to 2006 were entered into a prospective database. Patient, tumour and treatment factors were analysed for association with the outcome of median survival (MS). Survival was calculated using the Kaplan-Meier technique and correlation was assessed using Cox proportional hazards regression.
Results: Forty-one patients with GBM were managed with radical intent over the 4year period. The median age was 54 years and 66% were Eastern Cooperative Oncology Group (ECOG) 0-1 performance status. Macroscopic, subtotal and biopsy alone procedures were performed in 61%, 29% and 10% of patients, respectively. The median time from surgery to RT was 26 days. Adjuvant TMZ was used in 44% of patients (n = 18). The MS of the total group was 13.6 months, with a 24% 2-year overall survival. The use of TMZ was associated with improved MS (19.6 versus 12.8 months; P = 0.035) and improved 2-year survival (43% versus 0%). A requirement of dexamethasone dose greater than 4 mg at the end of RT (P = 0.012) was associated with worse survival, but there was no association of MS with age, ECOG, tumour size or extent of surgery.
Conclusion: The median and 2-year survival outcomes are comparable to the results of the European Multicentre Study and justify the continued use of TMZ in routine clinical practice.
Key words: Adjuvant, Glioblastoma, Temozolomide
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