Outcome of salvage treatment for recurrent glioblastoma
Outcome of salvage treatment for recurrent glioblastoma
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DOI：
10.1016/j.jocn.2014.09.018
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发表时间：
2015-03-01
影响因子：
2
通讯作者：
Lee, Jung-Il
中科院分区：
文献类型：
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作者：
Kim, Hong Rye;Kim, Kyung Hwan;Lee, Jung-Il
大多数胶质母细胞瘤（GBM）病例在一年内复发，几乎所有病例都会在某个时候复发。复发性GBM的标准治疗尚未建立。我们研究了复发性GBM的各种挽救治疗的结果。回顾性分析了144例在最大减积手术后首次进展时接受挽救治疗的患者，随后接受同步放化疗和辅助替莫唑胺（TMZ）化疗。中位随访时间为18.2个月。我们根据挽救方式将这些患者分为5组：伽玛刀放射外科（GKS）组（n = 29），TMZ组（n = 31），GKS + TMZ组（n = 28），再次手术组（n = 38）和"其他治疗"组（n = 18）。自首次诊断至首次进展的中位时间为8.8个月。5个不同治疗组（GKS、TMZ、GKS + TMZ、再手术和"其他治疗"）的中位总生存期（OS）分别为9.2、5.6、15.5、13.2和8.0个月。中位无进展生存期（PFS）分别为3.6、2.3、6.0、4.3和2.6个月。GKS + TMZ组与其他组的OS配对比较显示，除再次手术组外，GKS + TMZ组的OS显著优于其他组。与TMZ组和"其他治疗"组相比，在GKS + TMZ组中观察到PFS统计学显著延长。在多变量分析中，GKS后TMZ挽救治疗是PFS和OS的良好预后因素。复发时，GKS + TMZ作为补救治疗的逆行术倾向于提供上级生存获益。(C)2014爱思唯尔有限公司版权所有。
Most glioblastoma (GBM) cases recur within a year and almost all cases recur at some point. Standard treatment for recurrent GBM has not yet been established. We investigated the outcome of various salvage treatments for recurrent GBM. Retrospective analysis was undertaken in 144 patients who received salvage treatment at the time of first progression after maximum debulking surgery followed by concomitant chemoradiotherapy and adjuvant temozolomide (TMZ) chemotherapy. The median follow-up period was 18.2 months. We grouped these patients into five groups according to the salvage modalities: Gamma Knife radiosurgery (GKS) group (n = 29), TMZ group (n = 31), GKS+TMZ group (n = 28), reoperation group (n = 38) and "other treatment" group (n = 18). The median time to first progression from initial diagnosis was 8.8 months. The median overall survival (OS) of the five different treatment groups; GKS, TMZ, GKS+TMZ, reoperation, and "other treatment", was 9.2, 5.6, 15.5, 13.2, and 8.0 months, respectively. Median progression-free survival (PFS) was 3.6, 2.3, 6.0, 4.3, and 2.6 months, respectively. Pairwise comparison of OS of the GKS+TMZ group with the other groups showed that the OS of the GKS+TMZ group was significantly better than all others except the reoperation group. Statistically significant prolongation of PFS was observed in the GKS+TMZ group compared with the TMZ group and the "other treatment" group. GKS followed by TMZ salvage treatment was a good prognostic factor for both PFS and OS in multivariate analysis. Retrospectively, GKS+TMZ as a salvage treatment, tended to provide a superior survival benefit at the time of recurrence. (C) 2014 Elsevier Ltd. All rights reserved.