Patterns of care in recurrent glioblastoma in Switzerland: a multicentre national approach based on diagnostic nodes
Patterns of care in recurrent glioblastoma in Switzerland: a multicentre national approach based on diagnostic nodes
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DOI：
10.1007/s11060-015-1957-0
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发表时间：
2016-01-01
影响因子：
3.9
通讯作者：
Putora, P. M.
中科院分区：
文献类型：
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作者：
Hundsberger, T.;Hottinger, A. F.;Putora, P. M.
尽管用放化疗一线治疗后胶质母细胞瘤的预后有中度改善，但最近的临床试验未能改善复发性胶质母细胞瘤的预后。在缺乏标准护理的情况下，我们旨在调查机构治疗策略，以确定复发性胶质母细胞瘤护理模式的异同。我们调查了瑞士8个神经肿瘤中心复发性胶质母细胞瘤的再治疗标准和治疗途径，并建立了一个多学科肿瘤委员会会议。采用客观共识方法对决策算法、差异和共识进行了分析。根据八种不同的决策标准，共确定了16种不同的治疗建议。每个中心实施的一套标准以及提供的一套治疗方法是不同的。针对具体情况，8个中心提供了多达6种不同的治疗建议。唯一确定的广泛共识是为不适合的患者提供最好的支持性护理。大多数推荐用于适合患者的不可手术的大型早期复发且MGMT启动子状态未甲基化：在此提供贝伐单抗。对于晚期复发不可手术的MGMT启动子甲基化胶质母细胞瘤患者，大多数推荐替莫唑胺。没有其他多数建议。在缺乏有力证据的情况下，我们确定了一些治疗复发性胶质母细胞瘤的共识建议。这与单一药物和治疗方式的有限可用性形成对比。异质性最大的临床情况可能适合在临床试验中解决，第二意见推荐可能产生不同的建议。
Despite moderate improvements in outcome of glioblastoma after first-line treatment with chemoradiation recent clinical trials failed to improve the prognosis of recurrent glioblastoma. In the absence of a standard of care we aimed to investigate institutional treatment strategies to identify similarities and differences in the pattern of care for recurrent glioblastoma. We investigated re-treatment criteria and therapeutic pathways for recurrent glioblastoma of eight neuro-oncology centres in Switzerland having an established multidisciplinary tumour-board conference. Decision algorithms, differences and consensus were analysed using the objective consensus methodology. A total of 16 different treatment recommendations were identified based on combinations of eight different decision criteria. The set of criteria implemented as well as the set of treatments offered was different in each centre. For specific situations, up to 6 different treatment recommendations were provided by the eight centres. The only wide-range consensus identified was to offer best supportive care to unfit patients. A majority recommendation was identified for non-operable large early recurrence with unmethylated MGMT promoter status in the fit patients: here bevacizumab was offered. In fit patients with late recurrent non-operable MGMT promoter methylated glioblastoma temozolomide was recommended by most. No other majority recommendations were present. In the absence of strong evidence we identified few consensus recommendations in the treatment of recurrent glioblastoma. This contrasts the limited availability of single drugs and treatment modalities. Clinical situations of greatest heterogeneity may be suitable to be addressed in clinical trials and second opinion referrals are likely to yield diverging recommendations.