Postoperative treatment of glioblastoma multiforme with radiation therapy plus concomitant and adjuvant temozolomide : A mono-institutional experience of 215 patients
Postoperative treatment of glioblastoma multiforme with radiation therapy plus concomitant and adjuvant temozolomide : A mono-institutional experience of 215 patients
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DOI：
10.4103/0973-1482.119310
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发表时间：
2013-07-01
影响因子：
1.3
通讯作者：
Rath, Goura Kisor
中科院分区：
文献类型：
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作者：
Julka, Pramod Kumar;Sharma, Daya Nand;Rath, Goura Kisor
目的：研究多形性胶质母细胞瘤（GBM）患者术后放疗（PORT）联合替莫唑胺辅助替莫唑胺治疗的临床结果和预后因素。方法：2005年至2008年，215名GBM患者（中位年龄48岁）接受了PORT联合替莫唑胺化疗。放射治疗 (RT) 采用常规分割，剂量为 60 Gy，分 30 次，持续 6 周，同时服用替莫唑胺（75 mg/m (2) /天）。辅助治疗包括 6 个周期的替莫唑胺（150 mg/m (2)，持续 5 天，28 天周期）。该研究的主要终点是总生存期（OS），次要终点是无进展生存期（PFS）和毒性。根据不同变量确定 OS，以研究预后意义。结果：中位随访时间为 11 个月（范围 2-50 个月）。中位 OS 和 PFS 分别为 13 个月和 11 个月。 1 年和 2 年 OS 分别为 44% 和 18%。年龄、性别、KP评分、解剖位置和手术范围没有统计学上的显着影响。无癫痫发作（单变量分析）和 6 个周期的替莫唑胺辅助治疗（单变量以及多变量分析）被发现是重要的预后因素。 16 名患者在 RT 过程中出现 III-IV 级中性粒细胞减少症/血小板减少症。结论：我们的结果证实了替莫唑胺化疗联合 PORT 联合辅助治疗 GBM 患者的作用。我们强烈推荐完整的 6 个周期的替莫唑胺辅助治疗，因为在我们的研究中它显着提高了生存率。
Objective: To study the clinical results and prognostic factors of patients with glioblastoma multiforme (GBM) treated by postoperative radiation therapy (PORT) and concomitant temozolomide followed by adjuvant temozolomide. Methods: From 2005 to 2008, 215 patients (median age 48 years) with GBM were treated with PORT plus temozolomide chemotherapy. Radiation therapy (RT) was employed with a dose of 60 Gy in 30 fractions over 6 weeks by conventional fractionation with concomitant temozolomide (75 mg/m (2) /day). Adjuvant therapy consisted of 6 cycles of temozolomide (150 mg/m (2) for 5 days, 28 days cycle). The primary end point of the study was overall survival (OS), and the secondary end points were progression free survival (PFS) and toxicity. OS was determined with respect to different variables to study the prognostic significance. Results: Median follow up was 11 months (range 2-50 months). Median OS and PFS were 13 months and 11 months respectively. The 1-year and 2-year OS was 44% and 18% respectively. There was no statistical significant impact of age, sex, KP score, anatomical location and extent of surgery. Presentation without seizures (on univariate analysis) and 6 cycles of adjuvant temozolomide therapy (on univariate as well as multivariate analysis) were found significant prognostic factors. Sixteen patients developed grade III-IV neutropenia/thrombocytopenia during the course of RT. Conclusion: Our results authenticate the role of concomitant and adjuvant temozolomide chemotherapy in combination with PORT for the management of GBM patients. We strongly recommend complete 6 cycle of adjuvant temozolomide since it significantly improved the survival in our study.