Waiting times do not negatively modify outcome of patients with multiform glioblastoma
Fiche publication
Date publication
janvier 2009
Auteurs
Membres identifiés du Cancéropôle Est :
Pr NOEL Georges, Dr QUETIN Philippe, Dr SCHOTT Roland
Tous les auteurs :
Noel G, Quetin P, Heymann S, Karamanoukian D, Schott R
Lien Pubmed
Résumé
Purpose. - To assess waiting time effect in patient with multiform glioblastoma (GBM) treated with 3D conformal planned postoperative radiotherapy and to investigate the impact of chemotherapy as first adjuvant treatment. Patients and methods. - We retrospectively analyzed 94 consecutive patients with histologically proven GBM. Surgery was considered as macroscopically complete in 33 cases (35%). Median irradiation (lose was 60 Gy (8-63, mean 56 Gy). Dose per fractions was 1.8 Gy (five patients), 2 Gy (76 patients) and 2.7 Gy (13 patients). Forty patients received adjuvant pre-radiotherapy chemotherapy Lis intra-operative carmustine (nine patients) and adjuvant five-day protocol temozolomide alone (31 patients) or with cisplatinum (two patients). All patients received only one chemotherapy cycle. Results. - There were 56 males and 38 females. Median age was 62.1 years old (7-82, mean: 59.2 year). Median follow-up was nine months (1-49). For overall patients, median waiting time between fist clinical sign and start of the non surgical treatment was 68 days (3-274, mean: 81.9 days). For those who received chemotherapy as first treatment, this waiting time was 54 days (3-221, mean 68.3 days). For overall patients, median waiting time between surgery and beginning of radiotherapy was 46 days (8-401, mean 59.3 days). For patients who did not receive chemotherapy as first adjuvant treatment this waiting time was 46 days (-278, mean 55.4 days). Median local control was 14.5 months. Six, 12-, 18-, and 24-month local control rates were 75.6 +/- 4.6%, 57.6 +/- 6.2%, and 36.7 +/- 8% and 27.6 +/- 8.2%, respectively. According to multivariate analysis, we retrieved two independent prognostic factors of local control, macroscopically total removal of the tumor [RR = 2.85, IC 95% (1.3-6.5), p = 0.012] and irradiation dose above 60 Gy, [RR = 3.14, IC 95% (1.5-6.6), p = 0.002]. Median overall survival was 14.3 months. Six-, 12-, 18, and 24-month overall survival rates were 84 +/- 3.9%, 55.1 +/- 5.9%, 34.2 +/- 6.3% and 30.4 +/- 6.7%, respectively. There was no independent prognostic factor. Conclusion. - In our series neither waiting times nor adjuvant immediate chemotherapy were prognosticator of local control and overall survival outcome of patients with glioblastoma. (c) 2008 Publie par Elsevier Masson SAS.
Référence
Cancer Radiother. 2009 Jan;13(1):17-23