Dasantha Jayamanne1,2, Helen Wheeler1,3,4, Raymond Cook4,5, Charles Teo6, David Brazier3,7, Geoff Schembri3,8, Marina Kastelan1,4, Linxin Guo1, Michael F Back1,2,3,4. 1. Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia. 2. Central Coast Cancer Centre, Gosford Hospital, Sydney, New South Wales, Australia. 3. Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia. 4. Sydney NeuroOncology Group, Sydney, New South Wales, Australia. 5. Department of Neurosurgery, Royal North Shore Hospital, Sydney, New South Wales, Australia. 6. Department of Neurosurgery, Prince of Wales Private Hospital, Sydney, New South Wales, Australia. 7. Department of Radiology, Royal North Shore Hospital, Sydney, New South Wales, Australia. 8. Department of Nuclear Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia.
Abstract
BACKGROUND: Evaluate survival of patients diagnosed with glioblastoma multiforme (GBM) managed with adjuvant intensity modulated radiation therapy and temozolomide since the introduction of the European Organisation for Research and Treatment of Cancer and National Cancer Institute of Canada Clinical Trials Group (EORTC-NCIC) protocol. METHODS: All patients with GBM managed between May 2007 and December 2014 with EORTC-NCIC protocol were entered into a prospective database. The primary endpoint was the median survival. Univariate predictors of survival were evaluated with respect to tumour resection, age and Eastern Cooperative Oncology Group (ECOG) performance status using log-rank comparisons. RESULTS: Two hundred and thirty-three patients were managed under the protocol and analysed for outcome. The median age was 57 years; the rate of gross total resection, subtotal resection and biopsy were 47.2%, 35.2% and 17.6%, respectively. At progression, 49 patients had re-resection, and in addition to second-line chemotherapy, 86 patients had Bevacizumab including 26 with re-irradiation. Median survival was 17.0 months (95% CI: 15.4-18.6). On univariate evaluation, extent of resection (P = 0.001), age, ECOG performance status and recursive partitioning analysis class III were shown to significantly improve survival (P < 0.0001). The median survival for gross total resection, age <50 years, ECOG 0-1 and recursive partitioning analysis class III were 21, 27, 20 and 47 months, respectively. CONCLUSION: This study confirms the significant improvement in median survival in GBM that has occurred in recent years since introduction of the EORTC-NCIC protocol. Further improvements have occurred presumably related to subspecialized care, improved resection rates, sophisticated radiotherapy targeting and early systemic salvage therapies. However, the burden of the disease within the community remains high and the median survival improvements over time have plateaued.
BACKGROUND: Evaluate survival of patients diagnosed with glioblastoma multiforme (GBM) managed with adjuvant intensity modulated radiation therapy and temozolomide since the introduction of the European Organisation for Research and Treatment of Cancer and National Cancer Institute of Canada Clinical Trials Group (EORTC-NCIC) protocol. METHODS: All patients with GBM managed between May 2007 and December 2014 with EORTC-NCIC protocol were entered into a prospective database. The primary endpoint was the median survival. Univariate predictors of survival were evaluated with respect to tumour resection, age and Eastern Cooperative Oncology Group (ECOG) performance status using log-rank comparisons. RESULTS: Two hundred and thirty-three patients were managed under the protocol and analysed for outcome. The median age was 57 years; the rate of gross total resection, subtotal resection and biopsy were 47.2%, 35.2% and 17.6%, respectively. At progression, 49 patients had re-resection, and in addition to second-line chemotherapy, 86 patients had Bevacizumab including 26 with re-irradiation. Median survival was 17.0 months (95% CI: 15.4-18.6). On univariate evaluation, extent of resection (P = 0.001), age, ECOG performance status and recursive partitioning analysis class III were shown to significantly improve survival (P < 0.0001). The median survival for gross total resection, age <50 years, ECOG 0-1 and recursive partitioning analysis class III were 21, 27, 20 and 47 months, respectively. CONCLUSION: This study confirms the significant improvement in median survival in GBM that has occurred in recent years since introduction of the EORTC-NCIC protocol. Further improvements have occurred presumably related to subspecialized care, improved resection rates, sophisticated radiotherapy targeting and early systemic salvage therapies. However, the burden of the disease within the community remains high and the median survival improvements over time have plateaued.
Authors: Theresa A Cook; Dasantha T Jayamanne; Helen R Wheeler; Matthew H F Wong; Jonathon F Parkinson; Raymond J Cook; Marina A Kastelan; Nicola J Cove; Christopher Brown; Michael F Back Journal: Neurooncol Pract Date: 2021-06-09
Authors: Amy Johnston; Nicola Creighton; Jonathon Parkinson; Eng-Siew Koh; Helen Wheeler; Elizabeth Hovey; Michael Rodriguez; David C Currow Journal: Neurooncol Pract Date: 2019-07-06
Authors: Michael Back; Dasantha Jayamanne; Nicola Cove; Helen Wheeler; Mustafa Khasraw; Linxin Guo; Jemimah Back; Matthew Wong Journal: Brain Sci Date: 2018-10-15