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Initial and cumulative recurrence patterns of glioblastoma after temozolomide-based chemoradiotherapy and salvage treatment: a retrospective cohort study in a single institution.

Ogura K, Mizowaki T, Arakawa Y, Ogura M, Sakanaka K, Miyamoto S, Hiraoka M - Radiat Oncol (2013)

Bottom Line: Twenty-one patients with glioblastoma that recurred after concurrent temozolomide and localized radiotherapy were retrospectively analyzed (11 male, 10 female; median age, 57 years; range, 27-74).Disease progression was assessed by new response criteria proposed by the Response Assessment in Neuro-Oncology Working Group of the American Society of Clinical Oncology.The median follow-up of the recurrent patients was 501 (range, 217-1815) days after initial surgery.

View Article: PubMed Central - HTML - PubMed

Affiliation: Departments of Radiation Oncology and Image-applied Therapy, 54 Kawahara-cho, Shogoin Sakyo-ku, Kyoto 606-8507, Japan. mizo@kuhp.kyoto-u.ac.jp.

ABSTRACT

Purpose: To analyze initial recurrence patterns in patients with newly diagnosed glioblastoma after radiotherapy plus concurrent and adjuvant temozolomide, and to investigate cumulative recurrence patterns after salvage treatment, including surgery, stereotactic radiotherapy, and chemotherapy.

Methods: Twenty-one patients with glioblastoma that recurred after concurrent temozolomide and localized radiotherapy were retrospectively analyzed (11 male, 10 female; median age, 57 years; range, 27-74). Disease progression was assessed by new response criteria proposed by the Response Assessment in Neuro-Oncology Working Group of the American Society of Clinical Oncology. The pattern of recurrence was determined by relationships between locations of recurrent tumors and irradiated doses. Central, in-field, marginal, and out-field recurrences were defined relative to the prescribed isodose line. Distant recurrence was operationally defined as subependymal or disseminated disease. Initial and cumulative patterns of recurrence were evaluated in each patient.

Results: The median follow-up of the recurrent patients was 501 (range, 217-1815) days after initial surgery. Initial recurrences were central in 14 patients (66.7%), in-field in four patients (19.0%), marginal in no patient (0%), out-field in two patients (9.5%), and distant in four patients (19.0%). One patient had both central and in-field recurrences simultaneously, and two had both central and distant recurrences. In the analysis of cumulative recurrence patterns, five patients, who had no scans after initial recurrences, were excluded and the remaining 16 were included. Cumulative recurrences were central in 11 patients (68.8%), in-field in five patients (31.3%), marginal in three patients (18.8%), out-field in five patients (31.3%), and distant in 14 patients (87.5%). Regarding salvage treatments, 11 (52.4%), 11 (52.4%) and 17 (81.0%) patients underwent surgery, stereotactic radiotherapy and chemotherapy, respectively. Eighteen (85.7%) patients had died at the time of analysis, and 16 of them (88.9%) had suffered distant recurrences, which could have been the immediate causes of death.

Conclusions: Recurrence patterns of glioblastoma after radiotherapy plus concomitant and adjuvant temozolomide were mainly central at first, and distant recurrences were often detected during the clinical course. Much better local control and prevention of distant recurrence, including effective salvage treatment, seem to be important.

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Overall survival and progression-free survival. Overall survival (OS) and progression-free survival (PFS) of 21 recurrent patients were estimated using the Kaplan-Meier method.
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Figure 2: Overall survival and progression-free survival. Overall survival (OS) and progression-free survival (PFS) of 21 recurrent patients were estimated using the Kaplan-Meier method.

Mentions: To date, of 37 eligible patients, 21 (56.8%) have been diagnosed with progressive disease. The characteristics of recurrent patients are summarized in Table 1. Eighteen (85.7%) died at a median follow-up of 501 (range, 217–1815) days after initial surgery. The 1-year and 2-year OSs of recurrent patients were 81.0% (95% confidence interval [CI], 65.8–99.6) and 31.7% (95% CI, 16.7–60.4), respectively. The 6-month and 12-month PFSs of recurrent patients were 66.7% (95% CI, 49.2–90.2) and 19.1% (95% CI, 7.9–46.0), respectively (Figure 2).


Initial and cumulative recurrence patterns of glioblastoma after temozolomide-based chemoradiotherapy and salvage treatment: a retrospective cohort study in a single institution.

Ogura K, Mizowaki T, Arakawa Y, Ogura M, Sakanaka K, Miyamoto S, Hiraoka M - Radiat Oncol (2013)

Overall survival and progression-free survival. Overall survival (OS) and progression-free survival (PFS) of 21 recurrent patients were estimated using the Kaplan-Meier method.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3643853&req=5

Figure 2: Overall survival and progression-free survival. Overall survival (OS) and progression-free survival (PFS) of 21 recurrent patients were estimated using the Kaplan-Meier method.
Mentions: To date, of 37 eligible patients, 21 (56.8%) have been diagnosed with progressive disease. The characteristics of recurrent patients are summarized in Table 1. Eighteen (85.7%) died at a median follow-up of 501 (range, 217–1815) days after initial surgery. The 1-year and 2-year OSs of recurrent patients were 81.0% (95% confidence interval [CI], 65.8–99.6) and 31.7% (95% CI, 16.7–60.4), respectively. The 6-month and 12-month PFSs of recurrent patients were 66.7% (95% CI, 49.2–90.2) and 19.1% (95% CI, 7.9–46.0), respectively (Figure 2).

Bottom Line: Twenty-one patients with glioblastoma that recurred after concurrent temozolomide and localized radiotherapy were retrospectively analyzed (11 male, 10 female; median age, 57 years; range, 27-74).Disease progression was assessed by new response criteria proposed by the Response Assessment in Neuro-Oncology Working Group of the American Society of Clinical Oncology.The median follow-up of the recurrent patients was 501 (range, 217-1815) days after initial surgery.

View Article: PubMed Central - HTML - PubMed

Affiliation: Departments of Radiation Oncology and Image-applied Therapy, 54 Kawahara-cho, Shogoin Sakyo-ku, Kyoto 606-8507, Japan. mizo@kuhp.kyoto-u.ac.jp.

ABSTRACT

Purpose: To analyze initial recurrence patterns in patients with newly diagnosed glioblastoma after radiotherapy plus concurrent and adjuvant temozolomide, and to investigate cumulative recurrence patterns after salvage treatment, including surgery, stereotactic radiotherapy, and chemotherapy.

Methods: Twenty-one patients with glioblastoma that recurred after concurrent temozolomide and localized radiotherapy were retrospectively analyzed (11 male, 10 female; median age, 57 years; range, 27-74). Disease progression was assessed by new response criteria proposed by the Response Assessment in Neuro-Oncology Working Group of the American Society of Clinical Oncology. The pattern of recurrence was determined by relationships between locations of recurrent tumors and irradiated doses. Central, in-field, marginal, and out-field recurrences were defined relative to the prescribed isodose line. Distant recurrence was operationally defined as subependymal or disseminated disease. Initial and cumulative patterns of recurrence were evaluated in each patient.

Results: The median follow-up of the recurrent patients was 501 (range, 217-1815) days after initial surgery. Initial recurrences were central in 14 patients (66.7%), in-field in four patients (19.0%), marginal in no patient (0%), out-field in two patients (9.5%), and distant in four patients (19.0%). One patient had both central and in-field recurrences simultaneously, and two had both central and distant recurrences. In the analysis of cumulative recurrence patterns, five patients, who had no scans after initial recurrences, were excluded and the remaining 16 were included. Cumulative recurrences were central in 11 patients (68.8%), in-field in five patients (31.3%), marginal in three patients (18.8%), out-field in five patients (31.3%), and distant in 14 patients (87.5%). Regarding salvage treatments, 11 (52.4%), 11 (52.4%) and 17 (81.0%) patients underwent surgery, stereotactic radiotherapy and chemotherapy, respectively. Eighteen (85.7%) patients had died at the time of analysis, and 16 of them (88.9%) had suffered distant recurrences, which could have been the immediate causes of death.

Conclusions: Recurrence patterns of glioblastoma after radiotherapy plus concomitant and adjuvant temozolomide were mainly central at first, and distant recurrences were often detected during the clinical course. Much better local control and prevention of distant recurrence, including effective salvage treatment, seem to be important.

Show MeSH
Related in: MedlinePlus