Dataset Information

Scale to predict survival after surgery for recurrent glioblastoma multiforme.

ABSTRACT:

Purpose

Despite initial treatment with surgical resection, radiotherapy, and chemotherapy, glioblastoma multiforme (GBM) virtually always recurs. Surgery is sometimes recommended to treat recurrence. In this study, we sought to devise a preoperative scale that predicts survival after surgery for recurrent glioblastoma multiforme.

Patients and methods

The preoperative clinical and radiographic data of 34 patients who underwent re-operation of recurrent GBM tumors were analyzed using Kaplan-Meier survival analysis and Cox proportional hazards regression modeling. The factors associated with decreased postoperative survival (P < .05) were used to devise a prognostic scale which was validated with a separate cohort of 109 patients.

Results

The factors associated with poor postoperative survival were: tumor involvement of prespecified eloquent/critical brain regions (P = .021), Karnofsky performance status (KPS) < or = 80 (P = .030), and tumor volume > or = 50 cm(3) (P = .048). An additive scale (range, 0 to 3 points) comprised of these three variables distinguishes patients with good (0 points), intermediate (1 to 2 points), and poor (3 points) postoperative survival (median survival, 10.8, 4.5, and 1.0 months, respectively; P < .001). The scale identified three statistically distinct groups within the validation cohort as well (median survival, 9.2, 6.3, and 1.9 months, respectively; P < .001).

Conclusion

We devised and validated a preoperative scale that identifies patients likely to have poor, intermediate, and good relative outcomes after surgical resection of a recurrent GBM tumor. Application of this simple scale may be useful in counseling patients regarding their treatment options and in designing clinical trials.

SUBMITTER: Park JK

PROVIDER: S-EPMC2940401 | biostudies-literature | 2010 Aug

REPOSITORIES: biostudies-literature

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Publications

Scale to predict survival after surgery for recurrent glioblastoma multiforme.

Park John K JK Hodges Tiffany T Arko Leopold L Shen Michael M Dello Iacono Donna D McNabb Adrian A Olsen Bailey Nancy N Kreisl Teri Nguyen TN Iwamoto Fabio M FM Sul Joohee J Auh Sungyoung S Park Grace E GE Fine Howard A HA Black Peter McL PM

Journal of clinical oncology : official journal of the American Society of Clinical Oncology 20100719 24

<h4>Purpose</h4>Despite initial treatment with surgical resection, radiotherapy, and chemotherapy, glioblastoma multiforme (GBM) virtually always recurs. Surgery is sometimes recommended to treat recurrence. In this study, we sought to devise a preoperative scale that predicts survival after surgery for recurrent glioblastoma multiforme.<h4>Patients and methods</h4>The preoperative clinical and radiographic data of 34 patients who underwent re-operation of recurrent GBM tumors were analyzed usin ...[more]

PMID: 20644085

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Project description:PURPOSE:We investigated serum cytokine and T-cell responses directed against tumour-associated antigens (TAAs) in association with survival of patients with glioblastoma multiforme (GBM). PATIENTS AND METHODS:Peripheral blood from 205 treatment-naïve patients with glioma (GBM?=?145; non-GBM?=?60) was obtained on the day of surgery to measure (i) circulating T-cells reacting to viral antigens and TAAs, in the presence or absence of cytokine conditioning with IL-2/IL-15/IL-21 or IL-2/IL-7, and (ii) serum cytokine levels (IL-4, IL-5, IL-6, TNF-?, IFN-? and IL-17A). Patients were followed-up for at least 1000?days post-surgery. Survivin protein and gene expression in resected GBM tumour tissue were confirmed by immunohistochemistry and real-time polymerase chain reaction, respectively. Antigen-specific T-cell responses were gauged by ICS (intracellular cytokine production). Associations between patient survival and immunological reactivity patterns were analysed using univariate and multivariate statistics. RESULTS:Approximately 2% of patients with GBM and 18% of patients with non-GBM glioma, were alive beyond 1000?days of surgery. Univariate analysis indicated that the combination of three cytokines (IL-4/IL-5/IL-6, p?=?.0022; IFN-?/TNF-?/IL-17A, p?=?.0083) but not a 'partial' combination of these cytokines, the IFN-? immune response to EBV-EBNA-1 (p?<?.0001) as well as T-cell responses to the survivin97-111 peptide (p?=?.0152) correlated with longer survival among patients with GBM. Multivariate analysis identified survivin97-111-directed IFN-? production with IL-2/IL-15/IL-21 conditioning (p?=?.024), and the combined presence of serum IFN-?/TNF-?/IL-17a (p?=?.003) as independent predictors of survival. CONCLUSION:Serum cytokine patterns and lymphocyte reactivity to survivin97-111, particularly with IL-2, IL-15 and IL-21 conditioning may be instrumental in predicting survival among patients with GBM. This has implications for clinical follow-up of patients with GBM and the targeted development of immunotherapy for patients with CNS tumours.

Project description:ObjectivesTumour recurrence of glioblastoma multiforme (GBM) after initial treatment with surgical resection, radiotherapy and chemotherapy is an inevitable phenomenon. This retrospective cohort study compared the efficacy of interstitial high dose rate brachytherapy (HDR-BRT), re-resection and sole dose dense temozolomide chemotherapy (ddTMZ) in the treatment of recurrent glioblastoma after initial surgery and radiochemotherapy.DesignRetropective cohort study.SettingPrimary level of care with two participating centres. The geographical location was central Germany.ParticipantsFrom January 2005 to December 2010, a total of 111 patients developed recurrent GBM after initial surgery and radiotherapy with concomitant temozolomide. The inclusion criteria were as follows: (1) histology-proven diagnosis of primary GBM (WHO grade 4), (2) primary treatment with resection and radiochemotherapy, and (3) tumour recurrence/progression.InterventionsThis study compared retrospectively the efficacy of interstitial HDR-BRT, re-resection and ddTMZ alone in the treatment of recurrent glioblastoma.Primary and secondary outcome measuresMedian survival, progression free survival and complication rate.ResultsMedian survival after salvage therapy of the recurrence was 37, 30 and 26 weeks, respectively. The HDR-BRT group did significantly better than both the reoperation (p<0.05) and the ddTMZ groups (p<0.05). Moderate to severe complications in the HDR-BRT, reoperation and sole chemotherapy groups occurred in 5/50 (10%), 4/36 (11%) and 9/25 (36%) cases, respectively.ConclusionsCT-guided interstitial HDR-BRT attained higher survival benefits in the management of recurrent glioblastoma after initial surgery and radiotherapy with concurrent temozolomide in comparison with the other treatment modalities. The low risk of complications of the HDR-BRT and the fact that it can be delivered percutaneously in local anaesthesia render it a promissing treatment option for selected patients which should be further evaluated.

Dataset Information

Scale to predict survival after surgery for recurrent glioblastoma multiforme.

Purpose

Patients and methods

Results

Conclusion

Publications

Scale to predict survival after surgery for recurrent glioblastoma multiforme.

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