Concurrent Chemoradiotherapy with Temozolomide Followed by Adjuvant Temozolomide for Newly Diagnosed Glioblastoma Patients: A Retrospective Multicenter Observation Study in Korea

Overview

Journal Cancer Res Treat

Specialty Oncology

Date 2016 Jul 8

PMID 27384161

Citations 24

Authors

Byung Sup Kim

Ho Jun Seol

Do-Hyun Nam

Chul-Kee Park

Il Han Kim

Tae Min Kim

Jeong Hoon Kim

Young Hyun Cho

Sang Min Yoon

Jong Hee Chang

Seok-Gu Kang

Eui Hyun Kim

Chang-Ok Suh

Tae-Young Jung

Kyung-Hwa Lee

Chae-Yong Kim

In Ah Kim

Chang-Ki Hong

Heon Yoo

Jin Hee Kim

Shin-Hyuk Kang

Min Kyu Kang

Eun-Young Kim

Sun-Hwan Kim

Dong-Sup Chung

Sun-Chul Hwang

Joon-Ho Song

Sung Jin Cho

Sun-Il Lee

Youn-Soo Lee

Kook-Jin Ahn

Se Hoon Kim

Do Hun Lim

Ho-Shin Gwak

Se-Hoon Lee

Yong-Kil Hong

Affiliations

Soon will be listed here.

Abstract

Purpose: The purpose of this study was to investigate the feasibility and survival benefits of combined treatment with radiotherapy and adjuvant temozolomide (TMZ) in a Korean sample.

Materials And Methods: A total of 750 Korean patients with histologically confirmed glioblastoma multiforme, who received concurrent chemoradiotherapy with TMZ (CCRT) and adjuvant TMZ from January 2006 until June 2011, were analyzed retrospectively.

Results: After the first operation, a gross total resection (GTR), subtotal resection (STR), partial resection (PR), biopsy alone were achieved in 388 (51.7%), 159 (21.2%), 96 (12.8%), and 107 (14.3%) patients, respectively. The methylation status of O-methylguanine-DNA methyltransferase (MGMT) was reviewed retrospectively in 217 patients. The median follow-up period was 16.3 months and the median overall survival (OS) was 17.5 months. The actuarial survival rates at the 1-, 3-, and 5-year OS were 72.1%, 21.0%, and 9.0%, respectively. The median progression-free survival (PFS) was 10.1 months, and the actuarial PFS at 1-, 3-, and 5-year PFS were 42.2%, 13.0%, and 7.8%, respectively. The patients who received GTR showed a significantly longer OS and PFS than those who received STR, PR, or biopsy alone, regardless of the methylation status of the MGMT promoter. Patients with a methylated MGMT promoter also showed a significantly longer OS and PFS than those with an unmethylated MGMT promoter. Patients who received more than six cycles of adjuvant TMZ had a longer OS and PFS than those who received six or fewer cycles. Hematologic toxicity of grade 3 or 4 was observed in 8.4% of patients during the CCRT period and in 10.2% during the adjuvant TMZ period.

Conclusion: Patients treated with CCRT followed by adjuvant TMZ had more favorable survival rates and tolerable toxicity than those who did not undergo this treatment.

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References

Stupp R, Hegi M, Mason W, van den Bent M, Taphoorn M, Janzer R . Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol. 2009; 10(5):459-66. DOI: 10.1016/S1470-2045(09)70025-7. View

Park C, Lee S, Kim T, Choi S, Park S, Heo D . The value of temozolomide in combination with radiotherapy during standard treatment for newly diagnosed glioblastoma. J Neurooncol. 2013; 112(2):277-83. DOI: 10.1007/s11060-013-1060-3. View

Curran Jr W, Scott C, Horton J, Nelson J, Weinstein A, Fischbach A . Recursive partitioning analysis of prognostic factors in three Radiation Therapy Oncology Group malignant glioma trials. J Natl Cancer Inst. 1993; 85(9):704-10. DOI: 10.1093/jnci/85.9.704. View

DeAngelis L . Brain tumors. N Engl J Med. 2001; 344(2):114-23. DOI: 10.1056/NEJM200101113440207. View

Suzuki Y, Shirai K, Oka K, Mobaraki A, Yoshida Y, Noda S . Higher pAkt expression predicts a significant worse prognosis in glioblastomas. J Radiat Res. 2010; 51(3):343-8. DOI: 10.1269/jrr.09109. View

Esteller M, Garcia-Foncillas J, Andion E, Goodman S, Hidalgo O, Vanaclocha V . Inactivation of the DNA-repair gene MGMT and the clinical response of gliomas to alkylating agents. N Engl J Med. 2000; 343(19):1350-4. DOI: 10.1056/NEJM200011093431901. View

Joo J, Chang J, Kim J, Hong Y, Kim Y, Kim C . Temozolomide during and after Radiotherapy for Newly Diagnosed Glioblastomas : A Prospective Multicenter Study of Korean Patients. J Korean Neurosurg Soc. 2012; 52(2):92-7. PMC: 3467382. DOI: 10.3340/jkns.2012.52.2.92. View

Lawrence Y, Blumenthal D, Matceyevsky D, Kanner A, Bokstein F, Corn B . Delayed initiation of radiotherapy for glioblastoma: how important is it to push to the front (or the back) of the line?. J Neurooncol. 2011; 105(1):1-7. DOI: 10.1007/s11060-011-0589-2. View

Wen P, Macdonald D, Reardon D, Cloughesy T, Sorensen A, Galanis E . Updated response assessment criteria for high-grade gliomas: response assessment in neuro-oncology working group. J Clin Oncol. 2010; 28(11):1963-72. DOI: 10.1200/JCO.2009.26.3541. View

10.

Stummer W, Reulen H, Meinel T, Pichlmeier U, Schumacher W, Tonn J . Extent of resection and survival in glioblastoma multiforme: identification of and adjustment for bias. Neurosurgery. 2008; 62(3):564-76. DOI: 10.1227/01.neu.0000317304.31579.17. View

11.

Oike T, Suzuki Y, Sugawara K, Shirai K, Noda S, Tamaki T . Radiotherapy plus concomitant adjuvant temozolomide for glioblastoma: Japanese mono-institutional results. PLoS One. 2013; 8(11):e78943. PMC: 3827088. DOI: 10.1371/journal.pone.0078943. View

12.

Kreth F, Thon N, Simon M, Westphal M, Schackert G, Nikkhah G . Gross total but not incomplete resection of glioblastoma prolongs survival in the era of radiochemotherapy. Ann Oncol. 2013; 24(12):3117-23. DOI: 10.1093/annonc/mdt388. View

13.

Rivera A, Pelloski C, Gilbert M, Colman H, De La Cruz C, Sulman E . MGMT promoter methylation is predictive of response to radiotherapy and prognostic in the absence of adjuvant alkylating chemotherapy for glioblastoma. Neuro Oncol. 2010; 12(2):116-21. PMC: 2940581. DOI: 10.1093/neuonc/nop020. View

14.

Criniere E, Kaloshi G, Laigle-Donadey F, Lejeune J, Auger N, Benouaich-Amiel A . MGMT prognostic impact on glioblastoma is dependent on therapeutic modalities. J Neurooncol. 2007; 83(2):173-9. DOI: 10.1007/s11060-006-9320-0. View

15.

Buckner J . Factors influencing survival in high-grade gliomas. Semin Oncol. 2004; 30(6 Suppl 19):10-4. DOI: 10.1053/j.seminoncol.2003.11.031. View

16.

Lamborn K, Chang S, Prados M . Prognostic factors for survival of patients with glioblastoma: recursive partitioning analysis. Neuro Oncol. 2004; 6(3):227-35. PMC: 1871999. DOI: 10.1215/S1152851703000620. View

17.

Hegi M, Diserens A, Gorlia T, Hamou M, De Tribolet N, Weller M . MGMT gene silencing and benefit from temozolomide in glioblastoma. N Engl J Med. 2005; 352(10):997-1003. DOI: 10.1056/NEJMoa043331. View

18.

Senft C, Bink A, Franz K, Vatter H, Gasser T, Seifert V . Intraoperative MRI guidance and extent of resection in glioma surgery: a randomised, controlled trial. Lancet Oncol. 2011; 12(11):997-1003. DOI: 10.1016/S1470-2045(11)70196-6. View

19.

Laws E, Parney I, Huang W, Anderson F, Morris A, Asher A . Survival following surgery and prognostic factors for recently diagnosed malignant glioma: data from the Glioma Outcomes Project. J Neurosurg. 2003; 99(3):467-73. DOI: 10.3171/jns.2003.99.3.0467. View

20.

Esteller M, Hamilton S, Burger P, Baylin S, Herman J . Inactivation of the DNA repair gene O6-methylguanine-DNA methyltransferase by promoter hypermethylation is a common event in primary human neoplasia. Cancer Res. 1999; 59(4):793-7. View