Treatment outcome of patients with recurrent glioblastoma multiforme: a retrospective multicenter analysis

Myra E van Linde, Cyrillo G Brahm, Philip C de Witt Hamer, Jaap C Reijneveld, Anna M E Bruynzeel, W Peter Vandertop, Peter M van de Ven, Michiel Wagemakers, Hiske L van der Weide, Roelien H Enting, Annemiek M E Walenkamp, Henk M W Verheul, Myra E van Linde, Cyrillo G Brahm, Philip C de Witt Hamer, Jaap C Reijneveld, Anna M E Bruynzeel, W Peter Vandertop, Peter M van de Ven, Michiel Wagemakers, Hiske L van der Weide, Roelien H Enting, Annemiek M E Walenkamp, Henk M W Verheul

Abstract

Glioblastoma multiforme (GBM) universally recurs with dismal prognosis. We evaluated the efficacy of standard treatment strategies for patients with recurrent GBM (rGBM). From two centers in the Netherlands, 299 patients with rGBM after first-line treatment, diagnosed between 2005 and 2014, were retrospectively evaluated. Four different treatment strategies were defined: systemic treatment (SYST), re-irradiation (RT), re-resection followed by adjuvant treatment (SURG) and best supportive care (BSC). Median OS for all patients was 6.5 months, and median PFS (excluding patients receiving BSC) was 5.5 months. Older age, multifocal lesions and steroid use were significantly associated with a shorter survival. After correction for confounders, patients receiving SYST (34.8%) and SURG (18.7%) had a significantly longer survival than patients receiving BSC (39.5%), 7.3 and 11.0 versus 3.1 months, respectively [HR 0.46 (p < 0.001) and 0.36 (p < 0.001)]. Median survival for patients receiving RT (7.0%) was 9.2 months, but this was not significantly different from patients receiving BSC (p = 0.068). Patients receiving SURG compared to SYST had a longer PFS (9.0 vs. 4.3 months, respectively; p < 0.001), but no difference in OS was observed. After adjustments for confounders, patients with rGBM selected for treatment with SURG or SYST do survive significantly longer than patients who are selected for BSC based on clinical parameters. The value of reoperation versus systemic treatment strategies needs further investigation.

Keywords: Recurrent glioblastoma multiforme; Survival outcome; Treatment effectiveness; Treatment strategies.

Figures

Fig. 1
Fig. 1
Flow chart
Fig. 2
Fig. 2
Kaplan–Meier curves of a overall survival and b progression-free survival for all patients

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