Resection and survival in glioblastoma multiforme: an RTOG recursive partitioning analysis of ALA study patients
Uwe Pichlmeier, Andrea Bink, Gabriele Schackert, Walter Stummer, ALA Glioma Study Group, F Oppel, A Brune, W Lanksch, C Woiciechowsky, M Brock, J Vesper, J-C Tonn, C Goetz, J M Gilsbach, L Mayfrank, M F Oertel, V Seifert, K Franz, A Bink, G Schackert, T Pinzer, W Hassler, A Bani, H-J Meisel, B C Kern, H M Mehdorn, A Mehdorn, A Brawanski, O W Ullrich, D K Böker, M Winking, F Weber, U Langenbach, M Westphal, U Kähler, H Arnold, U Knopp, T Grumme, T Stretz, D Stolke, H Wiedemayer, B Turowski, T Pietsch, O D Wiestler, H-J Reulen, W Stummer, Uwe Pichlmeier, Andrea Bink, Gabriele Schackert, Walter Stummer, ALA Glioma Study Group, F Oppel, A Brune, W Lanksch, C Woiciechowsky, M Brock, J Vesper, J-C Tonn, C Goetz, J M Gilsbach, L Mayfrank, M F Oertel, V Seifert, K Franz, A Bink, G Schackert, T Pinzer, W Hassler, A Bani, H-J Meisel, B C Kern, H M Mehdorn, A Mehdorn, A Brawanski, O W Ullrich, D K Böker, M Winking, F Weber, U Langenbach, M Westphal, U Kähler, H Arnold, U Knopp, T Grumme, T Stretz, D Stolke, H Wiedemayer, B Turowski, T Pietsch, O D Wiestler, H-J Reulen, W Stummer
Abstract
The benefit of cytoreductive surgery for glioblastoma multiforme (GBM) is unclear, and selection bias in past series has been observed. The 5-aminolevulinic acid (ALA) study investigated the influence of fluorescence-guided resections on outcome and generated an extensive database of GBM patients with optimized resections. We evaluated whether the Radiation Therapy Oncology Group recursive partitioning analysis (RTOG-RPA) would predict survival of these patients and whether there was any benefit from extensive resections depending on RPA class. A total of 243 per-protocol patients with newly diagnosed GBM were operated on with or without ALA and treated by radiotherapy. Postoperative MRI was obtained in all patients. Patients were allocated into RTOG-RPA classes III-V based on age, KPS, neurological condition, and mental status (as derived from the NIH Stroke Scale). Median overall survival among RPA classes III, IV, and V was 17.8, 14.7, and 10.7 months, respectively, with 2-year survival rates of 26%, 12%, and 7% (p = 0.0007). Stratified for degree of resection, survival of patients with complete resections was clearly longer in RPA classes IV and V (17.7 months vs. 12.9 months, p = 0.0015, and 13.7 months vs. 10.4 months, p = 0.0398; 2-year rates: 21.0% vs. 4.4% and 11.1% vs. 2.6%, respectively), but was not in the small subgroup of RPA class III patients (19.3 vs. 16.3 months, p = 0.14). Survival of patients from the ALA study is correctly predicted by the RTOG-RPA classes. Differences in survival depending on resection status, especially in RPA classes IV and V, support a causal influence of resection on survival.
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Source: PubMed