Multimodality therapy approaches, local and systemic treatment, compared with chemotherapy alone in recurrent glioblastoma

Marta Scorsetti, Pierina Navarria, Federico Pessina, Anna Maria Ascolese, Giuseppe D'Agostino, Stefano Tomatis, Fiorenza De Rose, Elisa Villa, Giulia Maggi, Matteo Simonelli, Elena Clerici, Riccardo Soffietti, Armando Santoro, Luca Cozzi, Lorenzo Bello, Marta Scorsetti, Pierina Navarria, Federico Pessina, Anna Maria Ascolese, Giuseppe D'Agostino, Stefano Tomatis, Fiorenza De Rose, Elisa Villa, Giulia Maggi, Matteo Simonelli, Elena Clerici, Riccardo Soffietti, Armando Santoro, Luca Cozzi, Lorenzo Bello

Abstract

Background: Long-term local control in Glioblastoma is rarely achieved and nearly all patients relapse. In this study we evaluated the clinical effect of different treatment approaches in recurrent patients.

Methods: Forty-three patients, with median age of 51 years were evaluated for salvage treatment: re-resection and/or re-irradiation plus chemotherapy or chemotherapy alone. Response was recorded using the Response Assessment in Neuro-Oncology criteria. Hematologic and non-hematologic toxicities were graded according to Common Terminology Criteria for Adverse Events 4.0. Twenty-one patients underwent chemotherapy combined with local treatment, surgery and/or radiation therapy, and 22 underwent chemotherapy only.

Results: The median follow up was 7 months (range 3-28 months). The 1 and 2-years Progression Free Survival was 65 and 10 % for combined treatment and 22 and 0 % for chemotherapy alone (p < 0.01). The 1 and 2-years overall survival was 69 and 29 % for combined and 26 and 0 % for chemotherapy alone (p < 0.01). No toxicity greater than grade 2 was recorded.

Conclusion: These data showed that in glioblastoma recurrence the combination of several approaches in a limited group of patients is more effective than a single treatment alone. This stress the importance of multimodality treatment whenever clinically feasible.

Figures

Fig. 1
Fig. 1
Progression free survival (a) and Overall Survival (b)
Fig. 2
Fig. 2
Progression free survival (a) and Overall Survival (b) in relation with different treatment modalities. Solid line: combined treatment; dashed line: radiotherapy alone (RT)

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