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Glioblastoma: Patterns of Recurrence and Efficacy of Salvage Treatments

Published online by Cambridge University Press:  02 December 2014

Jiwon Oh ,
Arjun Sahgal ,
Paul Sanghera ,
May N. Tsao ,
Phil Davey ,
Kelvin Lam ,
Sean Symons ,
Richard Aviv  and
James R. Perry
Jiwon Oh*
Affiliation:
Divison of Neurology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Arjun Sahgal
Affiliation:
Departments of Medicine, and Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Paul Sanghera
Affiliation:
Departments of Medicine, and Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
May N. Tsao
Affiliation:
Departments of Medicine, and Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Phil Davey
Affiliation:
Departments of Medicine, and Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Kelvin Lam
Affiliation:
Divison of Neurology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Sean Symons
Affiliation:
Division of Neuroradiology, Department of Medical Imaging, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Richard Aviv
Affiliation:
Division of Neuroradiology, Department of Medical Imaging, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
James R. Perry
Affiliation:
Divison of Neurology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
*
Sunnybrook Health Sciences Centre, University of Toronto, A402, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada.
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Abstract:

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Background:

It is controversial if distant recurrence of glioblastoma is more common after temozolomide (TMZ) concurrent with radiotherapy (RT). Optimal therapy for patients with recurrent disease after RT/TMZ is unclear. Our purpose was to evaluate recurrence patterns in glioblastoma and the effect of treatment at recurrence upon survival.

Methods:

We performed a retrospective review of 67 patients with newly diagnosed glioblastoma treated with RT/TMZ between 2003-2007. Statistical analyses included Kaplan-Meier method for survival, and multivariate Cox proportional hazards model for the effect of salvage treatment on survival.

Results:

58 patients (86.6%) recurred locally; 9 patients (13.4%) had a distant non-contiguous focus of new disease. Median survival(MS) was 17 months; median time-to-progression(TTP) 6.8 months. The local and distant groups had comparable prognostic factors. There was no difference in MS(p=0.35) or TTP(p=0.95) by location of recurrence. At relapse, 26 patients(38.8%) received continuous, dose-intense TMZ, 24(35.8%) other therapy(4.5% RT; 20.9% lomustine+/-procarbazine; 4.5% etoposide; 1.5% conventional TMZ; 4.5% TMZ then lomustine), and 17(25.4%) were untreated. Dose-intense TMZ was associated with prolonged MS compared to all other patients(21.5 months vs. 12.4 months, p=0.019, HR=3.86, 95%CI: 1.81-8.22) and similar to MS with other chemotherapy regimens(18.8 months, p=0.40, HR=1.30, 95% CI: 0.65-2.61).

Conclusion:

The pattern of recurrence of glioblastoma treated with RT/TMZ was predominantly local. Second-line treatment with continuous dose-intense TMZ may prolong survival in patients with recurrent glioblastoma. Overall survival is similar to other conventional salvage regimens; however TMZ may be better tolerated. This study is limited by its retrospective nature and potential selection bias. Prospective controlled studies are needed.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 38 , Issue 4 , July 2011 , pp. 621 - 625
Copyright
Copyright © The Canadian Journal of Neurological 2011

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