Pattern of care and effectiveness of treatment for glioblastoma patients in the real world: Results from a prospective population-based registry. Could survival differ in a high-volume center?

• DOI: 10.1093/nop/npu021
• Publication Date: 2014-08-29T05:34:12Z
• Authors: Alba A. Brandes; Enrico Franceschi; Mario Ermani; Alicia Tosoni; Fiorenzo Albani; Roberta Depenni; Marina Faedi; Anna Pisanello; Girolamo Crisi; Benedetta Urbini; Claudio Dazzi; Luigi Cavanna; Claudia Mucciarini; Giuseppe Pasini; Stefania Bartolini; Gianluca Marucci; Luca Morandi; Elena Zunarelli; Serenella Cerasoli; Giorgio Gardini; Giovanni Lanza; Enrico Maria Silini; Silvio Cavuto; Agostino Baruzzi; A. Baruzzi; F. Albani; F. Calbucci; R. D'Alessandro; R. Michelucci; A. Brandes; V. Eusebi; S. Ceruti; E. Fainardi; R. Tamarozzi; E. Emiliani; M. Cavallo; E. Franceschi; A. Tosoni; M. Cavallo; F. Fiorica; A. Valentini; R. Depenni; C. Mucciarini; G. Crisi; E. Sasso; C. Biasini; L. Cavanna; D. Guidetti; N. Marcello; A. Pisanello; A.M. Cremonini; G. Guiducci; S. de Pasqua; S. Testoni; R. Agati; G. Ambrosetto; A. Bacci; E. Baldin; A. Baldrati; E. Barbieri; S. Bartolini; E. Bellavista; F. Bisulli; E. Bonora; F. Bunkheila; V. Carelli; M. Crisci; P. Dall'Occa; D. de Biase; S. Ferro; C. Franceschi; G. Frezza; V. Grasso; M. Leonardi; G. Marucci; V. Mazzocchi; L. Morandi; B. Mostacci; G. Palandri; E. Pasini; M. Pastore Trossello; A. Pession; M. Ragazzi; P. Riguzzi; R. Rinaldi; S. Rizzi; G. Romeo; F. Spagnolli; P. Tinuper; C. Trocino; S. Cerasoli; M. Dall'Agata; M. Faedi; M. Frattarelli; G. Gentili; A. Giovannini; P. Iorio; U. Pasquini; G. Galletti; C. Guidi; W. Neri; A. Patuelli; S. Strumia; M. Casmiro; A. Gamboni; F. Rasi; G. Cruciani; P. Cenni; C. Dazzi; AR. Guidi; F. Zumaglini; A. Amadori; G. Pasini; M. Pasquinelli; E. Pasquini; A. Polselli; A. Ravasio; B. Viti; M. Sintini; A. Ariatti; F. Bertolini; G. Bigliardi; P. Carpeggiani; F. Cavalleri; S. Meletti; P. Nichelli; E. Pettorelli; G. Pinna; E. Zunarelli; F. Artioli; I. Bernardini; M. Costa; G. Greco; R. Guerzoni; C. Stucchi; C. Iaccarino; R. Rizzi; G. Zuccoli; P. Api; F. Cartei; E. Fallica; E. Granieri; F. Latini; G. Lelli; C. Monetti; V. Ramponi; A. Saletti; R. Schivalocchi; S. Seraceni; M.R. Tola; B. Urbini; C. Giorgi; E. Montanari; D. Cerasti; P. Crafa; I. Dascola; I. Florindo; S. Mazza; F. Servadei; EM. Silini; P. Torelli; P. Immovilli; N. Morelli; C. Vanzo
• Keywords: surgery; 03 medical and health sciences; center volume; glioblastoma; radiotherapy; surgery; temozolomide; 0302 clinical medicine; glioblastoma; center volume; 610; center volume; glioblastoma; radiotherapy; surgery; temozolomide.; temozolomide; radiotherapy; 3. Good health

Abstract

Background As yet, no population-based prospective studies have been conducted to investigate the incidence and clinical outcome of glioblastoma (GBM) or the diffusion and impact of the current standard therapeutic approach in newly diagnosed patients younger than aged 70 years.

Methods Data on all new cases of primary brain tumors observed from January 1, 2009, to December 31, 2010, in adults residing within the Emilia-Romagna region were recorded in a prospective registry in the Project of Emilia Romagna on Neuro-Oncology (PERNO). Based on the data from this registry, a prospective evaluation was made of the treatment efficacy and outcome in GBM patients.

Results Two hundred sixty-seven GBM patients (median age, 64 y; range, 29–84 y) were enrolled. The median overall survival (OS) was 10.7 months (95% CI, 9.2–12.4). The 139 patients ≤aged 70 years who were given standard temozolomide treatment concomitant with and adjuvant to radiotherapy had a median OS of 16.4 months (95% CI, 14.0–18.5). With multivariate analysis, OS correlated significantly with KPS (HR = 0.458; 95% CI, 0.248–0.847; P = .0127), MGMT methylation status (HR = 0.612; 95% CI, 0.388–0.966; P = .0350), and treatment received in a high versus low-volume center (HR = 0.56; 95% CI, 0.328–0.986; P = .0446).

Conclusions The median OS following standard temozolomide treatment concurrent with and adjuvant to radiotherapy given to (72.8% of) patients aged ≤70 years is consistent with findings reported from randomized phase III trials. The volume and expertise of the treatment center should be further investigated as a prognostic factor.