Prognostic factors for survival in 676 consecutive patients with newly diagnosed primary glioblastoma

Graziella Filippini, Chiara Falcone, Amerigo Boiardi, Giovanni Broggi, Maria G. Bruzzone, Dario Caldiroli, Rita Farina, Mariangela Farinotti, Laura Fariselli, Gaetano Finocchiaro, Sergio Giombini, Bianca Pollo, Mario Savoiardo, Carlo L. Solero, Maria G. Valsecchi

Research output: Contribution to journalArticle

Abstract

Reliable data on large cohorts of patients with glioblastoma are needed because such studies differ importantly from trials that have a strong bias toward the recruitment of younger patients with a higher performance status. We analyzed the outcome of 676 patients with histologically confirmed newly diagnosed glioblastoma who were treated consecutively at a single institution over a 7-year period (1997-2003) with follow-up to April 30, 2006. Survival probabilities were 57% at 1 year, 16% at 2 years, and 7% at 3 years. Progression-free survival was 15% at 1 year. Prolongation of survival was significantly associated with surgery in patients with a good performance status, whatever the patient's age, with an adjusted hazard ratio of 0.55 (p <0.001) or a 45% relative decrease in the risk of death. Radiotherapy and chemotherapy improved survival, with adjusted hazard ratios of 0.61 (p = 0.001) and 0.89 (p = 0.04), respectively, regardless of age, performance status, or residual tumor volume. Recurrence occurred in 99% of patients throughout the follow-up. Reoperation was performed in one-fourth of these patients but was not effective, whether performed within 9 months (hazard ratio, 0.86; p = 0.256) or after 9 months (hazard ratio, 0.98; p = 0.860) of initial surgery, whereas second-line chemotherapy with procarbazine, lomustine, and vincristine (PCV) or with temozolomide improved survival (hazard ratio, 0.77; p = 0.008). Surgery followed by radiotherapy and chemotherapy should be considered in all patients with glioblastoma, and these treatments should not be withheld because of increasing age alone. The benefit of second surgery at recurrence is uncertain, and new trials are needed to assess its effectiveness. Chemotherapy with PCV or temozolomide seems to be a reasonable option at tumor recurrence.

Original languageEnglish
Pages (from-to)79-87
Number of pages9
JournalNeuro-Oncology
Volume10
Issue number1
DOIs
Publication statusPublished - Feb 2008

Fingerprint

Glioblastoma
temozolomide
Survival
Lomustine
Procarbazine
Drug Therapy
Vincristine
Recurrence
Radiotherapy
Residual Volume
Residual Neoplasm
Tumor Burden
Reoperation
Patient Selection
Disease-Free Survival
Neoplasms

Keywords

  • Chemotherapy
  • Elderly
  • Glioblastoma
  • Radiotherapy
  • Surgery
  • Survival analysis

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Clinical Neurology

Cite this

Prognostic factors for survival in 676 consecutive patients with newly diagnosed primary glioblastoma. / Filippini, Graziella; Falcone, Chiara; Boiardi, Amerigo; Broggi, Giovanni; Bruzzone, Maria G.; Caldiroli, Dario; Farina, Rita; Farinotti, Mariangela; Fariselli, Laura; Finocchiaro, Gaetano; Giombini, Sergio; Pollo, Bianca; Savoiardo, Mario; Solero, Carlo L.; Valsecchi, Maria G.

In: Neuro-Oncology, Vol. 10, No. 1, 02.2008, p. 79-87.

Research output: Contribution to journalArticle

Filippini, Graziella ; Falcone, Chiara ; Boiardi, Amerigo ; Broggi, Giovanni ; Bruzzone, Maria G. ; Caldiroli, Dario ; Farina, Rita ; Farinotti, Mariangela ; Fariselli, Laura ; Finocchiaro, Gaetano ; Giombini, Sergio ; Pollo, Bianca ; Savoiardo, Mario ; Solero, Carlo L. ; Valsecchi, Maria G. / Prognostic factors for survival in 676 consecutive patients with newly diagnosed primary glioblastoma. In: Neuro-Oncology. 2008 ; Vol. 10, No. 1. pp. 79-87.
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