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Terça-feira, 23.06.15

Does extent of resection matter in recurrent glioblastoma? Lessons from the DIRECTOR trial.

Does extent of resection matter in recurrent glioblastoma? Lessons from the DIRECTOR trial.

 

Category: 
Central Nervous System Tumors
Session Type and Session Title: 
Poster Session, Central Nervous System Tumors
Abstract Number: 

2041

Poster Board Number: 
Board #30
Citation: 
J Clin Oncol 33, 2015 (suppl; abstr 2041)
Author(s): 
Bogdana Suchorska, Michael Weller, Ghazaleh Tabatabai, Christian Senft, Peter Hau, Michael Sabel, Ulrich Herrlinger, Ralf Ketter, Uwe S. Schlegel, Christine Marosi, Guido Reifenberger, Wolfgang Wick, Joerg Tonn, Hans-Georg Wirsching; Department of Neurosurgery LMU, Munich, Germany; Department of Neurology, University Hospital Zurich, Zurich, Switzerland; University of Tübingen, Tübingen, Germany; Department of Neurosurgery, Goethe University Frankfurt, Frankfurt, Germany; University of Regensburg, Regensburg, Germany; Department of Neurosurgery, University Hospital Düsseldorf, Düsseldorf, Germany; University of Bonn, Bonn, Germany; Department of Neurosurgery, University Hospital Homburg, Homburg, Germany; Knappschaftskrankenhaus University Hospital, Bochum, Germany; University of Vienna, Wien, Austria; Institute of Neuropathology, Heinrich-Heine-University, Duesseldorf, Germany; Neurology Clinic, Heidelberg, Germany; Department of Neurosurgery, Ludwig-Maximilians University Munich, Munich, Germany

Abstract Disclosures

Abstract: 

Background: The role of surgery for recurrent glioblastoma is under debate. Tumor volume at recurrence was prognostic in single-institution retrospective studies, but no data from prospective multicenter trials for recurrent glioblastoma have been published to date. Here, we report the association with outcome of surgery for recurrent glioblastoma in a well characterized patient cohort treated in the DIRECTOR trial, which evaluated the effect of two different dose-intensified temozolomide regimens at first recurrence of glioblastoma. Methods: We analyzed prospectively collected clinical, molecular and imaging data from the DIRECTOR cohort (N = 105). Imaging data was available from 87 patients. Volumetric analysis was performed based on gadolinium (Gd) enhancement on MRI and correlated with progression-free survival (PFS) and overall survival (OS). Proportional hazard models were applied to obtain prognostic factors. Results: 71 of 105 patients received surgery at recurrence. Prognostic factors were balanced between patients who had undergone surgery and those who had not, including age (P = 0.358), O6-methylguanine DNA methyltransferase (MGMT) gene promoter methylation (P = 0.965), isocitrate dehydrogenase (IDH)-1 mutation (P = 0.724), Karnofsky performance score (P = 0.880), or steroid intake before randomization (P = 0.950). Mean tumor volumes in patients who had received surgery were smaller at study entry than in patients who had not undergone surgery (3.0 cm3[range 0-37] versus 6.8 cm3[range 1-23], P < 0.001). The outcomes in patients who did or did not receive surgery at recurrence were similar for PFS (2.0 months [95% CI 3.5-7.1] vs. 1.9 months [95% CI 1.9-6.4], P = 0.1974) and OS (9.2 months [95% CI 8.7-12.6] vs 9.4 months [95% CI 8.3-13.5], P = 0.9538). Among patients who underwent surgery for recurrence, post-surgery imaging was available in 59 cases. In these patients, complete resection of Gd-enhancing tumor (N = 39) versus residual detection of Gd enhancement (N = 20) was associated with improved OS (11.5 months [95% CI 9.3-15.1] vs. 6.7 months [95% CI 5.2-9.5], P = 0.006). Conclusions: Surgery at first recurrence of glioblastoma may improve outcome if complete resection of Gd-enhancing tumor is feasible.

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por cyto às 16:54



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