Öz
Amaç: Bu çalışmanın amacı adjuvan tedavi alan glioblastoma multiforme (GBM) hastalarında sağkalımı belirlemek ve ilişkili prognostik faktörleri araştırmaktır.
Gereç ve Yöntem: Çalışma popülasyonu, 1 Eylül 2022 ve 1 Mart 2024 tarihleri arasında kaydedilen izositrat dehidrogenaz vahşi tip GBM hastalarından oluşmaktadır. Birincil sonlanım noktası genel sağkalım, ikincil sonlanım noktası ise progresyonsuz sağkalımdır. Gruplar arasındaki karşılaştırmalar log-rank testi kullanılarak yapılmış ve çok değişkenli analizler Cox regresyonu kullanılarak gerçekleştirilmiştir.
Bulgular: Toplam 67 hasta değerlendirildi. Hastaların ortanca genel sağkalımı 19,3 aydı [%95 güven aralığı (GA) 15,1 ila ulaşılamadı (NR)]. Toplam 60 hastaya (%89,1) adjuvan tedavi uygulandı. Ortanca genel sağkalım ilk dört hafta içinde tedavi edilen hastalar için 31,1 ay (%95 GA ila 19,3-NR), dört ila altı hafta içinde tedavi edilenler için 15,7 ay (%95 GA ila 15,1-NR) ve altı haftadan sonra tedavi edilenler için 11,3 ay (%95 GA ila 9,8-NR) idi.
Sonuç: Çalışmamızda gözlenen sağkalım oranı klinik çalışmalarda bildirilenlerle karşılaştırılabilir düzeydedir. Ancak, daha geç dönemde tedavi alan hastalarda sağkalım oranı anlamlı derecede düşüktü. Bu nedenle, kılavuzların GBM hastalarında adjuvan tedavinin zamanlamasını daha doğru bir şekilde yansıtmasını sağlamak için daha geniş hasta popülasyonlarıyla daha fazla çalışma yapılması önerilmektedir.
Anahtar Kelimeler
: Glioblastoma multiforme stupp protokolü genel sağkalım tedaviye kadar geçen süre
Proje Numarası
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Kaynakça
- 1. Miller KD, Ostrom QT, Kruchko C, et al. Brain and other central nerv system tumor statistics, 2021. CA Cancer J Clin. 2021;71:381-406.
- 2. Louis DN, Perry A, Wesseling P, et al. The 2021 WHO classification of tumors of the central nervous system: a summary. Neuro Oncol. 2021;23:1231- 1251.
- 3. Molinaro AM, Taylor JW, Wiencke JK, et al. Genetic and molecular epidemiology of adult diffuse glioma. Nat Rev Neurol. 2019;15:405-417.
- 4. Skaga E, Skretteberg MA, Johannesen TB, et al. Real-world validity of randomized controlled phase III trials in newly diagnosed glioblastoma: to whom do the results of the trials apply? Neurooncol Adv. 2021;3:vdab008.
- 5. Sulman EP, Ismaila N, Armstrong TS, et al. Radiation therapy for glioblastoma: American Society of Clinical Oncology clinical practice guideline endorsement of the American Society for Radiation Oncology Guideline. J Clin Oncol. 2017;35:361-369.
- 6. Stupp R, Mason WP, van den Bent MJ, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005;352:987- 996.
- 7. Stupp R, Hegi ME, Mason WP, et al. Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study 5-year analysis of the EORTCNCIC trial. Lancet Oncol. 2009;10:459-466.
- 8. Weller M, van den Bent M, Hopkins K, et al. EANO guideline for the diagnosis and treatment of anaplastic gliomas and glioblastoma. Lancet Oncol. 2014;15:e395-403.
- 9. Ürün M, Sezgin Y, Uysal E. The impact of timing adjuvant therapy on disease-free survival among patients with stage iib-iiia non-small cell lung cancer receiving platinumbased treatment. Turk J Clin Lab. 2023;14:639- 644.
- 10. Chavez-MacGregor M, Clarke CA, Lichtensztajn DY, et al. Delayed initiation of adjuvant chemotherapy among patients with breast cancer. JAMA Oncol. 2016;2:322-329.
- 11. Ius T, Somma T, Pasqualetti F, et al. Local therapy in glioma: an evolving paradigm from history to horizons (Review). Oncol Lett. 2024;28:440.
- 12. Abacıoğlu U, Çetin İ, Akgün Z et al. Treatment results and prognostic factors for adult patients with diagnosis of glioblastoma multiforme after radiotherapy. Turk J Oncol. 2004;19:112-118.
- 13. Gilbert MR, Wang M, Aldape KD, et al. Dose-dense temozolomide for newly diagnosed glioblastoma: a randomized phase III clinical trial. J Clin Oncol. 2013;31:4085-4091.
- 14. Benli Yavuz B, Kanyılmaz G, Aktan M. Comparison of prognostic factors in glioblastoma patients with short- and long-term survival. Turk J Oncol. 2023;38:392-398.
- 15. Benzekry S, Lamont C, Beheshti A, et al. Classical mathematical models for description and prediction of experimental tumor growth. PLoS Comput Biol. 2014;10:e1003800.
- 16. Burnet NG, Jena R, Jefferies SJ, et al. Mathematical modelling of survival of glioblastoma patients suggests a role for radiotherapy dose escalation and predicts poorer outcome after delay to start treatment. Clin Oncol (R Coll Radiol). 2006;18:93-103.
- 17. Blumenthal DT, Won M, Mehta MP, et al. Short delay in initiation of radiotherapy may not affect outcome of patients with glioblastoma: a secondary analysis from the radiation therapy oncology group database. J Clin Oncol. 2009;27:733-739.
- 18. Pollom EL, Fujimoto DK, Han SS, et al. Newly diagnosed glioblastoma: adverse socioeconomic factors correlate with delay in radiotherapy initiation and worse overall survival. J Radiat Res. 2018;59(suppl_1):i11-i18.
- 19. Nathan JK, Brezzell AL, Kim MM, et al. Early initiation of chemoradiation following index craniotomy is associated with decreased survival in highgrade glioma. J Neurooncol. 2017;135:325-333.
- 20. Zur I, Tzuk-Shina T, Guriel M, et al. Survival impact of the time gap between surgery and chemo-radiotherapy in glioblastoma patients. Sci Rep. 2020;10:9595.
- 21. Han SJ, Rutledge WC, Molinaro AM, et al. The effect of timing of concurrent chemoradiation in patients with newly diagnosed glioblastoma. Neurosurgery. 2015;77:248-253.
- 22. Wang TJ, Jani A, Estrada JP, et al. Timing of adjuvant radiotherapy in glioblastoma patients: a single-institution experience with more than 400 patients. Neurosurgery. 2016;78:676-682.
- 23. Adeberg S, Bostel T, Harrabi S, et al. Impact of delays in initiating postoperative chemoradiation while determining the MGMT promotermethylation statuses of patients with primary glioblastoma. BMC Cancer. 2015;15:558.
- 24. Spratt DE, Folkert M, Zumsteg ZS, et al. Temporal relationship of postoperative radiotherapy with temozolomide and oncologic outcome for mglioblastoma. J Neurooncol. 2014;116:357-363. 25. Loureiro LV, Victor Eda S, Callegaro-Filho D, et al. Minimizing the uncertainties regarding the effects of delaying radiotherapy for Glioblastoma: a systematic review and meta-analysis. Radiother Oncol. 2016;118:1-8
Öz
Objectives: To determine survival and investigate associated prognostic factors in glioblastoma multiforme (GBM) patients receiving adjuvant
therapy.
Materials and Methods: The study population comprised patients with isocitrate dehydrogenase wild-type GBM who were September 2022 and 1 March 2024. The primary endpoint was overall survival (OS), while the secondary endpoint was progression-free survival. Comparisons between groups were conducted using the log-rank test, and multivariate analyses were performed using Cox regression. Results: A total of 67 patients were evaluated. The median OS of patients was 19.3
months [95% confidence interval (CI) 15.1 to not reached (NR)]. A total of 60 patients (89.1%) underwent adjuvant treatment. The median OS was 31.1 months (95% CI 19.3 to NR) for patients treated within the first four weeks, 15.7 months (95% CI 15.1 to NR) for those treated within four to six weeks, and 11.3 months (95% CI 9.8 to NR) for those treated after six weeks.
Conclusion: The observed survival rate in our study was comparable to that reported in clinical trials. However, the survival rate was significantly lower in patients who received treatment at a later stage. Therefore, further studies with larger patient populations are recommended to ensure that the guidelines more accurately reflect the timing of adjuvant therapy in GBM patients.
Anahtar Kelimeler
Glioblastoma multiforme stupp protocol overall survival time to treatment
Etik Beyan
Ethics Committee Approval: This study was approved by the Scientific Research Evaluation and Ethics Committee of Etlik City Hospital (decision no.: AEŞH-BADEK-2024-758, date: 02.10.2024). Informed Consent: Consent was not obtained since it was a retrospective study
Destekleyen Kurum
-
Proje Numarası
-
Teşekkür
-
Kaynakça
- 1. Miller KD, Ostrom QT, Kruchko C, et al. Brain and other central nerv system tumor statistics, 2021. CA Cancer J Clin. 2021;71:381-406.
- 2. Louis DN, Perry A, Wesseling P, et al. The 2021 WHO classification of tumors of the central nervous system: a summary. Neuro Oncol. 2021;23:1231- 1251.
- 3. Molinaro AM, Taylor JW, Wiencke JK, et al. Genetic and molecular epidemiology of adult diffuse glioma. Nat Rev Neurol. 2019;15:405-417.
- 4. Skaga E, Skretteberg MA, Johannesen TB, et al. Real-world validity of randomized controlled phase III trials in newly diagnosed glioblastoma: to whom do the results of the trials apply? Neurooncol Adv. 2021;3:vdab008.
- 5. Sulman EP, Ismaila N, Armstrong TS, et al. Radiation therapy for glioblastoma: American Society of Clinical Oncology clinical practice guideline endorsement of the American Society for Radiation Oncology Guideline. J Clin Oncol. 2017;35:361-369.
- 6. Stupp R, Mason WP, van den Bent MJ, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005;352:987- 996.
- 7. Stupp R, Hegi ME, Mason WP, et al. Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study 5-year analysis of the EORTCNCIC trial. Lancet Oncol. 2009;10:459-466.
- 8. Weller M, van den Bent M, Hopkins K, et al. EANO guideline for the diagnosis and treatment of anaplastic gliomas and glioblastoma. Lancet Oncol. 2014;15:e395-403.
- 9. Ürün M, Sezgin Y, Uysal E. The impact of timing adjuvant therapy on disease-free survival among patients with stage iib-iiia non-small cell lung cancer receiving platinumbased treatment. Turk J Clin Lab. 2023;14:639- 644.
- 10. Chavez-MacGregor M, Clarke CA, Lichtensztajn DY, et al. Delayed initiation of adjuvant chemotherapy among patients with breast cancer. JAMA Oncol. 2016;2:322-329.
- 11. Ius T, Somma T, Pasqualetti F, et al. Local therapy in glioma: an evolving paradigm from history to horizons (Review). Oncol Lett. 2024;28:440.
- 12. Abacıoğlu U, Çetin İ, Akgün Z et al. Treatment results and prognostic factors for adult patients with diagnosis of glioblastoma multiforme after radiotherapy. Turk J Oncol. 2004;19:112-118.
- 13. Gilbert MR, Wang M, Aldape KD, et al. Dose-dense temozolomide for newly diagnosed glioblastoma: a randomized phase III clinical trial. J Clin Oncol. 2013;31:4085-4091.
- 14. Benli Yavuz B, Kanyılmaz G, Aktan M. Comparison of prognostic factors in glioblastoma patients with short- and long-term survival. Turk J Oncol. 2023;38:392-398.
- 15. Benzekry S, Lamont C, Beheshti A, et al. Classical mathematical models for description and prediction of experimental tumor growth. PLoS Comput Biol. 2014;10:e1003800.
- 16. Burnet NG, Jena R, Jefferies SJ, et al. Mathematical modelling of survival of glioblastoma patients suggests a role for radiotherapy dose escalation and predicts poorer outcome after delay to start treatment. Clin Oncol (R Coll Radiol). 2006;18:93-103.
- 17. Blumenthal DT, Won M, Mehta MP, et al. Short delay in initiation of radiotherapy may not affect outcome of patients with glioblastoma: a secondary analysis from the radiation therapy oncology group database. J Clin Oncol. 2009;27:733-739.
- 18. Pollom EL, Fujimoto DK, Han SS, et al. Newly diagnosed glioblastoma: adverse socioeconomic factors correlate with delay in radiotherapy initiation and worse overall survival. J Radiat Res. 2018;59(suppl_1):i11-i18.
- 19. Nathan JK, Brezzell AL, Kim MM, et al. Early initiation of chemoradiation following index craniotomy is associated with decreased survival in highgrade glioma. J Neurooncol. 2017;135:325-333.
- 20. Zur I, Tzuk-Shina T, Guriel M, et al. Survival impact of the time gap between surgery and chemo-radiotherapy in glioblastoma patients. Sci Rep. 2020;10:9595.
- 21. Han SJ, Rutledge WC, Molinaro AM, et al. The effect of timing of concurrent chemoradiation in patients with newly diagnosed glioblastoma. Neurosurgery. 2015;77:248-253.
- 22. Wang TJ, Jani A, Estrada JP, et al. Timing of adjuvant radiotherapy in glioblastoma patients: a single-institution experience with more than 400 patients. Neurosurgery. 2016;78:676-682.
- 23. Adeberg S, Bostel T, Harrabi S, et al. Impact of delays in initiating postoperative chemoradiation while determining the MGMT promotermethylation statuses of patients with primary glioblastoma. BMC Cancer. 2015;15:558.
- 24. Spratt DE, Folkert M, Zumsteg ZS, et al. Temporal relationship of postoperative radiotherapy with temozolomide and oncologic outcome for mglioblastoma. J Neurooncol. 2014;116:357-363. 25. Loureiro LV, Victor Eda S, Callegaro-Filho D, et al. Minimizing the uncertainties regarding the effects of delaying radiotherapy for Glioblastoma: a systematic review and meta-analysis. Radiother Oncol. 2016;118:1-8
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Klinik Onkoloji |
| Bölüm | Makaleler |
| Yazarlar | |
| Proje Numarası | - |
| Yayımlanma Tarihi | 31 Mart 2025 |
| Gönderilme Tarihi | 16 Ekim 2024 |
| Kabul Tarihi | 12 Ocak 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 78 Sayı: 1 |
