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Very late relapses in glioblastoma long-term survivors.

Posted on: 05/14/2009

Very late relapses in glioblastoma long-term survivors.

Author(s): O. Baehr, U. Herrlinger, M. Weller, J. P. Steinbach; Universitiy Hospital Frankfurt, Frankfurt am Main, Germany; University Hospital Bonn, Bonn, Germany; University Hospital Zürich, Zürich, Switzerland



Background: Long-term survival of patients with histologically confirmed glioblastoma is a rare event with figures in the range of 2-3% for 5-year survival. Prognosis and further clinical course of these patients beyond 5 years after diagnosis are in essence unknown with only anecdotal reports of patients surviving for 10 years or more. Methods: We here report on the extended follow-up (mean, 139.4 months) of a cohort of 10 glioblastoma long-term survivors. Retrospective central histology, clinical monitoring, and regular magnetic resonance imaging were done. Results: A total of 5 patients of the 9 patients alive at a previous analysis have died during the extended follow-up. Four of these patients died from recurrent tumor. One patient died from leukoencephalopathy-associated complications without evidence of tumor progression. Details concerning the occurrence of relapses and their treatment are displayed in table 1. Notably, very late relapses occurred in three patients after 118, 124, and 126 months of progression-free survival. Thus, from the original cohort of 10 patients only 3 remain free from recurrence after the extended follow up of more than 10 years. Conclusions: Very late relapses pose a serious threat for glioblastoma long-term survivors and call for continuous vigilance. The maintenance of a tight control schedule even in patients surviving for more than 10 years should be considered.

Gy (primary
of relapses,
at recurrence

1/42/M 90 GTR 54 ACNU/Ara-C - - 145
 2/35/F 50 GTR 54 ACNU/VM26 126 - 128
3/44/F 80 GTR 40/62 ACNU/VM26 26 PR+PCV 109
          77 PCV  
          93 TMZ  
          106 None  
4/42/M 90 GTR 60 ACNU/Ara-C 27 GTR+PCV 152
5/54/M 90 GTR 60 ACNU/VM26 34 GTR  69
          46 PR+TMZ/Gem  
          62 PR+PCV  
          67 None  
6/52/F 90 GTR 60 None 17 GTR+PCV 102
          28 GTR+PCV  
7/25/F 100 GTR 60 ACNU/VM26 - - 134
8/30/F 90 GTR 60 ACNU/VM26 - - 123
9/38/M 100 GTR 60 ACNU/Ara-C 124 PR+ACNU 127
          126  None  
10/45/F 90 Biopsy 54 ACNU 118 PR+TMZ 138
          132 Imatinib/hydroxyurea  

KPS = Karnofsky performance score, GTR = gross total resection, ACNU = nimustine, Ara-C = cytarabine, VM26 = teniposide, PR = partial resection, PCV= procarbazine, lomustine, and vincristine, TMZ = temozolomide, Gem = gemcitabine

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