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The impact of improved treatment strategies on overall survival in glioblastoma patients.

Al's Comment:

 This is one of the most important articles of the year. First, it shows that adding Temodar at the same time as radiation will double overall survival times compared to using radiation without Temodar.. We already knew that but it is nice to see it confirmed. The new part is that using a dye called 5-ALA at the time of surgery (that allows the surgeon to see where the tumor is)  adds another 3.5 months to the average survival time.. and in those cases where it allows for a complete resection, it adds another 11 months.   

This dye is approved in Europe and used as a standard treatment for years.  Getting it approved here in the USA would be a big step foward.  3.5 months might not seem like much, but it can buy the time for other treatments to work.  

 


Posted on: 04/17/2013

Acta Neurochir (Wien). 2013 Apr 16. [Epub ahead of print]
 
The impact of improved treatment strategies on overall survival in glioblastoma patients.
 
Slotty PJ, Siantidis B, Beez T, Steiger HJ, Sabel M.
Neurochirurgische Klinik, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany, slotty@med.uni-duesseldorf.de.
 
Abstract
BACKGROUND: 
The introduction of ALA-Fluorescence-guided surgery (FGS) followed by concomitant radiochemotherapy according to the Stupp-protocol is representative of the major changes in glioblastoma therapy in the past years. We were interested in the impact of this new first-line treatment on the overall survival of patients suffering from newly diagnosed primary glioblastoma in a retrospective single-centre study.
 
METHOD: 
For this retrospective analysis, data was derived from a prospective single-centre database. Patients were divided into three treatment groups: A (FGS-/radiochemotherapy-), B (FGS-/radiochemotherapy+) and C (FGS+/radiochemotherapy+). Further stratification was applied regarding MGMT-methylation status and degree of resection. Statistical analysis was performed to determine factors (treatment regime, age, gender, performance status, MGMT promoter methylation status) significantly influencing overall survival (OAS).
 
RESULTS: 
Two hundred and fifty-three patients suffering from primary glioblastoma treated by cytoreductive surgery between 2002 and 2009 were included in this survey. Median OAS differed significantly between the treatment groups (A = 8.8, B = 16.6, C = 20.1, p < 0.01). Resection data was available in all 253 patients. The usage of FGS highly significantly correlated with a complete resection (p < 0.01). Complete resection was positively correlated with an increase in OAS (complete 20.3 months vs. incomplete 9.3 months, p < 0.01).
 
CONCLUSIONS: 
FGS and radiochemotherapy according to the Stupp protocol have induced an impressive improvement in overall survival in glioblastoma patients. This effect is not limited to clinical trials, but is reproducible in daily routine.
 
 PMID: 23588276 [PubMed - as supplied by publisher] 
 

 


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