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60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

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Radiotherapy and adjuvant temozolomide compared with radiotherapy and concomitant plus adjuvant temozolomide in surgically treated patients with glioblastoma multiforme: a retrospective single institution study

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  • M. Göppert - Neurochirurgische Klinik, Heinrich-Heine-Universität Düsseldorf
  • M. Rapp - Neurochirurgische Klinik, Heinrich-Heine-Universität Düsseldorf
  • J. Felsberg - Institut für Neuropathologie, Heinrich-Heine-Universität Düsseldorf
  • W. Stummer - Neurochirurgische Klinik, Heinrich-Heine-Universität Düsseldorf
  • G. Reifenberger - Institut für Neuropathologie, Heinrich-Heine-Universität Düsseldorf
  • H.-J. Steiger - Neurochirurgische Klinik, Heinrich-Heine-Universität Düsseldorf
  • M. Sabel - Neurochirurgische Klinik, Heinrich-Heine-Universität Düsseldorf

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocP04-07

doi: 10.3205/09dgnc287, urn:nbn:de:0183-09dgnc2876

Published: May 20, 2009

© 2009 Göppert et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: The benefit of the introduction of alkylating chemotherapy in treatment of glioblastoma multiforme (GBM) patients has recently been demonstrated by the comparison of radiotherapy with concomitant plus adjuvant temozolomide to radiation therapy alone. The impact of the concomitant part of this protocol on survival remains unclear. Therefore we retrospectively compared patients treated with surgery followed by radiotherapy and adjuvant temozolomide (TMZ) (group A) with the concomitant plus adjuvant (Stupp) protocol (group B) with respect to overall survival (OS) and progression-free survival (PFS).

Methods: 90 patients with primary GBM treated between 2002 and 2007 by open resection, radiotherapy and at least 2 cycles of TMZ were analyzed. Patients were stratified for extent of resection (partial [PR] vs. complete [CR]) and MGMT promoter methylation (MGMT[+] vs. MGMT[-]). For OS/PFS, a total of 3/1 patients in group A (n=43) and 21/7 patients in group B (n=47) were censored.

Results: Both groups were balanced for established prognostic factors like age (median: 58y), pre-operative Karnofsky performance score (median 80%) and MGMT status. However, the groups differed regarding the extent of resection (group A: 16 CR / 27 PR versus group B 26 CR / 21 PR). OS and PFS were 16.6m / 5.1m for group A and 20.7m / 6.0m for group B (p=0.076 / p=0.125). MGMT[-] patients (group A: n=25, group B, n=26) demonstrated an OS of 16.2m vs. 16.3m (p=0.164). MGMT[+] patients (group A: n=17, group B: n=17) demonstrated an OS of 20.0m vs. 23.0m (p=0.503). Regardless of the treatment, MGMT hypermethylation (22.1m MGMT[+] /16.2m MGMT[-], p=0.006) and extent of resection (21.5m CR / 16.1m PR, p=0.024) were associated with longer OS.

Conclusions: At present, due to the high number of censored patients in group B, a final conclusion can not be drawn regarding the comparison between the concomitant plus adjuvant versus the adjuvant protocol. However, as yet there seems to be no difference between both treatment protocols regarding OS. MGMT hypermethylation and extent of resection are associated with longer survival for both treatment groups.