Princess Margaret Hospital, 610 University Avenue, Suite 18-717, Toronto, ON, M5G 2M9, Canada.
J Neurooncol. 2013 Nov;115(2):303-10. doi: 10.1007/s11060-013-1230-3. Epub 2013 Aug 25.
Temozolomide (TMZ) during and after radiotherapy (RT) is recommended for patients with newly diagnosed glioblastoma (GBM). We analyzed the adoption of this new standard of care for GBM in an academic cancer centre in Canada and assessed its impact on survival. GBM patients registered with Cancer Care Ontario between 2004 and 2008 were identified. Those ≥ 16 years age, newly diagnosed, treated at our institution, had confirmed pathology and complete records were included. Demographics, treatments, toxicity and outcome were captured. For survival analysis patients were stratified by age, ECOG, and treatment modalities including total cycles of TMZ. Descriptive statistics were used for early progressors and long term survivors. Kaplan-Meier curves, log-rank test and Cox proportional hazards model were used for survival analyses. At a median follow-up of 28 months, we compared our outcome to updated EORTC-NCIC CE 3 results. Of 517 patients 433 were included for analysis. Majority were male (63 %), ECOG 0-1 (66 %), and ≤ 65 years (55 %). 44 % received CRT followed by TMZ, 13 % had CRT only, 30 % had RT only and 13 % had best supportive care. 10 % were early progressors and 9 % survived beyond 2 years. Comparison of our results to NCIC CTG CE.3 study data showed median survival was 15.8 versus 14.6 months, 2 year survival rate for CRT plus TMZ was 35 versus 26 %, and for RT alone 0 versus 10 %, respectively. <50 % of GBM patients complete CRT with TMZ in the real-world setting. Prognosis for most patients with GBM remains dismal particularly if they are not suitable for RT and CRT.
替莫唑胺（TMZ）在放化疗期间和之后推荐用于新诊断的胶质母细胞瘤（GBM）患者。我们分析了加拿大一家学术癌症中心对 GBM 患者采用这种新的治疗标准的情况，并评估了其对生存的影响。在 2004 年至 2008 年间，在安大略癌症护理注册的 GBM 患者被确定。年龄≥16 岁、新诊断、在我们机构治疗、有明确的病理学和完整记录的患者被纳入研究。收集了人口统计学、治疗、毒性和结果数据。对于生存分析，根据年龄、ECOG 和治疗方式对患者进行分层，包括 TMZ 的总周期。早期进展者和长期生存者采用描述性统计。生存分析采用 Kaplan-Meier 曲线、对数秩检验和 Cox 比例风险模型。在中位随访 28 个月时，我们将我们的结果与更新的 EORTC-NCIC CE3 结果进行了比较。在 517 例患者中，有 433 例患者被纳入分析。大多数患者为男性（63%），ECOG 0-1（66%），年龄≤65 岁（55%）。44%的患者接受了放化疗联合 TMZ，13%的患者仅接受了放化疗，30%的患者仅接受了放疗，13%的患者接受了最佳支持治疗。10%的患者为早期进展者，9%的患者生存时间超过 2 年。与 NCIC CTG CE3 研究数据相比，我们的结果显示中位生存期为 15.8 个月对 14.6 个月，放化疗联合 TMZ 的 2 年生存率为 35%对 26%，单纯放疗的 2 年生存率为 0%对 10%。在真实世界环境中，不到 50%的 GBM 患者完成 CRT 加 TMZ 治疗。大多数 GBM 患者的预后仍然很差，特别是如果他们不适合放疗和放化疗。
