Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia.
Institute of Pathology, Faculty of Medicine, University of Ljubljana, Slovenia.
Radiol Oncol. 2014 Jan 22;48(1):72-9. doi: 10.2478/raon-2014-0002. eCollection 2014 Mar.
Glioblastoma is the most common primary brain tumour. It has a poor prognosis despite some advances in treatment that have been achieved over the last ten years. In Slovenia, 50 to 60 glioblastoma patients are diagnosed each year. In order to establish whether the current treatment options have any influence on the survival of the Slovenian glioblastoma patients, their data in the period from the beginning of the year 1997 to the end of the year 2008 have been analysed.
All patients treated at the Institute of Oncology Ljubljana from 1997 to 2008 were included in the retrospective study. Demographics, treatment details, and survival time after the diagnosis were collected and statistically analysed for the group as a whole and for subgroups.
From 1997 to 2008, 527 adult patients were diagnosed with glioblastoma and referred to the Institute of Oncology for further treatment. Their median age was 59 years (from 20 to 85) and all but one had the diagnosis confirmed by a pathologist. Gross total resection was reported by surgeons in 261 (49.5%) patients; good functional status (WHO 0 or 1) after surgery was observed in 336 (63.7%) patients, radiotherapy was performed in 422 (80.1%) patients, in 317 (75.1%) of them with radical intent, and 198 (62.5 %) of those received some form of systemic treatment (usually temozolomide). The median survival of all patients amounted to 9.7 months. There was no difference in median survival of all patients or of all treated patients before or after the chemo-radiotherapy era. However, the overall survival of patients treated with radical intent was significantly better (11.4 months; p < 0.05). A better survival was also noticed in radically treated patients who received additional temozolomide therapy (11.4 vs. 13.1 months; p = 0.014). The longer survival was associated with a younger age and a good performance status as well as with a more extensive tumour resection. In patients treated with radical intent, having a good performance status, and receiving radiotherapy and additional temozolomide therapy, the survival was significantly longer, based on multivariate analysis.
We observed a gradual increase in the survival of glioblastoma patients who were treated with radical intent over the last ten years. Good functional surgery, advances in radiotherapy and addition of temozolomide all contributed to this increase. Though the increased survival seems to be more pronounced in certain subgroups, we have still not been able to exactly define them. Further research, especially in tumour biology and genetics is needed.
胶质母细胞瘤是最常见的原发性脑肿瘤。尽管在过去十年中治疗方面取得了一些进展，但它的预后仍然很差。在斯洛文尼亚，每年诊断出 50 到 60 名胶质母细胞瘤患者。为了确定当前的治疗选择是否对斯洛文尼亚胶质母细胞瘤患者的生存有任何影响，对 1997 年初至 2008 年底期间的患者数据进行了分析。
从 1997 年至 2008 年在卢布尔雅那肿瘤研究所接受治疗的所有患者均纳入回顾性研究。收集了患者的人口统计学、治疗细节和诊断后的生存时间，并对整个组和亚组进行了统计学分析。
从 1997 年至 2008 年，诊断出 527 名成年胶质母细胞瘤患者，并转介至肿瘤研究所进行进一步治疗。他们的中位年龄为 59 岁（20-85 岁），除 1 人外均经病理学家确诊。外科医生报告 261 例（49.5%）患者行全切除；336 例（63.7%）患者术后功能状态良好（世界卫生组织 0 或 1 级），422 例（80.1%）患者接受放疗，317 例（75.1%）患者接受根治性放疗，198 例（62.5%）患者接受某种形式的系统治疗（通常为替莫唑胺）。所有患者的中位生存期为 9.7 个月。在放化疗时代前后，所有患者或所有接受治疗的患者的中位生存期均无差异。然而，接受根治性治疗的患者的总生存率明显更好（11.4 个月；p<0.05）。在接受额外替莫唑胺治疗的根治性治疗患者中，也观察到了更好的生存（11.4 对 13.1 个月；p=0.014）。更长的生存时间与年龄较小、功能状态良好以及肿瘤切除范围较广有关。在接受根治性治疗、功能状态良好、接受放疗和额外替莫唑胺治疗的患者中，基于多变量分析，生存时间显著延长。
我们观察到，在过去十年中，接受根治性治疗的胶质母细胞瘤患者的生存率逐渐提高。良好的功能手术、放疗的进步以及替莫唑胺的加入都促成了这一增长。尽管在某些亚组中，生存时间的增加似乎更为明显，但我们仍未能准确界定这些亚组。需要进一步的研究，特别是在肿瘤生物学和遗传学方面的研究。
