Jayamanne Dasantha, Wheeler Helen, Cook Raymond, Teo Charles, Brazier David, Schembri Geoff, Kastelan Marina, Guo Linxin, Back Michael F
Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia.
Central Coast Cancer Centre, Gosford Hospital, Sydney, New South Wales, Australia.
ANZ J Surg. 2018 Mar;88(3):196-201. doi: 10.1111/ans.14153. Epub 2017 Sep 18.
Evaluate survival of patients diagnosed with glioblastoma multiforme (GBM) managed with adjuvant intensity modulated radiation therapy and temozolomide since the introduction of the European Organisation for Research and Treatment of Cancer and National Cancer Institute of Canada Clinical Trials Group (EORTC-NCIC) protocol.
All patients with GBM managed between May 2007 and December 2014 with EORTC-NCIC protocol were entered into a prospective database. The primary endpoint was the median survival. Univariate predictors of survival were evaluated with respect to tumour resection, age and Eastern Cooperative Oncology Group (ECOG) performance status using log-rank comparisons.
Two hundred and thirty-three patients were managed under the protocol and analysed for outcome. The median age was 57 years; the rate of gross total resection, subtotal resection and biopsy were 47.2%, 35.2% and 17.6%, respectively. At progression, 49 patients had re-resection, and in addition to second-line chemotherapy, 86 patients had Bevacizumab including 26 with re-irradiation. Median survival was 17.0 months (95% CI: 15.4-18.6). On univariate evaluation, extent of resection (P = 0.001), age, ECOG performance status and recursive partitioning analysis class III were shown to significantly improve survival (P < 0.0001). The median survival for gross total resection, age <50 years, ECOG 0-1 and recursive partitioning analysis class III were 21, 27, 20 and 47 months, respectively.
This study confirms the significant improvement in median survival in GBM that has occurred in recent years since introduction of the EORTC-NCIC protocol. Further improvements have occurred presumably related to subspecialized care, improved resection rates, sophisticated radiotherapy targeting and early systemic salvage therapies. However, the burden of the disease within the community remains high and the median survival improvements over time have plateaued.
自欧洲癌症研究与治疗组织和加拿大国家癌症研究所临床试验组（EORTC-NCIC）方案推出以来，评估接受辅助调强放疗和替莫唑胺治疗的多形性胶质母细胞瘤（GBM）患者的生存率。
2007年5月至2014年12月期间按照EORTC-NCIC方案治疗的所有GBM患者被纳入一个前瞻性数据库。主要终点是中位生存期。使用对数秩检验比较，评估肿瘤切除、年龄和东部肿瘤协作组（ECOG）体能状态等生存单因素预测指标。
233例患者按照该方案进行治疗并分析结局。中位年龄为57岁；大体全切、次全切除和活检率分别为47.2%、35.2%和17.6%。病情进展时，49例患者进行了再次切除，除二线化疗外，86例患者接受了贝伐单抗治疗，其中26例接受了再次放疗。中位生存期为17.0个月（95%CI：15.4 - 18.6）。单因素评估显示，切除范围（P = 0.001）、年龄、ECOG体能状态和递归划分分析III级显著改善生存率（P < 0.0001）。大体全切、年龄<50岁、ECOG 0 - 1和递归划分分析III级患者的中位生存期分别为21、27、20和47个月。
本研究证实，自引入EORTC-NCIC方案以来，近年来GBM患者的中位生存期有显著改善。可能由于专科护理、切除率提高、精确放疗靶向和早期全身挽救治疗，生存期进一步得到改善。然而，社区内该疾病的负担仍然很高，随着时间推移，中位生存期的改善已趋于平稳。
