Glioblastoma: Patterns of recurrence and efficacy of salvage treatments

Jiwon Oh, Arjun Sahgal, Paul Sanghera, May Tsao, Phil Davey, Kelvin Lam, Sean Symons, Richard Aviv, James Perry

Research output: Contribution to journalArticle

Abstract

Background: It is controversial if distant recurrence of glioblastoma is more common after temozolomide (TMZ) concurrent with radiotherapy (RT). Optimal therapy for patients with recurrent disease after RT/TMZ is unclear. Our purpose was to evaluate recurrence patterns in glioblastoma and the effect of treatment at recurrence upon survival. Methods: We performed a retrospective review of 67 patients with newly diagnosed glioblastoma treated with RT/TMZ between 2003-2007. Statistical analyses included Kaplan-Meier method for survival, and multivariate Cox proportional hazards model for the effect of salvage treatment on survival. Results: 58 patients (86.6%) recurred locally; 9 patients (13.4%) had a distant non-contiguous focus of new disease. Median survival(MS) was 17 months; median time-to-progression(TTP) 6.8 months. The local and distant groups had comparable prognostic factors. There was no difference in MS(p=0.35) or TTP(p=0.95) by location of recurrence. At relapse, 26 patients(38.8%) received continuous, dose-intense TMZ, 24(35.8%) other therapy(4.5% RT; 20.9% lomustine+/-procarbazine; 4.5% etoposide; 1.5% conventional TMZ; 4.5% TMZ then lomustine), and 17(25.4%) were untreated. Dose-intense TMZ was associated with prolonged MS compared to all other patients(21.5 months vs. 12.4 months, p=0.019, HR=3.86, 95%CI: 1.81-8.22) and similar to MS with other chemotherapy regimens(18.8 months, p=0.40, HR=1.30, 95% CI: 0.65-2.61). Conclusion: The pattern of recurrence of glioblastoma treated with RT/TMZ was predominantly local. Second-line treatment with continuous dose-intense TMZ may prolong survival in patients with recurrent glioblastoma. Overall survival is similar to other conventional salvage regimens; however TMZ may be better tolerated. This study is limited by its retrospective nature and potential selection bias. Prospective controlled studies are needed.

Original languageEnglish (US)
Pages (from-to)621-625
Number of pages5
JournalCanadian Journal of Neurological Sciences
Volume38
Issue number4
StatePublished - Jul 1 2011
Externally publishedYes

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temozolomide
Salvage Therapy
Glioblastoma
Recurrence
Survival
Radiotherapy
Lomustine
Procarbazine
Selection Bias

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Oh, J., Sahgal, A., Sanghera, P., Tsao, M., Davey, P., Lam, K., ... Perry, J. (2011). Glioblastoma: Patterns of recurrence and efficacy of salvage treatments. Canadian Journal of Neurological Sciences, 38(4), 621-625.

Glioblastoma : Patterns of recurrence and efficacy of salvage treatments. / Oh, Jiwon; Sahgal, Arjun; Sanghera, Paul; Tsao, May; Davey, Phil; Lam, Kelvin; Symons, Sean; Aviv, Richard; Perry, James.

In: Canadian Journal of Neurological Sciences, Vol. 38, No. 4, 01.07.2011, p. 621-625.

Research output: Contribution to journalArticle

Oh, J, Sahgal, A, Sanghera, P, Tsao, M, Davey, P, Lam, K, Symons, S, Aviv, R & Perry, J 2011, 'Glioblastoma: Patterns of recurrence and efficacy of salvage treatments', Canadian Journal of Neurological Sciences, vol. 38, no. 4, pp. 621-625.
Oh J, Sahgal A, Sanghera P, Tsao M, Davey P, Lam K et al. Glioblastoma: Patterns of recurrence and efficacy of salvage treatments. Canadian Journal of Neurological Sciences. 2011 Jul 1;38(4):621-625.
Oh, Jiwon ; Sahgal, Arjun ; Sanghera, Paul ; Tsao, May ; Davey, Phil ; Lam, Kelvin ; Symons, Sean ; Aviv, Richard ; Perry, James. / Glioblastoma : Patterns of recurrence and efficacy of salvage treatments. In: Canadian Journal of Neurological Sciences. 2011 ; Vol. 38, No. 4. pp. 621-625.
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title = "Glioblastoma: Patterns of recurrence and efficacy of salvage treatments",
abstract = "Background: It is controversial if distant recurrence of glioblastoma is more common after temozolomide (TMZ) concurrent with radiotherapy (RT). Optimal therapy for patients with recurrent disease after RT/TMZ is unclear. Our purpose was to evaluate recurrence patterns in glioblastoma and the effect of treatment at recurrence upon survival. Methods: We performed a retrospective review of 67 patients with newly diagnosed glioblastoma treated with RT/TMZ between 2003-2007. Statistical analyses included Kaplan-Meier method for survival, and multivariate Cox proportional hazards model for the effect of salvage treatment on survival. Results: 58 patients (86.6{\%}) recurred locally; 9 patients (13.4{\%}) had a distant non-contiguous focus of new disease. Median survival(MS) was 17 months; median time-to-progression(TTP) 6.8 months. The local and distant groups had comparable prognostic factors. There was no difference in MS(p=0.35) or TTP(p=0.95) by location of recurrence. At relapse, 26 patients(38.8{\%}) received continuous, dose-intense TMZ, 24(35.8{\%}) other therapy(4.5{\%} RT; 20.9{\%} lomustine+/-procarbazine; 4.5{\%} etoposide; 1.5{\%} conventional TMZ; 4.5{\%} TMZ then lomustine), and 17(25.4{\%}) were untreated. Dose-intense TMZ was associated with prolonged MS compared to all other patients(21.5 months vs. 12.4 months, p=0.019, HR=3.86, 95{\%}CI: 1.81-8.22) and similar to MS with other chemotherapy regimens(18.8 months, p=0.40, HR=1.30, 95{\%} CI: 0.65-2.61). Conclusion: The pattern of recurrence of glioblastoma treated with RT/TMZ was predominantly local. Second-line treatment with continuous dose-intense TMZ may prolong survival in patients with recurrent glioblastoma. Overall survival is similar to other conventional salvage regimens; however TMZ may be better tolerated. This study is limited by its retrospective nature and potential selection bias. Prospective controlled studies are needed.",
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AU - Sahgal, Arjun

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AU - Lam, Kelvin

AU - Symons, Sean

AU - Aviv, Richard

AU - Perry, James

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