lunes, 4 de marzo de 2013

Patterns of care and outcome for patients with glioblastoma diagnosed during 2008–2010 in Spain

    • Francesc Graus
    • Jordi Bruna
    • Javier Pardo
    • Domingo Escudero
    • Dolores Vilas,
    • Inés Barceló
    • Marta Brell
    • Carmen Pascual
    • José A. Crespo
    • Elena Erro,
    • Juan C. García-Romero
    • Jordi Estela
    • Juan Martino
    • Almudena García-Castaño,
    • Elena Mata,
    • Manuela Lema
    • Miguel Gelabert
    • Rafel Fuentes
    • Pedro Pérez
    • Arancha Manzano
    • Jesús Aguas
    • Antonio Belenguer
    • Ana Simón,
    • Iván Henríquez,
    • Mauricio Murcia
    • Rosa Vivanco,
    • Iñigo Rojas-Marcos
    • David Muñoz-Carmona,
    • Inmaculada Navas
    • Pablo de Andrés
    • Gemma Mas
    • Miguel Gil
    • and Eugènia Verger. 

Service of Neurology (F.G.) and Radiotherapy, Hospital Clinic, Barcelona (E.V.); Service of Neurology (J.B.), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat. Service of Neurology, Hospital Quirón, Madrid (J.P.); Service of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona (D.E., D.V.); Service of Neurology (I.B.), Neurosurgery, Hospital Son Espases, Mallorca (M.B.); Service of Neurology, Hospital Universitario Miguel Servet, Zaragoza (C.P., J.A.C.); Service of Neurology (E.E.), Neurosurgery, Complejo Hospitalario de Navarra, Pamplona (J.C.G.-R.); Service of Neurology, Hospital Parc Taulí, Sabadell (J.E.); Service of Neurosurgery (J.M.), Medical Oncology, Hospital Universitario Marqués de Valdecilla, Santander (A.G.-C., E.M.); Service of Neurology(M.L.), Neurosurgery (M.G.), Complejo Hospitalario Universitario de Santiago, Santiago de Compostela; Service of Radiotherapy (R.F.), Hospital Universitari Josep Trueta,GironaService of Medical Oncology, Hospital Clínico San Carlos, Madrid (P.P., A.M.);Service of Neurosurgery, Hospital Clínico Universitario Lozano Blesa, Zaragoza (J.A.);Service of Neurology, Hospital General de Castelló, Castelló (A.B., A.S.); Service of Radiotherapy, Hospital Universitari de Sant Joan, Reus (I.H., M.M.); Service of Neurology, Hospital del Mar, Barcelona (R.V.); Service of Neurology (I.R.-M.),Radiotherapy, Hospital General Juan Ramón Jiménez, Huelva (D.M.-C.); Service of Neurology (I.N.), Neurosurgery, Fundación Jiménez Díaz. Madrid (P.A.); Service of Neurology, Hospital Francesc de Borja, Gandía (G.M.); Service of Medical Oncology, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Spain (M.G.)
Background To assess management patterns and outcome in patients with glioblastoma multiforme (GBM) treated during 2008–2010 in Spain.
Methods Retrospective analysis of clinical, therapeutic, and survival data collected through filled questionnaires from patients with histologically confirmed GBM diagnosed in 19 Spanish hospitals.
Results We identified 834 patients (23% aged >70 years). Surgical resection was achieved in 66% of patients, although the extent of surgery was confirmed by postoperative MRI in only 41%. There were major postoperative complications in 14% of patients, and age was the only independent predictor (Odds ratio [OR], 1.03; 95% confidence interval [CI],1.01–1.05; P = .006). After surgery, 57% received radiotherapy (RT) with concomitant and adjuvant temozolomide, 21% received other regimens, and 22% were not further treated. In patients treated with surgical resection, RT, and chemotherapy (n = 396), initiation of RT ≤42 days was associated with longer progression-free survival (hazard ratio [HR], 0.8; 95% CI, 0.64–0.99; P = .042) but not with overall survival (HR, 0.79; 95% CI, 0.62–1.00; P = .055). Only 32% of patients older than 70 years received RT with concomitant and adjuvant temozolomide. The median survival in this group was 10.8 months (95% CI, 6.8–14.9 months), compared with 17.0 months (95% CI, 15.5–18.4 months; P = .034) among younger patients with GBM treated with the same regimen.
Conclusions In a community setting, 57% of all patients with GBM and only 32% of older patients received RT with concomitant and adjuvant temozolomide. In patients with surgical resection who were eligible for chemoradiation, initiation of RT ≤42 days was associated with better progression-free survival.