Extent of resection and radiotherapy in GBM: A 1973 to 2007 surveillance, epidemiology and end results analysis of 21,783 patients

Surgery, radiation and chemotherapy are the standard of care for GBM patients, however, the impact of extent of resection (EOR) and radiotherapy (RT) on patient survival across age groups has not been established. Therefore, we present the current largest study on EOR and RT in GBM over the past thr...

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Veröffentlicht in:	International journal of oncology Jg. 42; H. 3; S. 929 - 934
Hauptverfasser:	ZINN, PASCAL O, COLEN, RIVKA R, KASPER, EKKEHARD M, BURKHARDT, JAN-KARL
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	Greece D.A. Spandidos 01.03.2013 Spandidos Publications UK Ltd
Schlagworte:	Age Age Factors Biopsy Brain Neoplasms - drug therapy Brain Neoplasms - radiotherapy Brain Neoplasms - surgery Cancer therapies Chemotherapy Combined Modality Therapy Epidemiological Monitoring Epidemiology Ethnicity extent of resection Female Glioblastoma - mortality Glioblastoma - radiotherapy Glioblastoma - surgery glioblastoma multiforme Humans Kaplan-Meier Estimate Male Medical prognosis Neurosurgical Procedures Patients Prognosis Proportional Hazards Models radiotherapy Radiotherapy, Adjuvant SEER SEER Program Statistical analysis Studies Surgery Surveillance Survival Survival Analysis Survival Rate Treatment Outcome United States Variables Volumetric analysis United States United States > US
ISSN:	1019-6439, 1791-2423, 1791-2423
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Abstract	Surgery, radiation and chemotherapy are the standard of care for GBM patients, however, the impact of extent of resection (EOR) and radiotherapy (RT) on patient survival across age groups has not been established. Therefore, we present the current largest study on EOR and RT in GBM over the past three decades. Using the population based Surveillance, Epidemiology and End Results (SEER) registry, we identified a total of 21,783 GBM patients (1973-2007). Survival analysis based on EOR and RT was performed by means of factor analysis, Kaplan-Meier survival and Cox proportional hazard's ratio. Age, RT and EOR were highly prognostic (p<0.00001). Combined gross total resection (GTR) and RT showed the longest median survival (11 months) compared to subtotal resection (STR) and RT (9 months). Survival times after monotherapy with RT, GTR and STR were 5, 3 and 2 months, respectively. Patients without therapy showed a median survival of 1 month. RT and GTR demonstrated highest median survival. Interestingly, survival advantage of GTR versus STR amounted to only 1-2 months. Monotherapy (GTR, STR or RT) showed a significantly lower survival rate compared to combination therapies. RT alone yielded significantly better survival compared to any resective approach. Relative to overall age-specific median survival, elderly patients still reasonably benefit from RT alone. However, across all age groups multimodality treatment with surgery and RT continues to provide the largest survival benefit compared to either treatment alone and, thus, should be pursued whenever feasible.
AbstractList	Surgery, radiation and chemotherapy are the standard of care for GBM patients, however, the impact of extent of resection (EOR) and radiotherapy (RT) on patient survival across age groups has not been established. Therefore, we present the current largest study on EOR and RT in GBM over the past three decades. Using the population based Surveillance, Epidemiology and End Results (SEER) registry, we identified a total of 21,783 GBM patients (1973-2007). Survival analysis based on EOR and RT was performed by means of factor analysis, Kaplan-Meier survival and Cox proportional hazard's ratio. Age, RT and EOR were highly prognostic (p<0.00001). Combined gross total resection (GTR) and RT showed the longest median survival (11 months) compared to subtotal resection (STR) and RT (9 months). Survival times after monotherapy with RT, GTR and STR were 5, 3 and 2 months, respectively. Patients without therapy showed a median survival of 1 month. RT and GTR demonstrated highest median survival. Interestingly, survival advantage of GTR versus STR amounted to only 1-2 months. Monotherapy (GTR, STR or RT) showed a significantly lower survival rate compared to combination therapies. RT alone yielded significantly better survival compared to any resective approach. Relative to overall age-specific median survival, elderly patients still reasonably benefit from RT alone. However, across all age groups multimodality treatment with surgery and RT continues to provide the largest survival benefit compared to either treatment alone and, thus, should be pursued whenever feasible. Surgery, radiation and chemotherapy are the standard of care for GBM patients, however, the impact of extent of resection (EOR) and radiotherapy (RT) on patient survival across age groups has not been established. Therefore, we present the current largest study on EOR and RT in GBM over the past three decades. Using the population based Surveillance, Epidemiology and End Results (SEER) registry, we identified a total of 21,783 GBM patients (1973-2007). Survival analysis based on EOR and RT was performed by means of factor analysis, Kaplan-Meier survival and Cox proportional hazard's ratio. Age, RT and EOR were highly prognostic (p<0.00001). Combined gross total resection (GTR) and RT showed the longest median survival (11 months) compared to subtotal resection (STR) and RT (9 months). Survival times after monotherapy with RT, GTR and STR were 5, 3 and 2 months, respectively. Patients without therapy showed a median survival of 1 month. RT and GTR demonstrated highest median survival. Interestingly, survival advantage of GTR versus STR amounted to only 1-2 months. Monotherapy (GTR, STR or RT) showed a significantly lower survival rate compared to combination therapies. RT alone yielded significantly better survival compared to any resective approach. Relative to overall age-specific median survival, elderly patients still reasonably benefit from RT alone. However, across all age groups multimodality treatment with surgery and RT continues to provide the largest survival benefit compared to either treatment alone and, thus, should be pursued whenever feasible.Surgery, radiation and chemotherapy are the standard of care for GBM patients, however, the impact of extent of resection (EOR) and radiotherapy (RT) on patient survival across age groups has not been established. Therefore, we present the current largest study on EOR and RT in GBM over the past three decades. Using the population based Surveillance, Epidemiology and End Results (SEER) registry, we identified a total of 21,783 GBM patients (1973-2007). Survival analysis based on EOR and RT was performed by means of factor analysis, Kaplan-Meier survival and Cox proportional hazard's ratio. Age, RT and EOR were highly prognostic (p<0.00001). Combined gross total resection (GTR) and RT showed the longest median survival (11 months) compared to subtotal resection (STR) and RT (9 months). Survival times after monotherapy with RT, GTR and STR were 5, 3 and 2 months, respectively. Patients without therapy showed a median survival of 1 month. RT and GTR demonstrated highest median survival. Interestingly, survival advantage of GTR versus STR amounted to only 1-2 months. Monotherapy (GTR, STR or RT) showed a significantly lower survival rate compared to combination therapies. RT alone yielded significantly better survival compared to any resective approach. Relative to overall age-specific median survival, elderly patients still reasonably benefit from RT alone. However, across all age groups multimodality treatment with surgery and RT continues to provide the largest survival benefit compared to either treatment alone and, thus, should be pursued whenever feasible.
Author	ZINN, PASCAL O KASPER, EKKEHARD M BURKHARDT, JAN-KARL COLEN, RIVKA R
Author_xml	– sequence: 1 givenname: PASCAL O surname: ZINN fullname: ZINN, PASCAL O organization: Department of Neurosurgery, Baylor College of Medicine, Houston, TX – sequence: 2 givenname: RIVKA R surname: COLEN fullname: COLEN, RIVKA R organization: Department of Radiology, M.D. Anderson Cancer Center, University of Texas, Houston, TX – sequence: 3 givenname: EKKEHARD M surname: KASPER fullname: KASPER, EKKEHARD M organization: Department of Surgery, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA – sequence: 4 givenname: JAN-KARL surname: BURKHARDT fullname: BURKHARDT, JAN-KARL organization: Department of Neurosurgery, University Hospital, Zurich, Switzerland
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Copyright	Copyright © 2013, Spandidos Publications Copyright Spandidos Publications UK Ltd. 2013
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key20180107180750_b27-ijo-42-03-0929 article-title: Glioblastoma multiforme oncogenomics and signaling pathways publication-title: Clin Med Oncol – volume: 34 start-page: 3 year: 2009 ident: key20180107180750_b7-ijo-42-03-0929 article-title: Present and potential future adjuvant issues in high-grade astrocytic glioma treatment publication-title: Adv Tech Stand Neurosurg doi: 10.1007/978-3-211-78741-0_1 – volume: 107 start-page: 359 year: 2012 ident: key20180107180750_b22-ijo-42-03-0929 article-title: Glioblastoma survival in the United States before and during the temozolomide era publication-title: J Neurooncol doi: 10.1007/s11060-011-0749-4 – volume: 12 start-page: 190 year: 2010 ident: key20180107180750_b31-ijo-42-03-0929 article-title: The timing of cranial radiation in elderly patients with newly diagnosed glioblastoma multiforme publication-title: Neuro Oncol doi: 10.1093/neuonc/nop004 – year: 2008 ident: key20180107180750_b15-ijo-42-03-0929 – volume: 5 start-page: e12548 year: 2010 ident: key20180107180750_b20-ijo-42-03-0929 article-title: The proneural molecular signature is enriched in oligodendrogliomas and predicts improved survival among diffuse gliomas publication-title: PLoS One doi: 10.1371/journal.pone.0012548 – volume: 62 start-page: 753 year: 2008 ident: key20180107180750_b10-ijo-42-03-0929 article-title: Glioma extent of resection and its impact on patient outcome publication-title: Neurosurgery doi: 10.1227/01.neu.0000318159.21731.cf – volume: 122 start-page: 1245 year: 2009 ident: key20180107180750_b8-ijo-42-03-0929 article-title: Prognostic factors influencing clinical outcomes of glioblastoma multiforme publication-title: Chin Med J (Engl) – volume: 81 start-page: 206 year: 2011 ident: key20180107180750_b12-ijo-42-03-0929 article-title: Effectiveness of radiotherapy for elderly patients with glioblastoma publication-title: Int J Radiat Oncol Biol Phys doi: 10.1016/j.ijrobp.2010.04.033 – volume: 107 start-page: 207 year: 2012 ident: 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Snippet	Surgery, radiation and chemotherapy are the standard of care for GBM patients, however, the impact of extent of resection (EOR) and radiotherapy (RT) on...
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SubjectTerms	Age Age Factors Biopsy Brain Neoplasms - drug therapy Brain Neoplasms - radiotherapy Brain Neoplasms - surgery Cancer therapies Chemotherapy Combined Modality Therapy Epidemiological Monitoring Epidemiology Ethnicity extent of resection Female Glioblastoma - mortality Glioblastoma - radiotherapy Glioblastoma - surgery glioblastoma multiforme Humans Kaplan-Meier Estimate Male Medical prognosis Neurosurgical Procedures Patients Prognosis Proportional Hazards Models radiotherapy Radiotherapy, Adjuvant SEER SEER Program Statistical analysis Studies Surgery Surveillance Survival Survival Analysis Survival Rate Treatment Outcome United States Variables Volumetric analysis
Title	Extent of resection and radiotherapy in GBM: A 1973 to 2007 surveillance, epidemiology and end results analysis of 21,783 patients
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