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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Vydáno v:	International journal of oncology Ročník 42; číslo 3; s. 929 - 934
Hlavní autoři:	ZINN, PASCAL O, COLEN, RIVKA R, KASPER, EKKEHARD M, BURKHARDT, JAN-KARL
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	Greece D.A. Spandidos 01.03.2013 Spandidos Publications UK Ltd
Témata:	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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J (Engl) – volume: 7 start-page: e41522 year: 2012 ident: b16-ijo-42-03-0929 article-title: A novel volume-age-KPS (VAK) glioblastoma classification identifies a prognostic cognate microRNA-gene signature publication-title: PLoS One – volume: 356 start-page: 1527 year: 2007 end-page: 1535 ident: b30-ijo-42-03-0929 article-title: Radiotherapy for glioblastoma in the elderly publication-title: N Engl J Med – volume: 3 start-page: 39 year: 2009 end-page: 52 ident: b27-ijo-42-03-0929 article-title: Glioblastoma multiforme oncogenomics and signaling pathways publication-title: Clin Med Oncol – volume: 6 start-page: 227 year: 2004 end-page: 235 ident: b6-ijo-42-03-0929 article-title: Prognostic factors for survival of patients with glioblastoma: recursive partitioning analysis publication-title: Neuro Oncol – volume: 107 start-page: 359 year: 2012 end-page: 364 ident: b22-ijo-42-03-0929 article-title: Glioblastoma survival in the United States before and during the temozolomide era publication-title: J Neurooncol – volume: 62 start-page: 753 year: 2008 end-page: 764 ident: b10-ijo-42-03-0929 article-title: Glioma extent of resection and its impact on patient outcome publication-title: Neurosurgery – volume: 12 start-page: 49 year: 2010 end-page: 57 ident: b19-ijo-42-03-0929 article-title: A multigene predictor of outcome in glioblastoma publication-title: Neuro Oncol – volume: 10 start-page: 459 year: 2009 ident: key20180107180750_b13-ijo-42-03-0929 article-title: Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial publication-title: Lancet Oncol doi: 10.1016/S1470-2045(09)70025-7 – volume: 12 start-page: 49 year: 2010 ident: key20180107180750_b19-ijo-42-03-0929 article-title: A multigene predictor of outcome in glioblastoma publication-title: Neuro Oncol doi: 10.1093/neuonc/nop007 – volume: 352 start-page: 987 year: 2005 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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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glioblastoma: recursive partitioning analysis publication-title: Neuro Oncol doi: 10.1215/S1152851703000620 – volume: 356 start-page: 1527 year: 2007 ident: key20180107180750_b30-ijo-42-03-0929 article-title: Radiotherapy for glioblastoma in the elderly publication-title: N Engl J Med doi: 10.1056/NEJMoa065901 – volume: 37 start-page: 625 year: 2010 ident: key20180107180750_b26-ijo-42-03-0929 article-title: Clinical significance of molecular biomarkers in glioblastoma publication-title: Can J Neurol Sci doi: 10.1017/S0317167100010805 – volume: 91 start-page: 395 year: 2008 ident: key20180107180750_b17-ijo-42-03-0929 article-title: Genomic expression patterns distinguish long-term from short-term glioblastoma survivors: a preliminary feasibility study publication-title: Genomics doi: 10.1016/j.ygeno.2008.01.002 – volume: 95 start-page: 190 year: 2001 ident: key20180107180750_b5-ijo-42-03-0929 article-title: A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, 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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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