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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Bibliographic Details
Published in:International journal of oncology Vol. 42; no. 3; pp. 929 - 934
Main Authors: ZINN, PASCAL O, COLEN, RIVKA R, KASPER, EKKEHARD M, BURKHARDT, JAN-KARL
Format: Journal Article
Language:English
Published: Greece D.A. Spandidos 01.03.2013
Spandidos Publications UK Ltd
Subjects:
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
Online Access:Get full text
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Summary: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.
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ISSN:1019-6439
1791-2423
1791-2423
DOI:10.3892/ijo.2013.1770