Oncological patterns of care and outcome for 952 patients with newly diagnosed glioblastoma in 2004

Abstract

This report, an audit requested by the French government, describes oncological patterns of care, prognostic factors, and survival for patients with newly diagnosed and histologically confirmed glioblastoma multiforme (GBM) in France. The French Brain Tumor DataBase, which is a national multidisciplinary (neurosurgeons, neuropathologists, radiotherapists, neurooncologists, epidemiologists, and biostatisticians) network, prospectively collected initial data for the cases of GBM in 2004, and a specific data card was used to retrospectively collect data on the management and follow-up care of these patients between January 1, 2004, and December 1, 2006. We recorded 952 cases of GBM (male/female ratio 1.6, median age 63.9 years, mean preoperative Karnofsky performance status [KPS] 79). Surgery consisted of resection (RS; n = 541) and biopsy (n = 411); 180 patients did not have subsequent oncological treatment. After surgery, first-line treatment (n = 772) consisted of radiotherapy (RT) and temozolomide (TMZ) concomitant +/- adjuvant in 314 patients, RT alone in 236 patients, chemotherapy (CT) alone in 157 patients, and other treatment modalities in 65 patients. Median overall survival was 286 days (95% CI, 266-314) and was significantly affected by age, KPS, and tumor location. Median survival (days, 95% CI) associated with these main strategies, when analyzed by a surgical group, were as follows: RS + RT-TMZ((n=224)): 476 (441-506), biopsy + RT-TMZ((n=90)): 329 (301-413), RS + RT((n=147)): 363 (331-431), biopsy + RT((n=89)): 178 (153-237), RS + CT((n=61)): 245 (190-361), biopsy + CT((n=96)): 244 (198-280), and biopsy only((n=118)): 55 (46-71). This study illustrates the usefulness of a national brain tumor database. To our knowledge, this work is the largest report of recent GBM management in Europe.

Fig. 1.

Survival and prognostic factors: Kaplan–Meier estimates of survival by age at diagnosis (≤55, ]55–65, ]65–71, and >71 years) (A), preoperative KPS (≤60, 70–80, and 90–100) (B), and location (right, left, and bilateral) (C). MS, median survival; CI, confidence interval; KPS, Karnofsky performance status.

Fig. 2.

Survival and treatment patterns: Kaplan–Meier estimates of survival by first treatment (RS, CRC, CT, RT, and no treatment) (A), first surgery (total RS, subtotal RS, partial RS, not otherwise specified RS, and biopsy) (B), first 2 oncological managements (biopsy or RS, followed by CT or RT or CRC) (C), and surgery (biopsy vs RS) in the CRC with TMZ concomitant +/− adjuvant in first-line treatment after surgery (D). RS, resection; CRC, concomitant radiochemotherapy; CT, chemotherapy; RT, radiotherapy; MS, median survival; CI, confidence interval; NOS, not otherwise specified; B, biopsy; RT-TMZ, radiotherapy and TMZ concomitant +/− adjuvant in first-line treatment after surgery.