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. 2019 Mar;142(1):91-101.
doi: 10.1007/s11060-018-03065-z. Epub 2018 Dec 6.

Association of patterns of care, prognostic factors, and use of radiotherapy-temozolomide therapy with survival in patients with newly diagnosed glioblastoma: a French national population-based study

Pascale Fabbro-Peray  1   2 , Sonia Zouaoui  3   4   5 , Amélie Darlix  5   6 , Michel Fabbro  5   6 , Johan Pallud  7 , Valérie Rigau  5   8 , Hélène Mathieu-Daude  5   9 , Faiza Bessaoud  10 , Fabienne Bauchet  5 , Adeline Riondel  1   2 , Elodie Sorbets  1   2 , Marie Charissoux  5   11 , Aymeric Amelot  12 , Emmanuel Mandonnet  12 , Dominique Figarella-Branger  13 , Hugues Duffau  3   4   5 , Brigitte Tretarre  10 , Luc Taillandier  14 , Luc Bauchet  15   16   17
Affiliations

Association of patterns of care, prognostic factors, and use of radiotherapy-temozolomide therapy with survival in patients with newly diagnosed glioblastoma: a French national population-based study

Pascale Fabbro-Peray et al. J Neurooncol. 2019 Mar.

Abstract

Background: Glioblastoma is the most frequent primary malignant brain tumor. In daily practice and at whole country level, oncological care management for glioblastoma patients is not completely known.

Objectives: To describe oncological patterns of care, prognostic factors, and survival for all patients in France with newly-diagnosed and histologically confirmed glioblastoma, and evaluate the impact of extended temozolomide use at the population level.

Methods: Nationwide population-based cohort study including all patients with newly-diagnosed and histologically confirmed glioblastoma in France in 2008 and followed until 2015.

Results: Data from 2053 glioblastoma patients were analyzed (male/female ratio 1.5, median age 64 years). Median overall survival (OS) was 11.2 [95% confidence interval (CI) 10.7-11.9] months. The first-line therapy and corresponding median survival (MS, in months) were: 13% did not receive any oncological treatment (biopsy only) (MS = 1.8, 95% CI 1.6-2.1), 27% received treatment without the combination of radiotherapy (RT)-temozolomide (MS = 5.9, 95% CI 5.5-6.6), 60% received treatment including the initiation of the concomitant phase of RT-temozolomide (MS = 16.4, 95% CI 15.2-17.4) whom 44% of patients initiated the temozolomide adjuvant phase (MS = 18.9, 95% CI 18.0-19.8). Only 22% patients received 6 cycles or more of adjuvant temozolomide (MS = 25.5, 95% CI 24.0-28.3). The multivariate analysis showed that the risk of mortality was significantly higher for the non-progressive patients who stopped at 6 cycles (standard protocol) than those who continued the treatment, hazard ratio = 1.5 (95% CI 1.2-1.9).

Conclusion: In non-progressive patients, prolonging the adjuvant temozolomide beyond 6 cycles may improve OS.

Keywords: Clinical epidemiology; Glioblastoma; Neuro-oncology; Neurosurgery; Population-based study; Temozolomide.

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Conflict of interest statement

None of the authors have any competing interests.

Figures

Fig. 1
Fig. 1
Survival and treatment patterns. Kaplan–Meier estimates of survival by: a first surgery (total RS, partial RS, NOS RS, and biopsy), b treatment including or excluding the combination of radiotherapy and temozolomide (RT–TMZ) in first-line treatment, c surgery (RS vs. biopsy) in the group of patients who initiated (at least) the RT–TMZ, d treatment with versus without local chemotherapy (carmustine wafer, CW) in the group of patients with total or subtotal RS and who initiated (at least) the RT–TMZ, e number of cycles of temozolomide (TMZ) (< 6, = 6, > 6c) in the group of patients who received adjuvant TMZ, f continuation versus discontinuation of the adjuvant TMZ after 6 cycles as defined by the Stupp protocol (in the group of patients free of progression). *Median survival (MS) and confidence interval (CI) are expressed in months (m). c Cycle, NOS not otherwise specified, RS resection
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