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

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 patie...

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Published in:Journal of neuro-oncology 2019-03, Vol.142 (1), p.91-101
Main Authors: Fabbro-Peray, Pascale, Zouaoui, Sonia, Darlix, Amélie, Fabbro, Michel, Pallud, Johan, Rigau, Valérie, Mathieu-Daude, Hélène, Bessaoud, Faiza, Bauchet, Fabienne, Riondel, Adeline, Sorbets, Elodie, Charissoux, Marie, Amelot, Aymeric, Mandonnet, Emmanuel, Figarella-Branger, Dominique, Duffau, Hugues, Tretarre, Brigitte, Taillandier, Luc, Bauchet, Luc
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Antineoplastic Agents, Alkylating - therapeutic use
Biopsy
Brain cancer
Brain Neoplasms - drug therapy
Brain Neoplasms - mortality
Brain Neoplasms - radiotherapy
Brain Neoplasms - therapy
Brain tumors
Clinical Study
Combined Modality Therapy
Databases, Factual
Female
France - epidemiology
Glioblastoma
Glioblastoma - drug therapy
Glioblastoma - mortality
Glioblastoma - radiotherapy
Glioblastoma - therapy
Health risk assessment
Human health and pathology
Humans
Life Sciences
Male
Medical prognosis
Medicine
Medicine & Public Health
Middle Aged
Multivariate analysis
Neurology
Oncology
Patients
Population studies
Population-based studies
Practice Patterns, Physicians
Prognosis
Radiation therapy
Survival
Survival Rate
Temozolomide
Temozolomide - therapeutic use
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Summary: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.
ISSN:0167-594X
1573-7373
DOI:10.1007/s11060-018-03065-z