Abstract

INTRODUCTION

We aimed to investigate salvage treatment options for glioblastoma and to explore the role of surgery in early progression.

METHODS

The study was designed as a retrospective review of 73 recurrent glioblastoma patients treated between July 2011 and March 2016. Patients were divided into two groups according to time of progression and re-treatments were analyzed for each. Early and late progressions were defined as progression before and after completion of the standard treatment package (≤9 months versus >9 months). Survival analysis were made with Kaplan-Meier method. Survival time comparisons between groups were made with Log-Rank test. Effect of variables on survival times were evaluated with Cox-Regression Analysis.

RESULTS

Median overall survival time from the first diagnosis was 20 months (95% CI 17.0-22.9) and 2-year survival rate was 32.9%. Median time to progression was 10 (1-42) months. Median post progression survival (PPS) time was 8 months (95% CI 6.2-9.8). In multivariable analysis, we found early progression (9 months or less, p<0.001) and the use of supportive care after progression (p<0.001) as negative prognostic factors for PPS. In late progression, re-operation provided higher rates of PPS than systemic therapy (median 27 vs 10 months, p: 0.005) and supportive care (median 27 vs 3 months, p<0.001). However, no significant difference was found between reoperation and supportive care in case of early progression (median 3 vs 1 months, p: 0.143).

DISCUSSION AND CONCLUSION

Progression is inevitable after standard treatment of glioblastoma. Survival after relapse is considered to be shorter than a year and appropriate patient selection is crucial when deciding on re-treatments. Survival rates of patients with progression earlier than 9 months are lower, and reoperation may not be an ideal option for this group.