Abstract
Objective With the publication of the European Organization for Research and Treatment of Cancer/National
Cancer Information Center (EORTC/NCIC) trial, concomitant radiochemotherapy followed
by intermittent chemotherapy became the new treatment standard for patients with primary
glioblastoma. Eight years after widespread introduction of this protocol, it is of
interest to investigate whether this new standard has been established in daily neuro-oncologic
practice. We were particularly interested in its practicality within a neurosurgical
neuro-oncologic setting.
Patients and Methods We analyzed primary glioblastoma patients diagnosed between 2005 and 2013 treated
at our center according to the EORTC/NCIC trial. Parameters associated with treatment
performance (interruption of radiotherapy, concomitant chemotherapy and intermittent
chemotherapy, total number of cycles, and side effects) were retrospectively analyzed
and compared with the available data from the EORTC/NCIC trial.
Results In this single-center retrospective study, we identified 189 patients (116 men, 73
women; median age: 62 years) who were treated according to the EORTC/NCIC trial protocol.
A total of 176 patients received cytoreductive surgery; 13 patients had stereotactic
biopsy only (EORTC/NCIC trial: 239 patients and 48 patients, respectively). Radiotherapy
had to be interrupted in 9 patients (5%) (EORTC/NCIC trial: 15 patients [5%]) and
concomitant chemotherapy in 26 patients (14%) (EORTC/NCIC trial: 37 patients [13%]).
In 156 patients (83%), adjuvant TMZ chemotherapy was initiated (6 median temozolomide
[TMZ] cycles; range: 1–30). In the EORTC/NCIC trial, 223 patients (47%) received the
intermittent chemotherapy protocol (median: 3 cycles; range: 1–7). Overall, 97 patients
(62%) completed 6 TMZ cycles (EORTC/NCIC-trial: 105 patients [47%]); dose escalation
to 200 mg/qm at the second cycle was performed in 91 patients (58%) (versus 149 patients
[67%]). Intermittent TMZ therapy was discontinued in 59 patients (38%) (versus 118
patients [53%]). Median overall survival in our patient cohort was 19 months (versus
14.6 months); median time to progression was 9 months (versus 6.9 months).
Conclusion Comparison between the feasibility of the treatment protocol established by the EORTC/NCIC
trial (performed within the setting of a prospective randomized trial) and the daily
routine in a dedicated neurosurgical neuro-oncologic department demonstrates that
the protocol is suitable for daily practice within a neurosurgical unit.
Keywords
glioblastoma - temozolomide - concomitant radio chemotherapy
