Adjuvant treatment of Grade 4 Glioma, outcomes at a UK tertiary centre

Abstract BackgroundThe 5 year overall survival (OS) for Glioblastoma (GBM) remains low. Our cohort had a lower percentage completing adjuvant treatment than those reported in trials. Therefore, we assess those not completing planned 6 cycles of adjuvant treatment and effect on survival outcomes. We also assess survival data for those who had Gliadel wafer insertion at the time of primary surgery. We go on to assess the combination of these factors on survival outcomes.MethodsWe carried out a retrospective cohort study of 110 patients who underwent neurosurgery followed by chemoradiotherapy (CRT) 60 Gray in 30 fractions and adjuvant Temazolomide (TMZ) from 2007 to 2016. We assessed OS and progression free survival (PFS) and carried out a number of subset analyses. ResultsOS was 16 months and PFS 11.9 months. 57% of patients completed 4-6 cycles of adjuvant TMZ 43% received 3 or less cycles of TMZ. Those unable to complete planned adjuvant TMZ had a poorer OS (10 vs 20 months, Cox analysis P-value 0.0003). Those who had maximal safe debulking plus Gliadel wafer insertion, median OS was improved, 19.5 months P=0.06. The group with the combination of significant factors, median OS was 2 months greater than those that did not receive Gliadel wafers and could not complete 4 cycles of adjuvant TMZ. ConclusionsSurvival outcomes were improved with Gliadel wafer insertion and completing 4-6 cycles of TMZ. Consequently the combination of these factors led to improved outcomes.