Survival effects of a strategy favoring second-line multimodal treatment compared to supportive care in glioblastoma patients at first progression

Pantelis Stavrinou; Aristotelis Kalyvas; Stefan Grau; Christina Hamisch; Norbert Galldiks; Sotirios Katsigiannis; Christoph Kabbasch; Marco Timmer; Roland Goldbrunner; George Stranjalis

doi:10.3171/2018.7.JNS18228

Survival effects of a strategy favoring second-line multimodal treatment compared to supportive care in glioblastoma patients at first progression

J Neurosurg. 2018 Nov 30;131(4):1136-1141. doi: 10.3171/2018.7.JNS18228.

Affiliations

¹ 1Department of Neurosurgery, University Hospital of Cologne, Germany.
² 2Department of Neurosurgery, Evangelismos Hospital, University of Athens, Greece.
³ 3Department of Neurology, University Hospital Cologne, Germany.
⁴ 4Institute of Neuroscience and Medicine, Research Center Juelich, Germany.
⁵ 5Center of Integrated Oncology, Universities of Cologne and Bonn, Cologne, Germany; and.
⁶ 6Department of Neuroradiology, University Hospital Cologne, Germany.

PMID: 30544353
DOI: 10.3171/2018.7.JNS18228

Abstract

Objective: Data on the survival effects of supportive care compared to second-line multimodal treatment for glioblastoma progression are scarce. Thus, the authors assessed survival in two population-based, similar cohorts from two European university hospitals with different treatment strategies at first progression.

Methods: The authors retrospectively identified patients with newly diagnosed glioblastoma treated at two neurooncological centers. After diagnosis, patients from both centers received identical treatments, but at tumor progression each center used a different approach. In the majority of cases, at center A (Greece), supportive care or a single therapeutic modality was offered at progression, whereas center B (Germany) provided multimodal second-line therapy. The main outcome measure was survival after progression (SaP). The influence of the treatment strategy on SaP was assessed by multivariate analysis.

Results: One hundred three patients from center A and 156 from center B were included. Tumor progression was observed in 86 patients (center A) and 136 patients (center B). At center A, 53 patients (72.6%) received supportive care alone, while at center B, 91 patients (80.5%) received second-line treatment. Progression-free survival at both centers was similar (9.4 months [center A] vs 9.0 months [center B]; p = 0.97), but SaP was significantly improved in the patients treated with multimodal second-line therapy at center B (7 months, 95% CI 5.3-8.7 months) compared to those treated with supportive care or a single therapeutic modality at center A (4.5 months, 95% CI 3.5-5.5 months; p = 0.003). In the multivariate analysis, the treatment center was an independent prognostic factor for overall survival (HR 1.59, 95% CI 0.17-2.15; p = 0.002).

Conclusions: Treatment strategy favoring multimodal second-line treatment over minimal treatment or supportive care at glioblastoma progression is associated with significantly better overall survival.

Keywords: glioblastoma; oncology; palliative care; progression; second-line treatment; survival; therapy.