Search

Objective: To analyze the treatment effect of patients with glioblastoma (GBM) and explore prognostic factors. Methods: The clinical data of 635 patients diagnosed as GBM at Neurosurgical Oncology Department Ⅳ of Beijing Tiantan Hospital, Capital Medical University from January 2007 to March 2018 were retrospectively reviewed. There were 386 males and 249 females with an age of (48.7±11.8) years (range: 18-75 years). Patients were divided into three groups according to the time of admission: 2007-2010 group( n= 174), 2011-2014 group ( n= 237) and 2015-2018 group ( n= 224). Kaplan-Meier plot was used to analyze the effects of different treatment periods, treatment schemes and clinical factors on the survival of patients with GBM. Cox proportion hazard regression analysis was used to identify independent prognostic factors. Results: The median progression-free survival (PFS) and overall survival (OS) of patients in 2007-2010 group, 2011-2014 group, 2015-2018 group was 9.0 months (95% CI : 7.5-10.5), 10.0 months (95% CI : 8.8-11.2), 12.0 months (95% CI : 10.7-13.3) and 17.0 months (95% CI : 13.2-20.8), 20.0 months (95% CI : 16.9-23.1), 23.0 months(95% CI : 17.5-28.5), respectively. The PFS and OS of patients improved significantly over the years (χ(2)=9.693, P= 0.008 and χ(2)=8.616, P= 0.013). Multivariate survival analysis showed that age, extent of resection, radiotherapy and tumor distant dissemination were independent prognostic factors (all P< 0.05). Conclusions: With the continuous development of clinical treatment regimen, the therapeutic effect of Chinese GBM patients has improved remarkably. Age, extent of resection, radiotherapy and tumor distant dissemination are independent prognostic factors associated with survival time.

Background & Objective: Malignant glioma cells are resistant to most chemotherapeutic agents. Nitrosourea and temozolomide (TMZ) are main agents for treating malignant glioma. Resistance of malignant glioma to these agents is frequently associated with high levels of DNA repair protein O6-methylguanine-DNA methyltransferase (MGMT). This study was to evaluate the efficacy of individualized chemotherapy, according to chemotherapy sensitivity and resistance assays (CSRAs) and MGMT expression pattern, on malignant glioma, and observe the adverse events., Methods: The pathologically confirmed malignant glioma patients, treated by operation at Cancer Center of Sun Yat-sen University from Dec. 2001 to Feb. 2006, were enrolled. The fresh tumor tissues obtained during operation were immediately sent for CSRAs using MTT assay. The expression of MGMT protein was detected by immunohistochemistry. After radiotherapy,the patients received chemotherapy according to the results of CSRAs and MGMT expression. The patients were evaluated for response to chemotherapy according to WHO criteria, and for toxicity according to National Cancer Institute (NCI) criteria., Results: Forty-two patients were evaluated for response to chemotherapy. Seven patients received 2 chemotherapy regimens consecutively, therefore, overall 49 cases were evaluable. Of the 49 cases, 6 (12%) achieved complete remission (CR), 10 (20%) achieved partial remission (PR), 20 (41%) had stable disease (SD), and 13 (27%) had progressive disease (PD). The objective response rate (CR and PR) was 33%, and the disease control rate (CR, PR, and SD) was 73%. Hematologic toxicities were the main adverse events observed in this study, included grade IV anemia (1%), grade III-IV leukopenia (28%), and grade III-IV thrombocytopenia (8%). Non-hematologic toxicities mainly included nausea/vomit, fatigue, and alopecia., Conclusion: Individualized chemotherapy based on in vitro CSRAs and MGMT expression for patients with malignant glioma could improve overall response rate.

Background & Objective: Correctly distinguishing normal tissue reactive changes, tumor residue or relapse, and radioencephalopathy of glioma after radiotherapy by imaging methods is difficult. This study was to analysis MRI representations of glioma radioencephalopathy., Methods: MRI records of 5 patients with golima radioencephalopathy treated in our hospital from Sept. 1998 to May 2004 were collected, 4 cases were confirmed by operation, and 1 was diagnosed by MRI and PET. All these 5 cases were suspected recurrence in MRI scans after 1 or 2 radiotherapy periods, but them were confirmed radioencephalopathy pathologically after excision., Results: MRI revealed all patients deteriorated within 40 days to 7 months. The edema aggravated (5/5), and most were moderate or severe (4/5). Space occupying signs aggravated (5/5). Lesions enlarged (5/5) with irregular shapes like coral, map, or ring in enhanced scans., Conclusions: Radioencephalopathy of glioma occurs within 2 years after radiotherapy mostly. MRI scans manifest edema and space occupying signs aggravated, meanwhile the lesions enlarged progressively in a rather short time. It is characteristic that enhanced lesions were irregular and radiate.

Background & Objective: Surgery is the major treatment for glioma, and radiotherapy is often needed after operation. This study was to evaluate prognostic factors of patients with cerebral glioma treated with radiotherapy., Methods: Records of 158 patients with cerebral glioma, including 123 patients with astrocytoma (AC), 12 patients with oligodendroglioma (OD) or mixed oligoastrocytoma (OA), and 23 patients with glioblastoma multiforme (GBM), received radiotherapy in our center were analyzed. Eighty patients received total resection, 77 received subtotal resection, and 1 received biopsy before radiotherapy. Median radiation dose was 58 Gy (36-75 Gy). Median waiting time from operation to radiotherapy was 29 days (12-261 days). Sixty-eight patients received chemotherapy before or after radiotherapy. Cox model was used for univariate and multivariate analysis., Results: Median follow-up was 23 months (2-62 months), 27 patients relapsed, and 57 patients died. The 2- and 4-year overall survival rate were 66.5% and 45.7%. Univariate analysis showed that histologic grade (I/II vs. II/IV), histologic type (AC/OD vs. GBM), Karnofsky performance state (KPS) before radiotherapy (>/=80 vs.< 80), extent of resection (total vs non-total), and age(40 years) were significant predictors in association with overall survival rate of patients with glioma. Multivariate analysis showed that histologic grade (P=0.001), age (P=0.006), KPS before radiotherapy (P=0.009), and extent of resection (P=0.037) were independent prognostic factors of glioma., Conclusion: Low grade (I/II), age /=80 before radiotherapy, and total resection are independent factors for predicting better survival of glioma patients.

Background & Objective: Astrocytomas, constitute about 75% of neuroepithelial tumors, is one of the most common primary tumors in central nervous system with fairly high incidence and poor prognosis. Individualized multimodality is the hope for improving prognosis of patients with astrocytoma. This study was designed to investigate the efficiency of individualized treatment of microsurgery, radiotherapy, and chemotherapy for 62 patients with astrocytoma., Methods: Sixty-two patients with astrocytoma in study group were treated with individualized multimodality of microsurgery, postoperative radiotherapy, and/or postoperative chemotherapy according to in vitro sensitivity assay. After microsurgery, 59 patients accepted radiotherapy, 46 patients received chemotherapy. Fifty patients with astrocytoma in control group were treated with conventional treatment of surgery, chemotherapy, and radiotherapy. After surgery, 31 patients received radiotherapy following by BCNU chemotherapy, while 19 patients accepted BCNU chemotherapy following radiotherapy. Pathologic diagnosis of patients in study group were 19 cases of grade, 32 cases of grade III, and 11 cases of grade IV; in control group were 13 cases of grade II, 28 cases of grade III, and 9 cases of grade IV. Mean follow-up time were 25.8 months, and the outcome was evaluated by MRI, KPS, and survival rate., Results: Tumor total resection rate in study group was 67.7%, while that in control group was 58.0%. There was no significant difference of KPS and survival rate in patients with low-grade astrocytoma between 2 groups, while the outcome of patients with malignant astrocytoma was significantly improved by individualized treatment. In study group, 2-year expectant survival rate of patients with astrocytoma of grade III, and grade IV were 93.7%, and 36.3%, while in control group were 67.5%, and 22.2% (P< 0.05). In glioblastoma patients, median survival time of study group was 18.68 months, while that of control group was 12.83 months (P< 0.01)., Conclusion: Individualized microsurgery may improve the total resection of astrocytoma, and benefit to postoperative treatment.Individualized radiotherapy/chemotherapy may prevent patients from some complications. Individualized management may improve prognosis of patients with astrocytoma, particularly malignant astrocytoma.

Objective: To study the efficacy of chemotherapy for glioblastoma on the basis of brain irradiation., Methods: It was previously reported that the permeability of the blood brain barrier (BBB) to methotrexate could be increased by brain irradiation. In this study, glioblastoma patients were divided into 2 groups, 28 patients in each group. On group of patients was treated with CCNU or BCNU after having given 20-40 Gy irradiation to the brain. The other group of patients received radiation treatment alone., Results: The 1-, 3-, and 5-year survival rate of the two groups of patients was 57.1%, 22.5%, 15.0% and 17.9%, 7.1%, 3.6%, respectively. The median survival time was 29.7 +/- 7.0 and 9.7 +/- 3.5 months, respectively (P < 0.001)., Conclusion: Increase in permeability of the BBB after 20-40 Gy brain irradiation may provide an optimal chance for intracranial chemotherapy of glioblastoma.

Three hundred twenty-six cases of adult patients with glioma in the cerebral hemisphere treated by post-operative radiotherapy at the General Hospital, Tianjin Medical University from 1976 through 1990 were reviewed. The 1-, 3-, 5- and 10-year survival rate was 76.8%, 62%, 55.7% and 42.1%, respectively in low grade gliomas and the 1-, 3-, and 5-year survival rate was 44.3%, 35% and 27.1% respectively in high grade gliomas. In this study, patients' age, performance status before radiotherapy and histopathologic type of the tumor are important factors influencing the treatment outcome. There is no correlation between radiation dose and survival rate. Since 1988, combined photon and electron beams from linear accelerator have been used with a total dose of 65-70Gy to the target area.

A retrospective analysis of 73 patients with glioblastoma multiforme treated with surgery plus radiotherapy (63 cases) or surgery alone (10 cases) showed that the 5-year survival was 16% versus 0% and the median survival time was 14 versus 5 months. The median survival time in patients receiving postoperative radiotherapy was almost 3 times as long as that in patients treated with surgery alone. The difference in survival was insignificant between patients treated with a local extended field and those with whole brain plus local irradiation. The age, sex, course of disease, extent of operation and dose of irradiation are the factors influencing prognosis.