Publication

Abstract : Background Glioblastomamultiforme(GBM) isthemostcommon primarytumorof braininadults.Radiotherapy(RT)plus concomitantandadjuvanttemozolamide treatment is the current standard therapy for newly diagnosed GBM.The aim ofour study is to analyse the clinical results and prognostic factors of GBM patients treated by post operative RT and concomitant Temozolamide followed by adjuvant temozolamide in a low income nation. Methods We retrospectively evaluated 143 patients with GBM, treated in our institutionfromApril2006toJune2015.Demographicanddiseasecharacteristicswere recorded. PrimaryendpointofthestudywasOverallsurvival(OS) andsecondary endpointwas Progression FreeSurvival(PFS).OSwasstudiedwith respecttovarious variables includingsex, ECOGscore, extentofsurgery, presentationwithorwithout seizures, andnumberofadjuvantcyclesoftemozolamide(<6versus 6) .OSandPFS were determined by the Kaplan-Meier method.The survival curves were compared by the log rank test. Results:Medianageatpresentation was52years(range18-77years).Maletofemale ratioof1.74:1.All143patientsunderwentsurgerywith22patients(15.4%)havinga biopsy alone,28(19.6%) partial resection and 93(65%) complete resection. All patients received RT, 25 did not complete prescribed 60 Gy either due to toxicity or disease progression. 88.1% received concomitant temozolamide, and 15(10.5%) completed less than 75%oftheplanneddoseoftemozolamideduetotoxicity. Median OSwas 13.8 months(95%CI10.8 -16.7).On univariateanalysis, sexorseizuresatpresentation did not affect survival, but better survival outcome was seen with performance status <2 (p= 0.011), completeresection(p <0.001) andcompletion of6cyclesofadjuvant temozolamide(p<0.001).MedianPFSwas 11.76months(95%CI9.5-14.0).The1 year OS was 55.7% and 2 year OS was 27.4%. Conclusions Our single institution experience demonstrates that adherence to globally acceptedguidelinesfortreatmentandmanagementofgliobastomamultiforme, gives similar results to that in literature.Good PS, lack ofresidual disease and completion of6 cyclesofadjuvanttemozolamidearefactors predictingafavourableoutcome.