Glioblastoma Multiforme Tanılı Olgularımızda Sağkalım ve Prognostik Faktörlerin Değerlendirilmesi: Retrospektif Çalışma

Yıl 2023, Cilt: 49 Sayı: 1, 63 - 70, 09.06.2023

Süreyya Sarıhan , Gürkan Gurbay Aslan Türkkan Evrensel Hasan Kocaeli

https://doi.org/10.32708/uutfd.1232437

Öz

Glioblastoma Multiforme (GBM) tanılı olgularımızda sağkalım ve prognostik faktörleri değerlendirmeyi amaçladık. 2015-2020 arasında ortanca 5980 cGy (3400-6090) radyoterapi (RT) ile tedavi edilmiş 69 olgu, Ağustos 2021’de değerlendirildi. Ortanca izlem 12 ay (2-68) ve ortanca yaş 60 (39-77) idi. Total eksizyon, subtotal eksizyon ve biyopsi sırasıyla, %81, %15 ve %4 hastaya uygulanmıştı. RT ile eşzamanlı veya eşzamanlı ve adjuvan veya adjuvan temozolomid (TMZ), sırasıyla %10, %72 ve %9 olguya uygulandı. RT sonrası ilk değerlendirmede %89 (56/63) lokal kontrol, %11 progresyon (7/63) bulundu. Nörolojik düzelme %26 (10/38) olguda gözlendi. Nüks ortanca 7 ayda (3-46) %80 (50/62) olguda gözlenmiş olup son kontrolde olguların %85’si progrese idi (55/66). Tüm olgular için ortanca ve 2 yıllık genel sağkalım (GSK), 12 ay (3-69) ve %17 iken, hastalıksız sağkalım (HSK) sırasıyla, 7 ay (3-55) ve %9 bulundu. Univaryat analizde konvansiyonel RT ve eşzamanlı TMZ alanlarda, sadece RT alanlara göre ortanca GSK (18 vs 5 ay, p < 0.005) ve HSK (13 vs 5 ay, p < 0.002) daha iyi bulundu. Multivaryat analizde GSK için RT sonrası Karnofsky performans skoru ≥ 80 olması, adjuvan TMZ ≥ 5 kür almak, RT dozu ≥ 40 Gy anlamlı bulundu (p < 0,05). Stupp ve arkadaşları, randomize çalışma ile konvansiyonel 60 Gy RT, eşzamanlı ve adjuvan TMZ alanlarda tek başına RT alanlara göre 2 yıl GSK’da anlamlı artış (%27 vs %11) bildirmiştir. İyi prognostik faktörleri olan GBM’li hastalarda, konvansiyonel 60 Gy RT ile eşzamanlı ve adjuvan TMZ, standart tedavi yaklaşımı olup çalışmamızda bu olgularda 2 yıllık GSK %25 oranında elde edilmiştir.

Anahtar Kelimeler

Glioblastoma multiforme, cerrahi, radyoterapi, temozolomid, sağkalım, surgery, radiotherapy, temozolomide, survival

Destekleyen Kurum

yok

Proje Numarası

yok

Teşekkür

Bu çalışmanın istatistiki analizi, Bursa Uludağ Üniversitesi, Tıp Fakültesi, Biyoistatistik AD öğretim üyesi, Doç. Dr Gökhan Ocakoğlu tarafınca gerçekleştirilmiştir.

Evaluation of Survival and Prognostic Factors in Our Glioblastoma Multiforme Patients: Retrospective Study

Öz

We aimed to evaluate survival and prognostic factors in our cases diagnosed with Glioblastoma Multiforme (GBM). 69 cases treated with a median of 5980 cGy (3400-6090) radiotherapy (RT) between 2015 and 2020 were evaluated on August, 2021. The median follow-up was 12 months (2-68), and median age was 60 (39-77). Total excision, subtotal excision and biopsy were performed in 81%, 15% and 4% of patients, respectively. Concomitant or concomitant and adjuvant or adjuvant temozolomide (TMZ) was administered to 10% and 72% and 9% of cases, respectively. In the first evaluation after RT, there was 89% (56/63) local control and 11% progression (7/63). Neurological improvement was observed in 26% (10/38) of cases. Relapse was observed in a median of 7 months (3-46) in 80% of cases (50/62) and 85% of cases (55/66) were progressed at the last control. The median and 2-year overall survival (OS) was 12 months (3-69), and 17%, while for disease-free survival (DFS) was 7 months (3-55), and 9%, respectively, for all cases. The median OS (18 vs 5 months, p < 0.005) and DFS (13 vs 5 months, p= 0.022) were found better in those who received conventional RT and concomitant TMZ than those who received RT alone in univariate analysis. In the multivariate analysis, Karnofsky performance score ≥ 80 after RT, ≥ 5 courses of adjuvant TMZ, and RT dose ≥ 40 Gy were found significant for OS (p < 0.05). In a randomized study, 2-year OS was reported as 27% (vs 11%) in those who received conventional 60 Gy RT and concomitant TMZ compared RT alone. Conventional 60 Gy RT with concurrent and adjuvant TMZ is the standard treatment approach in patients with GBM who have good prognostic factors, and in our study, 2-year OS was obtained in 25% of these cases.

Anahtar Kelimeler

surgery, radiotherapy, temozolomide, survival

Proje Numarası

yok

Kaynakça

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