Pattern of care and effectiveness of treatment for glioblastoma patients in the real world: Results from a prospective population-based registry. Could survival differ in a high-volume center?
Authors: Brandes Alba A. , Franceschi Enrico , Ermani Mario , Tosoni Alicia , Albani Fiorenzo , Depenni Roberta , Faedi Marina , Pisanello Anna , Crisi Girolamo , Urbini Benedetta , Dazzi Claudio , Cavanna Luigi , Mucciarini Claudia , Pasini Giuseppe , Bartolini Stefania , Marucci Gianluca , Morandi Luca , Zunarelli Elena , Cerasoli Serenella , Gardini Giorgio , Lanza Giovanni , Silini Enrico Maria , Cavuto Silvio , Baruzzi Agostino , Baruzzi A. , Albani F. , Calbucci F. , D'Alessandro R. , Michelucci R. , Brandes A. , Eusebi V. , Ceruti S. , Fainardi E. , Tamarozzi R. , Emiliani E. , Cavallo M. , Franceschi E. , Tosoni A. , Cavallo M. , Fiorica F. , Valentini A. , Depenni R. , Mucciarini C. , Crisi G. , Sasso E. , Biasini C. , Cavanna L. , Guidetti D. , Marcello N. , Pisanello A. , Cremonini A.M. , Guiducci G. , de Pasqua S. , Testoni S. , Agati R. , Ambrosetto G. , Bacci A. , Baldin E. , Baldrati A. , Barbieri E. , Bartolini S. , Bellavista E. , Bisulli F. , Bonora E. , Bunkheila F. , Carelli V. , Crisci M. , Dall'Occa P. , de Biase D. , Ferro S. , Franceschi C. , Frezza G. , Grasso V. , Leonardi M. , Marucci G. , Mazzocchi V. , Morandi L. , Mostacci B. , Palandri G. , Pasini E. , Pastore Trossello M. , Pession A. , Ragazzi M. , Riguzzi P. , Rinaldi R. , Rizzi S. , Romeo G. , Spagnolli F. , Tinuper P. , Trocino C. , Cerasoli S. , Dall'Agata M. , Faedi M. , Frattarelli M. , Gentili G. , Giovannini A. , Iorio P. , Pasquini U. , Galletti G. , Guidi C. , Neri W. , Patuelli A. , Strumia S. , Casmiro M. , Gamboni A. , Rasi F. , Cruciani G. , Cenni P. , Dazzi C. , Guidi AR. , Zumaglini F. , Amadori A. , Pasini G. , Pasquinelli M. , Pasquini E. , Polselli A. , Ravasio A. , Viti B. , Sintini M. , Ariatti A. , Bertolini F. , Bigliardi G. , Carpeggiani P. , Cavalleri F. , Meletti S. , Nichelli P. , Pettorelli E. , Pinna G. , Zunarelli E. , Artioli F. , Bernardini I. , Costa M. , Greco G. , Guerzoni R. , Stucchi C. , Iaccarino C. , Rizzi R. , Zuccoli G. , Api P. , Cartei F. , Fallica E. , Granieri E. , Latini F. , Lelli G. , Monetti C. , Ramponi V. , Saletti A. , Schivalocchi R. , Seraceni S. , Tola M.R. , Urbini B. , Giorgi C. , Montanari E. , Cerasti D. , Crafa P. , Dascola I. , Florindo I. , Mazza S. , Servadei F. , Silini EM. , Torelli P. , Immovilli P. , Morelli N. , Vanzo C. 
Published: August 2014

Abstract

Background
As yet, no population-based prospective studies have been conducted to investigate the incidence and clinical outcome of glioblastoma (GBM) or the diffusion and impact of the current standard therapeutic approach in newly diagnosed patients younger than aged 70 years.

Methods
Data on all new cases of primary brain tumors observed from January 1, 2009, to December 31, 2010, in adults residing within the Emilia-Romagna region were recorded in a prospective registry in the Project of Emilia Romagna on Neuro-Oncology (PERNO). Based on the data from this registry, a prospective evaluation was made of the treatment efficacy and outcome in GBM patients.

Results
Two hundred sixty-seven GBM patients (median age, 64 y; range, 29–84 y) were enrolled. The median overall survival (OS) was 10.7 months (95% CI, 9.2–12.4). The 139 patients ≤aged 70 years who were given standard temozolomide treatment concomitant with and adjuvant to radiotherapy had a median OS of 16.4 months (95% CI, 14.0–18.5). With multivariate analysis, OS correlated significantly with KPS (HR = 0.458; 95% CI, 0.248–0.847; P = .0127), MGMT methylation status (HR = 0.612; 95% CI, 0.388–0.966; P = .0350), and treatment received in a high versus low-volume center (HR = 0.56; 95% CI, 0.328–0.986; P = .0446).

Conclusions
The median OS following standard temozolomide treatment concurrent with and adjuvant to radiotherapy given to (72.8% of) patients aged ≤70 years is consistent with findings reported from randomized phase III trials. The volume and expertise of the treatment center should be further investigated as a prognostic factor.