Outcomes of symptomatic compared to asymptomatic recurrences in patients with glioblastoma multiforme (GBM)

• Published in: Journal of radiation oncology Vol. 5; no. 1; pp. 33 - 39
• Main Authors: Amini, Arya, Altoos, Basel, Karam, Sana D., Waxweiler, Timothy V., Rusthoven, Chad G., Gaspar, Laurie E., Honce, Justin M., Damek, Denise M., Ney, Douglas E., Ormond, D. Ryan, Lillehei, Kevin O., Chen, Changhu, Kavanagh, Brian D., Liu, Arthur K.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.03.2016
• Subjects: Cancer Research; Imaging; Medicine; Medicine & Public Health; Oncology; Original Research; Radiology; Radiotherapy; Surgery; Surgical Oncology; Survival outcomes; Symptomatic recurrence; Asymptomatic recurrence; Glioblastoma multiforme (GBM)
• ISSN: 1948-7894; 1948-7908
• DOI: 10.1007/s13566-015-0231-6

Objective Glioblastoma multiforme (GBM) is a nearly uniformly fatal brain tumor with a median recurrence rate of 7 months and survival of 14 months after multimodality treatment. We sought to evaluate outcomes based on the presence or absence of symptoms at the time of recurrence. Methods We reviewed 60 patients with GBM treated from 2007 to 2014. All patients had documented radiographic evidence of recurrence. Symptomatic recurrence was defined as development of new or recurring symptoms prior to evidence of radiographic recurrence; those in this group had follow-up imaging confirming recurrence. Asymptomatic recurrence was defined as unequivocal evidence of recurrence on MRI. Results Median age for the symptomatic and asymptomatic groups was 58 and 57 years, respectively. Recursive partitioning analysis classes and other clinical factors were similar between both groups. The median time to recurrence was 9.5 months (range 3–49 months). Forty relapses (66.7 %) were symptomatic; 20 (33.3 %) were asymptomatic. Median overall survival (OS) for the symptomatic and asymptomatic cohorts was 17 and 23 months, respectively, a relative difference of 6 months ( p  = 0.08). Post-relapse survival was 3 months in patients who recurred symptomatically and 10 months for those who recurred by imaging ( p  = 0.06). Among the asymptomatic recurrence cohort, those who later went on to develop symptoms also had a median survival from symptom onset of 3 months. Conclusions In summary, OS is worse in GBM patients who present with symptoms at time of recurrence. This difference in survival is relatively large and should be validated in larger patient cohorts.