الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Every year, approximately 100,000 people worldwide are diagnosed as having diffuse gliomas. Glioblastoma multiform (GBM), the most lethal glioma, accounts for 75% of all diffuse glioma diagnoses and has a median overall survival of 14–17 months.
The standard initial approach for GBM is maximal safe surgical resection, which is followed by radiotherapy (RT) (60 Gray [Gy] over 6 weeks) with concomitant daily Temozolomide (TMZ) and a further 6 cycles of maintenance TMZ.
Despite using the multimodality treatment, patients’ outcomes remain poor. Extending TMZ beyond 6 cycles has been shown to delay disease progression in some studies. Some guidelines suggest that this strategy is to be considered in patients with partial response or with continuing radiological improvement at the end of the 6th cycle. The residual disease is however expected in all patients with GBM and thus, it is hoped that additional cycles of TMZ will delay recurrence.
We conducted this study to ascertain the impact of extended Temozolomide maintenance therapy in comparison to the 6-cycle standard therapy on OS and PFS in GBM patients.
This is a retrospective study conducted at Clinical Oncology Department at Alexandria University, and SUN, where patients with GBM treated between January 2008 and December 2018 were included.
Out of 317 patients, 199 (62.8%) were males and 274 (86.4%) were above 40 years of age. 294 Patients (92.7%) had ECOG PS ≤2. 300/317 patients (94.6%) underwent surgery while 17 patients (5.4%) had no surgery.
Radiotherapy (RT) was given in 176/317 patients (55.5%), and thus were the only ones included in further analysis. 10 patients (5.7%) received a dose less than 50 Gy, while 166 patients (94.3%) received a RT dose higher than 50 Gy. 3DCRT was used in 95.5% of patients. 159 patients (90.3%) received RT with concomitant TMZ; while 17 patients received RT alone. 105 patients (59.7%) received TMZ maintenance after the completion of RT.
Of 105 patients who received maintenance TMZ, 74 received standard TMZ maintenance (6 cycles or less); while 31 patients received extended TMZ maintenance (more than 6 cycles). The median time between diagnosis and the start of RT was 5.86 weeks (4.4-8.9). The median RT duration was 6.71 weeks (6.4-7.3).
103 patients had disease progression based on follow-up MRI. The median PFS after RT (176 patients) was 10.7 months compared to 3.5 months in the no RT group, p<0.001.
Patients 40 years or younger had a median PFS of 16.1 months compared to 9.7 months in patients older than 40 years, p=0.028.
The median PFS was 26.1 months in the patients receiving extended TMZ compared to 11.4 months in patients receiving 6 cycles or less TMZ, p=<0.001.
64 patients, who progressed, received second-line treatment for GBM. 60 patients received systemic therapy while 10 patients had re-surgery, and only 1 patient received re-irradiation.
The median OS was 18.5 months for patients who received RT compared to 3 months in the no RT group, p<0.001.