Concurrent Chemoradiation Followed by Adjuvant Temozolomide in the Management of Malignant Gliomas

Purpose: The current standard of care for newly diagnosed glioblastoma remains surgical resection followed by concurrent chemoradiation. The same treatment is often applied to other malignant gliomas. In this study, we report outcomes of patients with malignant gliomas treated with concomitant chemoradiation in the adjuvant setting at our institution. Patients and Methods: We retrospectively reviewed the records of 59 patients treated at our center between March 2003 and May 2009 for malignant gliomas. Median follow up was 19 months (3-61). Variables reviewed for analysis were histology (glioblastoma 61%, anaplastic astrocytoma 20%, mixed anaplastic oligoastrocytoma 10%, and anaplastic oligodendrogioma 9%), tissue sampling technique (open surgery 66%, stereotactic biopsy 34%), and extent of resection in the open surgery group: gross total resection (GTR) 44%, partial resection (PR) 22%. Radiotherapy was delivered to the tumor bed using 3D-conformal radiation for a total dose of 60 Gy in 30 fractions with concurrent and adjuvant temozolomide in all cases. Results: Median overall survival was 21 months (95% CI, 17.8-24.3). The two-year survival rate was 43% for the entire cohort and 68% in the subset of patients who had debulking surgery and therefore better than those who had only stereotactic biopsy (p=0.026). Conclusion: Outcomes of patients with malignant gliomas treated with concurrent chemoradiation followed by adjuvant temozolomide in our institution was comparable to historical data from the literature. Patients who had debulking surgery upfront and prior to concurrent and adjuvant treatment had better survival than those who had stereotactic biopsy in the same setting.