Adjuvant treatment of Grade IV Glioma, outcomes at a UK tertiary centre

Purpose: The 5 year overall survival (OS) for Glioblastoma multiforme (GBM) remains low.Our cohort had a lower percentage completing adjuvant treatment than those reported in trials. We assess those not completing planned 6 cycles of adjuvant treatment.We assess survival data for those who had Gliadel wafer insertion at the time of primary surgery. We go on to assess the combination of these factors on survival. Methods: Cohort of 110 patients who had undergone neurosurgery followed by chemo-radiotherapy (CRT) 60 Gray in 30 fractions and adjuvant Temazolomide (TMZ) from 2007 to 2016. Results: OS was 16 months and progression free survival (PFS) 11.9 months.57% of patients completed 4-6 cycles of adjuvant TMZ 43% received 3 or less cycles of TMZ. Those unable to complete planned adjuvant TMZ had a poorer OS (10 vs 20 months, Cox analysis P-value 0.0003).Those who had maximal safe debulking plus Gliadel wafer insertion, median OS was improved, 19.5 months P=0.06. The group with the combination of significant factors, median OS was 2 months greater than those that did not receive Gliadel wafers and could not complete 4 cycles of adjuvant TMZ. Conclusions: Survival outcomes were improved with Gliadel wafer insertion, completing 4-6 cycles of TMZ. Consequently the combination of these factors led to improved outcomes. Second-line chemotherapy improved OS at relapse regardless of second line surgery.