Investigating the effect of re-irradiation or systemic therapy in patients with GBM after tumor progression : a secondary analysis of NRG Oncology RTOG 0525
Menée à partir d'une nouvelle analyse des données d'un essai portant sur 637 patients atteints d'un glioblastome ayant évolué après une chimioradiothérapie standard, cette étude évalue l'effet d'une seconde irradiation et/ou chimiothérapie sur la survie des patients
Purpose : The optimal treatment for glioblastoma patients who progress after standard chemo-radiotherapy remains uncertain and lacking definitive evidence. Materials and Methods : This analysis of patients from Trial XXXX investigated the effect of re-irradiation or systemic treatment after tumor progression. Survival from first progression was compared between patients receiving no therapy, systemic therapy alone, radiation alone, and both modalities. The Cox proportional hazards model was used to compare the mortality hazard, controlling for potential confounders. Results : The analysis included 637 patients who progressed and had information on their management, excluding those who died less than 1/2 month after progression. 267 patients (42%) received neither re-radiation nor systemic treatment at progression, 24 (4%) received radiation alone, 282 (44%) received systemic treatment only, and 64 (10%) received both radiation and systemic therapy. Patients who received no treatment had a median survival of 4.8 months, lower than radiation treatment alone (8.2 months), systemic therapy alone (10.6 months), and both radiation and systemic therapy (12.2 months). In survival models controlling for potential confounders, those who received radiation alone had modestly better survival (hazard ratio (HR) = 0.74, 95% confidence interval (CI) 0.43,1.28), while those who underwent systemic therapy either without (HR = 0.42, 95% CI 0.34,0.53) or with radiation therapy (HR= 0.44, 95% CI 0.30,0.63) had better survival. There was no significant survival difference between patients who received who received radiation only and those who received systemic therapy (either with radiation or alone). Conclusions : Patients who received no salvage treatment had poorer survival than those received radiation, chemotherapy, or the combination. However, patient selection for no treatment likely reflects poorer expected prognosis. There was no significant survival difference among those receiving radiation therapy, systemic therapy, or both. Ongoing clinical trials will help define the role of re-irradiation after glioblastoma progression.