P11.04 Autonomy duration as analyzed by KPS≥70 cumulative time in patients with biopsy-only glioblastoma (BO-GBM). A sub-analysis of the Timone cohort

Abstract BACKGROUND Improvement or maintenance of autonomy is a crucial and understudied issue for glioblastoma (GBM) patients whose outcome is poor. Biopsy-only GBM (BO-GBM) is a situation where survival is short and independence is of particular importance. Our objective was to explore functional outcome in biopsy-only patients. MATERIAL AND METHODS A regional glioma SIRIC cohort was conducted at CHU Timone in 2014–2017 and we retrospectively reviewed the BO-GBM subgroup. We prospectively collected age, corticosteroid dose, tumoral surface, treatment allocated and completed, and survival outcome. Functional independence was analyzed as a cumulative time of Karnofsky performance status (KPS) ≥70 from the date of diagnosis until death. We analyzed potential factors associated to time with KPS ≥70. RESULTS Among 535 patients enrolled in the cohort, surgery was restricted to biopsy in 139 patients (BO-GBM). Mean tumoral surface measured on gadolinium-enhanced T1-weighted MRI was 1198mm2 (min: 65; max: 4515mm2). Mean steroid dose at diagnosis was 50mg prednisolone per day. Corticosteroid dose was ≥50mg prednisolone per day for 77 patients and <50mg per day for 56 patients. Fifty-four patients (39%) were referred to radiotherapy-temozolomide (RT-TMZ), 68 (49%) considered unfitted for RT received chemotherapy upfront only (CT-UF), and 17 patients (12%) were referred to palliative care only. Median overall survival (OS) was 7.5 months (95%CI: 6.0–9.2), 14.0 months (95%CI: 9.7–18.7) and 6.0 months (95%CI: 4.6–7.7) for BO-GBM, RT-TMZ and CT-UF respectively. At diagnosis, 81 (58.3%) patients presented with self-care capacity (KPS ≥ 70%). For these patients, median time of autonomy preservation was 7.6 months (95%CI: 6.1–9.0). Median time of autonomy preservation differed according to treatment modalities: it was 8.6 months (95%CI: 5.9–11.3) versus 6.3 months (95%CI: 2.9–9.7) for RT-TMZ versus CT-UF group respectively (p<0.001). In univariate analysis, time with KPS ≥ 70% was correlated with age (p=0.001), initial KPS (p<0.001), tumoral surface measured on gadolinium-enhanced T1-weighted MRI (p=0.03) and corticosteroid dose (p=0.001). In multivariate analysis, time with KPS≥70 was correlated with age (p=0.001) and KPS at diagnosis (p<0.001). CONCLUSION Patients with inoperable GBM referred to radiotherapy-temozolomide present a valuable duration of functional independence, although shorter in patients not referred to RT. Duration of functional independence could be considered in addition to PFS and OS for treatment evaluation in patients with GBM.

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QOLP-09. AUTONOMY DURATION AS ANALYZED BY KPS ≥ 70 CUMULATIVE TIME IN PATIENTS WITH BIOPSY-ONLY GLIOBLASTOMA (BO-GBM). A SUB-ANALYSIS OF THE TIMONE COHORT

Neuro-Oncology ◽

10.1093/neuonc/noab196.730 ◽

2021 ◽

Vol 23 (Supplement_6) ◽

pp. vi184-vi184

Author(s):

Vincent Harlay ◽

Anderson Loundou ◽

Céline Boucard ◽

Gregorio Petrirena ◽

Maryline Barrie ◽

...

Keyword(s):

Median Time ◽

Karnofsky Performance Status ◽

Performance Status ◽

Functional Independence ◽

Survival Outcome ◽

Treatment Modalities ◽

Factors Associated ◽

Potential Factors ◽

Care Capacity ◽

Cumulative Time

Abstract BACKGROUND Maintenance of autonomy is a crucial and understudied issue for glioblastoma patients whose outcome is poor. Biopsy-only glioblastoma (BO-GBM) present with short survival and independence is of particular importance. Our objective was to explore their functional outcome. MATERIAL AND METHODS A regional glioma SIRIC cohort was conducted at CHU Timone in 2014-2017 and we retrospectively reviewed the BO-GBM subgroup. We prospectively collected age, tumoral surface, treatment allocated and completed, and survival outcome. Functional independence was analyzed as a cumulative time of Karnofsky performance status (KPS) ≥ 70 from the date of diagnosis until death. We analyzed potential factors associated to time with KPS ≥ 70. RESULTS Among 535 patients enrolled in the cohort, surgery was restricted to biopsy in 139 patients (BO-GBM). Mean tumoral surface measured on gadolinium-enhanced T1-weighted MRI was 1198 mm2 (min: 65; max: 4515mm2). Forty-seven patients were referred to radiotherapy-temozolomide (RT-TMZ), 75 considered unfitted for RT received chemotherapy upfront (CT-UF), and 17 patients were referred to palliative care. Median OS was 7.5 months (95%CI: 6.0-9.2), 14.0 months (95%CI: 9.7-18.7) and 6.0 months (95%CI: 4.6-7.7) for BO-GBM, RT-TMZ and CT-UF respectively. At diagnosis, 81 (58.3%) patients presented with self-care capacity (KPS ≥ 70%). For these patients, median time of autonomy preservation was 7.6 months (95%CI: 6.1-9.0). Median time of autonomy preservation differed according to treatment modalities: it was 8.6 months (95%CI: 5.9-11.3) versus 6.3 months (95%CI: 2.9-9.7) for RT-TMZ versus CT-UF group respectively (p< 0.001). In multivariate analysis, time with KPS ≥ 70 was correlated with age (p=0.001) and KPS at diagnosis (p< 0.001). CONCLUSION Patients with inoperable GBM referred to radiotherapy-temozolomide present a valuable duration of functional independence, although shorter in patients not referred to RT. Duration of functional independence could be considered in addition to PFS and OS for treatment evaluation in patients with GBM.

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Cyberknife® hypofractionated stereotactic radiosurgery (CK-hSRS) as salvage treatment for brain metastases

Journal of Cancer Research and Clinical Oncology ◽

10.1007/s00432-021-03564-z ◽

2021 ◽

Author(s):

Sergej Telentschak ◽

Daniel Ruess ◽

Stefan Grau ◽

Roland Goldbrunner ◽

Niklas von Spreckelsen ◽

...

Keyword(s):

Brain Metastases ◽

Stereotactic Radiosurgery ◽

Poor Prognosis ◽

Karnofsky Performance Status ◽

Performance Status ◽

Salvage Treatment ◽

Treatment Modalities ◽

Large Tumor ◽

Fractionated Radiotherapy ◽

Hypofractionated Stereotactic Radiosurgery

Abstract Purpose The introduction of hypofractionated stereotactic radiosurgery (hSRS) extended the treatment modalities beyond the well-established single-fraction stereotactic radiosurgery and fractionated radiotherapy. Here, we report the efficacy and side effects of hSRS using Cyberknife® (CK-hSRS) for the treatment of patients with critical brain metastases (BM) and a very poor prognosis. We discuss our experience in light of current literature. Methods All patients who underwent CK-hSRS over 3 years were retrospectively included. We applied a surface dose of 27 Gy in 3 fractions. Rates of local control (LC), systemic progression-free survival (PFS), and overall survival (OS) were estimated using Kaplan–Meier method. Treatment-related complications were rated using the Common Terminology Criteria for Adverse Events (CTCAE). Results We analyzed 34 patients with 75 BM. 53% of the patients had a large tumor, tumor location was eloquent in 32%, and deep seated in 15%. 36% of tumors were recurrent after previous irradiation. The median Karnofsky Performance Status was 65%. The actuarial rates of LC at 3, 6, and 12 months were 98%, 98%, and 78.6%, respectively. Three, 6, and 12 months PFS was 38%, 32%, and 15%, and OS was 65%, 47%, and 28%, respectively. Median OS was significantly associated with higher KPS, which was the only significant factor for survival. Complications CTCAE grade 1–3 were observed in 12%. Conclusion Our radiation schedule showed a reasonable treatment effectiveness and tolerance. Representing an optimal salvage treatment for critical BM in patients with a very poor prognosis and clinical performance state, CK-hSRS may close the gap between surgery, stereotactic radiosurgery, conventional radiotherapy, and palliative care.

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Mature Results of a Prospective Trial of Rituximab in Patients (Pt) with Post Transplant Lymphoproliferative Disorder (PTLD) Unresponsive or Ineligible for Reduced Immunosuppression (RIS).

Blood ◽

10.1182/blood.v108.11.2755.2755 ◽

2006 ◽

Vol 108 (11) ◽

pp. 2755-2755

Author(s):

Jeff P. Sharman ◽

Donald E. Tsai ◽

Clare J. Twist ◽

Steven M. Horwitz ◽

Carol D. Jones ◽

...

Keyword(s):

Site Response ◽

Karnofsky Performance Status ◽

Performance Status ◽

Univariate Analysis ◽

Prospective Trial ◽

Large Cell ◽

Cytotoxic Therapy ◽

Free Survival ◽

Co Morbidity ◽

The Impact

Abstract Background: PTLDs are typically B-cell neoplasms occurring as uncommon but serious complications of reduced T-cell immune surveillance associated with organ transplantation. RIS benefits only a subset of PTLD patients and cytotoxic therapy may be poorly tolerated. Therefore, in October 1998 we initiated a prospective study of rituximab in patients who failed or were unable to receive RIS and now report mature results. Methods: Patients with CD20+ PTLD were eligible if they had failed to completely respond to RIS or RIS was contraindicated and had Karnofsky performance status >60, age 3–70 years (y), measurable disease, and no change in immunosuppression for at least 2 weeks and no cytotoxic therapy within 4 weeks. Rituximab was given as 375 mg/m2 weekly x 4 with disease evaluation at 1, 3, 6, 9, 12 and 18 months. Response data, survival curves, and the impact of clinical and pathological factors were evaluated. Results: 24 of 26 enrolled pt were eligible and evaluable. Median age was 42y with 5 <17 y, 18 were male, and 14 progressed on RIS. Median time to PTLD from transplant was 47 months (m) (8 <24 m). 17/22 were EBV+, 17 were large cell or Burkitt histology, and 10 PTLD occurred in the allograft site. Response rate was 63% (46 %CR, 17% PR) and CRs were durable (1/11 progressed). With median follow-up of 65 m (range 44–82), outcomes at 5 y are: overall survival 48%, freedom from progression 41% and failure-free survival 21%. 7 pt died without progression, yielding 5 y cause-specific survival of 69%. Nine of 13 pt with disease progression were successfully salvaged with second-line therapy. In univariate analysis PTLD characteristics did not significantly correlate with outcome but 2/2 Burkitt pt quickly progressed. Conclusions: Rituximab provided effective, durable treatment for ~40% of pt failing RIS in this series of mainly late PTLD and a majority of pt progressing after rituximab could be treated successfully. However, overall and failure-free survival reflect significant co-morbidity in this population.

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Influence of genetic variants of genes potentially associated with colorectal brain metastases on overall survival.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.3_suppl.487 ◽

2014 ◽

Vol 32 (3_suppl) ◽

pp. 487-487

Author(s):

Stefan Stremitzer ◽

Anna Sophie Berghoff ◽

Nico Benjamin Volz ◽

Wu Zhang ◽

Dongyun Yang ◽

...

Keyword(s):

Overall Survival ◽

Brain Metastases ◽

Genetic Variants ◽

Karnofsky Performance Status ◽

Performance Status ◽

Univariate Analysis ◽

Nucleotide Polymorphisms ◽

Primary Tumor Site ◽

Prognostic Effect ◽

Significant Difference

487 Background: Brain metastases (BM) in colorectal cancer (CRC) are rare, developing in only 0.3-9% of the patients, and considered a late-stage manifestation of the disease. The aim of this study was to investigate whether genetic variants of genes involved in BM-related pathways, such as integrin, invasion- and adhesion-mediating, angiogenic and tumor suppressing pathways, are associated with outcome. Methods: Genomic DNA was extracted from formalin-fixed paraffin embedded resected BM from 70 patients with histologically proven CRC. Single nucleotide polymorphisms (SNP) in seven genes (CXCR4, MMP9, ST6GALNAC5, ITGAV, ITGB1, ITGB3, KLF4) were analyzed by direct Sanger DNA sequencing and evaluated for association with overall survival (OS) from resection of BM. Only SNPs with an allele frequency of ≥ 10% were analyzed. Results: In univariate analysis, rs17577 (MMP9) and rs4642 (ITGB3) showed a significant difference in OS [(G/G 7.4 months, G/A 5.1 months; HR (95% CI) 1.83 (0.95-3.53), p = 0.0440) and (A/A 9.4 months, A/G 4.8 months, G/G 4.3 months; HR (95% CI) 0.81 (0.44-1.49) and 2.14 (0.98-4.67), p = 0.0354), respectively]. In multivariate analysis adjusted for baseline characteristics [primary tumor site (right colon, left colon, rectal), chemotherapy before BM (yes/no), BM location (supratentorial, infratentorial, both), Karnofsky performance status (<80, 80-100)], rs2236599 (KLF4), and rs10171481 (ITGAV) are significant in OS [(G/G 7.4 months, G/A or A/A 4.8 months; HR (95% CI) 3.19 (1.55-6.53), p = 0.0016) and (A/A 5.7 months, A/G 4.4 months, G/G 15.5 months; HR (95% CI) 0.61 (0.29-1.29) and 0.25 (0.10-0.60), p = 0.0082), respectively]. Conclusions: This study suggests for the first time a prognostic effect of the SNPs involved in the BM pathway. Further analyses are needed to confirm these findings.

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Bone metastases treated with immune checkpoint inhibitors: A single center experience.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e14105 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e14105-e14105 ◽

Cited By ~ 1

Author(s):

Punita Grover ◽

Vidhya Karivedu ◽

Zheng Zhu ◽

Roman Jandarov ◽

Trisha Michel Wise-Draper

Keyword(s):

Bone Metastases ◽

Checkpoint Inhibitors ◽

Small Cell Lung Carcinoma ◽

Performance Status ◽

Univariate Analysis ◽

Additional Treatment ◽

Treatment Modalities ◽

Combination Immunotherapy ◽

Cell Lung Carcinoma ◽

Combination Methods

e14105 Background: We conducted a retrospective study to analyze the overall survival (OS) and progression free survival (PFS) among patients with bone metastases (BMs) from Non Small Cell Lung Carcinoma (NSCLC), Melanoma, Head and Neck Squamous Cell Carcinoma (HNSCC) and others (including genitourinary carcinoma) treated with immunotherapy (Nivolumab, Pembrolizumab, Ipilimumab or a combination). Methods: We retrospectively evaluated patients with BMs treated at our institute from 2012-2017 who received either immunotherapy alone or in combination with other therapies for BMs including: medical therapy (zoledronic acid or denosumab), radiation or surgery. Univariate analysis was utilized to analyze OS and PFS. Results: A total of 58 patients were identified, median age at diagnosis of BMs was 61 years (range 29 – 94). 39 patients were male (67.2%) and 47(81%) patients had good performance status (KPS 70-100) at the time of immunotherapy initiation. The median time to diagnosis of BMs was 11.4 months. 20 patients had a single BM, 16 had 2-4 BMs and 22 had ≥5 BMs. Axial-only BMs were seen in 27 patients, appendicular-only in 8 and both in 23 patients. 40 patients were symptomatic and 28 patients had skeletal events (pathological fractures, spinal cord compression or hypercalcemia). 51 patients had other metastatic sites at the time of initiation of immunotherapy. 25 patients received nivolumab, 20 patients received pembrolizumab and 4 patients received combination immunotherapy. 41 patients received additional treatments for BMs. The median OS from the start of immunotherapy was 5.15 months and median PFS was 3 months. On univariate analysis male sex (p = 0.03) and combination immunotherapy (p = 0.06) were associated with better OS. Patients who received additional treatments for BMs (p = 0.04) and combination immunotherapy (p = 0.02) had better PFS. Conclusions: Combination immunotherapy and use of additional treatment modalities for BMs is associated with better survival. Further analysis is required to validate these results. [Table: see text]

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Volumetric modulated arc radiosurgery for brain metastases from breast cancer: A single-center study

Colombia Medica ◽

10.25100/cm.v52i3.4567 ◽

2021 ◽

Vol 52 (3) ◽

pp. e2004567

Author(s):

José Manuel Sánchez-Villalobos ◽

Alfredo Serna-Berna ◽

Juan Salinas-Ramos ◽

Pedro Pablo Escolar-Pérez ◽

Emma Martínez-Alonso ◽

...

Keyword(s):

Breast Cancer ◽

Brain Metastases ◽

Molecular Subtype ◽

Karnofsky Performance Status ◽

Performance Status ◽

Volumetric Modulated Arc Therapy ◽

Treatment Modalities ◽

Her2 Status ◽

Prognostic Assessment ◽

Whole Brain Radiation

Background: Whole-brain radiation therapy (WBRT) and stereotactic radiosurgery (SRS) are two treatment modalities commonly utilized to treat brain metastases (BMs). Aim: The purpose of this study is to analyze retrospectively the local control and survival of patients with BMs of breast cancer (BC) treated via radiosurgery using Volumetric Modulated Arc Therapy (VMAT-RS). Methods: 18 patients with 41 BMs of BC and treated by VMAT-RS were studied. They were classified according to the molecular subtype of BC and the modified breast graded prognostic assessment -GPA- index. Patients presented 1-4 BMs, which were treated with 5 non-coplanar VMAT arcs. The spatial distribution of BMs, the influence of receptor status on the location of the lesions and survival assessed via the Kaplan-Meier model were analyzed. Results: The median survival time (MST) was 19.7 months. Statistically significant differences were determined in the MST according to the Karnofsky performance status (p= 0.02) and the HER2 status (p= 0.004), being more prolonged in the HER2+ patients. Finally, our results showed that the cerebellum is the predominant site of breast cancer BMs, and also suggested that HER2+BMs had a predilection for some structures of the posterior circulation, such as the cerebellum, brainstem and occipital lobes (p= 0.048). Conclusions: The VMAT-RS is a technique with an overall survival compared to other radiosurgery techniques. The baseline situation at the time of treatment, the modified breast-GPA and the molecular subtypes are factors that significantly influence patient survival.

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Radiosurgery and fractionated stereotactic body radiotherapy for patients with lung oligometastases

10.21203/rs.2.12297/v2 ◽

2019 ◽

Author(s):

Goda Kalinauskaite ◽

Ingeborg Tinhofer ◽

Marcus Kufeld ◽

Anne Kathrin Kluge ◽

Arne Grün ◽

...

Keyword(s):

Stereotactic Body Radiotherapy ◽

Cox Regression ◽

Lung Metastases ◽

Karnofsky Performance Status ◽

Performance Status ◽

Univariate Analysis ◽

Progression Free Survival ◽

Late Toxicity ◽

Invasive Treatment ◽

Free Survival

Abstract Background: Patients with oligometastatic disease can potentially be cured by using an ablative therapy for all active lesions. Stereotactic body radiotherapy (SBRT) is a non-invasive treatment option that lately proved to be as effective and safe as surgery in treating lung metastases (LM). However, it is not clear which patients benefit most and what are the most suitable fractionation regimes. The aim of this study was to analyze treatment outcomes after single fraction radiosurgery (SFRS) and fractionated SBRT (fSBRT) in patients with lung oligometastases and identify prognostic clinical features for better survival outcomes. Methods: Fifty-two patients with 94 LM treated with SFRS or fSBRT between 2010 and 2016 were analyzed. The characteristics of primary tumor, LM, treatment, toxicity profiles and outcomes were assessed. Kaplan-Meier and Cox regression analyses were used for estimation of local control (LC), overall survival (OS), progression free survival and distant metastases free survival (DMFS). Results: Ninety-four LM in 52 patients were treated using SFRS/fSBRT with a median of 2 lesions per patient (range: 1–5). The median planning target volume (PTV)-encompassing dose for SFRS was 24 Gy (range: 17-26) compared to 45 Gy (range: 20-60) in 2-12 fractions in fSBRT. The median follow-up time was 21 months (range: 3-68). LC rates at 1 and 2 years for SFSR vs. fSBRT were 89% and 83% vs. 75% and 59%, respectively (p=0.026). LM treated with SFSR were significantly smaller (p=0.001). The 1 and 2-year OS rates for all patients were 84% and 71%, respectively. In univariate analysis treatment with SFRS, an interval of ≥ 12 months between diagnosis of LM and treatment, non-colorectal cancer histology and BED <100 Gy were significantly associated with better LC. However, none of these parameters remained significant in the multivariate Cox regression model. OS was significantly better in patients with negative lymph nodes (N0), Karnofsky performance status (KPS) >70% and time to first metastasis ≥12 months. There was no grade 3 acute or late toxicity. Conclusions: We observed good LC and low toxicity rates after SFRS for small lung metastases. Longer time to first metastasis, good KPS and N0 predicted better OS.

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PS02.129: BRAIN METASTASIS FROM THORACIC ESOPHAGEAL CANCER AT A SINGLE INSTITUTE

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps02.129 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 157-158

Author(s):

Motohiro Hirao ◽

Eiichi Tanaka ◽

Y Okita ◽

T Fujinaka ◽

K Nishikawa ◽

...

Keyword(s):

Esophageal Cancer ◽

Conflicts Of Interest ◽

Karnofsky Performance Status ◽

Performance Status ◽

Univariate Analysis ◽

Clinical Information ◽

Esophageal Resection ◽

Average Score ◽

Thoracic Esophageal Cancer

Abstract Background Brain metastases (BM) from esophageal cancer (EC) are rare. Despite of an advance of treatments for the patients with BM from EC, life expectancy and quality of life of these patients are still poor. We present an overview of the patients with BM from EC at a single institute. Methods We retrospectively identified 10 patients with BM from EC treated with surgery, radiation, or a combination of multidisciplinary therapies at Osaka National Hospital between 2003 and 2017 for stages IIb through IV of primary EC (follow-up, > 157 days). Medical records were reviewed to collect demographic and clinical information. Results Median age at diagnosis of BM was 63.5 years (range, 53–79 years). 9 patients were male, and 7 patients had squamous cell carcinoma of EC at the primary esophageal resection. Median overall survival from the commencements of therapy for BM was 156 days (range, 17–5404 days). The interval between the primary esophagectomy and the start of therapy for BM from EC was 298 days (range, 64–860 days). The average score of Karnofsky performance status (KPS) just before a diagnosis of BM was 75 (range, 50–90). On univariate analysis, the patients with the lower score of KPS (P = 0.01) or the shorter interval between the primary esophageal surgery and the start of therapy for BM (P = 0.06) were found to have worsened survival after the therapy for BM from EC. Conclusion The patients who had a poor KPS just before a diagnosis of BM, or the shorter interval between the esophagectomy for the primary EC and the start of therapy for BM, had poor prognosis. Disclosure All authors have declared no conflicts of interest.

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Stereotactic radiosurgery for recurrent malignant gliomas.

Journal of Clinical Oncology ◽

10.1200/jco.1995.13.7.1642 ◽

1995 ◽

Vol 13 (7) ◽

pp. 1642-1648 ◽

Cited By ~ 124

Author(s):

W A Hall ◽

H R Djalilian ◽

P W Sperduto ◽

K H Cho ◽

B J Gerbi ◽

...

Keyword(s):

Stereotactic Radiosurgery ◽

Karnofsky Performance Status ◽

Performance Status ◽

Univariate Analysis ◽

Malignant Gliomas ◽

Mass Effect ◽

Reoperation Rate ◽

Actuarial Survival ◽

Treatment Dose ◽

Treatment Volume

PURPOSE To evaluate the role of stereotactic radiosurgery in the management of recurrent malignant gliomas. PATIENTS AND METHODS We treated 35 patients with large (median treatment volume, 28 cm3) recurrent tumors that had failed to respond to conventional treatment. Twenty-six patients (74%) had glioblastomas multiforme (GBM) and nine (26%) had anaplastic astrocytomas (AA). RESULTS The mean time from diagnosis to radiosurgery was 10 months (range, 1 to 36), from radiosurgery to death, 8.0 months (range, 1 to 23). Twenty-one GBM (81%) and six AA (67%) patients have died. The actuarial survival time for all patients was 21 months from diagnosis and 8 months from radiosurgery. Twenty-two of 26 patients (85%) died of local or marginal failure, three (12%) of noncontiguous failure, and one (4%) of CSF dissemination. Age (P = .0405) was associated with improved survival on multivariate analysis, and age (P = .0110) and Karnofsky performance status (KPS) (P = .0285) on univariate analysis. Histology, treatment volume, and treatment dose were not significant variables by univariate analysis. Seven patients required surgical resection for increasing mass effect a mean of 4.0 months after radiosurgery, for an actuarial reoperation rate of 31%. Surgery did not significantly influence survival. At surgery, four patients had recurrent tumor, two had radiation necrosis, and one had both tumor and necrosis. The actuarial necrosis rate was 14% and the pathologic findings could have been predicted by the integrated logistic formula for developing symptomatic brain injury. CONCLUSION Stereotactic radiosurgery appears to prolong survival for recurrent malignant gliomas and has a lower reoperative rate for symptomatic necrosis than does brachytherapy. Patterns of failure are similar for both of these techniques.

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P14.31 CMV reactivation in a cohort of newly-diagnosed glioblastoma patients treated with temozolomide chemoradiotherapy. A single center analysis

Neuro-Oncology ◽

10.1093/neuonc/noz126.266 ◽

2019 ◽

Vol 21 (Supplement_3) ◽

pp. iii73-iii74

Author(s):

R URSU ◽

J Doridam ◽

E Chaugne ◽

H Zannou ◽

C Belin ◽

...

Keyword(s):

Clinical Symptoms ◽

Karnofsky Performance Status ◽

Performance Status ◽

Univariate Analysis ◽

Progression Free Survival ◽

Newly Diagnosed ◽

Single Center ◽

Positive Serology ◽

Cd4 Lymphocyte ◽

Cmv Reactivation

Abstract BACKGROUND The Cytomegalovirus (CMV) is a ubiquitous herpes virus which infects 60–80 % of the population in Europe. Although the CMV usually remains latent, reactivation can occur in the context of an immunodepression, such as low CD4-lymphocyte levels in HIV patients. Glioblastoma (GBM) patients frequently show lymphopenia, which is related to both the immunosuppressive nature of the tumor and to the treatment with concomitant temozolomide (TMZ) and radiotherapy (RT). Surprisingly, the incidence of CMV reactivation in GBM patients has not been clearly studied so far. We report here our experience on CMV reactivation in a cohort of newly-diagnosed GBM patients, treated with RT and TMZ. We assessed the incidence of CMV reactivation in these patients and tried to identify risk factors for such reactivation. MATERIAL AND METHODS All consecutive patients with histologically confirmed malignant GBM recommended for temozolomide chemoradiotherapy in our institution from October 2013 to December 2015 were reviewed. In all patients, sex, age, Karnofsky performance status (KPS), lymphocyte level, serological CMV status and steroid dosages were recorded at the onset, and one month after completion of the concomitant radio-chemotherapy regimen. A CMV reactivation was defined by a detection of CMV DNA > 1000 copies/ml in the patient’s serum. RESULTS 103 patients meeting the analysis criteria were reviewed. Within these 103 patients, 34 patients (33%) had initial negative serology for CMV, and none of them developed a seroconversion after treatment with concomitant RT + TMZ. Among patients with positive IgG (n=69), 16 patients (23%) developed a positive viremia at one point during treatment with concomitant RT + TMZ. Age (>60 years), lymphocyte count before RT (<1500/mm3) and use of steroids were correlated with CMV reactivation (p<0.05 in univariate analysis). A positive CMV viremia during RT+TMZ did not impact the progression free survival (PFS) but was associated with a shorter overall survival (OS) when compared to the others patients (median: 12 months vs 15 months; p=0.04). No clinical symptoms suggestive of CMV infection were reported. CONCLUSION In this single center series, we showed that CMV reactivation occurs in 23% of the GBM patients having a positive serology for CMV. Reactivation was more frequent in older patients, with low lymphocyte counts and treated with steroids. A positive viremia was not associated with poor PFS, a fact that does not support a promoting role of CMV in glioma oncogenesis, which has been sometimes suggested. Yet, the group of patients with CMV reactivation showed a shorter OS, which might be related to an older age and /or poorer clinical conditions in this group.

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