Patterns of care in recurrent glioblastoma in Switzerland: a multicentre national approach based on diagnostic nodes

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• 作者：T. Hundsberger ; A. F. Hottinger ; U. Roelcke ; P. Roth…
• 关键词：Recurrent glioblastoma ; Diagnostic nodes ; Objective consensus ; Decision making ; Re ; treatment criteria
• 刊名：Journal of Neuro-Oncology
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：126
• 期：1
• 页码：175-183
• 全文大小：735 KB
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• 作者单位：T. Hundsberger (1)
  A. F. Hottinger (2)
  U. Roelcke (3)
  P. Roth (4)
  D. Migliorini (5)
  P. Y. Dietrich (5)
  K. Conen (6)
  G. Pesce (7)
  E. Hermann (8)
  A. Pica (8)
  M. W. Gross (9)
  D. Br眉gge (10)
  L. Plasswilm (10)
  M. Weller (4)
  P. M. Putora (10)
  
  1. Department of Neurology and Department of Haematology/Oncology, Cantonal Hospital St. Gallen, Rorschacherstr. 95, 9007, St. Gallen, Switzerland
  2. Department of Clinical Neurosciences & Oncology, University Hospital, Lausanne, Switzerland
  3. Department of Neurology and Brain Tumour Centre, Cantonal Hospital Aarau, Aarau, Switzerland
  4. Department of Neurology, and Brain Tumor Centre, University Hospital, Zurich, Switzerland
  5. Department of Oncology, University Hospital Geneva, Geneva, Switzerland
  6. Department of Oncology, University Hospital Basel, Basel, Switzerland
  7. Department of Radiation Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
  8. Department of Radiation Oncology, University Hospital Bern, Bern, Switzerland
  9. Department of Radiation Oncology, University Hospital Basel, Basel, Switzerland
  10. Department of Radiation Oncology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Oncology
  
• 出版者：Springer Netherlands
• ISSN：1573-7373

文摘

Despite moderate improvements in outcome of glioblastoma after first-line treatment with chemoradiation recent clinical trials failed to improve the prognosis of recurrent glioblastoma. In the absence of a standard of care we aimed to investigate institutional treatment strategies to identify similarities and differences in the pattern of care for recurrent glioblastoma. We investigated re-treatment criteria and therapeutic pathways for recurrent glioblastoma of eight neuro-oncology centres in Switzerland having an established multidisciplinary tumour-board conference. Decision algorithms, differences and consensus were analysed using the objective consensus methodology. A total of 16 different treatment recommendations were identified based on combinations of eight different decision criteria. The set of criteria implemented as well as the set of treatments offered was different in each centre. For specific situations, up to 6 different treatment recommendations were provided by the eight centres. The only wide-range consensus identified was to offer best supportive care to unfit patients. A majority recommendation was identified for non-operable large early recurrence with unmethylated MGMT promoter status in the fit patients: here bevacizumab was offered. In fit patients with late recurrent non-operable MGMT promoter methylated glioblastoma temozolomide was recommended by most. No other majority recommendations were present. In the absence of strong evidence we identified few consensus recommendations in the treatment of recurrent glioblastoma. This contrasts the limited availability of single drugs and treatment modalities. Clinical situations of greatest heterogeneity may be suitable to be addressed in clinical trials and second opinion referrals are likely to yield diverging recommendations. Keywords Recurrent glioblastoma Diagnostic nodes Objective consensus Decision making Re-treatment criteria