Pattern of care and effectiveness of treatment for glioblastoma patients in the real world: Results from a prospective population-based registry. Could survival differ in a high-volume center?

BACKGROUND: As yet, no population-based prospective studies have been conducted to investigate the incidence and clinical outcome of glioblastoma (GBM) or the diffusion and impact of the current standard therapeutic approach in newly diagnosed patients younger than aged 70 years. METHODS: Data on all new cases of primary brain tumors observed from January 1, 2009, to December 31, 2010, in adults residing within the Emilia-Romagna region were recorded in a prospective registry in the Project of Emilia Romagna on Neuro-Oncology (PERNO). Based on the data from this registry, a prospective evaluation was made of the treatment efficacy and outcome in GBM patients. RESULTS: Two hundred sixty-seven GBM patients (median age, 64 y; range, 29-84 y) were enrolled. The median overall survival (OS) was 10.7 months (95% CI, 9.2-12.4). The 139 patients 64aged 70 years who were given standard temozolomide treatment concomitant with and adjuvant to radiotherapy had a median OS of 16.4 months (95% CI, 14.0-18.5). With multivariate analysis, OS correlated significantly with KPS (HR = 0.458; 95% CI, 0.248-0.847; P = .0127), MGMT methylation status (HR = 0.612; 95% CI, 0.388-0.966; P = .0350), and treatment received in a high versus low-volume center (HR = 0.56; 95% CI, 0.328-0.986; P = .0446). CONCLUSIONS: The median OS following standard temozolomide treatment concurrent with and adjuvant to radiotherapy given to (72.8% of) patients aged 6470 years is consistent with findings reported from randomized phase III trials. The volume and expertise of the treatment center should be further investigated as a prognostic factor

Cognitive and emotive state in elderly treatment-na\uefve patients with advanced cancer compared with an elderly healthy control population

The elderly may have cognitive impairment due to several physiological and pathological conditions. In cancer patients cognitive impairment has been related to some anticancer treatments while few data are available regarding the role of advanced cancer itself. Thus, we planned a prospective study. We evaluated the Mini Mental State Examination (MMSE) of elderly patients with advanced cancer, before starting anticancer treatments, compared to a control population. Other causes of cognitive impairment, related to disease or to the treatment, were investigated and excluded. To investigate the possible influence of depression and Performance Status (PS) on cognitive status, the Geriatric Depression Scale (GDS), the Activities of Daily Living (ADL) and the Instrumental Activities of Daily Living (IADL) scores were also evaluated. Results: mean MMSE scores of cancer patients (n = 66) and control population (n = 31) were respectively 21.9 and 23.7. The difference was statistically significant (U = 694.5; p < 0.05). A difference between the 2 groups was seen also for ADL and IADL scores (U = 695.5; p < 0.01 and U = 501.5; p < 0.001 respectively), whilst no significant difference was seen for GDS score. Among cancer patients there was a correlation between MMSE, ADL and IADL (r = 0.38; p < 0.01 and r = 0.26; p < 0.05 respectively) while in the control group a negative correlation was found between MMSE and GDS (r = -0.49; p < 0.01). Anticancer treatment na\uefve patients with advanced cancer present with cognitive impairment that does not seem to be related to depression, as in healthy subjects, but to other causes among which the tumour might play a fundamental role

Hepatic arterial infusion (HAI) and systemic chemotherapy for unresectable liver metastases (LM) from colorectal carcinoma (CC)

Median survival of untreated patients with LM from CC ranges from 3 to 12 months (m) after diagnosis. Better results were seen with HAI, also in association with systemic chemotherapy (JNCI; 88:252-8 1996). We treated 26 patients (20 men, 6 women; mean age 58 yr) with LM (18 synchronous and 8 metachronous; 20 pts had more than 3 lesions). Two different dose-schedules were administered: (1) 5-fluorouracil (5-FU) 200 mg/m2/day iv chronic continuous infusion (cci) and HAI with cyclophosphamide (CTX) 250 mg/m2 plus platin (P) 25 mg/m2 for 3 consecutive days every 3 weeks (10 pts); (2) 5-FU 300 mg/m2/day (cci) and CTX 330 mg/m2 plus P 33 mg/m2 with the same schedule as above (16 pts). 23 pts were chemo-naive, while 3 pts were pre-treated with 5 FU-based regimen. At a median follow up of 18 m, 18 pts were alive and 8 have died. Response (WHO criteria): on 22 evaluable pts (4 too early) 3 complete response (CR, 14%), 7 partial response (PR, 32%), 6 disease stabilization (SD, 27%) and 6 disease progression (PD, 27%) for an overall response rate of 46%. Median duration of response was 14 m (range 3 to 29+). The actuarial overall survival at 3 years was 35%. As regards the different chemotherapy dosages, better results were seen in patients who received the higher doses of drugs, with a response rate of 58% (vs 30%) and a median duration of response of 19 m (vs 11). Grade 3-4 toxicity (26 pts evaluable) was seen in 8 pts (31%), mostly hematological and mucosal, with one toxic death for severe enteritis. In conclusion, combined locoregional and systemic chemotherapy is active in unresectable LM from CC. The study is ongoing also with G-CSF rescue

Metastatic oligodendrogliomas: A review of the literature and case report

Oligodendroglioma cells are detectable in the cerebro-spinal fluid in up to 14% of patients [10] and cerebellar and/or spinal cord involvement is a well known phenomenon [3]. Distant spread of oligodendroglioma is exceptional, probably due to the presence of the blood-brain barrier, the absence of lymphatic vessels and the short survival of patients. A review of the worldwide literature yielded 32 previously reported examples since 1951 to the present (Tab1e 1). This review was performed using NCBI-PubMed and "oligodendroglioma, oligodendrogliomas, metastatic, metastasis, metastases, extraneural", in different combinations, as key words and reviewing the bibliography of the consequent selected articles. New therapeutic approaches are prolonging the overall survival of patients with primitive brain tumours and in particular of those with high grade oligodendroglioma which is a chemo-sensitive disease. A longer overall survival could increase the risk of extracranial dissemination of gliomas that in the future might become a less rare clinical complication