ABSTRACT
The aims of this multicentre retrospective study were to identify prognostic or therapeutic factors impacting on overall survival in patients with gliosarcoma. The analysis included all patients treated for gliosarcoma between 1998 and 2014 in seven French academic centres. Seventy-five patients with a median age of 60 years (range from 23 to 79 years) were treated with a combination of surgery (n = 66), radiotherapy (adjuvant for 64 patients and exclusive for 8 patients) and temozolomide based chemotherapy (n = 58). Median follow-up was 12 months (range from 2 to 71 months). Two-year overall survival (OS) and disease free survival rates were 12 % (95 % CI 4-20 %) and 2 % (95 % CI 0-6 %), respectively. The median OS was 13 months. Treatment at recurrence consisted of chemotherapy (n = 38) (bevazicumab for 18 patients, repeat temozolomide for 10 patients), salvage surgery (n = 8) and radiochemotherapy (n = 1). In univariate analysis, younger age, higher total dose of radiotherapy, longer time to recurrence and treatment at recurrence significantly increased OS. In multivariate analysis, high total dose of radiotherapy (HR = 0.97, p = 0.007) and treatment at recurrence (HR = 0.28, p < 0.001) were favourable prognostic factors of OS. Radiotherapy at a minimum dose of 54 Gy and salvage treatment increased OS of gliosarcoma. Unlike glioblastoma, in our analysis, TMZ based chemotherapy was not associated with an improvement in OS compared to patients who received radiation therapy only.
Subject(s)
Brain Neoplasms/diagnosis , Brain Neoplasms/therapy , Gliosarcoma/diagnosis , Gliosarcoma/therapy , Adult , Aged , Antineoplastic Agents, Alkylating/therapeutic use , Brain Neoplasms/epidemiology , Combined Modality Therapy , Dacarbazine/analogs & derivatives , Dacarbazine/therapeutic use , Disease-Free Survival , Female , Gliosarcoma/epidemiology , Humans , Male , Middle Aged , Radiotherapy , Retrospective Studies , Salvage Therapy , Temozolomide , Treatment Outcome , Young AdultABSTRACT
Recent improvements in radiation therapy delivery techniques provide new tools to treat patients with liver-confined disease, either with hepatocellular carcinoma or liver metastases. An appropriate selection of the patients made during a multidisciplinary specialized tumour board is mandatory. It should be based on the disease extension, an accurate evaluation of the comorbidities and the liver functions. The added value of this approach has to be evaluated in well-designed trials, alone or in combination with other treatments such as surgery, local treatments, chemoembolization and/or chemotherapy with or without targeted agents. Stereotactic body radiation therapy should be applied under strict conditions of expertise of the radiation oncology departments, including equipment and educational training programmes. However under these conditions, preliminary results seems highly encouraging in terms of local control and tolerance but should be confirmed in large controlled prospective trials.
Subject(s)
Carcinoma, Hepatocellular/surgery , Liver Neoplasms/surgery , Radiosurgery , Carcinoma, Hepatocellular/mortality , Diagnostic Imaging , Humans , Liver Neoplasms/mortality , Patient Positioning , Radiotherapy Dosage , RespirationABSTRACT
Due to its increasing incidence and a grim prognosis, primary liver cancer remains a diagnostic and therapeutic challenge. For small localized tumors, surgical resection and liver transplantation are standard treatments with a curative-intent. Therapeutic options for locally advanced or metastatic diseases are limited. Globally, surgery fits less than 20% of patients. Early detection in high-risk patients and prevention of risk factors remain the key points in the standard care. External radiotherapy is a non invasive treatment with encouraging results for non operable patients. Emerging stereotactic radiotherapy yields high rates of local control without compromising toxicity. Tumors with bad prognostic factors could be cured with this approach.
