Clinical StudyManagement of glioblastoma in Victoria, Australia (2006–2008)
Introduction
Glioblastoma multiforme (GBM) represents more than 50% of all primary brain tumours in adults and has a poor prognosis [1], [2]. Where feasible, maximal surgical resection is vital to obtain the best outcomes but it is never curative [1], [3], [4]. Prior to 2005, the standard of care for newly diagnosed GBM was maximal surgical resection followed by radiotherapy. Although chemotherapy was sometimes used in the postoperative period, this was not widespread, as the benefits were generally seen to be modest [5]. In 2005, publication of the pivotal EORTC 26981/NCIC-CE3 Phase 3 study by Stupp et al. documented that the addition of temozolomide concurrently to radiotherapy followed by 6 months of temozolomide significantly improved survival of GBM patients [6].
A limited number of studies have examined community adoption of the EORTC 26981/NCIC-CE3 protocol (often referred to as the Stupp protocol) [7], [8], [9], [10]. These studies have shown rapid adoption of the Stupp protocol as a standard postoperative treatment. Factors significantly associated with reduced use of the Stupp protocol were advanced age [7], [8], [9], unsuitability for partial/gross resection [7], [8], [11], poor performance status [7], [8] and unmarried patients [7]. All reports documented improved survival with the use of this protocol but precise quantification was often limited due to the difficulties of defining a comparator group. For example, a review of the surveillance, epidemiology, and end results program (SEER) examined a large population of GBM patients in the USA in 2006 showing that outcomes were comparable to those reported by Stupp et al. [6] although data from a comparable SEER-defined population prior to 2005 were not available. Others compared outcomes in groups that received chemoradiation but included groups who received ad hoc chemoradiation prior to 2005, presumably in carefully selected patients [8], [9], [10].
We have previously reported a detailed study about the patterns of care and outcomes of patients with GBM treated in Victoria, Australia from 1998–2000, well before the adoption of the Stupp protocol [2], [12], [13]. This current study examined patients treated between 2006 and 2008, using an identical methodology to our previous study. The purpose was to identify patterns of care and outcomes in an Australian population between 2006 and 2008. Further, we aimed to examine outcome differences between two distinct cohorts: pre-Stupp protocol and post-Stupp protocol.
Section snippets
Questionnaire and data collection
A population-based sample of all adult patients (at least 16 years of age) with histologically confirmed GBM (International Classification of Diseases [ICD] codes 710–718) diagnosed in Victoria between 1 January 2006 and 31 December 2008 (inclusive) was identified from the Victorian Cancer Registry (VCR). The VCR is a statewide registry which receives notification of all diagnoses of cancer within Victoria, Australia, representing approximately one quarter of the Australian population [11].
Patterns of care and outcomes of treatment in the 2006–2008 cohort
A total of 688 patients were identified from the VCR (Fig. 1). Of these, 591 were eligible and 351 were reviewed. Of the remaining 240 patients, 207 were not reviewed because funding for the study ceased prematurely, 31 because the clinician declined to participate, one because the record had been destroyed and one because no treating doctor was able to be located. There was no significant difference in the characteristics of the 351 patients that were reviewed compared to those 240 who were
Discussion
Our data gratifyingly demonstrate a significant and appropriate shift in practice between our 1998–2000 cohort [2] and the more recent cohort in 2006–2008 with a four-fold increase in the rate of concurrent chemotherapy given postoperatively, mostly utilising the Stupp protocol. Hence, we confirm the findings of other studies that the results of the EORTC 26981/NCIC-C3 Phase 3 study have been widely adopted [7], [8], [9], [10]. We also found that our patterns of care were similar to those in
Conflicts of Interest/Disclosures
The authors declare that they have no financial or other conflicts of interest in relation to this research and its publication.
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