Prognostički faktori i savremeni terapijski pristup lečenju pacijenata obolelih od multiformnog glioblastoma

Abstract

Multiformni glioblastom predstavlja najčešći maligni primarni tumor mozga u odraslih. Incidenca ovog tumora je 2 do 3 na 100 000 stanovnika godišnje u Evropi. Srednja dužina preživljavanja je 12-18 meseci, u zavisnosti od prognostičkih parametara a stopa petogodišnjeg preživljavanja oko 4%. U literaturi su definisani prognostički faktori koji su povezani sa dužim preživljavanjem, a to su godine starosti pacijenta, stepen resekcije tumora kao i genski profil tumora. Savremeni pristup lečenju ovih pacijenata predstavlja multidisciplinarni pristup, gde operacija predstavlja samo prvi korak u lečenju, dok onkološka terapija zajedno sa intenzivnim praćenjem i pravovremenom reoperacijom u odabranim slučajevima omogućava produžetak preživljavanja, kao i bolji kvalitet života ovih pacijenata. Temozolomid je prvi hemioterapeutik koji je postigao značajan pomak u preživljavanju. Srednje preživljavaje je pomereno sa 12,1 na 14,6 meseci, dok je dvogodišnje preživljavanje sa standardnim protokolom 10,4% pomereno na 26,5%. Ciljevi Ciljevi ovog istraživanja obuhvataju određivanje procenta dvogodišnjeg preživljavanja, kao i procenu faktora koji utiču na dužinu preživljavanja, određivanje značaja stepena hirurške resekcije tumora, upoređivanje dužine preživljavanja pacijenata koji su dobijali karmustin ili lomustin sa onima koji su bili na terapijii temozolomidom, ispitativanje uticaja reoperacije i sekundarne hemioterapije na preživljavanje pacijenata i utvrđivanje kriterijuma za definisanje pseudoprogresije kod pacijenata koji su dobijali zračnu terapiju konkomitantno sa temozolomidom...

Glioblastoma multiforme is the most common malignant primary brain tumor in adults. The incidence of this tumor is 2 to 3 per 100 000 inhabitants per year in Europe. The median survival rate is 12-18 months, depending on the prognostic parameters, and the five-year survival rate is about 4%. The literature defines prognostic factors that are associated with longer survival, which are the age of the patient, the degree of tumor resection, and genetic profile of the tumor. The modern approach to the treatment of these patients is a multidisciplinary approach, where the operation is only the first step in the treatment, while oncological therapy, together with intensive monitoring and timely reoperation in selected cases, allows an extension of survival as well as a better quality of life for these patients. Temozolomide is the first chemotherapeutic who has made significant progress in survival. Mean survival was shifted from 12.1 to 14.6 months, while two-year survival with a standard protocol of 10.4% was shifted to 26.5%. Aims The objectives of this study include determining the percentage of two-year survival, as well as assessing the factors that influence the survival rate, determining the significance of the degree of surgical tumor resection, comparing the length of survival of patients who received carmustin or lomustin with those who were on therapy with temozolomide, examining the effect of the reoperation and secondary chemotherapy on survival of patients and determination of criteria for defining pseudoprogression in patients receiving radiotherapy concomitant with temozolomide. Methodology In the period from January 2010 to December 2012, 110 patients with newly diagnosed glioblastoma were operated on Neurooncology department. The data were collected prospectively, recorded in the electronic database, and subsequently analyzed retrospectively...