Multimodality therapy approaches, local and systemic treatment, compared with chemotherapy alone in recurrent glioblastoma

Background: Long-term local control in Glioblastoma is rarely achieved and nearly all patients relapse. In this study we evaluated the clinical effect of different treatment approaches in recurrent patients. Methods: Forty-three patients, with median age of 51years were evaluated for salvage treatment: re-resection and/or re-irradiation plus chemotherapy or chemotherapy alone. Response was recorded using the Response Assessment in Neuro-Oncology criteria. Hematologic and non-hematologic toxicities were graded according to Common Terminology Criteria for Adverse Events 4.0. Twenty-one patients underwent chemotherapy combined with local treatment, surgery and/or radiation therapy, and 22 underwent chemotherapy only. Results: The median follow up was 7months (range 3-28 months). The 1 and 2-years Progression Free Survival was 65 and 10% for combined treatment and 22 and 0% for chemotherapy alone (p < 0.01). The 1 and 2-years overall survival was 69 and 29% for combined and 26 and 0% for chemotherapy alone (p < 0.01). No toxicity greater than grade 2 was recorded. Conclusion: These data showed that in glioblastoma recurrence the combination of several approaches in a limited group of patients is more effective than a single treatment alone. This stress the importance of multimodality treatment whenever clinically feasible.