A five year review of the management of Glioblastoma Multiforme (GBM) in Northern Ireland

Background to the audit: Outcomes following radiotherapy (RT) in the treatment of GBM are poor. Concurrent chemoradiotherapy (CRT) with temozolomide is the optimal treatment for GBM. We report a five-year institutional experience. Standard, indicator and target: National Institute of Health and Care Excellence (NICE) guidance advises radical CRT for histologically proven World Health Organization (WHO) Grade IV brain tumours for patients with a performance status (PS) of 0 or 1 with an expected life expectancy of >12 weeks. Clinical outcomes were compared with Stupp data.1 MGMT methylation status was not routinely tested during this time period. Methodology: Initial audit (2007–2009) identified patients with GBM referred for treatment. A retrospective audit collected patient demographics, diagnostic and treatment modality, Kaplan Meier estimates of overall survival (OS) were calculated and outcomes compared using the log-rank test. Re-audit 2010–2012. Results of 1st audit round: 86 patients. 19 received CRT, nine had radical RT. There was 100% completion of concomitant temozolomide. 12/19 (63.1%) completed the adjuvant component of treatment. In those treated with CRT, good PS and prior debulking surgery were associated with improved OS (p<0.0001). Median OS for those receiving chemoradiotherapy was 22.9 months versus 7.5 months for radical radiotherapy alone (p<0.0001). All patients treated in adherence with NICE guidance. 1st action plan: Encourage biopsy/debulking for suitable patients. Brain registration database set-up. Results of 2nd audit round: Adherence to NICE guidance remained high (95.8%), three patients with grade III biopsies with adverse radiology were treated with CRT. Completion of CRT (92.7%). Median OS 15.5 months with CRT, 8.8 moths with radical RT and 7.2 moths with palliative RT. 2nd action plan: OS was comparable with trial data. MGMT methylation status testing may help to prognosticate and guide treatment for these patients. References: 1. Stupp R, Mason WP, van den Bent MJ et al. Radiotherapy plus Concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 2005; 352(10): 987–996.