Survival effects of a strategy favoring second-line multimodal treatment compared to supportive care in glioblastoma patients at first progression

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Data on the survival effects of supportive care compared to second-line multimodal treatment for glioblastoma progression are scarce. Thus, the authors assessed survival in two population-based, similar cohorts from two European university hospitals with different treatment strategies at first progression.


The authors retrospectively identified patients with newly diagnosed glioblastoma treated at two neurooncological centers. After diagnosis, patients from both centers received identical treatments, but at tumor progression each center used a different approach. In the majority of cases, at center A (Greece), supportive care or a single therapeutic modality was offered at progression, whereas center B (Germany) provided multimodal second-line therapy. The main outcome measure was survival after progression (SaP). The influence of the treatment strategy on SaP was assessed by multivariate analysis.


One hundred three patients from center A and 156 from center B were included. Tumor progression was observed in 86 patients (center A) and 136 patients (center B). At center A, 53 patients (72.6%) received supportive care alone, while at center B, 91 patients (80.5%) received second-line treatment. Progression-free survival at both centers was similar (9.4 months [center A] vs 9.0 months [center B]; p = 0.97), but SaP was significantly improved in the patients treated with multimodal second-line therapy at center B (7 months, 95% CI 5.3–8.7 months) compared to those treated with supportive care or a single therapeutic modality at center A (4.5 months, 95% CI 3.5–5.5 months; p = 0.003). In the multivariate analysis, the treatment center was an independent prognostic factor for overall survival (HR 1.59, 95% CI 0.17–2.15; p = 0.002).


Treatment strategy favoring multimodal second-line treatment over minimal treatment or supportive care at glioblastoma progression is associated with significantly better overall survival.

ABBREVIATIONS EORTC = European Organisation for Research and Treatment of Cancer; GBM = glioblastoma; KPS = Karnofsky Performance Scale; MGMT = O6-methylguanine-DNA methyltransferase; OS = overall survival; PFS = progression-free survival; QOL = quality of life; SaP = survival after progression.

Article Information

Correspondence Pantelis Stavrinou: University Hospital of Cologne, Germany.

INCLUDE WHEN CITING Published online November 30, 2018; DOI: 10.3171/2018.7.JNS18228.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.



  • View in gallery

    Kaplan-Meier curve for SaP between center A and center B, showing significantly longer survival for patients treated in center B (p = 0.003). Hash marks indicate censored cases.

  • View in gallery

    Kaplan-Meier curve for PFS between center A and center B, showing no difference in PFS between the two centers (p = 0.97). Hash marks indicate censored cases.



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