Evidence map›Paper›PMID 30977058›Full record

ArticleJournal of neuro-oncology2019

Dose-intensified chemoradiation is associated with altered patterns of failure and favorable survival in patients with newly diagnosed glioblastoma.

Michelle M Kim, Corey Speers, Pin Li, Matthew Schipper, Larry Junck, Denise Leung, Daniel Orringer, Jason Heth, Yoshie Umemura, Daniel E Spratt and 4 more

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In one paragraph

Article in Journal of neuro-oncology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

11 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Trial
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  6. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Michelle M KimDepartment of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA. michekim@med.umich.edu.ORCID http://orcid.org/0000-0001-7566-6411
Corey SpeersDepartment of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
Pin LiDepartment of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
Matthew SchipperDepartment of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
Larry JunckDepartment of Neurology, University of Michigan, Ann Arbor, MI, USA.
Denise LeungDepartment of Neurology, University of Michigan, Ann Arbor, MI, USA.
Daniel OrringerDepartment of Neurosurgery, University of Michigan, Ann Arbor, MI, USA.
Jason HethDepartment of Neurosurgery, University of Michigan, Ann Arbor, MI, USA.
Yoshie UmemuraDepartment of Neurology, University of Michigan, Ann Arbor, MI, USA.
Daniel E SprattDepartment of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
Daniel R WahlDepartment of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
Yue CaoDepartment of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
Theodore S LawrenceDepartment of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
Christina I TsienDepartment of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

background and purposeWe evaluated whether dose-intensified chemoradiation alters patterns of failure and is associated with favorable survival in the temozolomide era. MATERIALS AND

methodsBetween 2003 and 2015, 82 patients with newly diagnosed glioblastoma were treated with 66-81 Gy in 30 fractions using conventional magnetic resonance imaging. Progression-free (PFS) and overall survival (OS) were calculated using Kaplan-Meier methods. Factors associated with improved PFS, OS, and time to progression were assessed using multivariate Cox model and linear regression.

resultsMedian follow-up was 23 months (95% CI 4-124 months). Sixty-one percent of patients underwent subtotal resection or biopsy, and 38% (10/26) of patients with available data had MGMT promoter methylation. Median PFS was 8.4 months (95% CI 7.3-11.0) and OS was 18.7 months (95% CI 13.1-25.3). Only 30 patients (44%) experienced central recurrence, 6 (9%) in-field, 16 (23.5%) marginal and 16 (23.5%) distant. On multivariate analysis, younger age (HR 0.95, 95% CI 0.93-0.97, p = 0.0001), higher performance status (HR 0.39, 95% CI 0.16-0.95, p = 0.04), gross total resection (GTR) versus biopsy (HR 0.37, 95% CI 0.16-0.85, p = 0.02) and MGMT methylation (HR 0.25, 95% CI 0.09-0.71, p = 0.009) were associated with improved OS. Only distant versus central recurrence (p = 0.03) and GTR (p = 0.02) were associated with longer time to progression. Late grade 3 neurologic toxicity was rare (6%) in patients experiencing long-term survival.

conclusionDose-escalated chemoRT resulted in lower rates of central recurrence and prolonged time to progression compared to historical controls, although a significant number of central recurrences were still observed. Advanced imaging and correlative molecular studies may enable targeted treatment advances that reduce rates of in- and out-of-field progression.

Indexed as

Salvage TherapyAdultAgedAntineoplastic Agents, AlkylatingBrain NeoplasmsChemoradiotherapyClinical Trials, Phase I as TopicClinical Trials, Phase II as TopicFemaleFollow-Up StudiesGlioblastomaHumansMaleMiddle AgedPrognosisRetrospective StudiesAntineoplastic Agents, AlkylatingTemozolomideDose-escalationGlioblastomaOutcomesPatterns of failureRadiation

Identifiers

PMID30977058

What OpenQuestion holds

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Read underepoch 390

Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.