**2.4. Statistical analysis**

Progression-free survival and overall survival were assessed using clinical and moleculargenetic prognostic factors.

Statistical analysis was done using statistical software for Microsoft Office Excel 2010 (Microsoft Corporation) and Statistica 10.0 (StatSoft).

### **2.5. Results**

Between December 2013 and August 2017, 30 patients with newly diagnosed supratentorial glioblastoma were included into the study. Eight patients underwent gross total tumor resection, and 22 patients underwent subtotal resection. The status of IDH mutation and MGMT promoter methylation was analyzed in 73% of patients. Mutation of IDH was found in one patient. The frequency of MGMT promoter methylation was 54.5%. There were 19 male and 11 female patients aged from 21 to 71. The highest frequency of glioblastoma occurred in the age range of 50–61 (median age 56 years). Tumor involvement of more than one lobe was the most common. Tumors that infiltrated the parietal, temporal, and frontal lobes occurred less frequently. The medial structures and the occipital lobe were the least frequent sites in which cancer developed (**Figure 2**).

The median Karnofsky Performance Status (KPS) score was 85% (range 40–90%, 95% CI: 60–90%) (**Figure 3**).

**2.6. Treatment**

immediate response to TCRT.

**Figure 3.** Karnofsky performance status score.

syndrome occurring during atrophy of the brain.

dose of 200 mg/m<sup>2</sup>

**2.7. Treatment outcomes**

Of the 30 patients included into the study, 29 completed concurrent thermochemoradiotherapy (TCRT). One patient discontinued adjuvant chemotherapy after 42 Gy radiotherapy and eight sessions of local hyperthermia because of tumor progression. In this case, disease progression was diagnosed before starting TCRT. Two patients lost to follow-up after assessing

Patients who completed TCRT continued to receive chemotherapy with temozolomide at a

within 2 months after completion of treatment with no evidence of disease progression. Among the patients who died, one patient had extensive destructive pneumonia, one patient had severe neutropenia and thrombocytopenia, and another one patient had psycho-organic

Patients who had disease progression underwent surgery and second-line chemotherapy. Repeated radiation therapy at a total dose of 40 Gy was administered to patients who devel-

Progression-free survival and overall survival were the primary end points in evaluating treatment response in the study. The median follow-up time was 12 months (range 4–51 months; 95% CI: 8.5–23 months). The median disease-free survival was 9.6 months (95% CI: 7.2–19.0 months), and recurrence most often occurred within 6–12 months after treatment (**Figure 4A**).

oped disease progression 1 year after completion of adjuvant radiation therapy.

per day for five consecutive days in a 28-day cycle. Three patients died

Concurrent Thermochemoradiotherapy in Glioblastoma Treatment: Preliminary Results

http://dx.doi.org/10.5772/intechopen.76264

173

The average time from diagnosis to start of radiation therapy was 5.4 weeks. (95% CI: 4.5–6.5 weeks). Three patients who underwent subtotal tumor resection had disease progression at the time of initiation of adjuvant therapy.

**Figure 2.** GBM location in patients enrolled into the study.

Concurrent Thermochemoradiotherapy in Glioblastoma Treatment: Preliminary Results http://dx.doi.org/10.5772/intechopen.76264 173

**Figure 3.** Karnofsky performance status score.

### **2.6. Treatment**

**2.4. Statistical analysis**

genetic prognostic factors.

cancer developed (**Figure 2**).

the time of initiation of adjuvant therapy.

**Figure 2.** GBM location in patients enrolled into the study.

60–90%) (**Figure 3**).

**2.5. Results**

(Microsoft Corporation) and Statistica 10.0 (StatSoft).

172 Glioma - Contemporary Diagnostic and Therapeutic Approaches

Progression-free survival and overall survival were assessed using clinical and molecular-

Statistical analysis was done using statistical software for Microsoft Office Excel 2010

Between December 2013 and August 2017, 30 patients with newly diagnosed supratentorial glioblastoma were included into the study. Eight patients underwent gross total tumor resection, and 22 patients underwent subtotal resection. The status of IDH mutation and MGMT promoter methylation was analyzed in 73% of patients. Mutation of IDH was found in one patient. The frequency of MGMT promoter methylation was 54.5%. There were 19 male and 11 female patients aged from 21 to 71. The highest frequency of glioblastoma occurred in the age range of 50–61 (median age 56 years). Tumor involvement of more than one lobe was the most common. Tumors that infiltrated the parietal, temporal, and frontal lobes occurred less frequently. The medial structures and the occipital lobe were the least frequent sites in which

The median Karnofsky Performance Status (KPS) score was 85% (range 40–90%, 95% CI:

The average time from diagnosis to start of radiation therapy was 5.4 weeks. (95% CI: 4.5–6.5 weeks). Three patients who underwent subtotal tumor resection had disease progression at Of the 30 patients included into the study, 29 completed concurrent thermochemoradiotherapy (TCRT). One patient discontinued adjuvant chemotherapy after 42 Gy radiotherapy and eight sessions of local hyperthermia because of tumor progression. In this case, disease progression was diagnosed before starting TCRT. Two patients lost to follow-up after assessing immediate response to TCRT.

Patients who completed TCRT continued to receive chemotherapy with temozolomide at a dose of 200 mg/m<sup>2</sup> per day for five consecutive days in a 28-day cycle. Three patients died within 2 months after completion of treatment with no evidence of disease progression. Among the patients who died, one patient had extensive destructive pneumonia, one patient had severe neutropenia and thrombocytopenia, and another one patient had psycho-organic syndrome occurring during atrophy of the brain.

Patients who had disease progression underwent surgery and second-line chemotherapy. Repeated radiation therapy at a total dose of 40 Gy was administered to patients who developed disease progression 1 year after completion of adjuvant radiation therapy.

### **2.7. Treatment outcomes**

Progression-free survival and overall survival were the primary end points in evaluating treatment response in the study. The median follow-up time was 12 months (range 4–51 months; 95% CI: 8.5–23 months). The median disease-free survival was 9.6 months (95% CI: 7.2–19.0 months), and recurrence most often occurred within 6–12 months after treatment (**Figure 4A**).

**Figure 4.** Survival of GBM patients who received concurrent thermochemoradiotherapy. (A) Progression-free survival and (B) overall survival.

The 1-year disease-free survival rate was 41.3 ± 10.6%. Five patients were followed up for more than 24 months. One patient developed recurrent disease 34 months after diagnosis.

During the follow-up period, 11 patients died. Most deaths were registered within 6–12 months (five patients) and 12–24 months (four patients). The median overall survival time was 23.4 months. The 1-year survival rate was 73 ± 8.8%. Four patients had no evidence of recurrence 24 months after completion of treatment (**Figure 4B**).
