Radio-chemotherapy feasibility for biopsy-only unresectable IDH wild-type glioblastomas (BO-GBM)

Vincent Harlay; Romain Appay; Céline Bequet; Gregorio Petrirena; Chantal Campello; Maryline Barrié; Didier Autran; Thomas Graillon; Sébastien Boissonneau; Henry Dufour; Dominique Figarella-Branger; Laetitia Padovani; Anne Barlier; Isabelle Nanni; Emeline Tabouret; Olivier Chinot

doi:10.1093/nop/npad028

Radio-chemotherapy feasibility for biopsy-only unresectable IDH wild-type glioblastomas (BO-GBM)

Neurooncol Pract. 2023 May 30;10(6):536-543. doi: 10.1093/nop/npad028. eCollection 2023 Dec.

Authors

Vincent Harlay¹, Romain Appay^{2

3}, Céline Bequet¹, Gregorio Petrirena¹, Chantal Campello¹, Maryline Barrié¹, Didier Autran¹, Thomas Graillon⁴, Sébastien Boissonneau⁵, Henry Dufour⁴, Dominique Figarella-Branger^{2

6}, Laetitia Padovani⁷, Anne Barlier⁸, Isabelle Nanni⁶, Emeline Tabouret^{1

3}, Olivier Chinot^{1

3}

Affiliations

¹ Aix-Marseille University, AP-HM, Neuro-Oncology Department, University Hospital Timone, 13005 Marseille, France.
² Aix Marseille University, AP-HM, Neuropathology Department, University Hospital Timone, 13005 Marseille, France.
³ Aix-Marseille University, CNRS, INP, Institute of Neurophysiopathology, 13005 Marseille, France.
⁴ Aix-Marseille University, AP-HM, INSERM, MMG, Neurosurgery Department, University Hospital Timone, 13005 Marseille, France.
⁵ Aix-Marseille University, AP-HM, Neurosurgery Department, University Hospital Timone, 13005 Marseille, France.
⁶ Aix-Marseille University, Oncobiology Department, University Hospital Nord, 13005 Marseille, France.
⁷ Aix-Marseille University, AP-HM, Radiotherapy Department, University Hospital Timone, 13005 Marseille, France.
⁸ Aix Marseille University, APHM, INSERM, MMG, Laboratory of Molecular Biology Hospital La Conception, 13005 Marseille, France.

Abstract

Background: "Biopsy-only" glioblastoma (BO-GBM) is a heterogeneous, understudied group of patients associated with a poor outcome. Our objective was to explore the pattern of care and prognosis associated with BO-GBM in our center.

Methods: Patients with IDH wild-type BO-GBM included in a prospective regional cohort initiated in 2014 and closed in 2017 were retrospectively reviewed for patient characteristics, MRI findings, treatment allocation, and delivery.

Results: Of 535 patients included in the cohort, 137 patients were included in the present analysis. The median age was 66 years old and the median KPS was 70. Forty-six patients (33.6%) were referred to radiotherapy and chemotherapy (RT-TMZ) regimen, 75 (54.7%), considered unfitted for RT, received chemotherapy upfront (CT) and 16 (11.7%) were referred to palliative care (PC). Regarding the first group, 91% of patients completed the RT-TMZ. In the CT group, 11 of 75 patients (14.7%) underwent radiotherapy after chemotherapy upfront. Median overall survival was 12.3 months (95% CI, 15.30-24.16), 5.7 months (95% CI, 6.22-9.20), and 1.9 months (95% CI, 1.43-5.08) in RT-TMZ, CT, and PC groups, respectively. In multivariate analyses, progression-free survival was impacted by baseline KPS (P < .001) and MGMT status (P = .004). Overall survival was impacted by baseline KPS (P < .001) and age (P = .030).

Conclusion: BO-GBM constitute a large and heterogeneous population in which one-third of patients is amenable to the standard of care, with survival outcome close to one of the patients who underwent surgery. Reliable criteria are needed to help select patients for adequate treatment while new strategies are warranted for BO-GBM unfit for RT.

Keywords: biopsy-only; glioblastoma; treatments; unresectable.

© The Author(s) 2023. Published by Oxford University Press on behalf of the Society for Neuro-Oncology and the European Association of Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.