How surgery, radiotherapy and chemotherapy each contribute to the outcome of treatment for adult patients with Glioblastoma?
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Universidad Industrial de Santander
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Introducción: el glioblastoma es un tumor frecuente asociado a alta morbilidad y mortalidad, la mayoría de pacientes mueren antesde 2 años desde el diagnostico. La terapia estándar actual es resección quirúrgica máxima asociada a radioterapia mas temozolomida concomitante y coadyuvante. Objetivo: evaluar que tan determinantes son la resección quirúrgica, radioterapia y quimioterapia para el resultado del tratamiento en pacientes con glioblastoma. Métodología de búsqueda: una revisión de la literatura es hecha para identificar estudios que evalúen el resultado del tratamiento de adultos con glioblastoma tras ser tratados con cirugía, radioterapia o quimioterapia. El modelo de niveles de evidencia del Centro de Medicina basada en la evidencia de Oxford es usado para calificar la calidad de la evidencia encontrada. Resultados: 18 artículos, reportando resultados de 15 estudios son incluidos. Cinco estudios evalúan el efecto de cirugía en la sobrevida. La resección quirúrgica provee un beneficio tan alto como 4,9 meses en la sobrevida global en los casos en que la resección máxima es posible. Una revisión sistemática y cuatro ensayos clínicos han reportado que la radioterapia incrementa el promedio de sobrevida global en un rango de tres a cinco meses. La organización Europea para la investigación y manejo del Cáncer y el grupo de ensayos clínicos del instituto Nacional de Cáncer de Canadá (EORT-NCIC) describió en el 2005 un incremento en la sobrevida global en dos a tres meses en pacientes que reciben tratamiento concomitante y coadyuvante con temozolomida en comparación con pacientes que solo reciben radioterapia. La adición de uno de los nuevos agentes quimioterapéuticos parece mejorar el resultado del manejo comparado con el actual tratamiento estándar. Conclusión: el tratamiento quirúrgico, la radioterapia y la quimioterapia; cada uno tiene un efecto
modesto en el resultado del tratamiento de pacientes con glioblastoma. (MÉD.UIS. 2012;25(3):209-19).
Introduction: glioblastoma is a common condition associated with high morbidity and mortality; most of newly diagnosed patients willdie within two years. The current standard therapy is maximal surgical resection followed by radiotherapy plus concomitant and adjuvanttemozolamide. Objective: it is the aim of this review to evaluate how determinant surgical resection, radiotherapy and chemotherapy areto the outcome of patients with glioblastoma. Methods: a literature search is done to identify trials evaluating the outcome of adults withglioblastoma after being treated with surgery, radiotherapy or chemotherapy. The Oxford Centre for Evidence-based Medicine Levels ofEvidence model is used to grade the quality of the available evidence. Results: 18 articles, reporting results of 15 studies were included.Five trials evaluated the effect of surgery in survival. Surgical provides as much as 4.9 months benefit in overall survival in cases in whichcomplete resection is possible. A systematic review and four clinical trials reported that radiotherapy increases the mean overall survivalin a range from three to five months. The European organization for research and treatment of Cancer and The National Cancer Instituteof Canada Clinical Trials Group (EORT-NCIC) described in 2005 an increase of the survival by two - three months on patients receivingconcomitant and adjuvant TMZ compared to patients receiving radiotherapy alone. Addittion of a novel chemotherapeutic agent seemsto improve the outcome of patients compared to the current standard of care. Conclusion: surgery, radiotherapy and chemotherapy, each have a modest effect in the outcome of adults with glioblastoma. (MÉD.UIS. 2012;25(3):209-19).
Introduction: glioblastoma is a common condition associated with high morbidity and mortality; most of newly diagnosed patients willdie within two years. The current standard therapy is maximal surgical resection followed by radiotherapy plus concomitant and adjuvanttemozolamide. Objective: it is the aim of this review to evaluate how determinant surgical resection, radiotherapy and chemotherapy areto the outcome of patients with glioblastoma. Methods: a literature search is done to identify trials evaluating the outcome of adults withglioblastoma after being treated with surgery, radiotherapy or chemotherapy. The Oxford Centre for Evidence-based Medicine Levels ofEvidence model is used to grade the quality of the available evidence. Results: 18 articles, reporting results of 15 studies were included.Five trials evaluated the effect of surgery in survival. Surgical provides as much as 4.9 months benefit in overall survival in cases in whichcomplete resection is possible. A systematic review and four clinical trials reported that radiotherapy increases the mean overall survivalin a range from three to five months. The European organization for research and treatment of Cancer and The National Cancer Instituteof Canada Clinical Trials Group (EORT-NCIC) described in 2005 an increase of the survival by two - three months on patients receivingconcomitant and adjuvant TMZ compared to patients receiving radiotherapy alone. Addittion of a novel chemotherapeutic agent seemsto improve the outcome of patients compared to the current standard of care. Conclusion: surgery, radiotherapy and chemotherapy, each have a modest effect in the outcome of adults with glioblastoma. (MÉD.UIS. 2012;25(3):209-19).
Keywords
Glioblastoma, Cirugía General, Radioterapia, Quimioterapia, Resultado del Tratamiento, Glioblastoma, General Surgery, Radiotherapy, Chemotherapy, Treatment Outcome