Analysis Of The Efficacy Of Salvage Therapy In 80 Patients With Recurrent Glioma

Objective: Glioma is a primary malignant tumor that originates in the glial cells of the brain.The incidence rate is increasing year by year.Gliomas account for 80% of malignant brain tumors in adults.It has the characteristics of high morbidity,high recurrence rate,high mortality and low cure rate.About 80 to 86% of cases relapse within two years after the initial diagnosis.The prognosis of glioma recurrence is worse,and there is no effective therapeutic regimen.Therefore,it is essential to find effective treatments that can prolong the survival.This study retrospectively analyzed the clinical data of 80 patients with recurrent glioma,analyzed the efficacy of different treatment regimens,and provided reference for the treatment of recurrent glioma.Patients and Methods:80 cases of glioma patients diagnosed as recurrent by pathology or imaging,collected from the Second Hospital of Hebei Medical University from January 2010 to February 2017.All of these patients underwent surgical resection at the time of initial,confirmed by pathology as glioma and completed radiation therapy.This study compared the overall survival(OS)of the different treatment regimens after relapse.Survival analysis was performed using the Kaplan-Meier method to characterize survival curves and perform log-rank tests.Multivariate analysis was performed using Cox regression model and SPSS 22.0 was used for statistical analysis.The test level ?=0.05 was set,and a statistical difference was considered at P<0.05.Results:There were 80 patients with recurrent glioma,as follows: 6 patients with salvage surgery combined with radiotherapy and chemotherapy,5 patients with salvage surgery and radiotherapy,4 patients with salvage surgery and chemotherapy,7 patients with radiotherapy combined with chemotherapy,and 5 patients with radiotherapy alone.6 patients were treated with surgery alone,34 patients received chemotherapy alone,and 13 patients received symptomatic supportive care.1.Median Overall Survival(mOS)of whole group was 11 months(95% CI: 7.8-14.1m),with 1-year,2-year and 3-year survival rates of 47.2%,30% and 22.3% respectively.In the univariate analysis,tumor grade(P=0.007),initial therapy(P=0.027),and secondary radiotherapy(P=0.027)were associated with longer OS.Multivariate analysis showed that initial chemotherapy(P=0.610),secondary radiotherapy(P=0.203)and tumor grading(P=0.081)had no statistical significance for OS extension.2.23 patients received re-irradiation,while 57 patients did not.The median OS was 15.33 months in the re-irradiation group and 10.00 months in the control group(P=0.0394).3.After recurrence,patients received apatinib plus salvage adjuvant chemotherapy(n=12),chemotherapy alone(n=43)or only optimal supportive treatment(n=25).Median OS was 3.7 months in the optimal supportive treatment group,7.3 months in the chemotherapy alone group,and did not reach the median OS in the apatinib group(P=0.0138).Conclusions:1.Patients with re-irradiation have short survival and poor prognosis,and there is no standard treatment.There is still a need to actively seek effective solutions to extend survival and improve quality of life.2.Patients with recurrent glioma have short survival and poor prognosis,and there is no standard treatment.There is still a need to actively seek effective solutions to extend survival and improve quality of life.3.Apatinib combined with chemotherapy for patients with recurrent glioma can improve overall survival and patients are well tolerated.It is worth further prospective large sample study.