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The Clinical Application of Tumor Treating Fields Therapy in Glioblastoma

The Clinical Application of Tumor Treating Fields Therapy in Glioblastoma

Published on: April 16, 2019

Radiotherapy plus concomitant temozolomide in primary gliosarcoma.

Sebastian Adeberg^1,2,3, Denise Bernhardt^4,5, Semi Ben Harrabi^4,6,5

¹Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. Sebastian.adeberg@med.uni-heidelberg.de.

Journal of Neuro-Oncology

|March 31, 2016

Summary

Temozolomide (TMZ) combined with radiation therapy significantly improves overall survival for gliosarcoma (GSM) patients. This benefit is independent of O6-methylguanine-DNA-methyltransferase (MGMT) promoter methylation, supporting its use in gliosarcoma treatment.

Keywords:

Gliosarcoma IDH1 MGMT Radiation therapy TERT Temozolomide

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Area of Science:

Neuro-oncology
Cancer genetics
Clinical research

Background:

Gliosarcoma (GSM) treatment guidelines are not well-defined, often defaulting to glioblastoma (GBM) protocols.
The efficacy of temozolomide (TMZ) and the role of O6-methylguanine-DNA-methyltransferase (MGMT) promoter methylation in GSM remain unclear.

Purpose of the Study:

To evaluate the impact of TMZ therapy on overall survival (OS) in primary gliosarcoma patients.
To investigate the correlation between MGMT promoter methylation, TERT promoter mutation, and survival outcomes in GSM.

Main Methods:

Retrospective analysis of 37 primary GSM patients treated post-2005.
Comparison of outcomes between patients receiving chemoradiation with TMZ versus radiation therapy alone.
Molecular analysis for IDH1, MGMT promoter methylation, and TERT promoter mutation.

Main Results:

TMZ combined with radiation therapy significantly improved OS (13.9 months) compared to radiation alone (9.9 months; p=0.045).
The positive effect of TMZ on OS was independent of MGMT promoter methylation status.
MGMT promoter methylation was infrequent (33.3%), while TERT promoter mutations were common (86.7%) but did not influence survival.

Conclusions:

Concomitant TMZ with radiation therapy enhances survival in GSM patients, irrespective of MGMT promoter methylation.
GSM can be managed according to GBM guidelines, utilizing TMZ-based chemoradiation.
Further research is needed to elucidate the mechanisms of TMZ action in GSM.