Abstract
Background
The optimal choice and timing of treatment for recurrent GBM is unclear. Understanding the effect of further treatment on survival and quality of life, compared with best supportive care, is a top 10 clinical priority for the UK neuro-oncology community. Prior to developing a clinical trial to address this uncertainty we surveyed the neuro-oncology community to understand current variations in practice.
Methods
A google survey was designed to collect data. The Society of British Neurosurgeons, European Association of Neuro-oncology and a UK oncology network circulated the survey.
Results
233, responses were received from clinical/medical oncologists, neurosurgeons, neurologists and radiologists. Responders were from UK (45), rest of Europe (123) and outwith Europe (65). 40% of responders reduced the frequency of radiological surveillance to 6 monthly in second year after diagnosis. There were variations in radiological definition of recurrence; 45.1% local recurrence of enhancing disease, 21.0% MR spectroscopy, 21.4% MR perfusion, the remainder used PET. Only 64% respondents presented every case of recurrence for multidisciplinary review. 45% of respondents did not consider a maximum age in deciding a therapeutic strategy. 43.0% had a minimum KPS of 70, 27.5% a minimum of 80. 53.4% did not consider MGMTmethylations status important.Only 50.3% of respondents thought repeat surgery should be undertaken only if more than 90% resection is anticipated. 50.0% of respondents had no minimum time to have elapsed since the first operation before consideration of re-operation. 40.2% will consider repeat surgery even if no further oncological treatment available. 41.0% will consider repeat temozolomide as second-line option after repeat surgery, 33.0% will consider PCV, 18.0% lomustine. 70% respondents would consider re-irradiation.
Conclusion
The significant variation in management of recurrent disease reflects a lack of evidence-base treatment guidelines. This variation complicates design of clinical trials and consensus guidelines would help future trial design.