Kết quả bước đầu điều trị đa mô thức bệnh nhân u nguyên bào thần kinh đệm có làm xét nghiệm methyl hóa MGMT tại Bệnh viện Trung ương Quân đội 108

Abstract

Objective: To evaluate of the initial results of multidisciplinary treatment in glioblastoma patients at 108 Military Central Hospital and initial assessment of the role of MGMT methylation status and some influencing factors in prognosis. Subject and method: A prospective descriptive study of 21 giloblastoma patients underwent surgical resection followed by radiation and chemotherapy with alkylating agents, from January 2022 to December 2022 at 108 Military Central Hospital. Result: At operation, 9/21 (42.9%), 8/21 (38.1%) and 4/21 (19%) patients underwent gross total resection (GTR), partial resection (PR), and biopsy, respectively. 7/21 (33.3%) patients were found MGMT methylation. IDH1/IDH2 mutations were detected in 8/16 (50%) patients. In 12 patients who could not remove the entire tumor, after chemotherapy and radiotherapy, the response was assessed according to RANO criteria, showing that the majority of patients were in steady state 58.3%, 4 cases progressed (33.3%), 1 case of partial response (8.3%). The mean OS was 367 ± 26 days. Median PFS was 303 days. At 6 months, OS was 81.2%, PFS was 83.8%. Patients with a methylated MGMT promoter had a mean survival of 322 days, while those without methylation had a median survival of 373 days (p=0.75), the mean PFS of the 2 groups with MGMT methylated and unmethylated MGMT were 326 days and 270 days, respectively (p=0.6). The 6-month OS rate of the group with total tumor resection was 100% while that of the group without total tumor resection was 70.7% (p=0.17). The 6-month PFS rate of the group with total tumor resection was 100%, the group with no total tumor resection was 72.9% (p=0.14). The 6-month OS rate of the group ≤ 50 years old and > 50 years old were 85.7% (mean 383 days) and 77.1% (mean 314 days), p=0.55. The mean OS of the group with preoperative KPS ≥ 90 was higher than that of the group with KPS < 90 (392 days versus 197 days, p=0.17). The mean PFS of the preoperative KPS group ≥ 90 and < 90 were 317 days and 184 days (p=0.14). All patients tolerated the treatment well, with no serious life-threatening toxicity. Undesirable effects of grade 3, 4 were only seen in 2 patients with elevated liver enzymes GOT/GPT (9.5%), most of the rest were grade 1, 2. Conclusion: The study evaluated the initial treatment of patients with glioblastoma. The results obtained were based on the assessment of overall survival and progression-free survival. In our study, although there was a difference when comparing OS, PFS based on MGMT methylation status, IDH gene mutation, age group, KPS, level of tumor resection but not statistically significant enough. The study needs to be conducted with a larger sample size and long-term follow-up for a more accurate assessment.