KẾT QUẢ ĐIỀU TRỊ U THẦN KINH ĐỆM ĐỘ CAO TÁI PHÁT VÀ TIẾN TRIỂN TẠI BỆNH VIỆN K

Abstract

Background: To evaluate treatment outcomes of recurrent and progressive high-grade gliomas at Vietnam National Cancer Hospital (K Hospital). Methods: We conducted a retrospective descriptive study of 51 patients with recurrent and progressive high-grade glioma treated at K Hospital, Tan Trieu campus, from January 2022 to December 2024. All had received initial surgery and radiotherapy with or without  standard-regimen Temozolomide; Karnofsky Performance Status (KPS) ≥60. Salvage strategies included reoperation, re-irradiation, chemotherapy (standard 5-day or daily Temozolomide schedules or Temozolomide and bevacizumab). Results: Median OS after recurrence or progression was 12 months; 6- and 12-month OS rates were 78.9% and 44.1%, respectively. On univariate analysis, factors associated with lower mortality included KPS 80–100 (12-month OS 67.9% vs 29.3% for KPS 60–70; p=0.001), solitary lesion (54.1% vs 33.2% for multifocal; p=0.044), largest tumor diameter ≤4 cm (71.8% vs 26.1%; p=0.004), gross-total or near-total resection at recurrence (83.3% vs 56.3% and 0%; p=0.017), and re-irradiation (73.7% vs 28.7%; p=0.029). On multivariable Cox regression, KPS 60–70 increased the hazard of death (adjusted HR ≈4.17; p<0.01), largest diameter >4 cm increased risk (adjusted HR ≈3.03; p<0.05), while re-irradiation was protective (adjusted HR 0.34; 95% CI 0.13–0.89; p<0.05). Conclusions: Favorable prognosis in recurrent/progressive high-grade glioma is associated with higher KPS, small solitary tumors, gross or near-total re-resection, and re-irradiation. Systemic therapy with temozolomide and bevacizumab is widely used but confers limited survival benefit, underscoring the need for improved strategies.