Patterns of care in recurrent glioblastoma in Switzerland: a multicentre national approach based on diagnostic nodes.

Despite moderate improvements in outcome of glioblastoma after first-line treatment with chemoradiation recent clinical trials failed to improve the prognosis of recurrent glioblastoma. In the absence of a standard of care we aimed to investigate institutional treatment strategies to identify similarities and differences in the pattern of care for recurrent glioblastoma. We investigated re-treatment criteria and therapeutic pathways for recurrent glioblastoma of eight neuro-oncology centres in Switzerland having an established multidisciplinary tumour-board conference. Decision algorithms, differences and consensus were analysed using the objective consensus methodology. A total of 16 different treatment recommendations were identified based on combinations of eight different decision criteria. The set of criteria implemented as well as the set of treatments offered was different in each centre. For specific situations, up to 6 different treatment recommendations were provided by the eight centres. The only wide-range consensus identified was to offer best supportive care to unfit patients. A majority recommendation was identified for non-operable large early recurrence with unmethylated MGMT promoter status in the fit patients: here bevacizumab was offered. In fit patients with late recurrent non-operable MGMT promoter methylated glioblastoma temozolomide was recommended by most. No other majority recommendations were present. In the absence of strong evidence we identified few consensus recommendations in the treatment of recurrent glioblastoma. This contrasts the limited availability of single drugs and treatment modalities. Clinical situations of greatest heterogeneity may be suitable to be addressed in clinical trials and second opinion referrals are likely to yield diverging recommendations.

Mr [James Henry] Thomas quittant Downing Street [secrétaire général de la NUR, National Union of Railwaymen] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 56198

Mr [James] O'Grady arrivant à Caxton Hall [membre du Parlement anglais et secrétaire de la National Federation of General Workers] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 56233

[Joseph] Guillemot gagnant du National anglais [épreuve de cross à Windsor, le 13 mars 1920] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 58527

Le Mot d'ordre : organe de transmission des directives du Conseil national de la résistance, du Gouvernement provisoire de la République, du Commandement suprême allié

1944/06/06 (N1,EDDIFFERENTE).

Le Mot d'ordre : organe de transmission des directives du Conseil national de la résistance, du Gouvernement provisoire de la République, du Commandement suprême allié

1944/06/06 (N1).

M. Mangin [Louis, le nouveau] directeur du Muséum [national d'histoire naturelle de Paris] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 58398

M. Mangin [Louis, le nouveau] directeur du Muséum [national d'histoire naturelle de Paris] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 58399

M. Mangin [Louis, le nouveau] directeur du Muséum [national d'histoire naturelle de Paris] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 58400

M. Mangin [Louis, le nouveau] directeur du Muséum [national d'histoire naturelle de Paris] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 58401

Les vedettes du Rhin où on souscrit à l'emprunt [national, vedettes amarrées près du pont de la Concorde] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 58510

National anglais [épreuve de cross à Windsor], [Charles] Clibbon, [Joseph] Guillemot gagnant, [Christopher] Vose : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 58529