Vitamins, Dex and GBM

Background. The Stupp protocol is the standard of care for GBM. We explore the impacts of vitamin supplements and Dexamethasone dosages on GBM patient outcomes.
Methods. We screened electronic medical records to identify 173 GBM patients whose tumors met the 2021 WHO criteria and who received standard of care. 99 patients were Stupp protocol compliant, finishing 6-cycles of adjuvant temozolomide; 74 failed the protocol by receiving <6-cycles.
Results. Vitamin D supplements are a powerful therapeutic treatment adjunct for GBM patients and markedly improve progression free survival (PFS) and overall survival (OS). There is an inverse relationship between vitamin D supplementation and Dexamethasone usage. Vitamin D supplements increase PFS and OS, p<0.0001, and facilitate lower Dexamethasone dosages, p<0.0001. In addition, Stupp-compliance is 50% higher in patients taking vitamin D, p<0.001, independent of socioeconomic status. Vitamin D supplements also improve outcomes in those aged 61 or older, who in many studies have worse outcomes.
Dexamethasone usage shows a dose dependent negative impact on patient outcome at key steps in treatment. We find that using <1.2 mg/m2 Dexamethasone in the final week of chemoradiotherapy improves both PFS and OS. In addition, patients under this threshold were ≈50% more likely to become Stupp-compliant, p<0.003. If Dexamethasone levels are <1.2 mg/m2 at the start of adjuvant temozolomide chemotherapy, Stupp-compliance doubles, p<0.0001, and patients enjoy a two-fold improvement in OS, p<0.0001.
Conclusions. The use of Vitamin D supplementation allows for lower Dexamethasone dosage and is associated with significant improvement in PFS and OS.

研究背景
斯塔普方案（Stupp protocol）是胶质母细胞瘤（Glioblastoma, GBM）的标准治疗方案。本研究探讨维生素补充剂与地塞米松（Dexamethasone）剂量对胶质母细胞瘤患者预后的影响。

研究方法
本研究通过检索电子病历，筛选出173例符合2021年世界卫生组织（WHO）诊断标准、且接受标准治疗的胶质母细胞瘤患者。其中99例患者依从斯塔普方案，完成了6周期辅助替莫唑胺（temozolomide）化疗；剩余74例患者因接受不足6周期化疗而未达方案依从标准。

研究结果
维生素D补充剂是胶质母细胞瘤患者有效的治疗辅助手段，可显著改善患者的无进展生存期（Progression-Free Survival, PFS）与总生存期（Overall Survival, OS）。维生素D补充与地塞米松使用量呈负相关关系：维生素D补充可提升患者的无进展生存期与总生存期（p<0.0001），同时可降低地塞米松使用剂量（p<0.0001）。此外，服用维生素D的患者斯塔普方案依从率较对照组高50%（p<0.001），且该结果不受社会经济地位影响。维生素D补充剂还可改善61岁及以上患者的预后——此类患者在多数研究中通常预后较差。

地塞米松使用剂量在治疗关键阶段对患者预后呈现剂量依赖性负面影响。本研究发现，在放化疗的最后一周使用剂量低于1.2 mg/m²的地塞米松，可同时改善患者的无进展生存期与总生存期。此外，地塞米松使用剂量低于该阈值的患者，其斯塔普方案依从率提升约50%（p<0.003）。若在辅助替莫唑胺化疗开始时，患者地塞米松使用剂量低于1.2 mg/m²，则其斯塔普方案依从率翻倍（p<0.0001），且总生存期提升一倍（p<0.0001）。

研究结论
补充维生素D可降低地塞米松使用剂量，且与患者无进展生存期与总生存期的显著改善密切相关。