P r o g n o s t i c F a c t o r s f o r S u r v i v a l i n A d u l t P a t i e n t s W i t h C e r e b r a l L o w -G r a d e G l i o m aPurpose: To identify prognostic factors for survival in adult patients with cerebral low-grade glioma (LGG), to derive a prognostic scoring system, and to validate results using an independent data set.Patients and Methods: European Organization for Research and Treatment of Cancer (EORTC) trial 22844 and EORTC trial 22845 are the largest phase III trials ever carried out in adult patients with LGG. The trials were designed to investigate the dosage and timing of postoperative radiotherapy in LGG. Cox analysis was performed on 322 patients from EORTC trial 22844 (construction set), and the results were validated on 288 patients from trial 22845 (validation set). Patients with pilocytic astrocytomas were excluded from this prognostic factor analysis.Results: Multivariate analysis on the construction set showed that age > 40 years, astrocytoma histology subtype, largest diameter of the tumor > 6 cm, tumor crossing the midline, and presence of neurologic deficit before surgery were unfavorable prognostic factors for survival. The total number of unfavorable factors present can be used to determine the prognostic score. Presence of up to two of these factors identifies the lowrisk group, whereas a higher score identifies high-risk patients. The validity of the multivariate model and of the scoring system was confirmed in the validation set.Conclusion: In adult patients with LGG, older age, astrocytoma histology, presence of neurologic deficits before surgery, largest tumor diameter, and tumor crossing the midline were important prognostic factors for survival. These factors can be used to identify lowrisk and high-risk patients. L OW-GRADE GLIOMAS (LGGs) are in general relatively slow-growing primary brain tumors, but they have a very heterogeneous clinical behavior. Many patients present with seizures only and remain stable for a prolonged period of time, whereas others present with functional deficits or signs of increased intracranial pressure that necessitate prompt surgical treatment. The best treatment policy for these tumors is still unclear. Some physicians advocate early and extensive surgery or early radiation therapy, 1-3 whereas others tend to postpone treatment until functional deficits are present. [1][2][3][4] Several studies have attempted to identify prognostic factors in LGG. 1,[5][6][7][8][9][10][11][12] Prognostic factors have various applications that could be of particular value in the heterogeneous population of LGG. This includes guidance for stratification in phase III trials and ultimately for treatment in individual patients. However, except for age, the importance of other prognostic factors for survival in LGG remains a matter of debate, and the need for validated prognostic factors has not been resolved. A number of patient and tumor characteristics, such as age at diagnosis, performance status, histology subtype, primary tumor classification (T clas...

is G a spa r , M.D.,n E va N o o r d m a n , M.D., P h .D .* M a r ia n n e P ier a r t, M.Sc/1 a n d M a r t in e v a n G l a b b e k e , M.

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The role of early radiotherapy in the treatment of low-grade gliomas is controversial. For this reason the impact of radiotherapy on quality of life was studied in long-term survivors of biopsy-proved low-grade gliomas without signs of tumor recurrence. Twenty patients (age range, 18-66 years) had been treated with early radiotherapy; the other 21 patients (age range, 19-65 years) had undergone surgery or biopsy only. The interval from diagnosis to testing ranged from 1 to 12 years (mean, 3.5 years). Nineteen patients with low-grade hematological malignancies, surviving 1 to 15 years without central nervous system involvement, served as control subjects. Apart from the neurological and functional status, the patients' cognitive, affective, and psychological status was determined. None of the survivors had significant neurological impairment and the Karnofsky index for them was at least 70. However, more specific examinations of cognitive functions and the affective status (Profile of Mood States) indicated that, compared to the control subjects, the patients with low-grade gliomas had significantly more cognitive disturbances and suffered more frequently from fatigue and depressed moods. The two groups with low-grade gliomas, on the other hand, did not differ significantly on any of these measures. It is concluded that radiotherapy did not cause these disturbances and had no negative impact on quality of life in these patients.

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