Clinical Prognostic Factors in Patients With Malignant Glioma Treated With Combined Modality Approach

Abstract

The impact of various clinical pretreatment prognostic factors in patients with malignant glioma treated with a combined modality approach was investigated in 229 patients treated on four consecutive prospective phase II studies. The median survival time for all 229 patients is 14 months, and 2- and 5-year survival rates are 34%, and 9%, respectively. The median time to tumor progression is 14 months, and 2- and 5-year progression-free survival rates are 32%, and 9%, respectively. Females did better than males, while patients 55 years or less did better than those more than 55 years. Patients with Karnofsky performance status (KPS) 80 to 100 did better than those with KPS 50 to 70 as well as did patients having preoperative tumor sizes 4 cm or less when compared to those with larger tumors. Frontal tumor location as well as more extensive surgery favorably influenced survival. Patients harboring anaplastic astrocytoma fared significantly better than those with glioblastoma multiforme. Both univariate and multivariate Cox analyses confirmed independent influence of these prognosticators. When progression-free survival was used as an endpoint, all seven variables remained independent prognosticators. This study showed that sex, age, KPS, tumor size, tumor location, histology, and extent of surgery are independent prognosticators in patients with malignant glioma treated with combined modality approach.

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“…Barker et al 1 mention age as an independent variable to obtain good results in radiotherapy. Some studies 6 inform that age influences the tumor removal extension, which may partly explain more survivals in younger patients in our series. There was no difference in the tumor removal extension related to age ( Table 2).…”

“…Several authors declare that patients with higher KPS showed longer survival rather those with lower KPS. 2,6,8,10,14 According to Kreth et al 9 the youngest individuals tend to show higher KPS, which may be considered a confusing variable in the multivariate statistical analysis models. In Lacroix et al series 10 75% of patients showed KPS higher than 80.…”

“…3) Tumor volume -Several papers identify the tumor volume as a non-prognostic factor. 8,9,14,21 On the other hand, Jeremic et al 6 mention that tumors smaller than 40 cm 3 show better prognosis. The average tumor volume in Lacroix et al 10 series was 34 cm 3 .…”

“…Many other authors also believe that the total removal of GBM may influence the survival. 6,12,13,15,19 McGirt et al 13 analyzed 451 GBM patients and had 13 months of average survival of those submitted to the total resection. However, other authors did not find any relation between total removal and survival.…”

“…2) Radiotherapy -The role of RT in treating glioblastoma has already been established. 1,2,6,8,12,22 Mineo et al 15 mention radiotherapy as the factor with most influence on the prognosis independently of age, the KPS and the surgical extension. According to Barker et al 1 the radiotherapy has more influence in younger patients.…”