Journal of Clinical Oncology, Vol 15, 3129-3140, Copyright © 1997 by American Society of Clinical Oncology
Survival, prognostic factors, and therapeutic efficacy in low-grade glioma: a retrospective study in 379 patients
K Lote, T Egeland, B Hager, B Stenwig, K Skullerud, J Berg-Johnsen, I Storm- Mathisen and H Hirschberg
Department of Oncology, Norwegian Radium Hospital, Oslo, Norway.
PURPOSE: We report survival, prognostic factors, and treatment efficacy in
low-grade glioma. PATIENTS AND METHODS: A total of 379 patients with
histologic intracranial low-grade glioma received post-operative
radiotherapy (n = 361) and intraarterial carmustine (BCNU) chemotherapy (n
= 153). Overall survival and prognostic factors were evaluated with the
SPSS statistical program (SPSS Inc, Chicago, IL). RESULTS: Median survival
(all patients) was 100 months (95% confidence interval [CI], B7 to 113); in
age group 0 to 19 years (n = 41), 226 months; in age group 20 to 49 years
(n = 263), 106 months; in age group 50 to 59 years (n = 49), 76 months; and
for older patients (n = 26), 39 months. Projected survival at 10 and 15
years was 42% and 29%, respectively. Patient age, World Health Organization
(WHO) performance status, tumor computed tomography (CT) contrast
enhancement, mental changes, or initial corticosteroid dependency were
significant independent prognostic factors (p < .05), while histologic
subgroup, focal deficits, presence of seizures, prediagnostic symptom
duration, tumor category, and tumor stage were not. Patients aged 20 to 49
years with no independent negative prognostic factors (n = 132) had a
median survival time of 139 months versus 41 months in patients with two or
more factors (n = 33). Patients who presented with symptoms of expansion (n
= 97) survived longer when resected (P < .03); otherwise no survival
benefit was associated with initial tumor resection compared with biopsy.
Intraarterial chemotherapy and radiation doses more than 55 Gy were not
associated with prolonged survival. Among 66 reoperated patients, 45%
progressed to high-grade histology within 25 months. CONCLUSION: Prognosis
in low-grade glioma following postoperative radiotherapy seems largely
determined by the inherent biology of the glioma and patient age at
diagnosis.
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PROGNOSIS WITH LOW-GRADE GLIOMA
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