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Selection
bias, survival, and brachytherapy for glioma
Florell
RC, Macdonald DR, Irish WD, Bernstein M, Leibel SA, Gutin PH, Cairncross JG
Department
of Clinical Neurological Sciences, University of Western Ontario, London,
Ontario, Canada
Interstitial
irradiation is a promising treatment for malignant glioma.
Longer than expected survival periods following treatment of recurrent tumor
have led to the use of brachytherapy as an adjuvant treatment.
The impact of patient selection on survival data was studied among candidates
for this therapy.
Consecutive, conventionally treated adults with newly diagnosed supratentorial
tumors were identified retrospectively at a center where experience with glioma
is population-based.
Based on imaging and performance status, two surgeons and a radiation oncologist
designated each patient as either eligible or ineligible for adjuvant
brachytherapy.
The survival and prognostic factors in the eligible and ineligible groups were
analyzed.
Overall, the patients eligible for brachytherapy (32% of the series) lived
significantly longer than the ineligible patients (16.57 vs. 9.30 months), were
younger, and had larger resections and better function.
For glioblastoma, 40% of patients were eligible, and lived much longer than
those who were ineligible (13.90 vs. 5.80 months).
It is concluded that better outcome following adjuvant brachytherapy for glioma
is at least in part the result of patient selection. Randomized trials of
comparably selected patients will be necessary to demonstrate conclusively that
longer survival is also a result of treatment.
PMID:
1730945 [PubMed - indexed for MEDLINE]
Source:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1730945&dopt=Abstract |
