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Long-term
glioblastoma multiforme survivors: a population-based study
Scott JN, Rewcastle NB, Brasher PM, Fulton D, Hagen NA, MacKinnon JA,
Sutherland G, Cairncross JG, Forsyth P
Department of Clinical Neurosciences, University of Calgary
Background. Long-term glioblastoma multiforme survivors (LTGBMS) are
uncommon.
The frequency which these occur in an unselected population and factors which
produce these unusually long survivors are unknown.
Objectives. To determine in a population-based study
1) the frequency of LTGBMS in a population and
2) identify which patient, treatment or tumor characteristics would predict
which glioblastoma (GBM) patient would become a LTGBMS.
Methods.
The Alberta Cancer Registry was used to identify all patients diagnosed with GBM
in southern Alberta between 1/1/75-12/31/91.
Patient charts were reviewed and histology re-examined by a blinded
neuropathologist.
LTGBMS were defined as GBM patients surviving > or = 3 years after
diagnosis.
Each LTGBMS was compared to three age-, gender-, and year of diagnosis-matched
controls to compare patient, treatment, and tumor factors to GBM patients
without long-term survival.
Results.
There were 279 GBMs diagnosed in the study period.
Five (1.8%) survived > or = three years (range, 3.2-15.8 years).
Seven additional long-term survivors, who carried a diagnosis of GBM, were
excluded after neuropathologic review; the most common revised diagnosis was
malignant oligodendroglioma.
LTGBMS (avg. age = 45 years) were significantly younger when compared to all GBM
patients (avg. age = 59 years, p = 0.0001) diagnosed in the study period.
LTGBMS had a higher KPS at diagnosis (p = 0.001) compared to controls.
Tumors from LTGBMS tended to have fewer mitoses and a lower Ki-67 cellular
proliferative index compared to controls.
Radiation-induced dementia was common and disabling in LTGBMS.
Conclusions.
These data highlight the dismal prognosis for GBM patients who have both a short
median survival and very small chance (1.8%) of long-term survival.
The LTGBMS were younger, had a higher performance status, and their tumors
tended to proliferate less rapidly than control GBM patients.
When long-term survival does occur it is often accompanied by severe
treatment-induced dementia.
PMID: 9706720 [PubMed - indexed for MEDLINE]
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