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Quality-adjusted survival after tumor resection
and/or radiation therapy for elderly patients with glioblastoma multiforme
Muacevic A, Kreth FW
Department of Neurosurgery, Klinikum Grosshadern,
Ludwig-Maximilians-University, Marchioninistr. 15, 81377 Munich, Germany.
Objective.
Prognostic
factors are poorly defined for the elderly subpopulation with glioblastoma
multiforme and have been exclusively related to conventional survival
analysis.
In this study an additional quality adjusted survival analysis (QAS) was
performed.
The prognostic evaluation of both survival- and QAS data after standard
treatment were checked for concordant/discordant findings.
Their usefulness for estimation of treatment effects and treatment strategies
was then evaluated.
Methods.
123 patients
>or= 65 years of age with a supratentorial, de novo glioblastoma were
included in the current retrospective report.
Microsurgery plus radiation therapy (planned tumor dose: 60 Gy) was performed in
58 patients, and radiation therapy alone after stereotactic biopsy (planned
tumor dose: 60 Gy) in 65 patients.
The functional status of each patient was scored when joining the study and at
every follow-up using 15 selected neurological signs and symptoms (NSSs).
Gradation of severity of each NSS was performed with subjective weights.
Survival time of each patient was adjusted according to any changes in these
NSSs to become the Quality Time (Q-TIME).
Time intervals spent with side effects of the treatment (TOX) were subtracted
from Q-TIME to become the patient's QAS (QAS = Q-TIME-TOX).
Prognostic factors for both survival and QAS were obtained from the Cox
model.
Results.
Overall
survival and QAS were 24 weeks and 10.5 weeks, respectively.
Perioperative morbidity and mortality were 5.2 % and 1.7 % in the surgery group
and 1.5 % and 1.5 % in the biopsy group, respectively (p > 0.05).
Tumor resection gained favorable prognostic importance for patients with midline
shift in terms of both survival and QAS (p < 0.0001).
Otherwise, radiation therapy alone was as effective as surgery plus radiation
therapy (concordant finding).
A pretreatment Karnofsky Score (KPS) < 70 was an unfavorable predictor for
QAS (p < 0.002) but not for survival (discordant finding).
Median QAS for patients with a pretreatment KPS < 70 was only 10 weeks.
Age did not reach prognostic relevance.
Conclusion.
The dramatic
decrease of QAS as compared with survival indicates extremely limited
posttreatment improvement and/or rapid deterioration of the neurological score
after standard treatment for the older subpopulation with glioblastoma
multiforme.
Supportive treatment should be considered for patients with a pretreatment KPS
< 70.
PMID: 12736735 [PubMed - indexed for MEDLINE]
Source: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=12736735&dopt=Abstract
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