Computerized tomography in the prognosis of malignant cerebral gliomas

Restricted access

✓ Ninety-seven patients with supratentorial malignant gliomas who received postoperative radiation therapy and chemotherapy at the University of California, San Francisco, from 1977 through 1984 showed improvement in their follow-up computerized tomography (CT) scans. Twenty-one of these 97 “CT responders” were designated “complete responders” because on serial CT scans they had complete disappearance of the tumor mass and contrast enhancement, which had been present postoperatively. In the remaining 76 patients, CT scans showed reduction in the size, but not disappearance, of the lesions, and these were designated “partial responders.” Fifty-eight partial responders had glioblastoma multiforme (GM); their median survival time was 72 weeks. The median survival time for the 11 complete responders with GM has not yet been achieved, but survival at the 53rd percentile is 172 weeks. Among patients with highly anaplastic astrocytoma, the median survival time was 211 weeks for the 10 complete responders and 125 weeks for the 18 partial responders. Eleven of the 21 complete responders are alive at a median postoperative follow-up time of 163 weeks (range 114 to 470 weeks). Eighteen of these patients had subtotal resection of tumor; three patients had gross total tumor resections, but postoperative CT scans showed evidence of residual or possibly recurrent tumor within 1.5 to 4.5 months. Resolution of the tumor mass and contrast enhancement took 9 to 151 weeks; the time to resolution did not depend upon the configuration of the remaining tumor mass and contrast enhancement after surgery. In this study, patients with malignant gliomas whose CT scans eventually showed sustained complete disappearance of the tumor mass and contrast enhancement had a more favorable prognosis than did patients whose CT scans showed improvement, but not complete disappearance, of the tumor. These CT findings may prove useful in determining the prognosis of patients with malignant gliomas.

Article Information

Address reprint requests to: Judith Murovic, M.D., c/o The Editorial Office, Department of Neurological Surgery, 1360 Ninth Avenue, Suite 210, San Francisco, California 94122.

Dr. Murovic was supported by American Cancer Society Regular Fellowship PDT-15.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Case 5. Contrast-enhanced computerized tomography scans from a 53-year-old man with a left parietal glioblastoma multiforme. A: Preoperative scan. B: Initial postoperative scan, obtained 7 days after surgery. C: Scan obtained 8 weeks postoperatively, D: Scan obtained 40 weeks postoperatively. E: Scan obtained 80 weeks postoperatively showing no contrast enhancement.

  • View in gallery

    Case 6. Contrast-enhanced computerized tomography scans from a 62-year-old woman with a right parietal glioblastoma multiforme. A: Preoperative scan. B: Initial postoperative scan. Inset is a nonenhanced scan obtained the same day as the scan in B. C: Scan obtained 16 weeks postoperatively showing no contrast enhancement.

  • View in gallery

    Case 13. Computerized tomography scans from a 26-year-old woman with a left frontal highly anaplastic astrocytoma who underwent two operations 19 days apart. A: Contrast-enhanced scan obtained 6 days before the first operation. B: Contrast-enhanced scan obtained preoperatively on the day of the second operation. C: Contrast-enhanced scan obtained 5 days after the second operation, which consisted of “removal of a massive amount of necrotic tissue.” Inset is a nonenhanced scan obtained the same day as the scan in C. D: Contrast-enhanced scan obtained 11 weeks after the second operation. E: Contrast-enhanced scan obtained 26 weeks after the second operation. F: Contrast-enhanced scan obtained 89 weeks after the second operation. G: Contrast-enhanced scan obtained 93 weeks after the second operation showing complete resolution of the tumor and no contrast enhancement.

  • View in gallery
  • View in gallery

    Left: Kaplan-Meier survival curves for patients with glioblastoma multiforme (GM). There were 58 partial responders (dashed line) and 11 complete responders (solid line). The ticks represent censored patients. Right: Kaplan-Meier survival curves for patients with highly anaplastic astrocytoma (HAA). There were 18 partial responders (dashed line) and 10 complete responders (solid line). The ticks represent censored patients.

References

  • 1.

    Davis RLLiu HCVestnys Pet al: Correlation of survival and diagnosis in supratentorial malignant gliomas. J Neurooncol 2:2671984 (Abstract)Davis RL Liu HC Vestnys P et al: Correlation of survival and diagnosis in supratentorial malignant gliomas. J Neurooncol 2:267 1984 (Abstract)

  • 2.

    Gehan EA: A generalized Wilcoxon test for comparing arbitarily singly-censored samples. Biometrika 52:2032231965Gehan EA: A generalized Wilcoxon test for comparing arbitarily singly-censored samples. Biometrika 52:203–223 1965

  • 3.

    Jelsma RBucy PC: The treatment of glioblastoma multiforme of the brain. J Neurosurg 27:3884001967Jelsma R Bucy PC: The treatment of glioblastoma multiforme of the brain. J Neurosurg 27:388–400 1967

  • 4.

    Kaplan ELMeier P: Nonparametric estimation from incomplete observations. Am Stat Assoc J 53:4574811958Kaplan EL Meier P: Nonparametric estimation from incomplete observations. Am Stat Assoc J 53:457–481 1958

  • 5.

    Karnofsky DABurchendl JH: The clinical evaluation of chemotherapeutic agents in cancer in MacLeod CM (eds): Evaluation of Chemotherapeutic Agents. New York: Columbia University Press1949 pp 191205Karnofsky DA Burchendl JH: The clinical evaluation of chemotherapeutic agents in cancer in MacLeod CM (ed): Evaluation of Chemotherapeutic Agents. New York: Columbia University Press 1949 pp 191–205

  • 6.

    Levin VAHoffman WFHeilbron DCet al: Prognostic significance of the pretreatment CT scan on time to progression for patients with malignant gliomas. J Neurosurg 52:6426471980Levin VA Hoffman WF Heilbron DC et al: Prognostic significance of the pretreatment CT scan on time to progression for patients with malignant gliomas. J Neurosurg 52:642–647 1980

  • 7.

    Mantel N: Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep 50:1631701966Mantel N: Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep 50:163–170 1966

  • 8.

    Salcman M: Survival in glioblastoma: historical perspective. Neurosurgery 7:4354391980Salcman M: Survival in glioblastoma: historical perspective. Neurosurgery 7:435–439 1980

  • 9.

    Salcman MKaplan RSDucker TBet al: Effect of age and reoperation on survival in the combined modality treatment of malignant astrocytoma. Neurosurgery 10:4544631982Salcman M Kaplan RS Ducker TB et al: Effect of age and reoperation on survival in the combined modality treatment of malignant astrocytoma. Neurosurgery 10:454–463 1982

  • 10.

    Steinhoff HLanksch WKazner Eet al: Computed tomography in the diagnosis and differential diagnosis of glioblastomas. A qualitative study of 295 cases. Neuroradiology 14:1932001977Steinhoff H Lanksch W Kazner E et al: Computed tomography in the diagnosis and differential diagnosis of glioblastomas. A qualitative study of 295 cases. Neuroradiology 14:193–200 1977

  • 11.

    Takeuchi KHoshino K: Statistical analysis of factors affecting survival after glioblastoma multiforme. Acta Neurochir 37 57731977Takeuchi K Hoshino K: Statistical analysis of factors affecting survival after glioblastoma multiforme. Acta Neurochir 37:57–73 1977

  • 12.

    Walker MD: Brain and peripheral nervous system tumors in Holland JFFrei E III (eds): Cancer Medicineed 2. Philadelphia: Lea & Febiger1982 pp 16031647Walker MD: Brain and peripheral nervous system tumors in Holland JF Frei E III (eds): Cancer Medicine ed 2. Philadelphia: Lea & Febiger 1982 pp 1603–1647

  • 13.

    Walker MDGreen SBByar DPet al: Randomized comparisons of radiotherapy and nitrosoureas for the treatment of malignant glioma after surgery. N Engl J Med 303:132313291980Walker MD Green SB Byar DP et al: Randomized comparisons of radiotherapy and nitrosoureas for the treatment of malignant glioma after surgery. N Engl J Med 303:1323–1329 1980

TrendMD

Cited By

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 52 52 21
Full Text Views 238 238 2
PDF Downloads 63 63 0
EPUB Downloads 0 0 0

PubMed

Google Scholar