Radiation response and survival time in patients with glioblastoma multiforme

View More View Less
  • 1 Neuro-Oncology Service of the Brain Tumor Research Center, Department of Neurological Surgery, and Department of Radiation Oncology, School of Medicine, University of California, San Francisco, California
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

✓ To determine the value of radiographically assessed response to radiation therapy as a predictor of survival in patients with glioblastoma multiforme (GBM), the authors studied a cohort of 301 patients who were initially treated according to uniform clinical protocols. All patients had newly diagnosed supratentorial GBM and underwent the maximum safe resection followed by external-beam radiation treatment (60 Gy in standard daily fractions or 70.4 Gy in twice-daily fractions of 160 cGy). The radiation response and survival rates were assessable in 222 patients. The extent of resection and the immediate response to radiation therapy were highly correlated with survival, both in a univariate analysis and after correction for age and Karnofsky performance scale (KPS) score in a multivariate Cox model (p < 0.001 for radiation response and p = 0.04 for extent of resection). A subgroup analysis suggested that neuroimaging obtained within 3 days after surgery served as a better baseline for assessment of radiation response than images obtained later. Imaging obtained within 3 days after completion of a course of radiation therapy also provided valid radiation response scores. The impact of the radiographically assessed radiation response on survival time was comparable to that of age or KPS score. This information is easily obtained early in the course of the disease, may be of value for individual patients, and may also have implications for the design and analysis of trials of adjuvant therapy for GBM, including volume-dependent therapies such as radiosurgery or brachytherapy.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1.

    Albert FK, , Forsting M, & Sartor K, et al: Early postoperative magnetic resonance imaging after resection of malignant glioma: objective evaluation of residual tumor and its influence on regrowth and prognosis. Neurosurgery 34:4561, 1994 Albert FK, Forsting M, Sartor K, et al: Early postoperative magnetic resonance imaging after resection of malignant glioma: objective evaluation of residual tumor and its influence on regrowth and prognosis. Neurosurgery 34:45–61, 1994

    • Search Google Scholar
    • Export Citation
  • 2.

    Allalunis-Turner MJ, , Barron GM, & Day RS III, et al: Isolation of two cell lines from a human malignant glioma specimen differing in sensitivity to radiation and chemotherapeutic drugs. Radiat Res 134:349354, 1993 Allalunis-Turner MJ, Barron GM, Day RS III, et al: Isolation of two cell lines from a human malignant glioma specimen differing in sensitivity to radiation and chemotherapeutic drugs. Radiat Res 134:349–354, 1993

    • Search Google Scholar
    • Export Citation
  • 3.

    Allam A, , Taghian A, & Gioioso D, et al: Intratumoral heterogeneity of malignant gliomas measured in vitro. Int J Radiat Oncol Biol Phys 27:303308, 1993 Allam A, Taghian A, Gioioso D, et al: Intratumoral heterogeneity of malignant gliomas measured in vitro. Int J Radiat Oncol Biol Phys 27:303–308, 1993

    • Search Google Scholar
    • Export Citation
  • 4.

    Allen JC: The design and conduct of clinical trials in childhood brain tumors. Cancer 56:18271831, 1985 Allen JC: The design and conduct of clinical trials in childhood brain tumors. Cancer 56:1827–1831, 1985

    • Search Google Scholar
    • Export Citation
  • 5.

    Anderson JR, , Cain KC, & Gelber RD: Analysis of survival by tumor response. J Clin Oncol 1:710719, 1983 Anderson JR, Cain KC, Gelber RD: Analysis of survival by tumor response. J Clin Oncol 1:710–719, 1983

    • Search Google Scholar
    • Export Citation
  • 6.

    Barker FG, , Prados MD, & Chang SM, et al: Bromodeoxyuridine labeling index in glioblastoma multiforme: relation to radiation response, age and survival. Int J Radiat Oncol Biol Phys (In press, 1996) Barker FG, Prados MD, Chang SM, et al: Bromodeoxyuridine labeling index in glioblastoma multiforme: relation to radiation response, age and survival. Int J Radiat Oncol Biol Phys (In press, 1996)

    • Search Google Scholar
    • Export Citation
  • 7.

    Byar DP, , Green SB, & Strike TA: Prognostic factors for malignant glioma, in Walker MD (ed): Oncology of the Nervous System. Boston: Martinus Nijhoff, 1983, pp 379395 Byar DP, Green SB, Strike TA: Prognostic factors for malignant glioma, in Walker MD (ed): Oncology of the Nervous System. Boston: Martinus Nijhoff, 1983, pp 379–395

    • Search Google Scholar
    • Export Citation
  • 8.

    Cairncross JG, , Macdonald DR, & Pexman JHW, et al: Steroid-induced CT changes in patients with recurrent malignant glioma. Neurology 38:724726, 1988 Cairncross JG, Macdonald DR, Pexman JHW, et al: Steroid-induced CT changes in patients with recurrent malignant glioma. Neurology 38:724–726, 1988

    • Search Google Scholar
    • Export Citation
  • 9.

    Chandler KL, , Prados MD, & Malec M, et al: Long-term survival in patients with glioblastoma multiforme. Neurosurgery 32:716720, 1993 Chandler KL, Prados MD, Malec M, et al: Long-term survival in patients with glioblastoma multiforme. Neurosurgery 32:716–720, 1993

    • Search Google Scholar
    • Export Citation
  • 10.

    Chang CH, , Horton J, & Schoenfeld D, et al: Comparison of postoperative radiotherapy and combined postoperative radiotherapy and chemotherapy in the multidisciplinary management of malignant gliomas. A joint Radiation Therapy Oncology Group and Eastern Cooperative Oncology Group study. Cancer 52:9971007, 1983 Chang CH, Horton J, Schoenfeld D, et al: Comparison of postoperative radiotherapy and combined postoperative radiotherapy and chemotherapy in the multidisciplinary management of malignant gliomas. A joint Radiation Therapy Oncology Group and Eastern Cooperative Oncology Group study. Cancer 52:997–1007, 1983

    • Search Google Scholar
    • Export Citation
  • 11.

    Cox DR: Regression models and life tables. J R Stat Soc (B) 34:187202, 1972 Cox DR: Regression models and life tables. J R Stat Soc (B) 34:187–202, 1972

    • Search Google Scholar
    • Export Citation
  • 12.

    Davis RL: Grading of gliomas, in Fields WS (ed): Primary Brain Tumors. A Review of Histologic Classification. New York: Springer-Verlag, 1989, pp 151158 Davis RL: Grading of gliomas, in Fields WS (ed): Primary Brain Tumors. A Review of Histologic Classification. New York: Springer-Verlag, 1989, pp 151–158

    • Search Google Scholar
    • Export Citation
  • 13.

    Davis RL, , Liu HC, & Vestnys P, et al: Correlation of survival and diagnosis in supratentorial malignant gliomas. J Neurooncol 2:2670, 1984 (Abstract) Davis RL, Liu HC, Vestnys P, et al: Correlation of survival and diagnosis in supratentorial malignant gliomas. J Neurooncol 2:267–0, 1984 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 14.

    Devaux BC, , O'Fallon JR, & Kelly PJ: Resection, biopsy, and survival in malignant glial neoplasms. A retrospective study of clinical parameters, therapy, and outcome. J Neurosurg 78:767775, 1993 Devaux BC, O'Fallon JR, Kelly PJ: Resection, biopsy, and survival in malignant glial neoplasms. A retrospective study of clinical parameters, therapy, and outcome. J Neurosurg 78:767–775, 1993

    • Search Google Scholar
    • Export Citation
  • 15.

    Dinapoli RP, , Brown LD, & Arusell RM, et al: Phase III comparative evaluation of PCNU and carmustine combined with radiation therapy for high-grade glioma. J Clin Oncol 11:13161321, 1993 Dinapoli RP, Brown LD, Arusell RM, et al: Phase III comparative evaluation of PCNU and carmustine combined with radiation therapy for high-grade glioma. J Clin Oncol 11:1316–1321, 1993

    • Search Google Scholar
    • Export Citation
  • 16.

    Duncan GG, , Goodman GB, & Ludgate CM, et al: The treatment of adult supratentorial high grade astrocytomas. J Neurooncol 13:6372, 1992 Duncan GG, Goodman GB, Ludgate CM, et al: The treatment of adult supratentorial high grade astrocytomas. J Neurooncol 13:63–72, 1992

    • Search Google Scholar
    • Export Citation
  • 17.

    Finlay JL, , Geyer JR, & Turski PA, et al: Pre-irradiation chemotherapy in children with high-grade astrocytoma: tumor response to two cycles of the ‘8-drugs-in-1-day’ regimen. A Childrens Cancer Group study, CCG-945. J Neurooncol 21:255265, 1994 Finlay JL, Geyer JR, Turski PA, et al: Pre-irradiation chemotherapy in children with high-grade astrocytoma: tumor response to two cycles of the ‘8-drugs-in-1-day’ regimen. A Childrens Cancer Group study, CCG-945. J Neurooncol 21:255–265, 1994

    • Search Google Scholar
    • Export Citation
  • 18.

    Forsting M, , Albert FK, & Kunze S, et al: Extirpation of glioblastomas: MR and CT follow-up of residual tumor and regrowth patterns. AJNR 14:7787, 1993 Forsting M, Albert FK, Kunze S, et al: Extirpation of glioblastomas: MR and CT follow-up of residual tumor and regrowth patterns. AJNR 14:77–87, 1993

    • Search Google Scholar
    • Export Citation
  • 19.

    Franklin CIV: Does the extent of surgery make a difference in high grade malignant astrocytoma? Australas Radiol 36:4447, 1992 Franklin CIV: Does the extent of surgery make a difference in high grade malignant astrocytoma? Australas Radiol 36:44–47, 1992

    • Search Google Scholar
    • Export Citation
  • 20.

    Gaspar LE, , Fisher BJ, & MacDonald DR, et al: Malignant glioma—timing of response to radiation therapy. Int J Radiat Oncol Biol Phys 25:877879, 1993 Gaspar LE, Fisher BJ, MacDonald DR, et al: Malignant glioma—timing of response to radiation therapy. Int J Radiat Oncol Biol Phys 25:877–879, 1993

    • Search Google Scholar
    • Export Citation
  • 21.

    Gehan EA, & Walker MD: Prognostic factors for patients with brain tumors. Natl Cancer Inst Monogr 46:189195, 1977 Gehan EA, Walker MD: Prognostic factors for patients with brain tumors. Natl Cancer Inst Monogr 46:189–195, 1977

    • Search Google Scholar
    • Export Citation
  • 22.

    Green SB, , Byar DP, & Walker MD, et al: Comparisons of carmustine, procarbazine, and high-dose methylprednisolone as additions to surgery and radiotherapy for the treatment of malignant glioma. Cancer Treat Rep 67:121132, 1983 Green SB, Byar DP, Walker MD, et al: Comparisons of carmustine, procarbazine, and high-dose methylprednisolone as additions to surgery and radiotherapy for the treatment of malignant glioma. Cancer Treat Rep 67:121–132, 1983

    • Search Google Scholar
    • Export Citation
  • 23.

    Harris EK, & Albert A: Survivorship Analysis for Clinical Studies. New York: Marcel Dekker, 1991 Harris EK, Albert A: Survivorship Analysis for Clinical Studies. New York: Marcel Dekker, 1991

    • Search Google Scholar
    • Export Citation
  • 24.

    Kleihues P, , Burger PC, & Scheithauer BW: Histologic Typing of Tumours of the Central Nervous System, ed 2. Berlin: Springer-Verlag, 1993 Kleihues P, Burger PC, Scheithauer BW: Histologic Typing of Tumours of the Central Nervous System, ed 2. Berlin: Springer-Verlag, 1993

    • Search Google Scholar
    • Export Citation
  • 25.

    Kreth FW, , Warnke PC, & Scheremet R, et al: Surgical resection and radiation therapy versus biopsy and radiation therapy in the treatment of glioblastoma multiforme. J Neurosurg 78:762766, 1993 Kreth FW, Warnke PC, Scheremet R, et al: Surgical resection and radiation therapy versus biopsy and radiation therapy in the treatment of glioblastoma multiforme. J Neurosurg 78:762–766, 1993

    • Search Google Scholar
    • Export Citation
  • 26.

    Krouwer HGJ, & Prados MD: Infiltrative astrocytomas of the thalamus. J Neurosurg 82:548557, 1995 Krouwer HGJ, Prados MD: Infiltrative astrocytomas of the thalamus. J Neurosurg 82:548–557, 1995

    • Search Google Scholar
    • Export Citation
  • 27.

    Kumabe T, , Kayama T, & Yoshimoto T, et al: [Follow-up study of malignant astrocytomas showing complete response after initial treatment.] No Shinkei Geka 22:545551, 1994 (Jpn) Kumabe T, Kayama T, Yoshimoto T, et al: [Follow-up study of malignant astrocytomas showing complete response after initial treatment.] No Shinkei Geka 22:545–551, 1994 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 28.

    Laohaprasit V, , Silbergeld DL, & Ojemann GA, et al: Postoperative CT contrast enhancement following lobectomy for epilepsy. J Neurosurg 73:392395, 1990 Laohaprasit V, Silbergeld DL, Ojemann GA, et al: Postoperative CT contrast enhancement following lobectomy for epilepsy. J Neurosurg 73:392–395, 1990

    • Search Google Scholar
    • Export Citation
  • 29.

    Lee ET: Statistical Methods for Survival Data Analysis, ed 2. New York: John Wiley & Sons, 1992 Lee ET: Statistical Methods for Survival Data Analysis, ed 2. New York: John Wiley & Sons, 1992

    • Search Google Scholar
    • Export Citation
  • 30.

    Levin VA, , Prados MD, & Yung WKA, et al: Treatment of recurrent gliomas with eflornithine. J Natl Cancer Inst 84:14321437, 1992 Levin VA, Prados MD, Yung WKA, et al: Treatment of recurrent gliomas with eflornithine. J Natl Cancer Inst 84:1432–1437, 1992

    • Search Google Scholar
    • Export Citation
  • 31.

    Macdonald DR, , Cascino TL, & Schold SC Jr, et al: Response criteria for phase II studies of supratentorial malignant glioma. J Clin Oncol 8:12771280, 1990 Macdonald DR, Cascino TL, Schold SC Jr, et al: Response criteria for phase II studies of supratentorial malignant glioma. J Clin Oncol 8:1277–1280, 1990

    • Search Google Scholar
    • Export Citation
  • 32.

    Medical Research Council Brain Tumour Working Party: Prognostic factors for high-grade malignant glioma: development of a prognostic index. J Neurooncol 9:4755, 1990 Medical Research Council Brain Tumour Working Party: Prognostic factors for high-grade malignant glioma: development of a prognostic index. J Neurooncol 9:47–55, 1990

    • Search Google Scholar
    • Export Citation
  • 33.

    Murovic J, , Turowski K, & Wilson CB, et al: Computerized tomography in the prognosis of malignant cerebral gliomas. J Neurosurg 65:799806, 1986 Murovic J, Turowski K, Wilson CB, et al: Computerized tomography in the prognosis of malignant cerebral gliomas. J Neurosurg 65:799–806, 1986

    • Search Google Scholar
    • Export Citation
  • 34.

    Nazzaro JM, & Neuwelt EA: The role of surgery in the management of supratentorial intermediate and high-grade astrocytomas in adults. J Neurosurg 73:331344, 1990 Nazzaro JM, Neuwelt EA: The role of surgery in the management of supratentorial intermediate and high-grade astrocytomas in adults. J Neurosurg 73:331–344, 1990

    • Search Google Scholar
    • Export Citation
  • 35.

    Shapiro WR, , Green SB, & Burger PC, et al: Randomized trial of three chemotherapy regimens and two radiotherapy regimens in postoperative treatment of malignant glioma. Brain Tumor Cooperative Group Trial 8001. J Neurosurg 71:19, 1989 Shapiro WR, Green SB, Burger PC, et al: Randomized trial of three chemotherapy regimens and two radiotherapy regimens in postoperative treatment of malignant glioma. Brain Tumor Cooperative Group Trial 8001. J Neurosurg 71:1–9, 1989

    • Search Google Scholar
    • Export Citation
  • 36.

    Simpson JR, , Horton J, & Scott C, et al: Influence of location and extent of surgical resection on survival of patients with glioblastoma multiforme: results of three consecutive Radiation Therapy Oncology Group (RTOG) clinical trials. Int J Radiat Oncol Biol Phys 26:239244, 1993 Simpson JR, Horton J, Scott C, et al: Influence of location and extent of surgical resection on survival of patients with glioblastoma multiforme: results of three consecutive Radiation Therapy Oncology Group (RTOG) clinical trials. Int J Radiat Oncol Biol Phys 26:239–244, 1993

    • Search Google Scholar
    • Export Citation
  • 37.

    Taghian A, , Ramsay J, & Allalunis-Turner J, et al: Intrinsic radiation sensitivity may not be the major determinant of the poor clinical outcome of glioblastoma multiforme. Int J Radiat Oncol Biol Phys 25:243249, 1993 Taghian A, Ramsay J, Allalunis-Turner J, et al: Intrinsic radiation sensitivity may not be the major determinant of the poor clinical outcome of glioblastoma multiforme. Int J Radiat Oncol Biol Phys 25:243–249, 1993

    • Search Google Scholar
    • Export Citation
  • 38.

    Walker MD, , Alexander E Jr, & Hunt WE, et al: Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas. A cooperative clinical trial. J Neurosurg 49:333343, 1978 Walker MD, Alexander E Jr, Hunt WE, et al: Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas. A cooperative clinical trial. J Neurosurg 49:333–343, 1978

    • Search Google Scholar
    • Export Citation
  • 39.

    Walker 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 303:13231329, 1980 Walker 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

    • Search Google Scholar
    • Export Citation
  • 40.

    Watling CJ, , Lee DH, & Macdonald DR, et al: Corticosteroidinduced magnetic resonance imaging changes in patient with recurrent malignant glioma. J Clin Oncol 12:18861889, 1994 Watling CJ, Lee DH, Macdonald DR, et al: Corticosteroidinduced magnetic resonance imaging changes in patient with recurrent malignant glioma. J Clin Oncol 12:1886–1889, 1994

    • Search Google Scholar
    • Export Citation
  • 41.

    Weiss GB, , Bunce H III, & Hokanson JA: Comparing survival of responders and nonresponders after treatment: a potential source of confusion in interpreting cancer clinical trials. Controlled Clin Trials 4:4352, 1983 Weiss GB, Bunce H III, Hokanson JA: Comparing survival of responders and nonresponders after treatment: a potential source of confusion in interpreting cancer clinical trials. Controlled Clin Trials 4:43–52, 1983

    • Search Google Scholar
    • Export Citation
  • 42.

    Winger MJ, , Macdonald DR, & Cairncross JG: Supratentorial anaplastic gliomas in adults. The prognostic importance of extent of resection and prior low-grade glioma. J Neurosurg 71:487493, 1989 Winger MJ, Macdonald DR, Cairncross JG: Supratentorial anaplastic gliomas in adults. The prognostic importance of extent of resection and prior low-grade glioma. J Neurosurg 71:487–493, 1989

    • Search Google Scholar
    • Export Citation
  • 43.

    Wood JR, , Green SB, & Shapiro WR: The prognostic importance of tumor size in malignant gliomas: a computed tomographic scan study by the Brain Tumor Cooperative Group. J Clin Oncol 6:338343, 1988 Wood JR, Green SB, Shapiro WR: The prognostic importance of tumor size in malignant gliomas: a computed tomographic scan study by the Brain Tumor Cooperative Group. J Clin Oncol 6:338–343, 1988

    • Search Google Scholar
    • Export Citation
  • 44.

    Yamada S, , Takai Y, & Nemoto K, et al: Radioresponse and prognosis of malignant glioma. Tohoku J Exp Med 167:7987, 1992 Yamada S, Takai Y, Nemoto K, et al: Radioresponse and prognosis of malignant glioma. Tohoku J Exp Med 167:79–87, 1992

    • Search Google Scholar
    • Export Citation
  • 45.

    Zeltzer PM, , Friedman HS, & Norris DG, et al: Criteria and definitions for response and relapse in children with brain tumors. Cancer 56:18241826, 1985 Zeltzer PM, Friedman HS, Norris DG, et al: Criteria and definitions for response and relapse in children with brain tumors. Cancer 56:1824–1826, 1985

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 783 191 21
Full Text Views 245 10 0
PDF Downloads 82 5 0
EPUB Downloads 0 0 0