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Malignant cerebral glioma--I: Survival, disability, and morbidity after radiotherapy

^a Directorate of Neurosurgery and Clinical Neurosciences, St Bartholomew's Hospital, London EC1A 7BE, ^b Research Unit, Royal College of Physicians, London NW1 4LE

Correspondence to: Dr E Davies, Research Unit, Royal College of Physicians, London NW1 4LE.

Abstract

Objective: To describe survival, disability, and morbidity after radiotherapy for malignant glioma.
Design: Two year prospective study with home interviews with patients and relatives.
Setting: Seven neurosurgical and radiotherapy centres in London.
Subjects: 105 patients aged 21 to 75: 59 had biopsy; 46 had partial macroscopic resection; 92 received radiotherapy; and 13 received steroids alone.
Main outcome measures: Survival, time free from disability, and changes in disability after treatment.
Results: Six and 12 month survival for radiotherapy patients was 70% and 39%, respectively. Age, World Health Organisation clinical performance status, extent of surgery, and history of seizures before diagnosis each influenced survival. The Medical Research Council prognostic index was also significantly related to survival. Multivariate analysis showed that initial clinical performance status was the most important component of the index. Most (80%; 49/61) patients with a clinical performance status of 0, 1, or 2 lived at least six months before becoming permanently disabled. Most patients who had initially had a good clinical performance status (0-2) and who were alive six months after radiotherapy (68%; 36/52), however, had experienced either clinical deterioration or severe tiredness after treatment. In 17% (9/52) of these some permanent loss of function remained. These adverse effects were associated with increasing radiotherapy dose. Severely disabled patients (clinical performance status 3 or 4) gained little benefit.
Conclusion: Severely disabled patients gain little physical benefit from radiotherapy, whereas those not so disabled may experience considerable adverse effects.

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