Letters

Malignant cerebral glioma

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7084.899 (Published 22 March 1997) Cite this as: BMJ 1997;314:899

Anthony Hopkins died on 6 March 1997. An obituary will appear in a future issue.

Modern radiotherapy can give good quality survival for six months

  1. Michael Brada, Chairmana,
  2. David Thomas, Past chairmanb,
  3. Roy Rampling, Memberb,
  4. Peter Crawford, Memberb,
  5. Neil Burnet, Memberb,
  6. Paul Byrne, Memberb,
  7. Michael Sokal, Memberb
  1. a MRC Brain Tumour Working Party, Institute of Cancer Research and the Royal Marsden NHS Trust, Sutton, Surrey SM2 5PT
  2. b MRC Brain Tumour Working Party
  3. c Royal Marsden NHS Trust and Institute of Cancer Research, Sutton, Surrey SM2 5PT
  4. d London NW3 7DT
  5. e Department of Oncology and Neurosurgery, UmeÅ University, S-901 85 UmeÅ, Sweden
  6. f Department of Clinical Oncology, Addenbrooke's Hospital, Cambridge CB2 2QQ
  7. g Department of Clinical Oncology, Cookridge Hospital, Leeds LS16 6QB
  8. h Research Unit, Royal College of Physicians, London NW1 4LE
  9. i National Hospital for Neurology and Neurosurgery, London WC1N 3BG
  10. j Research Unit, Royal College of Physicians, London NW1 4LE

    Editor–We wish to correct misinformation reported by Elizabeth Davies and colleagues in their study of survival after radiotherapy for malignant cerebral glioma.1 Contrary to their suggestion in the acknowledgements, the study had not been supported by the Medical Research Council Brain Tumour Working Party. As the poor study design indicates, the study had never been officially submitted to the Medical Research Council and had therefore not been subjected to its rigorous protocol review process. For example, Davies and colleagues report that their criteria for assessment of treatment toxicity were derived in a “pragmatic fashion after discussion” by a “process of elimination,” without evidence from imaging to exclude tumour progression. This would be totally unacceptable, let alone publishable. The impression that the 105 patients represent an unselected consecutive series is difficult to believe as the seven centres should, over two years, have seen 400-800 eligible patients.2

    The reported adverse prognostic factors in patients with high grade glioma have been known for over 18 years.3 Although the authors appropriately conclude that severely disabled patients have a poor prognosis and may not be suitable for active treatment, the fact that they were considered for intensive treatment at all is surprising. Centres specialised in the treatment of patients with brain tumours would not have accepted patients with such a poor prognosis for high dose radiotherapy. Most of the patients also seemed to receive initial whole brain radiotherapy followed by a radiation boost to the tumour. Whole brain radiotherapy is nothing but toxic and has not been practised in specialist centres for many years.

    Given the use of outdated and often inappropriate high dose, wide field radiotherapy and the flawed assessment of morbidity from treatment, the conclusion …

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