Radiotherapeutic management of high grade glial tumors and prognostic factors: Metropolitan Hospital experience
Öz
OBJECTIVES Patients diagnosed with high grade glial tumors and treated in Metropolitan Hospital, were analysed retrospectively to evaluate radiotherapy results and the prognostic factors. METHODS One hundred and thirty-eight patients (63 females, 75 males) diagnosed with high grade glial tumors were analysed retrospectively to evaluate radiotherapy results and the prognostic factors. Radiotherapy was given after complete resection on 51 patients and after partial resection on 47 patients. The remaining 40 patients were irradiated after biopsy. Fifty-five patients received concomittant and/or adjuvant chemotherapy. RESULTS Median overall survival and progression free survival were 13 and 6 months. One and 2-year survival rates were %55 and %24 respectively. Univariate analysis showed that age (p=0.0021, p=0.0021), histology (p=0.0079, p=0.00001), resection type (p=0.04, p=0.01), Karnofsky Performance Status (KPS) (p=0.00001, p=0.00001) and Recursive Partitioning Analysis (RPA) (p=0.00001, p=0.000001) classification were the significant prognostic factors for the progression-free and overall survival. In multivariate analysis, KPS (p=0.03322), and RPA (p=0.0033) classification were the independent significant prognostic factors for overall and progression free survival respectively. CONCLUSION In our series KPS and RPA classification were the most significant prognostic factors for the progression and survival.
Anahtar Kelimeler
Prognosis Glioma Retrospective Studies Survival Astrocytoma Radiotherapy
Kaynakça
- 1) Kleihues P, Burger PC, Scheithauer BW. The new WHO classification of brain tumours. Brain Pathol 1993;3(3):255-68. 2) B u rger PC, Vogel FS, Green SB, Strike TA. Glioblastoma multiforme and anaplastic astrocytoma. Pathologic criteria and prognostic implications. Cancer 1985;56(5):1106-11. 3) Laperriere N, Zuraw L, Cairncross G; Cancer Care Ontario Practice Guidelines Initiative Neuro- Oncology Disease Site Group. Radiotherapy for newly diagnosed malignant glioma in adults: a systematic review. Radiother Oncol 2002;64(3):259-73. 4) Stewart LA. Chemotherapy in adult high-grade glioma: a systematic review and meta-analysis of individual patient data from 12 randomised trials. Lancet 2002;359(9311):1011-8. 5) Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 2005;352(10):987-96. 6) Curran WJ Jr, Scott CB, Horton J, Nelson JS, Weinstein AS, Fischbach AJ, et al. Recursive partitioning analysis of prognostic factors in three Radiation Therapy Oncology Group malignant glioma trials. J Natl Cancer Inst 1993;85(9):704-10. 7) Kaplan EL, Meier P. Non parametric estimation from incomplete observations. J Am Statist Assoc 1958;53:457-81. 8) Cox DR. Regression models and life table. J R Stat Soc 1972;34:187-220. 9) Mahaley MS Jr, Mettlin C, Natarajan N, Laws ER Jr, Peace BB. National survey of patterns of care for brain-tumor patients. J Neurosurg 1989;71(6):826-36. 10) Mirimanoff RO, Gorlia T, Mason W, Van den Bent MJ, Kortmann RD, Fisher B, et al. Radiotherapy and temozolomide for newly diagnosed glioblastoma: recursive partitioning analysis of the EORTC 26981/22981-NCIC CE3 phase III randomized trial. J Clin Oncol 2006;24(16):2563-9. 11) Gehan EA, Walker MD. Prognostic factors for patients with brain tumors. Natl Cancer Inst Monogr 1977;46:189-95. 12) Simpson JR, Horton J, Scott C, Curran WJ, Rubin P, Fischbach J, 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 1993;26 (2):239- 44. 13) Stupp R, Dietrich PY, Ostermann Kraljevic S, Pica A, Maillard I, Maeder P, et al. Promising survival for patients with newly diagnosed glioblastoma multiforme treated with concomitant radiation plus temozolomide followed by adjuvant temozolomide. J Clin Oncol 2002;20(5):1375-82. 14) Lacroix M, Abi-Said D, Fourney DR, Gokaslan ZL, Shi W, DeMonte F, et al. A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J Neurosurg 2001;95(2):190-8. 15) Athanassiou H, Synodinou M, Maragoudakis E, Paraskevaidis M, Verigos C, Misailidou D, et al. Randomized phase II study of temozolomide and radiotherapy compared with radiotherapy alone in newly diagnosed glioblastoma multiforme. J Clin Oncol 2005;23(10):2372-7. 16) Lamborn KR, Chang SM, Prados MD. Prognostic factors for survival of patients with glioblastoma: recursive partitioning analysis. Neuro Oncol 2004;6(3):227-35. 17) Eberlein KH, Nagel B, Franz K, Imhoff D, Seifert V, Boettcher HD, et al. Concomitant radiochemotherapy with temozolomide in non-selected patients with newly diagnosed high-grade gliomas. Anticancer Res 2006;26(6C):4959-64
Yüksek gradlı glial tümörlerde radyoterapi sonuçları ve prognostik faktörler: Metropolitan Hastanesi deneyimi
Öz
AMAÇ Yüksek gradlı glial tümörlerde radyoterapi sonuçlarını ve prognostik faktörleri değerlendirmek amacıyla Metropolitan Hastanesi'nde tedavi edilen olgular geriye dönük olarak analiz edildi. GEREÇ VE YÖNTEM Eylül 1998 ile Ocak 2007 tarihleri arasında yüksek gradlı gliom tanısıyla tedavi edilen toplam 138 olgu (63 kadın, 75 erkek) geriye dönük olarak incelendi. Olguların 51'ine total rezeksiyon, 47'sine subtotal rezeksiyon, 40'ına biyopsi sonrası radyoterapi uygulandı, 55 olguya eşzamanlı ve/veya adjuvan kemoterapi verildi. BULGULAR Genel sağkalım medyan 13 ay, progresyonsuz sağkalım medyan 6 ay, 1 ve 2 yıllık sağkalım oranları %55 ve %24'tür. Progresyon ve sağkalıma etkili faktörler tek değişkenli analizde sırasıyla yaş (p=0,0021, p=0,0021), histoloji (p=0,0079, p=0,00001), rezeksiyon genişliği (p=0,04, p=0,01), Karnofsky Performans Skoru (KPS) (p=0,00001, p=0,00001) ve “Recursive Partitioning Analysis” (RPA) sınıfıdır (p=0,00001, p=0,000001). Çok değişkenli analizde genel sağkalım için KPS (p=0,03322), progresyonsuz sağkalım için RPA sınıfı (p=0,0033) anlamlı prognostik faktörlerdir. SONUÇ Serimizde KPS ve RPA sınıflandırması progresyon ve sağkalıma etki eden en önemli prognostik faktörler olarak bulunmuştur.
Anahtar Kelimeler
Prognostik faktörler radyoterapi sağkalım yüksek gradlı glial tümör.
Kaynakça
- 1) Kleihues P, Burger PC, Scheithauer BW. The new WHO classification of brain tumours. Brain Pathol 1993;3(3):255-68. 2) B u rger PC, Vogel FS, Green SB, Strike TA. Glioblastoma multiforme and anaplastic astrocytoma. Pathologic criteria and prognostic implications. Cancer 1985;56(5):1106-11. 3) Laperriere N, Zuraw L, Cairncross G; Cancer Care Ontario Practice Guidelines Initiative Neuro- Oncology Disease Site Group. Radiotherapy for newly diagnosed malignant glioma in adults: a systematic review. Radiother Oncol 2002;64(3):259-73. 4) Stewart LA. Chemotherapy in adult high-grade glioma: a systematic review and meta-analysis of individual patient data from 12 randomised trials. Lancet 2002;359(9311):1011-8. 5) Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 2005;352(10):987-96. 6) Curran WJ Jr, Scott CB, Horton J, Nelson JS, Weinstein AS, Fischbach AJ, et al. Recursive partitioning analysis of prognostic factors in three Radiation Therapy Oncology Group malignant glioma trials. J Natl Cancer Inst 1993;85(9):704-10. 7) Kaplan EL, Meier P. Non parametric estimation from incomplete observations. J Am Statist Assoc 1958;53:457-81. 8) Cox DR. Regression models and life table. J R Stat Soc 1972;34:187-220. 9) Mahaley MS Jr, Mettlin C, Natarajan N, Laws ER Jr, Peace BB. National survey of patterns of care for brain-tumor patients. J Neurosurg 1989;71(6):826-36. 10) Mirimanoff RO, Gorlia T, Mason W, Van den Bent MJ, Kortmann RD, Fisher B, et al. Radiotherapy and temozolomide for newly diagnosed glioblastoma: recursive partitioning analysis of the EORTC 26981/22981-NCIC CE3 phase III randomized trial. J Clin Oncol 2006;24(16):2563-9. 11) Gehan EA, Walker MD. Prognostic factors for patients with brain tumors. Natl Cancer Inst Monogr 1977;46:189-95. 12) Simpson JR, Horton J, Scott C, Curran WJ, Rubin P, Fischbach J, 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 1993;26 (2):239- 44. 13) Stupp R, Dietrich PY, Ostermann Kraljevic S, Pica A, Maillard I, Maeder P, et al. Promising survival for patients with newly diagnosed glioblastoma multiforme treated with concomitant radiation plus temozolomide followed by adjuvant temozolomide. J Clin Oncol 2002;20(5):1375-82. 14) Lacroix M, Abi-Said D, Fourney DR, Gokaslan ZL, Shi W, DeMonte F, et al. A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J Neurosurg 2001;95(2):190-8. 15) Athanassiou H, Synodinou M, Maragoudakis E, Paraskevaidis M, Verigos C, Misailidou D, et al. Randomized phase II study of temozolomide and radiotherapy compared with radiotherapy alone in newly diagnosed glioblastoma multiforme. J Clin Oncol 2005;23(10):2372-7. 16) Lamborn KR, Chang SM, Prados MD. Prognostic factors for survival of patients with glioblastoma: recursive partitioning analysis. Neuro Oncol 2004;6(3):227-35. 17) Eberlein KH, Nagel B, Franz K, Imhoff D, Seifert V, Boettcher HD, et al. Concomitant radiochemotherapy with temozolomide in non-selected patients with newly diagnosed high-grade gliomas. Anticancer Res 2006;26(6C):4959-64
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Makaleler |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Şubat 2008 |
| Yayımlandığı Sayı | Yıl 2008 Cilt: 23 Sayı: 1 |