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

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. Activity of daily living checklists are useful in deciding on patients' initial per- formance status and in monitoring their progress As many as one quarter of non-disabled patients may experience clinical dete- rioration and a further 42% experience considerable tiredness after radiotherapy Techniques that spare normal brain from radiation should be considered