Evaluation of malignant glioma patients during the postirradiation period

Abstract

The syndrome of increased focal or generalized CNS dysfunction in the early postirradiation period in patients treated with radiation therapy (RT) for malignant gliomas was not well documented. Patients (51) with supratentorial malignant gliomas who survived longer than 26 wk from the time of diagnosis were studied retrospectively. All patients received irradiation and chemotherapy and were evaluated at 8 wk intervals. Each evaluation consisted of a neurological examination, computerized tomography (CT) and radionuclide scans, Karnofsky rating, and an evaluation of glucocorticoid levels needed to maintain neurological function. In all, 263 evaluable periods, consisting of 1290 individual evaluable tests (parameters), were analyzed. In the first 18 wk after RT, 26 of the 51 patients studied (51%) showed deterioration in 1 or more tests; 14 of the 26 (53%) did not improve. These 14 patients had a median time to tumor progression (MTP) of 31 wk. The remaining 12 patients in this group (47%) improved and had an MTP of 73 wk. Of the 51 patients, 25 (49%) showed deterioration significant enough to presume tumor progression (2 of the following 3 tests were unequivocally worse: neurological examination, CT scan, and radionuclide scan), 7 improved with no change in therapy and had an MTP of 66 wk, while the other 18 had an MTP of 32 wk. Excluding the Karnofsky rating, any individual test that showed worsening during the first 18 wk period had a 33% probability of significant improvement at a subsequent evaluation period. After 18 wk the probability of the test improving was only 4%. CNS decompensation up to 18 wk after RT, as ascertained from clinical examination, scans, or glucocorticoid dosage, does not invariably predict tumor progression, because in 28% (7/25) of such cases there will be subsequent improvement.